Non-ST-Segment Elevation Myocardial Infarction Shortly After Starting Steroid Replacement Therapy in a Patient With Adrenal Insufficiency.

Adrenal insufficiency is a rare disorder that results from etiological factors affecting either the hypothalamic-pituitary axis or the adrenal gland itself. Studies have associated an inherently increased risk of cardiovascular events with this condition. It is treated with exogenous steroid supplementation. However, in recent years, there have been an increasing number of reports regarding the potential of steroid therapy to precipitate acute cardiac events. However, this risk is generally assumed to be dose-dependent and could be absent in patients receiving low-dose glucocorticoid treatment. We present a case of a 71-year-old woman who was admitted to our institution with bilateral lower limb swelling. Blood investigation revealed hypoalbuminemia and hyponatremia. Upon further evaluation she was diagnosed to have adrenal insufficiency and was started on hydrocortisone replacement therapy; however, the patient developed non-ST-segment elevation myocardial infarction (NSTEMI) and acute pulmonary edema a few days after starting steroid replacement therapy. Here, we discuss the possible association between hydrocortisone use and the development of acute cardiac events

Characterization of (PVP-KCl) Composites

The polymers have uses in many industries. The addition of electrolytes to the polymers are produced a new materials use in many applications. Hence, in this paper study the effect of potassium chloride on the optical properties of polyvinyl pyrrolidone. The potassium chloride was added to polymer with different concentrations. The samples were prepared by using casting technique. The optical properties were measured in the wavelength range (200-800) nm. The experimental results showed that the absorbance (A), absorption coefficient (?), extinction coefficient (k), refractive index (n),  real and imaginary dielectric constants (?1 and ?2) of polyvinyl pyrrolidone are increasing with the increase of the potassium chloride weight percentages. The energy gap (Eg) of polyvinyl pyrrolidone decreases with the increase of the potassium chloride weight percentages. Keyword: optical properties , potassium chloride, polyvinyl pyrrolidone

Preparation and Characterization of (PVA-FeNO3) Composites

This works investigate the effects of addition FeNO3 on  optical  properties of poly-vinyl alcohol(PVA). The specimens were prepared by adding FeNO3 to the solution of poly-vinyl alcohol with weight percentages from FeNO3 are(0,1,2,3)wt.%. The experimental Results show that the absorbance of (PVA-FeNO3 )composites increases with increase the weight percentages of  FeNO3. The refractive index, real part of dielectric constant,  Berwster angle and coefficient of finesses are increasing with increase weight percentages of FeNO3. keywords: ,  poly-vinyl alcohol,  optical  properties, Composites

Assessment of procurement capacity challenges inhibiting public infrastructure procurement: A Nigerian inquiry

© 2018, Emerald Publishing Limited. Purpose: Public procurement capacity is composed of three facets: individual, organisational and an enabling national environment which encapsulates national legislation, policies and institutional arrangements that can facilitate or hamper the effectiveness of procurement. The purpose of this paper is to investigate the extent to which procurement capacity challenges in the national environment affect the effectiveness of infrastructure procurement by public agencies in Nigeria. Design/methodology/approach: A total of 30 procurement capacity challenges drawn from literature were operationalized in a survey of infrastructure procurement personnel in different tiers of public agencies (i.e. local and state government) in order to ascertain the critical challenges affecting the effectiveness of infrastructure procurement. The survey yielded 288 responses, which were analysed using descriptive statistics, one-sample t-test and independent-samples t-test. Findings: Challenges related to transparency, integrity and accountability are amongst the topmost challenges adversely affecting the effectiveness of public infrastructure procurement. There is limited difference in the extent to which the challenges affect the effectiveness of infrastructure procurement in different tiers of public agencies in Nigeria. Originality/value: Whilst various procurement capacity challenges have been identified in the extent literature, this study has shown that an assessment of their effect on the effectiveness of infrastructure procurement could reveal valuable insights regarding the status of public infrastructure procurement within a country, particularly countries in Sub-Saharan Africa and other developing regions where there is acute infrastructure deficits. Such insights could inform appropriate infrastructure procurement reforms by policy makers, procurement entities and infrastructure funders

Study of the Effect of Berry Paper Mulberry on Optical Properties of Poly Methyl Methacrylate

In this work, study the optical properties of composites consisting of poly Methyl Methacrylate and Berry Paper Mulberry. The samples of composites were prepared using casting method .The Berry Paper Mulberry (BPM) was added by different concentrations are (0, 2, 4 and 6)wt.%. The optical properties of composites have been studied in the wavelength range (200-800)nm. The absorption coefficient ,energy gap, refractive index, extinction coefficient and dielectric constants have been determined. The results show that the optical constants change with increase of BPM concentrations

Comparative study of significant molluscans dwelling at two sites of Jiwani coast, Pakistan

During the present study collectively eighty two (82) molluscan species have been explored from Bandri (25 04. 788 N; 61 45. 059 E) and Shapk beach (25 01. 885 N; 61 43. 682 E) of Jiwani coast. This study presents the first ever record of molluscan fauna from shapk beach of Jiwani. Amongst these fifty eight (58) species were found belonging to class gastropoda, twenty two (22) bivalves, one (1) scaphopod and one (1) polyplachopora comprised of thirty nine (39) families. Each collected samples was identified on species level as well as biometric data of certain species was calculated for both sites. Molluscan species similarity was also calculated between two sites. For gastropods it was remain 74 %, for bivalves 76 %, for Polyplacophora 100 % and for Scapophoda 0 %. Meanwhile total similarity of molluscan species between two sites was calculated 75 %. Notable identified species from Bandri and Shapak includes Oysters, Muricids, Babylonia shells, Trochids, Turbinids and shells belonging to Pinnidae, Arcidae, Veneridae families are of commercial significance which can be exploited for a variety of purposes like edible, ornamental, therapeutic, dye extraction, and in cement industry etc

