A histology and immunochemistry study comparing open versus close and open-method endoscopic saphenous vein harvesting.

Background: The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium. Methods: Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO2 (carbon dioxide) ESVH, open CO2 ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system. Results: Open CO2 ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO2 ESVH group (33.25% ± 28.71, P < 0.0003). This represents a more poorly preserved endothelial cells in the Open CO2 ESVH than the closed CO2 ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, p = 0.004). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH. Conclusion: We observed more endothelial detachment in the open CO2 ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. The closed CO2 ESVH group had more endothelial cells preserved, but the OSVH group fared the best with the least number of endothelial cell detachment and a higher score of CD31 antibody. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-024-01752-3.

Assessment of Cognitive Impairment and Related Factors Among Elderly People in Jordan.

Background: With an increase in elderly people, it is essential to address the issue of cognitive impairment and support healthy aging. This study aimed to assess cognitive impairment and factors associated with it among older adults. Materials and Methods: A cross-sectional study was carried out in different catchment areas within the Jerash governorate in the north of Jordan. The Elderly Cognitive Assessment Questionnaire (ECAQ) and a household face-to-face interview were used to collect data from 220 older adult participants aged 60 years and more. Descriptive statistics were conducted to describe the study variables. Correlation tests were applied to find associations between them. Logistic regression analysis was applied, with a minimum significance level (p < 0.05). Results: About 9.10% of the older adults had cognitive impairment. Cognitive impairment was correlated with age, self-perceived health, hypertension, stroke, and mental illness. The primary predictors of cognitive impairment were age [odds ratio (OR) =1.07 (1.01-1.14), p = 0.001] and stroke [OR = 10.92 (1.44-82.85), p = 0.001]. Conclusions: While many factors were correlated with cognitive impairment, the strongest predictors of cognitive impairment were age and stroke.

The experiences of young women living post-stroke in Jordan: a descriptive phenomenological study.

BACKGROUND: The incidence of stroke in younger adults is rising, particularly among women living with stroke who face multiple physical, psychological, and social challenges that negatively affect their quality of life. Consequently, women's roles in life would be negatively affected at home, work, and in society. This study aimed to explore the lived experience of women suffering from a stroke in Jordan. METHODOLOGY: This paper uses semi-structured interviews to present a descriptive phenomenological study of eight young women suffering from a stroke. The Colaizzi (1978) method was used to analyze interview transcripts. MAIN RESULTS: Three main emerging themes that describe the lived experiences of women with a stroke: 1) Experiencing stroke as a woman; 2) Stroke and the intimate relationship with the spouse; 3) Challenges of women's journey while receiving health care. CONCLUSION: After their stroke, Jordanian women have experienced profound, interrelated, and multifaceted difficulties in all aspects of their life and relationships inside and outside the family. Whilst healthcare providers recognize these stressful symptoms; however, there is a lack of attention and care to meet these needs.

Critical Care Nurses' Knowledge of Tracheostomy Care.

Background: Tracheostomy care is a standard procedure that nurses perform in Critical Care Units (CCUs) to reduce complications from tracheostomy. The literature indicates a clear variety of care and practice in managing tracheostomy patients within the healthcare system. This study was conducted to assess the knowledge level of tracheostomy care among nurses in CCUs in Jordanian hospitals. Materials and Methods: A cross-sectional descriptive design was used for this study. A convenience sample of 260 nurses working in the CCUs of four government hospitals completed a self-reported structured questionnaire. Data were collected from January 2021 to March 2021. A t-test and one-way Analysis of Variance (ANOVA) were used to assess the differences among socio-demographic variables in terms of knowledge score. Results: The result revealed that the level of knowledge was suboptimal. There was a statistically significant difference in the mean level of knowledge regarding tracheostomy care (in all dimensions) by age (F = 22.595, p < 0.001), educational level (F = 355.30, p < 0.001), and work experience (F = 13.63, p < 0.001). For gender, there was a statistically significant difference in knowledge of the tracheostomy suctioning dimension (p = 0.001). Conclusions: The level of knowledge among nurses regarding tracheostomy care was moderate, indicating an urgent need for education.

Application and Use of Andersen's Behavioral Model as Theoretical Framework: A Systematic Literature Review from 2012-2021.

