Introduction: Mitral prosthetic thrombosis (MPV) is a rare but dangerous complication. It is suspected by clinical examination; the diagnosis of MPV is made by trans-thoracic echocardiography and held by the trans-esophageal echocardiography; or a fluoroscopy which shows a lack of prosthesis opening. The treatment is based on the early establishment of anti-coagulation and surgical cure. The thrombolysis is an alternative therapy. Case report: We report the case of a 47-year-old man who undergone a mitroaortic mechanical prosthesis replacement 6 years ago. However, since a year, his INR has been sub therapeutic. He presented a 5 days history of a chest pain and dyspnea. A passing at the intensive care diagnosed a shock according to the cool extremities, sweats, tachypnea and low blood pressure. The ECG showed atrial fibrillation with complete left bundle block. An emergency TTE was performed and revealed a MPV with high transvalvular gradient, while the aortic prosthesis was functional. The left ventricle was dilated and globally hypo contractile; TEE was emergently performed and showed à stuck leaflet caused by thrombus with associated with a thrombus at the left auricle. Patient’s hemodynamic condition required a surgical cure with thrombectomy of the left atrium. Conclusions: Through this case we highlight the interest of echocardiography to diagnose the etiology of shock, and the importance of early management to avoid any complications.

Cerebral palsy is the commonest physical disability in childhood, occurring in 2.0 to 2.5 per 1000 live births [1] Cerebral palsy (CP), a neurodevelopment disorders, is usually associated with abnormalities of pregnancy, particularly 'birth asphyxia' and low birth weight [2]. In the present study all cases were males, mothers were more than 35 years, para4, and uncooked, illiterate and low socio economic status. They all had normal deliveries, were anemic, associated with severe pregnancy induced hypertension, preterm and extremely low birth weight and no genetic overlay Present study 5(0.05%) cases occurred out of 8500 deliveries. Cranial ultrasound imaging can describe patterns of neonatal brain damage in the low birth weight infant that are highly predictive of later cerebral palsy [3, 4].

Oil Exploration in Nigeria has contributed greatly towards pollution of the environment especially in the Niger Delta region of the country where most of the oil wells are located. In the process of their operations which include; drilling, refining transportation etc., oil spillage occurs which pollutes land, air and water bodies. This results to the release of dangerous gases into the air. Properties of soils in the contaminated areas are highly affected leading to poor agricultural produce and alteration of geotechnical properties of soils which may adversely affect engineering construction works. This research work examines the effect of crude oil pollution on the geotechnical properties of clay soil. The clay soil was obtained from Engenni Ahoada L.G.A of Rivers, Nigeria. Soil samples were collected at a depth of approximately 2 meters below the ground surface and artificially polluted with crude oil in the ratio of 0%, 2%, 4%, 6%, 8%, 10%, 12%, and 14% of the dry weight of the soil. The samples were further subjected to various laboratory soil tests to determine their geotechnical properties. The results shows LL, PL, and PI increased from 31%, 20% and 11% at 0% contamination to 56%, 41% and 11% at 14%contamination. SPGR, BD, and MDD decreased from 2.48, 1.33g/cm3 and 1.74g/cm3 at 0% contamination to 1.14, 0.97g/cm3 and 1.35g/cm3 at 14% contamination. OMC increased from 15% at 0% contamination to 16.5% at 14% contamination. Thus, crude oil pollution affects the geotechnical properties of soil greatly.

Dimethyl ether (DME) is used primarily as a propellant and a motor fuel alternative, (DME) is miscible with most organic solvents and has a high solubility in water. Recently, the use of (DME) as a fuel additive for diesel engines has been investigated due to its high volatility (desired for cold starting) and high cetane number of 55–60, with the advantage of high efficiency, and low exhaust emissions (no particulates, no Sulphur, and low NOx). Technical-quality (DME) is an alternative to liquefied petroleum gas (LPG). The production processes included catalytic dehydration of methanol in an adiabatic fixed-bed reactor and two columns product separations. In this study, the technological process for (DME) synthesis is simulated in Aspen Hysys V3.1 based on the combined parameters of the reaction dynamic model for methanol dehydration reaction, the improved NRTL model of the liquid phase, the PR model of vapor phase was selected as the fluid package as it is able to handle selected pure components (methanol, water and dimethyl ether). The equilibrium reaction was selected to describe conversion of methanol to DME reaction and it is about 80%. A feasibility study and design of a plant producing 99.9 wt% Dimethyl ether (DME). The plant is designed which is capable of producing 50,000 metric tons of (DME) per year via the catalytic dehydration of methanol over an acid zeolite catalyst.

