18 research outputs found
Perioperative Management for Surgical Repair of Ebstein's Anomaly.
No full textBackground: Ebstein's anomaly is a rare and complex heart defect that affects the tricuspid valve and is accountable for around 1% of congenital cardiac abnormalities. It is one of the most common congenital causes of tricuspid valve regurgitation. Ebstein's anomaly often is diagnosed prenatally, due to its severe cardiomegaly. Some individuals with this anomaly do not experience complications until adulthood and even then, they have mostly minor complaints like exercise intolerance. An atrial septal defect is most commonly (70-90%) associated with Ebstein's anomaly. However, ventricular septal defect (VSD) can be associated with 2-6% of the cases.
Case presentation: This report presents a case of surgical intervention for a 38-year-old female with Ebstein's anomaly symptomatic with moderate-severe pulmonary regurgitation and foramen ovale apertum.
Conclusions: Ebstein anomaly is a complicated form of congenital heart disease with variable clinical presentations. The anesthetic plan must also focus on maintenance of RV function and avoidance of increase in PVR. Reversible causes of increased PVR, such as acidemia, hypoxemia, and hypercarbia must be avoided. Agents that lower PVR, such as nitrates, and nitric oxide may be beneficial in patients with severe pulmonary hypertension.
With a sound knowledge of the cardiac anatomy, accurate scheming of surgical outcomes, routine follow-ups, multidisciplinary team approach, and better management, an experienced center can ultimately improve the prognosis of such patients
Anesthesia in Patient with Left Ventricular Assist Device LVAD support. A Case Report
No full textBackground; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms
Prof. Dr. Aleksandër Meksi, Xhamitë e Shqipërisë, Historia, Arkitektura, shek XV-XIX, AIITC, Tiranë 2015
No full textReview of the Book "Mosques of Albania, History of Architecture during the 15th-19th Centuries", published in an improved 2nd edition in 2015 by the Albanian Institute of Thought and Islamic Civilization. The book author Aleksandër Meksi is one of the best known scholars and restorers of medieval architecture in Albania. It is an enriched edition of the previous book of the same author in 2007
The Benefits of early Extubation in OR and ICU after Cardiac Surgery
No full textObjective: operating room (or) extubation after adult cardiac surgery with cardiopulmonary bypass cPB is rare. We examined the outcome, factors and benefits of OR extubation.Methods: We operated 60 patients in german Hospital tirana, from January 2019 to September 2020, who had undergone caBg cardiac operations: 52 patients, mitral valve repair 5 patients, aortic stenosis 1patient, Bentall procedure 1 patient, left atrial myxoma 1 patient. the patients age was from 46-82 years old, there were 24 female patients and 36 male patients, 24 diabetic patients, 36 non-diabetic patients, in all cases we did not apply epidural anesthesia. Anesthesia was used with low doses of fentanyl. in combination with propofol, sevoflurane. In all cases neostigmine was used for decurarisation.the quality and depth of anesthesia was assessed with obvious signs such as tachycardia, hypertension, sweating. endogenous stress was also assessed by monitoring glycemia during the intervention.as extubation criteria were assessed the patient’s consciousness, respiratory mechanics, hemodynamic stability, diuresis, bleeding from drains.Results: 16 patients were extubated in the or and 44 patients were extubated 15-20 minutes after the intervention in icU. there was no reintubation. 2 patients were transferred immediately from or to the repart. 35 patients were transferred to the ward 3-4 hours after extubation. 23 patients were transferred to the ward the next morning. Patients left the hospital after 5-7 days.Conclusions:extubation in the or in the early postoperative period has now become a routine in all specialized clinics. the time spent in the ICU is very low and the day spent in the ward was 5-7 days. The benefit is in the best and fastest activation of patients in the early postoperative period as well as in reduced intervention costs
Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery
No full textBackground: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternative is remifentanil. We compared the efficacity of remifentanil vs morphine -metamizole for post cardiac surgery pain relief.
Methods; Twenty patients undergoing on-pump coronary artery bypass surgery, receiving standardized propofol–fentanyl and propofol based anesthesia, remifentanil group (Group R, n = 10) and fentanyl (Group F, n = 10). Postoperative analgesia was provided in R group initially with remifentanil and later with morphine-metamizole and in F group immediately after operation. Pain was controlled by visual observation, questioning, in rest and during coughing, with a score (0-3).
