Mechanical Prosthetic Valves and Pregnancy : A therapeutic dilemma of anticoagulation

Choosing the best anticoagulant therapy for a pregnant patient with a mechanical prosthetic valve is controversial and the published international guidelines contain no clear-cut consensus on the best approach. This is due to the fact that there is presently no anticoagulant which can reliably decrease thromboembolic events while avoiding damage to the fetus. Current treatments include either continuing oral warfarin or substituting warfarin for subcutaneous unfractionated heparin or low-molecular-weight heparin (LMWH) in the first trimester (6–12 weeks) or at any point throughout the pregnancy. However, LMWH, while widely-prescribed, requires close monitoring of the blood anti-factor Xa levels. Unfortunately, facilities for such monitoring are not universally available, such as within hospitals in developing countries. This review evaluates the leading international guidelines concerning anticoagulant therapy in pregnant patients with mechanical prosthetic valves as well as proposing a simplified guideline which may be more relevant to hospitals in this region

Pyridazine and its related compounds: Part 33. Synthesis of some disperse dyes derived from 3-hydrazinyl-4,5-diphenyl-1H-pyrazolo[3,4-c]pyridazine and their color assessment on polyester fabric

Active methylene compound such as ethyl acetoacetate was coupled with diazotized arylamines to give ethyl arylazoacetoacetates. When the obtained compounds refluxed with 3-hydrazinyl-4,5-diphenyl-1H-pyrazolo[3,4-c]pyridazine in the presence of ethanol yielded 1-(4, 5-Diphenyl-1H-pyrazolo[3, 4-c]pyridazin-3-yl)-3-methyl-4-(2-phenylhydrazono)-1H-pyrazol-5(4H)-one derivatives. The dyes were applied to polyester fabric, and their absorption spectral characteristics, fastness properties and color assessment measured

مدى توافر أبعاد التوجه الإستراتيجي في القطاع المصرفي

هدفت هذه الدِّراسة إلى تحديد مدى توافر أبعاد التوجه الإستراتيجي: التوجه الريادي، التوجه نحو العملاء، التوجه نحو التكنولوجيا في فروع المصارف التجارية الخاصة في الساحل السوري, اعتمد الباحث في هذه الدراسة على المنهج الوصفي، الذي يقوم على وصف الظاهرة وصفا دقيقا وتحليلها للإجابة على أهداف الدراسة ومناقشة فرضياتها. أما بالنسبة لطرائق البحث تم تطوير استبانة من خلال اطلاع الباحث على الأدبيات المنشورة كأداة لجمع البيانات الأولية, وتمّ توزيع الدرجات على بنود الاستبانة وفقاً لمقياس ليكرت الخماسي, وقاد تمثلت عينة البحث بـــ110 مفردة من كادر العاملين في المصارف، ومن ثمَّ أجرى دراسة ميدانيَّة بغرض بيان هذه العلاقة. وقد خلصت الدِّراسة إلى إن إدارة المصارف لا تتقبل ولا تنفذ الأفكار التي لم يتم التفكير فيها مسبقاً، وليس لدى المصارف  استعداداً لتحمل المخاطرة من جراء تقديم خدمات جديدة ، وإن المصارف لا تقوم باستطلاع آراء العملاء لمعرفة رضاهم عن الخدمات المقدمة، وبلغ متوسّط إجابات أفراد العيّنة لمتغيّر التوجه نحو المنافسين2.984 ، وهو يدلّ على عدم توافر بعد التوجه نحو المنافسين كأحد أبعاد التوجه الإستراتيجي في القطاع المصرف

Crystal structures of 4-phenylpiperazin-1-ium 6-chloro-5-ethyl-2,4-dioxopyrimidin-1-ide and 4-phenylpiperazin-1-ium 6-chloro-5-isopropyl-2,4-dioxopyrimidin-1-ide