This research was prompted by a reflection on the level of preparation and the way in which the course of Principles of Economic Theory is taught at the last grade of secondary education in Greece. Under the Greek system of access to tertiary education, this course determines, to a large extent, admission to university departments of economics. The research was conducted with students in a department of economics by investigating the degree of satisfaction from their high school preparation in relation to their decision to attend private supplementary teaching for the national admission exams to tertiary education. Additionally, there was an investigation into the choices of the educators as to the way in which the course in question was taught.

Economic diversification entails the process of reducing dependence on single source of income or output generation. The basic idea behind economic diversification, therefore, is to develop the kind of diverse sectors that make significant value addition in an economy rather than relying on a single sector. It is in this backdrop that the present study is articulated to shed light on the pattern of economic diversification among the countries of the Middle Eastern region. The present paper employed two measures of diversification such as share of employment and value added of a particular sector in Gross Value Added over the period 1970-2016. The study has found that the region as a whole is witnessing economic diversification in terms of both the criterions at a moderate speed. Dynamic tradeable sectors should be developed in order to enhance the pace of economic diversification to strengthen macro-economy.

The Integrated Management System (IMS) could consider as one of the most important factors that eases the process of integrating many quality and safety management systems into one system to facilitate the implementation of the systems requirements. Jubail Technical Institute (JTI) obtained ISO 9001 certificate in 2015, followed by several certificates such as ISO 22000, OHSAS 18001 and ISO 10015 respectively. These certificates and others made it necessary for JTI to unify efforts and increase the effectiveness of meeting the requirements of these systems. The used tool for achieving these purposes was the MISWEB which is an internal website that organizes the integration of quality and safety management systems in IMS and provides many internal services. Throughout the MISWEB, JTI has been developed many electronic procedures, documents and forms to communicate them for the sake of increasing the use of forms, procedures. In this case study, the impact of IMS (ISO 9001, ISO 22000, OHSAS 18001 and ISO 10015) through MISWEB was measured. Specifically, the satisfaction rates of the faculty members, and the administrative staff on the procedures, forms and documents of IMS. Many tools and methods such as the tables, figures, and shape in addition to the Likert scale for the surveys were used to illustrate the impact of the IMS. A group of faculty members and the administrative staff have been surveyed over five years. The number of those samples from the two surveys were (152, 159, 125, 120, 82) for the years (2015, 2016, 2017, 2018, 2019) respectively. The analysis of data went through several steps such as the average scores and the range was from (3.87 to 4.45) out of 5. Moreover, the standard deviation of the data was measured and ranged between (0.67 and 1.08). The results of the Cronbach Alpha tests reached (0.89). The overall satisfaction rate of the faculty members and administrative staff on the procedures, forms and documents in the IMS at the MISWEB website were (86%). The satisfaction rate of the faculty members on the clarity of responsibilities in the procedures and clarity of procedures were (93%). While, the satisfaction rate of administrative staff on the clarity of procedures and forms, the extent of updating these forms, the suitability of these procedures and forms is equivalent to (80%). These results have led to improving the integrated management system. As well as enhance the work of MISWEB and pursue the satisfaction of faculty members and administrative staff to ensure high-quality services.

Background: In modern-day Dentistry, a significant emphasis is over esthetics. Hence, it is crucial to understand the various agents capable of adversely affecting the esthetics of a restoration due to its staining capacity. Objective: The aim of this in vitro study was to evaluate the effect of surface polishing, oral beverages and food colorants on the surface roughness and color stability of Restorative Materials. Materials and Methods: 60 Disks of Nanohybrid resin composite of different manufacturers measuring 4 mm in diameter and 5 mm in thickness were fabricated using a custom made Teflon mold. Pre-polishing surface roughness (Ra1) of all the five samples was measured using a Surface Profilometer. Pre immersion Spectrophotometric value (ΔE1) recorded for the baseline color of the samples. Three groups were formed consisting of 20 samples in each group, ie. Group I: Control group; Group II; Group III. The samples divided into subgroups (A, B, C, D), which was immersed in the respective test solution for 10 min thrice a day for 15 days. Sub Group- A - lipstick; Sub Group –B-Indian Blueberries; Sub Group–C -Sugar Candy; Sub Group -D –Carbonated drink- Fanta. Post immersion Profilometric value was recorded to evaluate roughness brought about by the solutions (Ra2), and Spectrophotometric amount was recorded to evaluate the color change in samples (ΔE2). Results were statistically analyzed using ANOVA. Results: Mean roughness (Ra2-Ra1) values are recorded in Sof-Lex, followed by the Diamond polishing paste and Control group. There were records of a Comparison of surface roughness caused due to beverages and food colorant solutions. Conclusion: Color alteration materials are affected by type and storage time.