Molecular epidemiology of SARS-CoV-2: A tertiary care hospital experience from Pakistan

Objectives: The current study was conducted to assess the molecular epidemiology of SARS-CoV-2 in the general population. Methodology: This study was conducted from April to July 2020, at the Molecular Diagnostic Laboratory, Pakistan Atomic Energy Commission (PAEC) General Hospital Islamabad, Pakistan. A total of 28,274 nasopharyngeal swabs were collected in Viral Transport Medium (VTM) media from symptomatic and asymptomatic individuals at the sample collection centers of our hospital and other affiliated hospitals. RNA was extracted using both automated and manual extraction platforms as per the manufacturer's instructions. Multiple qualitative reverse transcription real-time PCR kits for the identification of SARS-CoV-2 were used. Results: The results showed that 1,722 (6.09%) were positive for SARA-CoV-2 RNA. The males exhibited a prevalence of 2.76% while females showed a high prevalence of 13.44%. Among males,  most patients 424 (31.47%) were in the age group of 31-40 years followed by the age group of 41-50 years 306 (22.71%). Similarly among females, the majority of patients were from the age group 31-40 years with 91 (24.66%) followed by 41-50 years of age group 70 (18.66%) confirmed cases. Conclusion: The molecular epidemiological data may support the national policy formulation, transmission tracking, and the execution of measures to control viral transmission

Asphaltene Precipitation Investigation Using a Screening Techniques for Crude Oil Sample from the Nahr-Umr Formation/Halfaya Oil Field

Many oil and gas processes, including oil recovery, oil transportation, and petroleum processing, are negatively impacted by the precipitation and deposition of asphaltene. Screening methods for determining the stability of asphaltenes in crude oil have been developed due to the high cost of remediating asphaltene deposition in crude oil production and processing. The colloidal instability index, the Asphaltene-resin ratio, the De Boer plot, and the modified colloidal instability index were used to predict the stability of asphaltene in crude oil in this study. The screening approaches were investigated in detail, as done for the experimental results obtained from them. The factors regulating the asphaltene precipitation are different from one well to another, from the high-pressure-temperature reservoir to surface conditions. All these factors must be investigated on a case-by-case basis. Because the Halfaya oil field is still developing its petroleum sector, modelling, and forecasting the phase behavior and asphaltene precipitation is crucial. This work used crude oil bottom hole samples with an API of equal to 27 from a well in the Halfaya oil field/Nahr-Umr formation to create a thermodynamic model using Multiflash software. The data included the compositional analysis, the PVT data, and reservoir conditions. The thermodynamic model of asphaltene phase behavior was proposed using the Cubic-Plus association equation of state. All the screening techniques' results revealed the presence of an asphaltene precipitation issue (asphaltene unstable), which was confirmed by a thermodynamic fluid model. The aim of this paper is to predict the problem of asphaltene precipitation so that future proactive remedial methods can be developed to decrease the time and expense associated with it

Experimental evaluation of liquid nitrogen fracturing on the development of tight gas carbonate rocks in the Lower Indus Basin, Pakistan

Tight gas carbonate formations have enormous potential to meet the supply and demand of the ever-growing population. However, it is impossible to produce from these formations due to the reduced permeability and lower marginal porosity. Several methods have been used to extract unconventional tight gas from these reservoirs, including hydraulic fracturing and acidizing. However, field studies have demonstrated that these methods have environmental flaws and technical problems. Liquid nitrogen (LN2) fracturing is an effective stimulation technique that provides sudden thermal stress in the rock matrix, creating vivid fractures and improving the petro-physical potential. In this study, we acquired tight gas carbonate samples and thin sections of rock from the Laki limestone formation in the Lower Indus Basin, Pakistan, to experimentally quantify the effects of LN2 fracturing. Initially, these samples were characterized based on mineralogical (X-ray diffraction), petrography, and petro-physical (permeability and porosity) properties. Additionally, LK-18-06 Laki limestone rock samples were exposed to LN2 for different time intervals (30, 60, and 90 mins), and various techniques were applied to comprehend the effects of the LN2 before and after treatment, such as atomic force microscopy, scanning electron microscopy, energy-dispersive spectroscopy, nano-indentation, and petro-physical characterization. Our results reveal that the LN2 treatment was very effective and induced vivid fractures of up to 38 µm. The surface roughness increased from 275 to 946 nm, and indentation moduli significantly decreased due to the decreased compressibility of the rock matrix. Petro-physical measurements revealed that the porosity increased by 47% and that the permeability increased by 67% at an optimum LN2 treatment interval of 90 mins. This data can aid in an accurate assessment of LN2 fracturing for the better development of unconventional tight gas reservoirs

Adherence of Primary Health Care Physicians to Hypertension Management Guidelines in Aljouf Region of Saudi Arabia

Abstract Introduction: Hypertension affects more than one-third of the world population and is a common public health problem. Primary health care physician's (PHCP's) adherence to the hypertension management guidelines constitutes an essential step for controlling hypertension