Effect of aggregates with high gypsum content on the performance of concrete

Sulfates in fine aggregate are a major problem when it exists in excessive amount especially in the Middle East and Iraq. Most of sulfate salts in fine aggregate are composed of calcium, magnesium, potassium and sodium sulfates. Calcium sulfates is the most common salt present in fine aggregate. It is usually finding as gypsum. It is difficult to obtain the specific sulfates content in fine aggregate within standard specifications. This research was conducted to investigate the effect of adding different contents of gypsum to fine aggregate as a replacement by weight on some properties of two types of concrete {self-compacted concrete (SCC) and high strength concrete (HSC)}. In these work three bases mixes of each type of concrete are used: mixes with different contents of metakaolin, mixes with different contents of gypsum and mixes incorporating different contents of metakaolin and gypsum. This study is devoted to determine the allowable content of sulfates in fine aggregate. Three levels of gypsum were tested (0.5, 1, 1.5) % by weight of fine aggregate and three levels of metakaolin were tested (5, 10, 15) % by the weight of cement. The experimental program is devoted to produce concrete with different levels of metakaolin and gypsum and determine its mechanical properties such as compressive strength and splitting tensile strength. The results arrived from this work show that the optimum gypsum content was 1.5% by weight of fine aggregates for mixes of SCC which gives increases in compressive strength and tensile strength, and 1% gypsum for mixes of HSC, results showed also that the metakaolin improved the properties of the two types of concrete and increased the loss which caused by sulfates. The best mix ever in SCC is 1% gypsum with 5% metakaolin, and 1% gypsum with 10% metakaolin for HSC

Appraising Rufaidah Al-Aslamia, First Muslim Nurse and Pioneer of Islamic Nursing: Contributions and Legacy

Global advancement in nursing is attributed mainly to western pioneers with negligible recognition of Rufaidah Al-Aslamia, who was the first Muslim nurse, and pioneer in Islamic nursing more than 1,400 years ago in Madinah (Medina, Saudi Arabia). She responded to the need for the provision of organized nursing care to injured soldiers in the Islamic battles during the time of Prophet Mohammed (Peace & Blessings Upon Him). The paucity of focus on Rufaidah Al-Aslamia triggered this scientific study to appraise her contributions and legacy as the pioneer of Islamic nursing. A qualitative, historical research inquiry was conducted using a research design that was exploratory, descriptive, explanatory, interpretive, and contextual within the constructivist paradigm. Data collection of literature was conducted by purposive sampling. Data analysis was conducted in two parts, which is document analysis, and thematic and content analysis with the use of deductive, inductive and abductive logical reasoning. The results of topic themes related to nurse-, patient-, and system-focused activities are provided with the emerging themes including efficient organizer, effective communication, clinical practice teacher, community care, and spiritual care. The historical narrative is reconstructed using empirical data sources as part of the discussion that includes the biography of Rufaidah Al-Aslamia and a vivid comprehensive portrayal of the contributions and legacy of Rufaidah Al-Aslamia as the first Muslim nurse and the pioneer of Islamic nursing.   Abstrak Rufaidah Al-Aslamia, Perawat Muslim Pertama dan Pelopor Keperawatan Islam: Kontribusi dan Legasi. Kemajuan global di bidang keperawatan seringkali dikaitkan terutama dengan perintis barat dengan sedikit pengakuan terhadap Rufaidah Al-Aslamia, yang merupakan perawat Muslim pertama, dan pelopor dalam keperawatan Islam lebih dari 1.400 tahun yang lalu di Madinah (Arab Saudi). Rufaidah Al-Aslamia menanggapi kebutuhan penyediaan asuhan keperawatan yang terorganisir untuk tentara yang terluka dalam pertempuran Islam pada masa Nabi Muhammad (SAW). Kurangnya fokus pada Rufaidah Al-Aslamia memicu studi ilmiah ini untuk menilai kontribusi dan warisannya sebagai pelopor keperawatan Islam. Penelusuran sejarah dengan pendekatan kualitatif dilakukan dengan menggunakan desain penelitian yang bersifat eksploratif, deskriptif, eksplanatif, interpretif, dan kontekstual dalam paradigma konstruktivis. Pengumpul-an data literatur dilakukan dengan purposive sampling. Analisis data dilakukan dalam dua bagian, yaitu analisis dokumen, dan analisis tematik dan isi dengan menggunakan penalaran logis deduktif, induktif dan abduktif. Hasil dari topik yang berkaitan dengan kegiatan yang berfokus pada perawat, pasien, dan sistem disajikan dengan tema-tema yang muncul termasuk penyelenggara yang efisien, komunikasi yang efektif, guru praktik klinis, perawatan komunitas, dan perawatan spiritual. Narasi sejarah direkonstruksi menggunakan sumber data empiris sebagai bagian dari diskusi yang mencakup biografi Rufaidah Al-Aslamia dan penggambaran komprehensif yang jelas tentang kontribusi dan warisan Rufaidah Al-Aslamia sebagai perawat Muslim pertama dan pelopor keperawatan Islam. Kata kunci: Nabi Muhammad, pelopor keperawatan islam, perawat muslim pertama, Rufaidah Al-Aslami