The title molecular salts, C10H15N2+·C6H6ClN2O2−, (I), and C10H15N2+·C7H8ClN2O2−, (II), consist of 4-phenylpiperazin-1-ium cations with a 6-chloro-5-ethyl-2,4-dioxopyrimidin-1-ide anion in (I) and a 6-chloro-5-isopropyl-2,4-dioxopyrimidin-1-ide anion in (II). Salt (I) crystallizes with two independent cations and anions in the asymmetric unit. In the crystal structures of both salts, the ions are linked via N—H...O and N—H...N hydrogen bonds, forming sheets which are parallel to (100) in (I) and to (001) in (II). In (I), the sheets are linked via C—H...Cl hydrogen bonds, forming a three-dimensional framework

Comparing monolithic and fused core HPLC columns for fast chromatographic analysis of fat soluble vitamins

HPLC stationary phases of monolithic and fused core type can be used to achieve fast chromatographic separation as an alternative to UPLC. In this study, monolithic and fused core stationary phases are compared for fast separation of four fat-soluble vitamins. Three new methods on the first and second generation monolithic silica RP-18e columns and a fused core pentafluoro-phenyl propyl column were developed. Application of three fused core columns offered comparable separations of retinyl palmitate, DL-α-tocopheryl acetate, cholecalciferol and menadione in terms of elution speed and separation efficiency. Separation was achieved in approx. 5 min with good resolution (Rs >5) and precision (RSD ≤ 0.6 %). Monolithic columns showed, however, a higher number of theoretical plates, better precision and lower column backpressure than the fused core column. The three developed methods were successfully applied to separate and quantitate fat-soluble vitamins in commercial products

(E)-1-(1,3-Benzodioxol-5-yl)-4,4-di­methyl­pent-1-en-3-one

In the mol­ecule of the title compound, C14H16O3, all non-H atoms except for one methyl C atom lie on a crystallographic mirror plane. The conformation with respect to the C=C bond [1.3465 (12) Å] is trans. In the crystal, mol­ecules are linked via C—H⋯O hydrogen bonds into C(5) chains propagating along [100]

What shape do UK trainees want their training to be? Results of a cross-sectional study

OBJECTIVES: The British Government is acting on recommendations to overhaul postgraduate training to meet the needs of the changing population, to produce generalist doctors undergoing shorter broad-based training (Greenaway Review). Only 45 doctors in training were involved in the consultation process. This study aims to obtain a focused perspective on the proposed reforms by doctors in training from across specialities. DESIGN: Prospective, questionnaire-based cross-sectional study. SETTING/PARTICIPANTS: Following validation, a 31-item electronic questionnaire was distributed via trainee organisations and Postgraduate Local Education and Training Board (LETB) mailing lists. Throughout the 10-week study period, the survey was publicised on several social media platforms. RESULTS: Of the 3603 demographically representative respondents, 69% knew about proposed changes. Of the respondents, 73% expressed a desire to specialise, with 54% keen to provide general emergency cover. A small proportion (12%) stated that current training pathway length is too long, although 86% felt that it is impossible to achieve independent practitioner-level proficiency in a shorter period of time than is currently required. Opinions regarding credentialing were mixed, but tended towards disagreement. The vast majority (97%) felt credentialing should not be funded by doctors in training. Respondents preferred longer placement lengths with increasing career progression. Doctors in training value early generalised training (65%), with suggestions for further improvement. CONCLUSIONS: This is the first large-scale cross-specialty study regarding the Shape of Training Review. Although there are recommendations which trainees support, it is clear that one size does not fit all. Most trainees are keen to provide a specialist service on an emergency generalist background. Credentialing is a contentious issue; however, we believe removing aspects from curricula into post-Certificate of Completion of Training (CCT) credentialing programmes with shortened specialty training routes only degrades the current consultant expertise, and does not serve the population. Educational needs, not political winds, should drive changes in postgraduate medical education and all stakeholders should be involved

Clinical Pathways for Non-ST Elevation Acute Coronary Syndrome in Oman: An Oman Heart Association Protocol for Hospital Quality Improvement Initiative

In 2012, Oman Heart Association (OHA) published its own guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction, the aim was not to be comprehensive but rather simplified and practical in order to reduce the gap between the long comprehensive guidelines and our actual practice. However, we still feel that the busy registrars and residents need simpler and direct clinical pathways or protocol to be used in the emergency departments, coronary care units and in the wards. Clinical pathways are now one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes in acute care