Background: Anderson's model provides a theoretical structure to understand use of health service. This scoping review aimed to examine the application of Andersen's behavioral model in different studies. Methods: Related studies that were published between 2012 and 2021 were retrieved by searching PubMed, Science Direct, and CINAHL databases. Fourteen studies satisfied the criteria for inclusion. Results: The reviewed studies specified that the Andersen's Model has been used in numerous parts of the health system and concerning different illnesses. The reviewed studies revealed differences in the factors examined. Most of the studies examined age, education, gender, marital status, and employment status as predisposing factors, and income, medical insurance, and living location as enabling factors. While, the chronic illnesses and perceived general health status were examined as need factors, in addition to an extensive diversity of health conditions and illnesses. Though the associations were established among the key factors tested in the reviewed studies and health care service use, the findings were inconsistent. In the reviewed studies, the setting and the study population characteristics looked to have a strong influence on the direction and strength of these associations. Conclusion: Merely a slight number of common factors were examined and there were enormous differences in the methods by which these factors were classified. Future and primary studies are necessary to deepen our understanding of the use of health care services and the complexity of the Andersen's behavioral model.

Palliative care needs of Jordanian women's experience of living with stroke: a descriptive phenomenological study.

BACKGROUND: Stroke is a prevalent neurological disease that can have a profound impact on women's physical, psychosocial, and spiritual well-being. In many cases, women living with stroke may have marginalized palliative care needs that are often not adequately addressed by healthcare providers. Unfortunately, the experience of women with stroke and their specific palliative care needs have been largely overlooked in research conducted in Jordan. AIM: The purpose of this study is to examine the specific palliative care needs of women who have experienced a stroke and are currently living in Jordan. By conducting this research, we aim to identify the various physical, emotional, social, and spiritual needs of women with stroke and gain a better understanding of how these needs can be addressed through palliative care interventions. METHODS: This research utilized a phenomenological descriptive study approach to explore the experiences of twelve women recruited from the outpatient clinic of rehabilitation centers. The data was collected through semi-structured interviews. The analysis was conducted using the method of Colaizzi (1978), which involves identifying significant statements, extracting meanings, and formulating an exhaustive description of the phenomenon under study. RESULTS: The study findings uncovered three primary themes that reflect the palliative care needs of women who are currently living with stroke in Jordan, including (1) Spiritual practices, beliefs, and needs; (2) Coping with distressing symptoms; and (3) Managing the delivery of unfavorable news. DISCUSSION: This study provides valuable insights into the experiences of Jordanian women living with stroke, highlighting the far-reaching consequences of this condition on various aspects of their lives. The findings reveal that stroke has a significant impact on women's physical, emotional, social, and spiritual well-being, with many facing unmet palliative care needs. By illuminating these challenges, our study underscores the importance of taking a holistic approach to stroke care that addresses the multifaceted needs of women living with stroke. Healthcare providers must consider these findings and integrate palliative care interventions into treatment plans to improve the quality of life of women living with stroke in Jordan. CONCLUSION: This study provides valuable insights into the palliative care needs of women who have experienced a stroke. Our findings highlight the importance of addressing women's physical, psychosocial, and spiritual needs as part of a comprehensive approach to stroke care. We recommend integrating palliative care interventions into rehabilitation programs to improve the quality of life of women living with stroke in Jordan. By doing so, we can address the pain and complications that can arise from stroke, while also providing holistic support to address the emotional and spiritual impact of the illness. This approach has the potential to improve outcomes for women living with stroke and enhance their overall well-being.

Translation and Validation of the Arabic Version of the Spiritual Perspective Scale.

