The worldwide production of coal ashes is estimated to more than 800 million tonnes in 2012. Coal use is forecast to rise over 50% to 2030, with developing countries responsible for 97% of this increase worldwide. The estimated worldwide production of coal ashes is around 13.33 billion tonnes in 2030. The reuse rate for fly ash is around 47% whereas the reuse of bottom ash is only around 5.28%. It has contributed to environmental problems such as contaminating ground and surface water due to the limitation of dumping space, where it is still treated as waste and put in impoundment ponds, silos or landfills. By using Coal waste to replace cement production, the environmental benefits will occur and lead to a decrease in CO2 emissions by 0.9 tonnes for each ton of fly Ash used. According to the Environmental Protection Agency (EPA), living next to a coal ash disposal site can increase the human health risk of cancer or other diseases. It can also affect drinking water from a well where humans may get cancer from drinking water contaminated with arsenic. In Malaysia, there is seven coal-fired electric power station for the time being. In Peninsular Malaysia, there is four coalfired electric power station that produced at least 1400 MW of electric power. Coal waste is produced which includes coal ash in the fraction of about 75-85 % Fly Ash (FA) and 15-25 % Bottom Ash (BA). The study was conducted using the waste products from Tanjung Bin power plant which located in Mukim Serkat, Daerah Pontian, Johor, Malaysia that started operation in September 2006 with a capacity of (2100MW) electricity generating capacity. It is one of the four thermal power plants that utilize pulverized coal in the generation of electricity. Tanjung Bin power station produces 180 tonnes per day of bottom ash and 1,620 tonnes per day of fly ash from 18,000 tonnes per day of coal. This study presents the results of an experimental investigation on the probability of using Bottom-ash products in producing Fly-Ash bricks. By substituting 20% of cement with FA and fine aggregate (river sand) with partial replacement of 5%,10%,15% and 20% of BA where sand replacement can save the natural sand resources from depletion and also reduce the coal ash (CA) in Malaysia which classified under the Scheduled Waste (SW 104) Environmental Quality Act. The results of compressive strength at 7,14 & 28 days of air curing showed that the compressive strength and flexural strength decrease with the increasing of sand replacement of the bottom ash while noticed a visible increment of the water absorption ratio with increasing BA percentage wheras density shows the opposite of that.

Background: Tako-tsubo syndrome is an increasingly common cause of perioperative left ventricular dysfunction. It’s often transient and reversible. Until then, it mainly affect elderly patients but recently it begins to spread to a younger population. Case report: we report the case of a young female patient with takotsubo cardiomyopathy following a simple Laparoscopic abdominal surgery

Dental implants are in dynamism of the new world. Different systems are available in the market according to the patient’s economical standards. Even implants systems able to manage the treatment time simultaneously with cost. As it’s a surgical procedure and can be performed for replacement of single tooth or the whole edentulous arch there are protocols which needs to be followed. Various categories and criteria’s-based evaluation decides the implant placement strategies. It’s a specialty practice but now a day’s even general dentists are successfully placing implants. Keeping all this in mind this review is put forward about loading protocols in the implant dentistry which will be helpful for Implantologist throughout the world.

Essential thrombocythemia (ET) and chronic lymphocytic leukemia (CLL) are 2 distinct, clonal hematologic malignancies. The association of ET and CLL is very rare, and only a handful of cases have been described in the literature, the pathogenic mechanisms of this phenomenon remain unclear. Here we describe a patient with an uncommon case of Janus Kinase 2 (JAK2) V617F positive ET treated by hydroxyurea and pipobroman, who eventually developed a second unrelated hematologic malignancy, CLL

Medicinal plants have been used in virtually all cultures as a source of medicine. Asthishanharak (pacification of bones) [Cissus quadrangularis Linn.] belonging to Family Vitaceae is also popularly known as hadjod (bone setter) in Hindi. It is a perennial climber widely used in Ayurveda, for Pachana (digestive aid), Sara (relieves constipation), Athiyuk (strengthening bones), Vrishya (Aphrodisiac), Krumighna (destroys worms), Arshoghna (cures piles), Balya (provides strength), Amaghna (Relieves ama – a product of indigestion and altered metabolism), Kushthaghna (cures skin disorders) activities. It possesses calcium oxalate, β-carotene, ascorbic acid, β-sitosterol and 3-ketosteroids, also flavonoids like quercetin, and kaempferol. The stem has two unsymmetrical tetracyclic triterpenoids, onocer-7-ene-3α, 21β-diol and onocer- 7-ene-3β, 21 α –diol, two steroidal principles I and II, δ-amyrin, δ-amyrone. It has been reported to have bone fracture healing, Antioxidant, Free radical scavenging, Anti-microbial, Anti-fungal, Anti-bacterial activity, Anti-fungal, Anti- viral activity, Anti-ulcer activity, Analgesic, anti-inflammatory and stimulatory activity, Anti-obesity activity, Anti-pyretic activity, Anti-haemorrhoidal activity, Anti-tumour and cytotoxic activity, Anti-helminthic activity and Gastro-protective activities etc. Considering its therapeutic values, a review has been done to compile information on Ayurvedic aspect of Asthisanharak. Moreover Ayurvedic references, the present paper also emphasizes on its pharmacognostical studies, phytochemical constituents and researches conducted on this plant for its clinical and pharmacological evaluation which would be worthwhile to explore its unique features.