Introduction: Early diagnosis and therapeutic intervention can improve the outcome of acute myocardial infarction (AMI). However, there are no satisfactory cardiac biomarkers for the diagnosis of AMI within 6 hours of onset of symptoms. Among the novel biomarkers of AMI, we tested the diagnostic accuracy of Heart type Fatty Acid Binding Protein (HFABP) in prospectively recruited patients with independently adjudicated outcomes. Methods: Prospective observational study was conducted at the Department of Pathology and Department of Cardiology, Dr Ram Manohar Lohia Institute of Medical Sciences Lucknow. After taking informed consent, 80 cases of chest pain suggestive of coronary origin (within 6 hours) were included. Results: Group a included 55 patients while Group B included 25 patients. In our study on Receiver operator curve (ROC) analysis, the AUC (Area under curve) was 0.846 (95% C.I. 0.743 to 0.948; p value <0.001) for HFABP. The optimum cut-off value for HFABP to diagnose AMI was 6.38 ng/ml with a Sensitivity, Specificity, PPV (Positive Predictive Value) and NPV of 86.4%, 84.5%, 67.9% and 94.2% respectively. Conclusion: The optimum cut-off value for HFABP to diagnose AMI was found to be 6.38 ng/ml were in concordance with similar studies. A high sensitivity and NPV is essential for the early ‘rule out’ of AMI patients. Since more than 70% of patients who present with acute chest pain to an emergency department do not have AMI, HFABP can be used as rule out tool to prevent unnecessary admissions of patients suspected for AMI considering its high sensitivity and NPV. Though, it was not a reliable marker for AMI diagnosis because of low specificity and positive predictive value. Further larger studies are needed to understand whether HFABP can add incremental value in rule-in AMI.

A long with the digitalization of Youtube became an alternative means of campaigning for politicians before the general election. President Joko Widodo (Jokowi) used this video application to increase his popularity and, at the same time, socialize his political activities over the past 5 years. Through Youtube, Jokowi presents his daily activities as president, for example thr household activities and activities as President of the Republic of Indonesia. The researcher wanted to examine how much the influence of President Jokowi's Video Blog (Vlog) toward the Political image and Electability for the 2019 Presidential Election. This study intended to examine the validity of the S-O-R theory on the situation of social media booming. The method used was a survey method, with data collection techniques through questionnaires distributed to 221 respondents. The results showed that the variable of political image and a correlation value have 0.593 which produced an effect of 35.2%. While the coefficient of determination of the electability variable has 0.393 which resulted an effect of 15.5%. This means that 35.2% of the political image variable and 15.5% of the electability variable are contributed from the jokowi vlog variable. Whereas 49.3% can be explained or influenced by other variables which are not examined by the present researcher.

Skin and soft tissue infections (SSTI) are the most common infections encountered in community and healthcare settings. There are different risk factors associated with SSTI including trauma, surgery, skin disease, immune defects and injection drug usage. Intravenous drug users (IDU) are frequently susceptible to SSTI due to unsafe injection practices, sharing of needles and low immunity. Intravenous drug usage is most common in young and homeless people globally. Although Staphylococcus aureus and Streptococcus pyogenes are the commonest pathogens however there are serious infections caused by rare pathogens such as botulism by Clostridium botulinum and tetanus by Clostridium Tetni. Prompt diagnosis and accurate management at the healthcare level will help in alleviating the symptoms and improve the outcomes. The continuous education and enhancing the implementation of prevention strategies are the responsibilities of local and national government to reduce the harmful drug use. In this review we are addressing the current challenges associated with causative pathogens for SSTI in IDU and their management and preventive strategies.

Individuals undergoing radiological investigations are exposed to natural and man-made radiation which could be ionizing or non-ionizing. This study aimed at assessing the knowledge of radiation and practice of radiation protection measures among patients awaiting radiological investigations at a teaching hospital in Southwest Nigeria. Consenting patients awaiting investigations at the radiology department of LAUTECH teaching hospital were enrolled for this study. Semi-structured interviewer-administered questionnaire were used and knowledge scoring was done. The data were analyzed using Statistical Package for Social Scientists (SPSS) version 22 and p< 0.05 were considered statistically significant. The mean knowledge of radiation score among the 200 patients studied was 55.8%±20.8. Participants with high education had significantly higher score (62.46%±15.07) than those with low and no formal education (34.79%±22.38) p= 0.001. Participants who practiced personal protective measures had higher scores than those that do not p= 0.001. However, there was no statistically significant difference in the knowledge scores between the males and females (55.59%±20.41vs 56.14%±21.35) p>0.05. This study showed that knowledge about radiation helps in adopting a lifestyle that protects from radiation but the knowledge of participants about radiation appears to be shallow. Patients were not aware of the type of radiological investigation they undergo and the associated radiation risk. It is strongly recommended that patient should be well informed about the radiological investigations they undergo.

