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Recognizing Early Warning Signs (EWS) in Patients Is Critically Important

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Open Journal of Nursing 2023年第1期13卷 53-64页

作者： shamsa samani Salma Amin Rattani Faculty of Nursing Lincoln University College Petaling Jaya Malaysia School of Nursing and Midwifery Aga Khan University Karachi Pakistan

Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during hospitalization often display clinical decline for several hours before the event is observed. Non-critical care Nurses’ inconsistent recognition and response to patient deterioration lead to an increase in the length of hospital stay, unexpected admissions to the ICU, and increased morbidity and mortality. Aim: The study aimed to assess the factors that facilitate or impede the detection of early warning signs among adult patients hospitalized in tertiary care settings. Training should be provided to improve nurses’ knowledge, practice and attitude toward early warning signs of deteriorating patients leading to enhanced clinical judgment, skills and decision-making in addressing alerts. Methodology: A literature search was carried out in various databases;these were Cumulative Index to Nursing and Allied Health Literature (CINHAL), Google Scholar, PubMed, Science Direct, and Sage. The search area was narrowed from 2017 to 2022. The keywords used were “prevalence” AND “unplanned ICU admission”, “the importance of early warning signs” “outcome failure in rescue” “patient deterioration, communication” “improvement in early detection” AND “patient outcome admission” AND “early warning signs” AND “Pakistan”. After the analysis process, around 33 articles that met the inclusion criteria and were most relevant to the scope and context of the current study were considered. Conclusion: Most of the studies had reviewed literature in a qualitative retrospective observational study, content analysis, mixed method, and quasi-experimental study. The literature review identified that long hours of shift, nurse staffing levels, missed vital signs, lack of nursing training and education, and communication impact nurses’ ability to recognize and respond to early warning si

关键词： Early Warning Signs Handover Communication Long Hours Rapid Response Team Just in Time Training

Thrombotic Thrombocytopenic Purpura in Pregnancy Presented with Stroke at 29 Weeks: A Case Report

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Open Journal of Obstetrics and Gynecology 2024年第3期14卷 359-364页

作者： shamsa Kassam Jodie Lam Gabrielle Baptiste Department of Women’s Health Luton and Dunstable University Hospital Bedfordshire Hospitals NHS Foundation Trust Luton UK

Thrombotic thrombocytopenic purpura (TTP) is a rare but acute, life-threatening condition which may be precipitated by pregnancy. This disorder that presents with thrombocytopenia, haemolytic anemia, and clinical consequences of microvascular thrombosis such as stroke. The exact cause is not known but it is associated with a deficiency of ADAMTS13 enzymes. Immune mediated TTP is more common and can present in pregnancy. The aim of this case is to bring awareness as many clinicians are unaware of this condition in pregnancy, its diagnosis may be missed or delayed, leading to fetal loss or serious maternal implications. In this case the patient presented at 29 weeks with stroke in Emergency department, referred to delivery suit for Obstetric review, with suspicion of Pre-eclampsia/HELLP. The diagnosis of TTP was achieved by a multidisciplinary team who worked tirelessly together. The patient was transferred to a Specialist Tertiary Care Centre for further management. The pregnancy continued until 33 weeks and 5 days. She underwent an emergency caesarean section for fetal distress. Steroids and Rituximab were continued postnatally. The outcome was favourable due to fast and efficient multidisciplinary care. Awareness of this rare but important condition can lead to recognition of clinical presentation, prompt diagnosis and appropriate management.

关键词： Thrombotic Thrombocytopenic Purpura Pregnancy Ischemic Stroke Caesarean Section

CFTR mutations causing congenital unilateral absence of the vas deferens(CUAVD)and congenital absence of the uterus(CAU)in a consanguineous family

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Asian Journal of Andrology 2022年第4期24卷 416-421页

作者： Mahdieh Daliri Ghouchanatigh Ranjha Khan Majid Mojarrad Uzma Hameed Muhammad Zubair Ahmed Waqas Mohsen Jalali Mahmoudreza Kalantari Ali shamsa Huan Zhang Qing-Hua Shi The First Affiliated Hospital of USTC Hefei National Laboratory for Physical Sciences at the MicroscaleSchool of Life SciencesCAS Center for Excellence in Molecular Cell ScienceUniversity of Science and Technology of ChinaCollaborative Innovation Center of Genetics and DevelopmentHefei 230027China Department of Medical Genetics School of MedicineMashhad University of Medical SciencesMashhad 91735Iran Institute of Industrial Biotechnology Government College UniversityLahore 54000Pakistan Department of Zoology Division of Science and TechnologyUniversity of Education LahoreMultan CampusMultan 60000Pakistan Department of Reproductive Medicine Armaghan Infertility CenterMashhad 91735Iran Department of Pathology Mashhad University of Medical SciencesMashhad 91735Iran.