Background and Purpose: No valid and reliable instrument exists in Arabic to measure the spiritual perspectives of Arab Muslims and Christians. This study translated the Spiritual Perspective Scale (SPS; Reed, 1987) into Arabic and examined its psychometric properties. Methods: The Arabic SPS was tested in a convenience sample of 206 Jordanian Christians and 182 Jordanian Muslim undergraduate nurses. Correlational and exploratory factor analysis were used. Results: For both sample groups, the factor analysis supported a clear two-factor structure for the Arabic SPS. A significant moderate positive correlation between the spiritual perspectives and religiosity was in the expected direction. The internal consistency reliability of the Arabic SPS was high. This study revealed that the Arabic SPS is a valid and reliable instrument to measure spiritual perspectives among Jordanian Muslim student nurses and adult Christians. Implications for Practice: Developing an Arabic version of the SPS exhibited good evidence of validity and reliability is important because it contributes to the evaluation of the spiritual behaviors and spiritual values and beliefs of Arab nurses and their patients. It also opens the way for comparison and transcultural studies regarding individual's spiritual perspectives.

Broadband Plasmonic Metamaterial Optical Absorber for the Visible to Near-Infrared Region.

An oblique angle and polarization insensitive metamaterial absorber (MA) are highly desired for the visible and infrared optical applications like, wave energy harvesting, optical filters, and detecting thermal leaks and electrical defects. In this paper, a multi-layered MA consisting of two layers of tungsten resonators on a silicon dioxide substrate, coated with additional SiO2 materials is investigated. The unit cell size of the MA is 0.5λ × 0.5λ × 0.8λ, at the lowest wavelength. The proposed MA offers an average absorption of 92% from 400 nm to 2400 nm with stable oblique incident angles up to 45°. The structure also achieves polarization insensitivity at the entire visible and near-infrared spectrum. Moreover, the MA is found highly compatible for solar absorber applications with high y AAM1.5. The structure is also compatible for filter application in optical communication system by modifying the plasmonic nano structure. The modified structure can block the wavelengths of the visible band (450 nm to 800 nm) and transmit optical communication bands (800 to 1675 nm). These versatile absorption and filtering performance make the proposed design highly potential for solar energy harvesting, photodetection, thermal imaging, photo-trapping, and optical communications applications.

Spiritual Wellbeing and Quality of Life among Hemodialysis Patients in Jordan: A Cross-Sectional Correlational Study.

Purpose: Nursing research studies investigating the relationship between spiritual wellbeing and health-related quality of life are lacking among Arab hemodialysis patients in Jordan or any other Arab country. The purpose of this study was to explore the associations between spiritual wellbeing, its religious and existential wellbeing dimensions, and health-related quality of life among Jordanian Muslim hemodialysis patients. Design: A cross sectional, quantitative correlational study. Methods: A convenience sample of 150 Jordanian hemodialysis patients completed a structured, self-administered questionnaire. Descriptive, bivariate, and multivariate regression models were used. Findings: The Jordanian hemodialysis patients had a moderate level of spiritual wellbeing and religious wellbeing, a low level of existential wellbeing, and a poor health-related quality of life. The findings revealed a significant moderate positive correlation between the spiritual wellbeing and its dimensions, and health-related quality of life. The existential wellbeing was the strongest predictor, with a large, positive, and significant effect after controlling for other spiritual, demographic and medical-related variables. Conclusion: Overall, the study suggests Jordanian hemodialysis patients use their religious and spiritual beliefs and practices as a coping mechanism, especially as sources of satisfaction, peace, comfort, strength and support, to help improve their health-related quality of life.

Nurses' knowledge of chemotherapy-induced neutropenia and its management: a cross-sectional survey.

BACKGROUND: Chemotherapy-induced neutropenia (CIN) is a serious and potentially life-threatening condition that is associated with high morbidity, mortality, and healthcare costs. OBJECTIVE: This study aims to assess nurses' level of knowledge of CIN and its association with socio-demographic factors. METHODS: A cross-sectional survey design was used. RESULTS: Participants had a mean age of 34.1 years (SD = 7.1 years) and were predominantly female (78%) and with a bachelor's degree in nursing (95.6%). The nurses had a moderate level of knowledge about neutropenia and its management (mean total score 16.3 out of 30, SD = 3.7). Those who had a post-graduate degree (P = .048), had received an oncology educational course (P = .011), had attended a course on neutropenia (P = .007), who were working in an oncology unit (P = .002), and had more oncology experience (P = 001) were more likely to have a higher level of knowledge of CIN and its management compared to their other counterparts. CONCLUSION: Based on the findings of a moderate level of knowledge of CIN among nurses, the findings call for the need for further education and training. As a long-term plan, this might be accomplished by encouraging nurses to pursue post-graduate education or oncology-specialized certification and supporting them with scholarship grants. However, deliberate plans for short courses, training and workshops on oncology or CIN are other choices with a more immediate impact on nurses' knowledge and clinical practice. Finally, integrating oncology nursing education within nursing curricula is urgently needed.