Who knows best? A Q methodology study to explore perspectives of professional stakeholders and community participants on health in low-income communities

Abstract Background Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While there is growing understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these groups. Methods Q methodology was used to identify and describe the shared perspectives (‘subjectivities’) that exist on i) why health is worse in low-income communities (‘Causes’) and ii) the ways that health could be improved in these same communities (‘Solutions’). Purposively selected individuals (n = 53) from low-income communities (n = 25) and professional stakeholder groups (n = 28) ranked ordered sets of statements – 34 ‘Causes’ and 39 ‘Solutions’ – onto quasi-normal shaped grids according to their point of view. Factor analysis was used to identify shared points of view. ‘Causes’ and ‘Solutions’ were analysed independently, before examining correlations between perspectives on causes and perspectives on solutions. Results Analysis produced three factor solutions for both the ‘Causes’ and ‘Solutions’. Broadly summarised these accounts for ‘Causes’ are: i) ‘Unfair Society’, ii) ‘Dependent, workless and lazy’, iii) ‘Intergenerational hardships’ and for ‘Solutions’: i) ‘Empower communities’, ii) ‘Paternalism’, iii) ‘Redistribution’. No professionals defined (i.e. had a significant association with one factor only) the ‘Causes’ factor ‘Dependent, workless and lazy’ and the ‘Solutions’ factor ‘Paternalism’. No community participants defined the ‘Solutions’ factor ‘Redistribution’. The direction of correlations between the two sets of factor solutions – ‘Causes’ and ‘Solutions’ – appear to be intuitive, given the accounts identified. Conclusions Despite the plurality of views there was broad agreement across accounts about issues relating to money. This is important as it points a way forward for tackling health inequalities, highlighting areas for policy and future research to focus on

The antiproliferative effect of mulberry (Morus alba L.) plant on hepatocarcinoma cell line HepG2

AbstractThis study aimed to investigate the antiproliferative effect of aqueous and organic extracts of mulberry leaves (Morus Alba L.) on human hepatocellular carcinoma HepG2 cell line. Mulberry leaf extracts were prepared using the solvents: water, 50% aqueous MeOH, and 100% MeOH for different time intervals, while the cells treated with dimethyl sulfoxide (DMSO) served as control. The effects of aqueous and organic extracts of M. alba L. leaves on HepG2 cell viability, nuclear factor kappa B (NF-κB) gene expression, alfa-fetoprotein (AFP), albumin (ALB), gamma-glutamyl transpeptidase (γ-GT) and alkaline phosphatase (ALP) were measured. The results of the cell viability assays showed that water, 50% aqueous MeOH, and 100% MeOH extracts exhibited a highly significant inhibitory effect on HepG2 cell proliferation which was evidenced by a reduction in viable cell count. The results were confirmed by microscopical examination of cell morphology. Furthermore, the mulberry leaf extracts suppressed the activity of NF-κB gene expression of HepG2 cells compared to the control. Also a highly significant depression occurred at the levels of AFP, γ-GT and ALP in HepG2 cells compared with that of controls in a time dependent manner. By contrast, the mulberry leaf extracts increased the secretion of ALB. Therefore, the conclusion was that the organic and aqueous extracts of mulberry leaves inhibit the growth of HepG2 cells through suppressing the activity of NF-κB gene expression and modulate the biochemical markers

