Infection at the site of vascular anastomosis is a serious complication of vascular surgery and is associated with a high limb loss and mortality rate. The classical method of management is ligation of the injured artery, adequate wound debridement and restoration of circulation. The latter is achieved by either in situ or extra-anatomic bypass. If the distal circulation is not maintained, subsequent amputation is most likely.
Objectives: In this study we tried to assess the efficacy of extra-anatomic synthetic bypass grafts in the treatment of vascular infection in the groin to save the limb and avoid the inevitable amputation.
Methods: Between January 2006 and December 2007, ten male patients aged twenty to thirty five years (mean=27.3years), with previous vascular surgery (reversed saphenous vein grafting) for sub-inguinal penetrating injuries complicated with infection and bleeding were admitted and managed surgically in the Department of Thoracic and Vascular Surgery, Surgical Specialties Hospital, Medical City Teaching Complex, Baghdad. These patients were studied retrospectively regarding their demographic and clinical features as well as details of the operative procedures and surgical outcome.
All patients received emergency wound debridement, arterial ligation and extra-anatomic synthetic (PTFE) bypass grafts (External iliac or common femoral to distal superficial femoral or popliteal artery, six routed laterally and four routed medially in the thigh away from the original surgical field).
Results: Excellent results were obtained in nine patients who saved amputation while one patient ended with above knee amputation. No mortality recorded.
Conclusion: Extra-anatomic bypass is a useful approach in dealing with infected and disrupted vascular anastomosis and can be used in emergency as well as elective situations as mentioned in most literatures.
Occupies total quality management applications play a key role in the development of institutions of higher education performance and achieve its strategic objectives through the commitment of senior management and their employees to continuous improvement of the quality of performance in the various areas of work, and can be integrated knowledge management processes, which means identifying information of value and how to take advantage. The data were collected using the style of the questionnaire for the purpose of analyzing their results on a sample composed of 83 member of the administrative leadership in colleges as representing the decision-making centers in those colleges .
 
... Show MoreAn electrochemical sensor based on an amino-functionalized iron NH2-MIL-101(Fe) metal-organic framework (MOF)/Pd nanoparticles (NPs) composite-modified screen-printed electrode (SPE) is prepared for the simultaneous determination of norepinephrine (NEPI) and acetaminophen (ACP). The NH2-MIL-101(Fe) MOF/Pd NPs/SPE electrochemical sensor shows a significant enhancement in the response peak current of NEPI, as compared to bare SPE. This suggests that the unique features of NH2-MIL-101(Fe) MOF/Pd NPs composite-modified SPE improve the electrocatalytic oxidation of NEPI. Such a synergistic effect between NH2-MIL-101(Fe) MOF and Pd NPs results in a significant enhancement in the response, where the MOF's high surface area co
... Show MoreSub-threshold operation has received a lot of attention in limited performance applications.However, energy optimization of sub-threshold circuits should be performed with the concern of the performance limitation of such circuit. In this paper, a dual size design is proposed for energy minimization of sub-threshold CMOS circuits. The optimal downsizing factor is determined and assigned for some gates on the off-critical paths to minimize the energy at the maximum allowable performance. This assignment is performed using the proposed slack based genetic algorithm which is a heuristic-mixed evolutionary algorithm. Some gates are heuristically assigned to the original and the downsized design based on their slack time determined by static tim
... Show MoreIn the last years of the twentieth century, scholars solidly focused on paradiplomacy as a study subject, linking it to federalism and decentralised systems. In the Arab world, which has 22 countries, a few states have adopted federalism or decentralisation. Only five countries, i.e., 22.7%, have adopted federalism and decentralised experience. Therefore, limited research and academic work has been conducted regarding paradiplomacy. This paper aims to research the relationship between federalism and paradiplomacy conceptually and practically and then analyse the Arab experiences in federalism and whether they applied paradiplomacy and succeeded in doing so. To explore that, the paper studies and compares the related articles of constitution
... Show MoreIn the last years of the twentieth century, scholars solidly focused on paradiplomacy as a study subject, linking it to federalism and decentralised systems. In the Arab world, which has 22 countries, a few states have adopted federalism or decentralisation. Only five countries, i.e., 22.7%, have adopted federalism and decentralised experience. Therefore, limited research and academic work has been conducted regarding paradiplomacy. This paper aims to research the relationship between federalism and paradiplomacy conceptually and practically and then analyse the Arab experiences in federalism and whether they applied paradiplomacy and succeeded in doing so. To explore that, the paper studies and compares the related articles of constitution
... Show MoreFunctionalized Multi-Walled Carbon Nanotubes (MWCNTs-OH) network with thickness 4μm was made by the vacuum filtration from suspension (FFS) method. The morphology, structure and optical properties of the MWCNTs film were characterized by SEM and UV-Vis. spectra techniques. The SEM images reflected highly ordered network in the form of ropes or bundles with close-packing which looks like spaghetti. The absorbance spectrum revealed that the network has a good absorbance in the UV-Vis. region. The gas sensor system was used to test the MWCNT-OH network to detect NH3gas at room temperature. The resistance of the sensor was increased when exposed to the NH3gas. The sensitivities of the network w
... Show MoreBackground: Opportunistic viral infections make an important threat to renal transplantation recipients (RTRs), and with the use of more intense newly-developed immunosuppressive drugs; the risk of renal allograft loss due to reactivation of these viruses has increased considerably. At the top priority of these viruses lie BK polyomavirus (BKV) and human cytomegalovirus (CMV). Reactivation of these viruses in these chronically immunosuppressed RTRs can lead to renal impairment and subsequently allograft loss, unless early detected and properly treated. Objectives: The study aimed to detect and quantify plasma viral load of BKV and CMV in RTRs using quantitative real time PCR (qRT-PCR), in order to study the prevalence of these two viruses i
... Show MorePemphigus vulgaris is an autoimmune disease of the skin and mucous membrane. Renal transplantation is a common procedure in
To study the frequency of skin tumors and infections in patients with pemphigus vulgaris compared with renal transplant recipients and normal controls.
One hundred kidney transplant recipients, their ages ranged from 14 to 70 (46.65 ± 4.74) years
International relations scholars have increasingly debated the evolving landscape of actors that challenge the traditional state-centric world order. A key element of this transformation is the rise of sub-state actors, which engages in alternative diplomacy parallel to the state, transcending traditional state-centric frameworks. This paper explores the significant shifts in international actorness over the late 20th century, focusing on the emergence and implications of sub-state diplomacy, or "paradiplomacy." First, the study introduces sub-state actors and their role in challenging the dominant state-centric discourse. It then examines the dynamic evolution of paradiplomacy, highlighting how sub-states have expanded their global
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