Assessment of symptoms among among patients living with cancer: prevalence, distress and its correlation with quality of life.

Background: Several symptoms known to be experienced by cancer patients receiving palliative care remain under-reported, inadequately managed and unexplored in Jordan. Aim: To describe the prevalence of symptoms, the distress caused and the correlation with quality-of-life among cancer patients receiving palliative care in Jordan. Methods: A cross-sectional correlational survey design was used. The Rotterdam Symptom Checklist and the Quality-of-Life Index-Cancer version were used for data collection. Data were analysed using descriptive statistics, unpaired t-test and Pearson correlation coefficients. Results: The sample comprises of 124 patients with a mean age of 55.7 years (SD=12.9). A total of 57.3% of them were females. Patients reported having an average of 17.3 (SD=7.1) symptoms. The most reported symptoms were tiredness (90.3%), lack of energy (81.5%), sore muscles (81.5%) and worry (76.6%). The mean total score for quality of life was 17.9 (SD=5.9) out of 30. A negative (P<0.05) relationship was found between the number of concurrent symptoms and the total quality of life score. Conclusions: Palliative care patients in Jordan reported a high number of co-occurring symptoms and experienced high levels of symptom distress, which negatively impacted their quality of life. Further research to evaluate the impact of total symptom management, its efficacy and feasibility is needed.

Nurses' knowledge of anticoagulation therapy for atrial fibrillation patients: Effectiveness of an educational course.

BACKGROUND: Oral anticoagulation is the most common method to decrease the risk of stroke in people with atrial fibrillation. PURPOSE: To assess the knowledge of Jordanian nurses about anticoagulation therapy, the effectiveness of educational courses in increasing their knowledge, and the factors that affect nurses' changing knowledge following completion of an educational course. METHOD: A pre/posttest quasi-experimental design was used. A total of 123 nurses participated in the study, identified by convenience sampling and recruited from five governmental hospitals in Jordan. To assess changes in knowledge between pre-and posttest, a questionnaire based on European cardiovascular nurses' knowledge of anticoagulation therapy was used. An educational course was given to improve participants' knowledge of anticoagulation therapy. The participants' knowledge was assessed before and after the educational course. For data analysis, Statistical Package for the Social Sciences version 23 was used. RESULTS: Nurses' knowledge of anticoagulants was poor; however, a significant improvement was achieved following the educational course (M = 25.5, SD = 3.41), as compared to before conducting it (M = 12.2, SD = 5.3, t = 42.54, p < 0.001). Having an academic degree was found to affect the change in knowledge scores among participants (t = -3.52, p = 0.001). CONCLUSION: The educational course was effective in improving the nurses' knowledge. Baccalaureate degree holders achieved more improvement in their knowledge scores. Post-graduate education for nurses would help to improve their knowledge of anticoagulants. Revision of nursing curricula may be deemed necessary to improve the quality of education for nurses during their degree work, especially regarding anticoagulants.

Polarization Independent Metamaterial Absorber with Anti-Reflection Coating Nanoarchitectonics for Visible and Infrared Window Applications.

The visible and infrared wavelengths are the most frequently used electromagnetic (EM) waves in the frequency spectrum; able to penetrate the atmosphere and reach Earth's surface. These wavelengths have attracted much attention in solar energy harvesting; thermography; and infrared imaging applications for the detection of electrical failures; faults; or thermal leakage hot spots and inspection of tapped live energized components. This paper presents a numerical analysis of a compact cubic cross-shaped four-layer metamaterial absorber (MA) structure by using a simple metal-dielectric-metal-dielectric configuration for wideband visible and infrared applications. The proposed MA achieved above 80% absorption in both visible and near-infrared regions of the spectrum from 350 to 1250 nm wavelength with an overall unit cell size of 0.57λ × 0.57λ × 0.59λ. The SiO2 based anti-reflection coating of sandwiched tungsten facilitates to achieve the wide high absorption bandwidth. The perceptible novelty of the proposed metamaterial is to achieve an average absorptivity of 95.3% for both visible and infrared wavelengths with a maximum absorptivity of 98% from 400 nm to 900 nm. Furthermore, the proposed structure provides polarization insensitivity with a higher oblique incidence angle tolerance up to 45°.