Central hypothyroidism is a thyroid hormone deficiency due to a disorder of the pituitary, hypothalamus or hypothalamic -pituitary portal system, leading to diminished thyroid –stimulating hormone (TSH), thyrotropin–releasing hormone (TRH) or both. It has an estimated prevalence of approximately 1 in 100.000. It is rarely isolated and occurs more commonly in conjunction with other pituitary hormones deficiency as well as neurological signs. The clinical manifestations of isolated central hypothyroidism are usually non -specific and are often delayed or miss diagnosised. The diagnosis can be difficult and usually based on low level of free hormone (FT4) and low to normal level of thyroid –stimulating hormone (TSH). The diagnostic value of Thyrotropin –releasing hormone (TRH) test has been evaluated in such situation. The screening, in the majority relay on TSH measurement. In this article we describe three infants who were diagnosed with congenital isolated central hypothyroidism at the KKUH, Riyadh, Saudi Arabia during the period from January 2016 to April 2019, as pediatricans need to be aware of this rare condition to avoid diagnostic delay and to start the appropriate replacement therapy

Sarcoidosis is a disease in which inflammatory granulomas cells are formed in the affected areas of body. Sarcoidosis, without a known aetiology commonly affects lymph nodes, lung tissues, skin, CNS, eyes, muscles, bone and heart. Cardiac sarcoidosis (CS) an infiltrative granulomatous disease of the myocardium that may present in about 2-7% of sarcoidosis patients and more than 20% cases are clinically silent. CS patients may suffer from asymptomatic left ventricular dysfunction, congestive heart failure, atrioventricular block, atrial or ventricular arrhythmia and sudden death. These symptoms are common in CS. The diagnosis could be done by using echocardiography, endocardiography, nuclear imaging like PET, CMR imaging and endomyocardial biopsy. Although randomized therapeutic trials have not been done but still corticosteroids (alone or combined with additional immunosuppressive medications) are usually used for the treatment. The natural approaches have also proved to be very beneficial for the management of the disease. These methods offer a cheaper, easily available and effective therapy devoid of side effects. The current manuscript mainly highlights the clinical manifestations, diagnosis, imaging techniques and therapies including the natural approaches to treat the disease.

Visual acuity loss and colour defects among young adults often times occur without notice. The aim of this study was to determine the visual acuity status and colour defects amongst secondary school subjects in Ogoja urban of Cross River state, Nigeria. A descriptive cross-sectional study was conducted using the multi- stage sampling technique amongst 500 secondary school students in Ogoja urban. The standard Snellen’s chart was used to assess visual acuity. The Ishihara chart Plates 1-15 of the 2008 edition of the Ishihara’s colour album were used to detect colour defects. The mean age of the subjects was 13.33 ±0.12 years for the male subjects while that for the females was 12.83 ±0.16 years. The heights of the male subject was 165.01 ±1.22cm while that for the females was 153.53 ±1.24cm, with the males being taller than the females (p<0.001); but the body weights did not differ. The visual acuity did not differ between the male and female subjects. However, when the visual acuity was categorised, only 80 subjects (16.1%) for the right eye and 77 subject (15.5%) for the left eye had normal visual acuity (6/6 to 6/8). The bulk of the other subjects belonged to the categories of mild (6/9 to 6/18), moderate (6/19 to 6/48) to severe (6/49 to 6/60) impairment in visual acuity: 235(47.2%) and 238(47.8%) for the right and left respectively having mild visual impairment; 78(15.7%) and 78(15.7%) for right and left respectively having moderate visual impairment; severe visual impairment was seen in 105(21.1%) and 105(21.1%) for the right and left eyes respectively. The frequency of distribution of colour defects amongst the secondary school subject showed that 0.75% of the subjects studies were red colour blind while 2.46% of the subjects were red-green colour blind. Therefore, in this population with a perceived normal visual acuity, the percentage of subject with visual impairment seemed higher than those with normal visual acuity. It is not clear what could be responsible for this

Flap design in facial reconstruction is particularly delicate given the face is the most visible structure of the body and has some of the most complex three-dimensional topography. The goals of facial reconstruction center on closing defects in an inconspicuous manner. Fortunately, the robust vascular supply of the face allows for many reconstructive options using flaps that are localized to the face.