Cystic fibrosis(CF)is one of the most common recessive genetic diseases,with a wide spectrum of phenotypes,ranging from infertility to severe pulmonary *** in the cystic fibrosis transmembrane conductance regulator(CFTR)gene are considered the main genetic cause for *** this study,we recruited a consanguineous Iranian pedigree with four male patients diagnosed with congenital unilateral absence of the vas deferens(CUAVD),and one female patient diagnosed with congenital absence of the uterus(CAU).Testicular biopsy of one patient was performed,and hematoxylin and eosin(H and E)staining of testis sections displayed the presence of germ cell types ranging from spermatogonia to mature spermatids,indicating obstructive *** explore the underlying genetic factor in this familial disorder,we therefore performed whole-exome sequencing(WES)on all available family *** data filtration and CFTR haplotype analysis identified compound heterozygous mutations in CFTR among four patients(two CUAVD patients carried p.H949Y and p.L997F,and one CUAVD and the female CAU patient carried p.H949Y and p.I148T).All these mutations were predicted to be deleterious by at least half of the prediction software programs and were confirmed by Sanger *** study reported that CFTR compound heterozygous mutations in a consanguineous Iranian family cause infertility in both sexes.

关键词： congenital absence of the uterus congenital unilateral absence of the vas deferens cystic fibrosis transmembrane conductance regulator whole-exome sequencing

在巴基斯坦企业工作的中国外籍员工面对的文化挑战

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在巴基斯坦企业工作的中国外籍员工面对的文化挑战

作者： shamsa Kanwal 华北电力大学(北京)

学位级别：硕士

劳动力市场的全球化导致了大量的外籍企业及外籍员工涌入海外寻求有利可图的商业机会和工作机会。而和本土相异的文化环境对外籍员工的适应性以及迁居海外的一系列问题密不可分。论文对中国侨民员工在巴基斯坦工作和社会中面对的挑战进... 详细信息

劳动力市场的全球化导致了大量的外籍企业及外籍员工涌入海外寻求有利可图的商业机会和工作机会。而和本土相异的文化环境对外籍员工的适应性以及迁居海外的一系列问题密不可分。论文对中国侨民员工在巴基斯坦工作和社会中面对的挑战进行了研究。论文的主要研究内容是:首先确定中国侨民在巴基斯坦工作和社会中所面临的困难;其次,明确影响中国侨民文化适应的重要影响要素,最后,通过本文的研究对中国侨民在巴基斯坦所面临的挑战进行明确,并给出相关建议。针对上述问题,论文采用定性和定量的混合方法进行研究,利用访谈和调查问卷从伊斯兰堡的中国侨民进行收集数据,研究数据集包含在2020年10月和2021年10月根据研究问题对116名外籍人士进行的调研和访谈数据,依据对数据的分析提出了研究假设,并通过皮尔逊相关和线性回归的方法验证这些假设是否正确。通过本文的研究表明,在巴基斯坦的华侨华人面临的基本挑战是工作以及社会环境中的社会差异和语言限制;通过正式和非正式学习方法准备的华侨华人能够适应他们的社会多元化环境。研究表明,在巴基斯坦呆的时间较长的华侨更容易适应。最后,中国侨民的健康状况、出生地、父母的居住地、子女、年龄和教育水平都对文化适应的预测具有一定的作用。

关键词：跨文化适应跨文化培训(CCT) 挑战中国外籍员工正式和非正式教育

Theoretical Study of Interaction between Apalutamide Anticancer Drug and Thymine by DFT Method

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Chinese Journal of Structural Chemistry 2019年第10期38卷 1645-1663,1609页

作者： SIYAMAK Shahab MASOOME Sheikhi MEHRNOOSH Khaleghian shamsa Sharifi SADEGH Kaviani Institute of Physical Organic Chemistry National Academy of Sciences of Belarus13 Surganov StrMinsk 220072Republic of Belarus Institute of Chemistry of New Materials National Academy of Sciences of Belarus36 Skarina Str.Minsk 220141Republic of Belarus Belarusian State University IS El BSUMinskRepublic of Belarus Young Researchers and Elite Club Gorgan BranchIslamic Azad UniversityGorganIran Young Researchers and Elite Club Islamshahr BranchIslamic Azad UniversityIslamshahrIran Department of Chemistry Robat Karim BranchIslamic Azad UniversityRobat KarimIran Department of Chemistry Ferdowsi University of MashhadMashhadIran