Results; There is no difference in time of extubation between groups but, pain score was much higher in F (3-9) group in first hour compared with R group (0-4). Morphine requirements was higher in (R) after remifentanil was stopped, in a first hour, but was lower after 24 hours compared with F group. Conclusion: Use of remifentanil is associated with lower scale of pain in postoperative period and lower morphine requirement after 24 hours, when analgesia treatment was changed
Management of COVID-19 Patient in Cardiac Surgery with Cardiopulmonary Bypass
No full textIntroduction: The diagnosis of COVID-19 is quite challenging due to the inconsistent correlation between laboratory findings, radiological imaging, and the clinical picture and contact history of the patient. the patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) face double risk because CBP triggers an intense inflammatory response and the leading cause of mortality in COVID-19 patients is “cytokine storm”. In our institution 15 confirmed cases operated on with open-heart surgery. 9 cases isolated caBg, 4 cases valvular combined with caBg, and 1 valvular disease. Materials and method: all patients undergoing elective or urgent cardiac surgery at “Mother theresa” ’s Hospital from 11 March to 30 november 2020 were included in this study. Patients diagnosed with coViD-19 infection via positive throat swab taken due to clinical suspicion postoperatively were reviewed. Patients characteristics, type of intervention, date of coViD-19 diagnosis.Results: 9 patients (72%) normal recovery, no respiratory failure, only 3-5 days of fever (max 39,4). 3 of them a moderate respiratory failure. 3 patients with severe respiratory failure. only 3 deaths (26,6%).Recommendation: it’s important to a preoperative screening for coViD-19 patients. the outcome of cardiac surgical patients who contracted coViD-19 infection perioperatively is extremely poor. aggressive respiratory assistance (early intubation), high doses of corticosteroids, and anticoagulation, better result
Social inclusion and inclusive education
No full textThe key question addressed in this article is social inclusion, as an opposite concept of social exclusion. The author provides a historical of social inclusion/exclusion terminology. Further, some of the principles of social inclusion are presented.
A brief review of the literature provides key views and theories of social inclusion.
In particular, the author brings to attention that the included/excluded dualism apparent in the writings of social inclusion and exclusion cannot be taken at face value.
In line with global debate on social inclusion and exclusion, the author brings the way this debate has now pervaded both the official and development policy discourse in Albania.Social inclusion is considered as one of the priorities of the current government, with poverty reduction as its main focus, which will be ensured not only through economic development.
In the end, the article focuses on the role of education as a very important and useful tool for ensuring social inclusion.Social inclusion through education, in particular through vocational education, considered by the author as the only way towards sustainable development of Albanian society
Juridical Analysis of the Perpetrator's Criminal Acts Sexual Violence Crime Based Law no. 12 of 2022 Concerning Crime of Sexual Violence (Medan Police Case Study)
No full text73 HalamanTindak Pidana Kekerasan Seksual ini merupakan upaya pembaharuan
hukum serta mengatasi permasalahan dalam perlindungan hukum terhadap
perempuan dan anak dari Tindak Kekerasan Seksual yaitu sebagai berikut:
mencegah segala bentuk kekerasan seksual, menangani, melindungi dan
merehabilitasi korban, melaksanakan penegakan hukum dan merehabilitasi
pelaku, menciptakan lingkungan yang bebas dari kekerasan seksual dan
memastikan kekerasan seksual tidak berulang . Oleh karena itu permasalahan dalam
penelitian ini :Pertama pengaturan hukum terhadap pelaku tindak pidana kejahatan
kekerasan seksual serta Kedua Faktor penyebab terjadinya tindak pidana kejahatan
kekerasan seksual Ketiga bagaimana eksistensi undang-undang No.12 Tahun 2022
tentang tindak pidana kekerasan seksual pada pelaku kejahatan kekerasan seksual.