Cattail (Typha domingensis) silage improves feed intake, blood profile, economics of production, and growth performance of beef cattle.

Sixteen Rahaji breed beef cattle (112.00 ± 0.15 kg body weight (BW)) were randomly assigned to one of four rations differing in the degree of substitution of sorghum straw with Cattail (Typha domingensis) silage. Growth performance, feed intake, blood profile, and economics of production were evaluated. Completely randomized design was used, and the feeding trial lasted for 42 days. Cattle were fed a total mixed ration of roughage:concentrate (400:600) g/kg dry matter and gamba hay free choice. The control diet (T0) contained 400 g/kg sorghum straw, expressed on a dry matter basis (DM). For additional treatments, Typha silage (TS) was included at 100 (T10), 200 (T20), and 300 (T30) g/kg of the mix replacing an equal DM weight of sorghum straw. Growth rate was similar (P > 0.05) regardless of the TS level. DM (5160.77-5524.96 g/d) and crude protein (846.36-955.82 g/d) intakes were higher (P < 0.05) in T20 and T30 diets, while the acid detergent fiber intake (471.27-512.46 g/d) reduced (P < 0.05) in TS-based diets. Red blood cell concentrations of cattle fed TS-based diets increased (P < 0.05). The mean corpuscular hemoglobin concentrations of cattle fed T20 diet decreased (P < 0.05) in comparison with the control. Sodium and albumin concentrations were higher (P < 0.05) in cattle fed TS-based diets. Total cost of feeding ($ 49.60-61.62) decreased (P < 0.05) in TS-based diets, while the gross benefit of cattle fed 300 g/kg TS diet ($ 74.98) was enhanced relative to cattle fed T0 and T10 diets. TS can be considered a new resource of feed for cattle.

The role of religion in mitigating the COVID-19 pandemic: the Malaysian multi-faith perspectives.

Social distancing is crucial in breaking the cycle of transmission of COVID-19. However, many religions require the faithful to congregate. In Malaysia, the number of COVID-19 cases spiked up from below 30 in February 2020 to more than a thousand a month later. The sudden increase was mostly linked to a large Islamic gathering attended by 16,000 near the capital, Kuala Lumpur. Another large COVID-19 cluster was from a church gathering in Kuching, Sarawak. Within a few weeks, Malaysia became the worst hit country by COVID-19 in Southeast Asia. While religious leaders have advised social distancing among their congregants, the belief that "God is our shield" is often cited for gathering. There is a need to promote sound decision-making among religious adherents so that they will not prioritize their loyalty to the subjective interpretation of religion over evidence-based medicine. Malaysia, a multi-cultural and multi-faith country, is an example of how religious beliefs could strongly influence health behaviours at individual and community levels. In this article, we detail the religious aspects of COVID-19 prevention and control in Malaysia and discuss the possible role of religious organizations in encouraging sound decision-making among religious adherents in mitigating this crisis. We make recommendations on how to promote a partnership between the healthcare system and religious organizations, and how religion and faith could be integrated into health promotion channels and resources in the response of COVID-19 and future communicable diseases.

Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis.