The main purpose of this study is a better comprehension of the non-bonded interaction between an anticancer drug apalutamide and deoxyribonucleic acid(DNA).In the prese nt work,the in teraction between an ticancer drug apalutamide and one of the DNA bases called 2,-deoxythymidine 5,-monophosphate(thymine)by Density Functional Theory(DFT)calculations in the solvent water has been investigated for the first *** non-bonded interaction effects of the molecule apalutamide with thymine on the electronic properties,chemical shift tensors and natural charges have been also *** natural bond orbital(NBO)analysis was performed for determining the role of electron donor and acceptor of the molecules apalutamide and thymine at the complex thymine/*** Electron location function(ELF),localized orbital locator(LOL)and quantum theory of atoms in molecules(QTAIM)analysis were carried out in order to determine the chemical bond nature in the investigated *** values of ELF and LOL parameters for the selected bonds are small,which confirms the non-covalent character of these bonds in *** electronic spectra of the apalutamide drug,thymine and complex thymine/apalutamide in solvent water were calculated by Time Dependent Density Functional Theory(TD-DFT)for the investigation of interaction effect;Non-bonded interaction between the compound apalutamide and thymine has changed the value of λmax.

关键词： apalutamide thymine DFT ELF NBO

Effects of Variable Thermal Conductivity and Non-linear Thermal Radiation Past an Eyring Powell Nanofluid Flow with Chemical Reaction

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Communications in Theoretical Physics 2017年第6期67卷 723-731页

作者： M.Ramzan M.Bilal shamsa Kanwal Jae Dong Chung Department of Computer Science Bahria UniversityIslamabad Campus Department of Mathematics Faculty of ComputingCapital University of Science and Technology Department of Mathematical Sciences Fatima Jinnah Women University Department of Mechanical Engineering Sejong University

Present analysis discusses the boundary layer flow of Eyring Powell nanofluid past a constantly moving surface under the influence of nonlinear thermal radiation. Heat and mass transfer mechanisms are examined under the physically suitable convective boundary condition. Effects of variable thermal conductivity and chemical reaction are also considered. Series solutions of all involved distributions using Homotopy Analysis method(HAM) are *** of dominating embedded flow parameters are discussed through graphical illustrations. It is observed that thermal radiation parameter shows increasing tendency in relation to temperature profile. However, chemical reaction parameter exhibits decreasing behavior versus concentration distribution.

关键词： Eyring Powell nanofluid nonlinear thermal radiation convective boundary condition variable thermal conductivity chemical reaction

Umbilicoplasty: An Important Step in Abdominoplasty Surgery for Massive Weight Loss Cases

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Modern Plastic Surgery 2023年第4期13卷 106-117页

作者： Medhat Emil Habib Omar Alameri Anoud Alqaydi Dalal Al Mansoori Aysha Al Naqbi shamsa Alameri Dalia Medhat Habib Department of Plastic and Reconstructive Surgery Zayed Military Hospital Abu Dhabi UAE

Aim: Excessive increase of weight followed by massive weight loss distorts the shape of the umbilicus as part of the affected skin of the abdomen. There is usually discrepancy between the elongated umbilicus at the time the patient was gaining excessive weight and the thinned abdominal wall after the massive weight loss. This study discusses a procedure that aims at restoring the shape of the umbilicus to its original shape as much as possible. Patients and Methods: In 4 years retrospective study from the 1st of March 2016 till the end of February 2020, the files of the patients who underwent abdominoplasty after massive weight loss with umbilicoplasty performed, as part of the procedure, were reviewed. In these patients the caudal part of the umbilicus at 6 o’clock site was excised in an oblique direction with slanting cut going to both 3 and 9 o’clock directions to shorten the elongated umbilicus keeping the cephalic part at 12 o’clock intact. This residual elongated cephalic part was utilized to make the shape of the hood of the umbilicus. A bolster suture was used at 12 o’clock to add a small depression above the hood. This technique gave the umbilicus the vertical “T” triangular shape with hooding. A questionnaire to assess patients’ satisfaction regarding the shape, depth, location, size, scarring and overall result of the umbilicoplasty procedure was conducted. The questionnaire used a five-point Likert-type scale as follows: 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). Results were collected and evaluated. Results: 197 patients underwent full abdominoplasty surgery during this 4 years study. Those who underwent umbilicoplasty during the abdominoplasty procedure were 34 patients. The results of the questionnaire could be obtained from 23 patients of them. Each patient gave a number from 1 - 5 for each aspect of the questionnaire of the umbilicus shape, depth, location, size, scarring and overall result. This resulted in total number of poin