We report the case of Mr IS 50 years old without notable antecedents, admitted in our service in a haemorrhagic table of shock associated with an abdominal mass giving the lumbar contact in connection with a broken aneurysm in the right renal artery associated with ipsilateral renal ischemia. A right nephrectomy was carried out and a subtotal resection of aneurysm with installation of a drainage. The operational continuations were simple. We review the literature regarding epidemiology, classification, symptomatology and management of aneurysms of the renal artery

Objective: This study was planned to determine what role nurses can perform in health screening of school children and what is their importance in identifying common ailments in school children. Methods: A cross sectional study was conducted between December 2014 to Jan 2015. Data was collected by using structure questionnaire after pilot testing. Head to toe screening of children was done by trained nurses and data was analyzed by using statistical package for social sciences (SPSS) version 22. Percentages and frequencies were calculated for various ailments found in school children. Results: In total 367 school children were screened. Mean age of the participants’ was13.56±1.9 years respectively. Out of 367 students, 154 were male and 213 were females. The common ailments found after thorough screening includes, malnourishment (14.2%), dental carries (20.4%), diarrhea (2.2%), vision problem (1.1%) and deviated nasal septum was (2.2%). Results were presented by using figure and table. Conclusion: School nurses can play a significant role in identification and management of common school ailments by timely performing health screening. School health nurses can also become a fundamental part for health promotion by promoting healthy habits among children at school level. Adequate attention needs to be paid to implent school health nurses for better future health of community.

International Dual Diploma Programs in undergraduate programs is one of the goals established by the internationalization of higher education institutions. Hence, each institution organizes itself in legal, administrative, teaching, political and financial terms in order to implement such a program. Objective: To report the experience of developing and implementing a Dual Diploma Program in undergraduate nursing programs in Brazil and Portugal. Method: Experience report. Results: An International Dual Diploma Program was established between the Undergraduate Nursing Programs of the Federal University of Santa Catarina (UFSC), Brazil and the Nursing School of Coimbra (ESenfC), Portugal. In Brazil, the process was initiated by the Coordination of the Undergraduate Nursing Program at UFSC, was considered by the university’s higher boards and by International Relations and Legal offices within the university. In Portugal, at the Nursing School of Coimbra, the International Relations Office together with the Technical-Scientific Council and the Office of the President of the ESenfC prepared the process. Two Brazilian students started attending the program in the second semester of 2018, after being selected through a public selection process. Conclusion: The program is in place and has proven to be feasible.

Nursing Managers hold a vital role in matching the vision of the institution with the vision of staff at the bed-side. Study Aim: Assess nursing manager's situational leadership style and nurses' work readiness levels. Study subject: nursing managers No=84 and 420 nurses. Setting: Assiut and Sohag Universities hospitals. Tools; consists of; 1) Personal data sheet, 2) Situational leadership styles questionnaire, 3) Work readiness scale validity and reliability were ensured Results: highest percentage of nursing managers at Assiut and Sohag universities hospitals utilize participative style (50% & 47.6%) respectively, meanwhile lowest percentage of them utilize delegative leadership style (4.8%, and 2.4%) respectively. Also the highest percentages of nurses at Assiut and Sohag Universities Hospitals had moderate work readiness level (54.8%, & 48.6%) respectively, followed by high work readiness level (38.1%, 28.6) respectively. Conclusions; this study concluded that; the majority of Assiut and Sohag Universities hospitals nursing managers not utilize situational leadership style. But only more than half of nursing managers at Assiut and less than half of nursing managers at Sohage utilize participative style, also highest percent of nurses work readiness levels were moderate. Recommendation: Condensed training for nursing managers must be done to enable nursing managers to utilize leadership styles that best fit with nurse's work readiness level.

Visual function is the most important sensory function of the human body; visual impairment is a common and debilitating health problem among elderly. It is affected elderly s’ daily life and leads to functional disabilities and other health problems. Thus: The aim of the current study was to assess relationship between visual impairment of elderly and their quality of life. Design: A descriptive correlational research design was adopted in this study. Setting: The study was conducted at outpatient clinics in Governmental Ophthalmic Hospital in Kafer El-Sheikh governorate, Egypt. Tools: Data were collected through interviewing elderly using two tools: I) Elderly Client Interviewing Questionnaire Tool which divided into two parts, 1st part: the demographic characteristics of the elderly and 2nd part: medical history and chronic disease. II) An Arabic Version of National Eye Institution Visual Function Questionnaires Tool (ARB-VFQ-25). Results: results revealed that, the main cause for visual impairment was cataract (84%). The highest mean score of subscale were vision health and color vision (66.13±34.67). A statistically significance correlation was found between visual impairment and quality of life among elderly (p= 0.012). Conclusion: Visual impairment is associated with significant reduction in different quality of life domains for the elderly. Quality of life becomes poor with increasing severity of visual impairment. Recommendations: the study recommended conducting a health education programs for elderly with visual impairment to promote their quality of life.

Eyelid scars usually aren’t thick, but they’re important because they inhibit the movement of small, delicate structures. For concerns, both cosmetic and functional, post-traumatic scarring of eyelids and periorbital area can pose a challenge for ophthalmologists. But the antimetabolite 5-fluorouracil (5-FU) offers a versatile option for approaching this common problem. 5-FU injections given at the first sign of contracture can help minimize scar tissue and dramatically improve eyelid function. Given its proven and long-standing track record in oncology, off-label applications of 5-FU have expanded in recent years into orbital and adnexal efforts to modify keloids and hypertrophic scars.