Adapu jenis penelitian hukum adalah yuridis normatif, Dalam kajian ini penulis
bermaksud untuk menganalisis persoalan bagaimana seharusnya pemerintah
mengambil langkah-langkah kebijakan dalam menanggulangi kekerasan seksual di
Indonesia. Berkaitan dengan pengaturan hukum, dengan diundangkannya
Undang-Undang No. 12 Tahun 2022 tentang Tindak Pidana Kekerasan Seksual
dapat menjerat pelaku dan dapat menjadi payung hukum yang melindungi korban
kekerasan seksual serta menjadi landasan hukum yang kuat untuk para aparat
penegak hukum. Aturan tersebut kemudian harus disosialisasikan kepada
masyarakat agar dapat meningkatkan pengetahuan serta kesadaran hukum
masyarakat untuk lebih waspada terhadap jenis kejahatan seperti ini. This Sexual Violence Crime is an effort to reform the law and overcome problems
in the legal protection of women and children from Sexual Violence, namely as
follows: preventing all forms of sexual violence, handling, protecting and
rehabilitating victims, carrying out law enforcement and rehabilitating
perpetrators, creating an environment free from sexual violence and ensuring
sexual violence does not recur. Therefore the problems in this study: First, the
factors that cause the crime of sexual violence crime, second, the legal
arrangements for the perpetrators of sexual violence crimes, and third, how the
existence of Law No.12 of 2022 concerning criminal acts of sexual violence on
perpetrators of sexual violence crimes. Adapu type of legal research is normative
juridical, In this study the author intends to analyze the issue of how the government
should take policy steps in tackling sexual violence in Indonesia. In connection with
legal arrangements, the enactment of Law No. 12 of 2022 concerning Crimes of
Sexual Violence can ensnare perpetrators and can be a legal umbrella that protects
victims of sexual violence and becomes a strong legal basis for law enforcement
officials. The regulation must then be socialized to the public in order to increase
the knowledge and legal awareness of the public to be more vigilant against this
type of crime
PENERAPAN MODEL PEMBELAJARAN KOOPERATIF TIPE TWO STAY TWO STRAY (TS-TS) TERHADAP KEMAMPUAN KOMUNIKASI MATEMATIKA SISWA
No full textThe problem that the author encountered in class X SMK Palapa Bandar Lampung is the low ability of mathematical communication. The purpose of the study was to determine the difference in average mathematical communication skills of students who use the Two Stay Two Stray (TS-TS)cooperative learning model with TS-TS using the Conventional learning model in class X students even semester of SMK Palapa Bandar Lampung. This study used an experimental method, the population of the study was 123 students of SMK Palapa Bandar Lampung, samples taken using the Random Sampling Cluster technique, namely the X PM class as the Experiment class and the AP X Class as the Control class. Students\u27 mathematical communication skills are carried out with an essay test which amounts to 6 questions which are first tested for their validity and reliability. From the results of testing the hypothesis using the t-test obtained thit = 4.94 from the t distribution table at a significant level of 5% known tdaf = 1.67. So thit > tdaf so that it can be concluded that "There is an Effect of the Application of the Two Stay Two Stray Cooperative Learning Model (TS-TS) on the Mathematical Communication Ability of Class X Students in the even semester of SMK Palapa Bandar Lampun
Pertunjukan Tari Inai Tingkat 12 Di Desa Panipahan Darat Kabupaten Rokan Hilir Provinsi Riau
No full textThis study aims to find out about Level 12 Henna Dance Performances in Panipahan Darat Village, Pasir Limau Kapas District, Rokan Hilir Regency, Riau Province. This research was conducted in Panipahan Darat Village, Pasir Limau Kapas District, Rokan Hilir Regency, Riau Province, the population in this study was 32 members in the studio organization including 5 dancers, 4 music players, 3 coaches or advisors. In this study the authors interviewed as the successor of the dance. This research was conducted using the method used Qualitative interactive using descriptive data, which is a technique of collecting data directly from people in the environment studied, meaning the author directly interacts with the research subject, namely the resource person, with data collection techniques through observation. , interview and documentation techniques. This dance is for a day's entertainment for the King / Bride at the time of the wedding in Panipahan Darat Village. In this Level 12 Inai Dance performance, there are elements, namely: motion, music, costumes, lighting, stage, floor pattern, property, theme, dynamics and audience. The theory used is Soedarsono's theory (1986: 103-119). The subject of this research is Henna Dance Level 12 in Panipahan Parat Village, Pasir Limau Kapas District, Rokan Hilir Regency, Riau Province