关键词： Umbilicoplasty Hooding Abdominoplasty Massive Weight Loss

Clinical Outcome of Abdominoplasty Cases—A Five-Year Retrospective Study

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Modern Plastic Surgery 2023年第1期13卷 1-15页

作者： Omar Alameri Medhat Emil Dalal Al Mansoori Anoud Al Qaydi Aysha Al Naqbi Ibrahim Al Marzooqi Dalia Medhat Habib shamsa Alameri Department of Plastic and Reconstructive Surgery Zayed Military Hospital Abu Dhabi United Arab of Emirates

Aim: The aim of this study is to analyze the outcome of cases who underwent abdominoplasty surgery in our facility for the last five years. Patients and Methods: This is a retrospective study analyzing the outcome of patients who underwent abdominoplasty from the beginning of January 2015 till the end of December 2019 in Zayed Military Hospital, Abu Dhabi, United Arab of Emirates. Postoperative complications were recorded. The effects of risk factors including age, sex, smoking, body mass index, associated comorbidity, previous bariatric surgery and combined procedures were evaluated. Results: 213 patients were included in this five-year study. Majority of the patients were females 161 cases (75.6%) while males presented 52 cases (24.4%). The mean age was 38.3 years. The mean BMI was 27 Kg/m2. 127 patients had previous bariatric surgery (59.6%) while 86 patients had not (40.4%). There were no major systemic complications in the cases as deep venous thrombosis, pulmonary embolism or paralytic ileus. There was no mortality in the study cases. Out of the 213 cases included in the study, 23 patients developed haematoma (10.8%), 8 patients developed seroma formation (3.8%), 3 patients had wound infection (1.4%) and one patient had tissue necrosis (0.5%). The complication rate was higher in males 36.4% compared to females 9.9% (p 2 or less had less complications 14.3% compared to those above that level 21.2% although it was not a significant difference (p = 0.231). 55.7% of the smokers had complications while the incidence among non smokers was 8.5% (p < 0.005). Those who underwent previous bariatric surgery had more complications 19.7% compared to those who had not undergone this surgery 11.6% but it was not statistically significant (p = 0.372). Those who had li

关键词： Abdominoplasty Outcome Complications Risk Factors

Incidence of Haematoma Formation in Relation to Smoking in Abdominoplasty Cases

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Modern Plastic Surgery 2023年第1期13卷 32-40页

作者： Dalal Al Mansoori Anood Alqaydi shamsa Alameri Medhat Emil Ibrahim Al Marzooqi Aysha Al Naqbi Muhammad Tariq Ayub Dalia Medhat Habib Omar Alameri Department of Plastic and Reconstructive Surgery Zayed Military Hospital Abu Dhabi United Arab of Emirates

Objective: This study aims at assessing the relation between smoking and the incidence of haematoma formation in abdominoplasty surgery cases. Patients and Methods: This is a 4 years retrospective study involving the patients who underwent abdominoplasty surgery between the period of May 2015 and April 2019 in Zayed Military Hospital, Abu Dhabi, United Arab of Emirates. The incidence of haematoma formation was assessed in relation to tobacco use in these patients. Results: 164 patients met the inclusion criteria of the study. 35 patients were smokers (21.3%) and 129 patients were non-smokers (78.7%). The mean age was 38.4 (21 - 59 years). The mean BMI was 27 kg/m2 (21.4 - 34.7 kg/m2) and the mean hospital stay was 6.5 days (4 - 19). 23 patients in the study developed haematoma (14%). 11 of them had surgical evacuation of the haematoma (6.7%) while the rest were aspirated in the out-patient clinic. Out of the 23 patients who developed haematoma, 17 patients were smokers and 6 were non-smokers. The incidence of haematoma among smokers was 48.6% (17 out of 35 cases) while its incidence among nonsmokers was 4.7% (6 out of 129 cases) showing a clear relationship between smoking and hematoma formation (p Conclusion: Our study shows a direct relationship between smoking and haematoma formation in abdominoplasty cases. Cessation of smoking during the perioperative period is required before embarking on such a procedure.

关键词： Haematoma Smoking Abdominoplasty Surgery Tobacco Use