Aims: To correlate AGE, TYPE, RBC INDICES in deciding the severity of anaemia in adult females in tertiory care hospital. Settings and Designs: A hospital based cross sectional study was done at our tertiary care centre in central clinical laboratory of Dr. D. Y. Patil Medical College & Hospital and Research Centre, Pimpri, Pune among 1000 adult females to evaluate prevalence of spectrum of anaemia. Considering a confidence level of 95% and confidence interval of 3.1 the number of patients in our study to achieve statistical significance is 999. This was calculated by Survey System (http://www.surveysystem.com/sscalc.htm#one). The Survey System ignores the population size when it is "large" or unknown. Population size is only likely to be a factor when you work with a relatively small and known group of people (e.g., the members of an association). Hence a sample size of 1000 was considered adequate for our study. Results: Majority of the females (42.44%) were in the age group of 26-35 years followed by 31.9% in the age group of 18-25 years, 19.2% in the age group of 36-45 years, 4.9% in the age group of 46-55 years and 1.6% in the age group of 56-65 years. 410 (41%) females had mild anaemia while 440 (44%) and 150 (15%) females had moderate and severe anaemia. The mean corpuscular volume (MCV) of females with mild anaemia was 70.94±1.35fl while the mean MCV of females with moderate and severe anaemia was 66.29±2.43fl and 60.82±1.77fl respectively. There was significant decrease in mean corpuscular volume (MCV) with increase in severity of anaemia as per ANOVA test (p<0.05). The mean corpuscular haemoglobin (MCH) of females with mild anaemia was 25.74±2.38pg while the mean MCH of females with moderate and severe anaemia was 21.16±2.07pg and 17.84±1.96pg respectively. There was significant decrease in mean corpuscular haemoglobin (MCH) with increase in severity of anaemia as per ANOVA test (p<0.05). The mean corpuscular haemoglobin concentration (MCHC) of females with mild anaemia was 32.76±3.14 while the mean MCHC of females with moderate and severe anaemia was 29.55±2.83 and 26.91±2.34 respectively. There was significant decrease in mean corpuscular haemoglobin concentration (MCHC) with increase in severity of anaemia as per ANOVA test (p<0.05). The mean red cell distribution width (RDW) of females with mild anaemia was 17.72±0.87% while the mean RDW of females with moderate and severe anaemia was 18.26±1.18% and 20.05±1.37% respectively. There was increase in red cell distribution width (RDW) with increase in severity of anaemia but the increase was statistically not significant as per ANOVA test (p>0.05). Conclusion: Iron deficiency anemia is increasing in females, specially in reproductive age group of developing countries. The haematological parameters can aid in early recognition of type and cause of anaemia and thereby improve the outcome. The study confirms that iron deficiency anaemia is the most common cause of anaemia in pregnancy and is a major health problem in developing and developed countries. Early detection, treatment and prevention of anemia can improve maternal as well as child outcome.

The case study seeks to explore the issue of parental involvement /intervention in the primary and secondary teachers’ work in Greece, in order to both the cases which contribute to a favorable and pleasant school climate that effectively helps the teachers’ work and the problems and difficulties that do not contribute positively to the work of the teacher and the school unit in general to be identified. For the conduct of this study, twenty five postgraduate students who are simultaneously teachers were recruited. As a research tool written texts were used, while the texts were analyzed by the qualitative content analysis. Overall, findings indicated that Greek parents are most of the times involved in the teachers’ work and in school units in general wrongfully, without having the appropriate and adequate pedagogical knowledge, while, on the other hand, teachers behave appropriately, from a pedagogical stance, as they deal with the parental involvement.

Background: Breast lumps are a common presentation among females. Breast carcinoma is 2nd commonest malignancy in females in India and needs early detection for proper management. Fine needle aspiration cytology (FNAC) is an established and highly accurate method in the investigation of palpable breast lumps. So the study was performed to analyse the cytomorphological spectrum of palpable breast lesions in a Tertiary Care Centre in North India. Material and Methods: This retrospective study was carried out in the Department of Pathology in GMC, Jammu. Female patients with suspected breast lumps who underwent FNAC in our department over a period of one year were included in the study. Detailed history including patient’s age, site and duration of breast lumps was noted. Findings of FNAC were recorded in detail and results tabulated. Results: Inadequate/Non-Diagnostic aspirations were seen in 13 cases. Majority of cases were seen in 4th decade of life. Among all aspirations, fibroadenoma was the commonest lesion seen in 36.4 % cases while malignancy was seen in 20.1 % cases. Conclusions: FNAC is a rapid, economical, and reliable tool for the diagnosis of palpable breast lesions. FNAC provides useful information in the management of the lesions and prevents unnecessary surgery in cases of non-neoplastic lesions.