A review of community-based health insurance in Nigeria

Background: The primary goal of many countries is to establish a healthcare financing system that guarantees universal health coverage (UHC) through equity in access to healthcare services as well as financial risk protection to the people. Community based health insurance (CBHI) has emerged as an alternative to reduce out-of-pocket (OOP) expenditures and improved financial risk protections in developing countries like Nigeria. The aim of this study is to review the CBHI in Nigeria and highlight the issues, weaknesses and strengths of the system. Materials and Methods: A systematic literature review on the CBHI was conducted using relevant studies searched from electronic databases: MEDLINE, Pubmed, scienceDirect.com, PLOS and public search engine (Google). It was done on 16th January, 2017. The phrases used are ‘health financing’, ‘community health insurance’ in ‘Nigeria’ which were put together by Boolean operator “and” articles or reports. Relevant materials for the past 7 years were included. A total of 5 articles fulfilled the criteria for review. SWOT (strength, weakness, opportunity and threat) tool was used for the analysis. Result: The strengths of CBHI scheme in Nigeria are it reduces OOP health expenditure and improves utilization rate on healthcare. However, the weaknesses are that the scheme tends to cover a comparatively small proportion of the social class, namely the lower social class. Also, involvement of the community sometimes is ineffective due to inadequate funding. The opportunities are that the CBHI scheme increases efforts towards improving healthcare system in the country and enables equity in access to healthcare. The threats are weak policy, lack of political commitment to health, poor funding especially in primary healthcare and poverty. Conclusion: Nigeria must start to make more commitment to health care, if they want to achieve UHC. The rate of out of pockets health expenditure is still very high and catastrophic on Nigerian healthcare system. Recommended strategies needs to be addressed urgently in order to improve equity in access to health care service as well as effective financial risk protection. CBHI may not be suitable in all situations but can play an important role in to health care programs in Nigeria

Diagnostic performance and predictive value of rheumatoid factor, anti-cyclic-citrullinated peptide antibodies and HLA-DRB1 locus genes in rheumatoid arthritis

<p>Abstract</p> <p>Background</p> <p>We evaluated the significance of the genes, defined as <it>DRB1*04 </it>or <it>DRB1*01</it>, in rheumatoid arthritis (RA) patients. We focused on the role of genetic and serologic markers to predict disease activity and destructive process of joints.</p> <p>Methods</p> <p>Sixty patients with RA were examined. Radiographic changes were evaluated by (Larsen score) and disease activity was measured by disease activity score 28 (DAS28). The markers analyzed were: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP2) and HLA-<it>DRB1 </it>alleles typed by PCR.</p> <p>Results</p> <p>In this study, anti-CCP antibodies, CRP, RF and AKA were detected in 83.3%, 56.7%, 71.7% and 52% of patients respectively. HLA-<it>DRB1</it>*01 was found in 45% of patients and 35% of them had one or two HLA-<it>DRB1*04 </it>alleles. According to <it>DRB1*04 </it>subtypes, (<it>DRB1* 0405</it>) was present in of 80% them. For prediction of grade of activity, the independent predictors were anti-CCP (OR 19.6), and <it>DRB1*04 </it>positive allele (OR 5.1). The combination of <it>DRB1*04 </it>+ anti-CCP antibodies gave increase in the specificity and positive predictive value to 92% and 90 respectively. As regards to the prediction of radiological joint damage, the independent predictors were HLA-<it>DRB1*04</it>, HLA-<it>DRB1*01</it>, RF, and CRP > 18 (OR 5.5, 4.5, 2.5, 2.0 respectively).</p> <p>Conclusion</p> <p>Our findings suggest that anti-CCP2 is superior to RF for the detection of RA and provided predictive information on joint destruction and disease activity. The presence of RA associated antibodies (ACCP or RF) and/or the SE genes are indicative for a poorer radiological outcome and higher grade of activity.</p

Vancomycin MIC Distribution among Methicillin-Resistant Staphylococcus Aureus. Is Reduced Vancomycin Susceptibility Related To MIC Creep?