Objective: The objective of this study is to analyse the incidence of postoperative atrial fibrillation (POAF), demography, post-operative outcomes including morbidity and mortality, length of Cardiac Intensive Care Unit (CICU) stay, High Dependency Unit (HDU) stay, and total hospital stay in patients undergoing coronary bypass grafting (CABG) at Institut Jantung Negana (IJN). Methods: We conducted a prospective, randomised, controlled trial. We supplied the treatment group with Tocovid capsules and the control group with placebo containing palm superolein. Results: Since January 2019, we have recruited the target population of 250 patients. However, the result is still blinded as we are still analysing blood samples for tocotrienol levels. 89.2% of patients completed the study with a 3.6% mortality and a 7.6% attrition rate. 35.2% of the patients developed POAF, the mean time being 46.06 ± 26.96 hours post-CABG. We did not observe any statistically significant difference when we compared left atrial size, New York Heart Association (NYHA) functional class, ejection fraction and premorbid history, besides EuroSCORE II (The European System for Cardiac Operative Risk Evaluation II) status except for older age group, right atrial size, and pleural effusion. There was also no difference in bypass time, cross clamp time or number of anastomoses. However, we noted a significant difference in death (p = 0.01) and renal failure requiring dialysis (p = 0.007) among patients with POAF; those patients also had a longer CICU stay (p = 0.005), HDU stay (p = 0.02), and total hospital stay (p = 0.001). Conclusions: POAF is associated with a higher incidence of renal failure and death while it increases CICU, HDU, and total hospital stay. It remains to be seen whether Tocovid reduces POAF and its associated sequelae. Clinical Trial Registration: NCT03807037 (Registered on 16 January 2019).

Primary osteosarcoma of the sphenoid wing in a middle-aged woman with extensive intracranial extension: A case report.

Primary osteosarcomas involving the base of the skull in middle-aged patients are rare. We describe the case of a 59-year-old Asian woman presenting with lethargy, epistaxis, left maxillary and mandibular pain, and headache. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large left greater sphenoid wing tumour with extensive local infiltration and intracranial extension. The tumour was diagnosed as osteosarcoma based on histological examination. In this report, we discuss the clinical presentations, radiological features, and imaging differential diagnoses of this case.

Erratum to: Hepatocellular carcinoma with extrahepatic blood supply from right renal artery.

[This corrects the article DOI: 10.1093/jscr/rjab391.].

A double-blind randomised controlled trial on the effect of Tocovid, a tocotrienol-rich capsule on postoperative atrial fibrillation at the National Heart Institute, Kuala Lumpur: an interim blinded analysis.

INTRODUCTION: Post-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. Its pathogenesis is initiated by systemic inflammation and oxidative stress. It is hypothesised that a potent antioxidant and anti-inflammatory agent such as tocotrienol, an isomer of Vitamin E, could reduce or prevent POAF. AIMS: The aim of this study is to determine whether a potent antioxidative and anti-inflammatory agent, Tocovid, a tocotrienol-rich capsule, could reduce the incidence of POAF and affect the mortality and morbidity as well as the duration of ICU, HDU and hospital stay. METHODS: This study was planned as a prospective, randomised, controlled trial with parallel groups. The control group received placebo containing palm superolein while the treatment group received Tocovid capsules. We investigated the incidence of POAF, the length of hospital stay after surgery and the health-related quality of life. RESULTS: Recruitment commenced in January 2019 but the preliminary results were unblinded as the study is still ongoing. Two-hundred and two patients have been recruited out of a target sample size of 250 as of January 2021. About 75% have completed the study and 6.4% were either lost during follow-up or withdrew; 4% of participants died. The mean age group was 61.44 ± 7.30 years with no statistical difference between the groups, with males having a preponderance for AF. The incidence of POAF was 24.36% and the mean time for developing POAF was 55.38 ± 29.9 h post-CABG. Obesity was not a predictive factor. No statistically significant difference was observed when comparing left atrial size, NYHA class, ejection fraction and the premorbid history. The mean cross-clamp time was 71 ± 34 min and the mean bypass time was 95 ± 46 min, with no difference between groups. There was a threefold increase in death among patients with POAF (p = 0.008) and an increase in the duration of ICU stay (p = 0.01), the total duration of hospital stay (p = 0.04) and reintubation (p = 0.045). CONCLUSION: A relatively low incidence rate of POAF was noted although the study is still ongoing. It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF. Clinical Registration Number: US National Library of Medicine. Clinical Trials - NCT03807037. Registered on 16th January 2019. Link: https://clinicaltrials.gov/ct2/show/NCT03807037.

Hepatocellular carcinoma with extrahepatic blood supply from right renal artery.

Extrahepatic blood supply is seen in around 17-27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70-83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any risk factors for extrahepatic circulation. He successfully underwent transarterial chemoembolization. There was no evidence of residual disease on repeat imaging.