AIM: To determine the distribution of vancomycin MIC and the frequency of S. aureus strains with reduced vancomycin susceptibility among Methicillin-Resistant Staphylococcus aureus (MRSA) isolates. METHODS: MRSA isolates (n = 100) were tested for reduced susceptibility to vancomycin using&nbsp; MIC broth microdilution method (BMD), vancomycin screening agar with different vancomycin concentrations with and without casein, and Vitek 2 system. RESULTS: BMD detected (22%) vancomycin-intermediate S. aureus (VISA) and (78%) vancomycin-susceptible S. aureus (VSSA) but couldn’t detect nine (Heterogeneous VISA) (hVISA)&nbsp;&nbsp; isolates (9%) with MIC ≤ 2 µg/ml that grew on screening agar 4 µg/ml or 6 µg/ml. Adding casein to vancomycin screening agar increased detection rate of VISA by 4.5%.&nbsp; Screening agar with 6 µg/ml vancomycin overall detection rate for VISA was 95.45%. Probable ‘pre-hVISA’isolates (17%) showed growth on vancomycin screening agar 2 µg/ml with casein. Vitek 2 system failed to detect any VISA isolates. CONCLUSION: Vancomycin screening agar; 2 µg/ml and (4 and 6 µg/ml) were able to detect; probable “pre hVISA and (hVISA and VISA) isolates respectively based on their BMD MIC values. Decreased vancomycin susceptibility in MRSA isolates might be related to MIC creep. Analysis of vancomycin MIC values over longer periods is recommended to further study this phenomenon and its impact on vancomycin treatment failure. &nbsp; ABSTRACT Aims: Determine the distribution of vancomycin MIC and the frequency of S. aureus strains with reduced vancomycin susceptibility among MRSA isolates. &nbsp;Methods: &nbsp;MRSA isolates&nbsp;(n =100) were tested for reduced susceptibility to vancomycin using&nbsp; MIC broth microdilution method(BMD), vancomycin screening agar with different vancomycin concentrations with and without casein, and Vitek 2 system. &nbsp;Results: BMD detected (22%) vancomycin intermediate S. aureus(VISA) and (78%) vancomycin susceptible S. aureus(VSSA) but failed to detect nine (Heterogeneous VISA) (hVISA)&nbsp;&nbsp;isolates (9%) with MIC ≤2ug/ml that grew on screening agar 4ug/ml or 6 ug/ml. Adding casein to vancomycin screening agar increased detection rate of VISA by 4.5%.&nbsp; Screening agar with 6 ug/ml vancomycin over all detection rate for VISA was 95.45%. Probable ‘pre-hVISA’isolates (17%) showed growth on vancomycin screening agar 2µg/ml with casein. Vitek 2 system failed to detect any VISA isolates. Conclusion: vancomycin screening agar; 2 µg/ml and (4 and 6 µg/ml) were able to detect; probable “pre hVISA and (hVISA and VISA) isolates respectively based on their BMD MIC values. Decreased vancomycin susceptibility in MRSA isolates might be related to MIC creep. Analysis of vancomycin MIC values over longer periods of time is recommended to further study this phenomenon and its impact on vancomycin treatment failure. &nbsp; &nbsp

NATURAL PRODUCTS PHARMACEUTICAL STANDARDIZATION TOWARDS PHYTOPHARMACA FOR INDONESIAN TRADITIONAL MEDICINE DEVELOPMENT: STANDARDISASI FARMASITIKAL BAHAN ALAM MENUJU FITOFARMAKA UNTUK PENGEMBANGAN OBAT TRADISIONAL INDONESIA

There is a tendency back to nature treatment in Indonesian community because modern/synthetic medicines is expensive and have a various alarming side effects.&nbsp; That is why natural products medicine becomes more popular, aside from mass media promotions. Researches on natural products such as herbal medicine increases along with the desire to get phytofarmaca that can compete with modern medicines. The aims of this literature review are to discuss and provides information on pharmaceutical standardization of natural products toward phytopharmaca for developing Indonesian traditional medicine. Pharmaceutical standardization will strengthen the basic of pharmaceutical science in producing safe, efficacy, and qualify traditional medicine products. The pharmaceutical standardization consists of standardizing simplicial quality, safety, efficacy, and stable formulation of medicines for use in health services.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp

A case of probable esomeprazole-induced transient liver injury in a pregnant woman with hyperemesis.

We report a case of 22-year-old primigravida presented to Women's Hospital - Hamad Medical Corporation emergency with severe epigastric pain, nausea, and vomiting. On admission, she was dehydrated with remarkably worsening symptoms. Laboratory findings revealed significantly elevated liver enzymes with unknown etiology. Her past medical history showed an admission for nausea and vomiting 3 weeks previously and she was discharged on antiemetics, and esomeprazole for the first time. Due to the predominantly elevated liver enzymes, the clinical pharmacist discussed the possibility of esomeprazole-induced adverse effects and suggested to suspend esomeprazole based on the evidence from literature review. The liver enzymes showed a substantial improvement within days after the discontinuation of the drug; however, a rechallenge was not done since it could have adversely affected the mother or the fetus. Using the Naranjo Adverse Drug Reaction Probability scales, the adverse reaction due to esomeprazole was classified as 'probably'