Role of Beta Blockers and Band Ligation in upper gastrointestinal tract bleeding.

Objective: To sort out the combine role of beta blockers and band ligation in upper gastrointestinal bleeding Methodology: In this prospective observational study 563 patients were included, (mean age 47 ±6 years, males 69%) with liver cirrhosis and deterioration from Medical ward Mayo hospital Lahore. All the patients had cirrhosis and esophageal varices confirmed by endoscopy. In hospital cirrhotic patients with hypertension and liver cell deteriorations. All the record of betablocker use and band ligation was carefully recorded. Data regarding patient presentation and characteristics were keenly monitored and observe with treatment and improvement as major variables. Mortality was taken as major influential factor. Linear regression model was used. Results: Overall, there were 426 patients getting pharmacological treatment and have band ligation treatment simultaneously. One Hundred and thirty-seven had gastrointestinal bleeding during study time. Standard deviation of patients who had no recurrence of bleeding from last two years was 67±4. Low level of serum albumin, presence of ascites, and treatment with betablockers were the only independent variables that directly influenced the bleeding. The percentage of patients who had only once bleeding during study period was 23±2 percent. The major effects by be ta blockers were preserving after band ligation of source of bleeding. Conclusion: This study demonstrates that best treatment of bleeding in upper gastrointestinal tract is beta blockers, with the use of b and ligation where it is needed. Strict monitoring and guidelines should be under consideration before stop the beta blockers upper gastrointestinal bleeding patients.  Keywords: Beta blockers, Band Ligation, Upper Gastrointestinal Trac

Evaluation of anxiety and depression in chronic liver disease patients.

Objective: To evaluate the risk factors of anxiety and depression in chronic liver disease patientsMethodology: In this longitudinal study seven hundred fifty-five patients (mean age 51+ 5 years, 59% males). All the patients were suffering from chronic hepatitis B, chronic Hepatitis C, Alcoholic liver disease and non-alcoholic fatty stomach disease. Questionnaires were included anxiety, using the Hamilton depressing rating scale (HDRS) and Hamilton anxiety scale (HARS), including socio-demographic, health status and family support. The criteria for inclusion in the study were having liver disease from last 15 months. Clinical functional and psychological assessments were performed.Results: In this study patients with depression was 59.3%, with anxiety 17.4% patients and both anxiety and depression were noted in 36.7% patients. After measuring and calculating all the variables score of depression and anxiety were recorded. A higher HDRS score was noted in patients older than 46 years (p=0.024). Patients with gastrointestinal bleeding had a prominent higher score of anxiety than those without bleeding (p=0.019). A higher HARS score was present in the women (p=0.011), unemployed patients (p=0.009) and those with alcoholic liver disease (p=0.006). There was direct correlation between the duration of disease and the value of HDRA and HARS score.Conclusion: In the chronic liver disease patients’ depression and anxiety are increasingly high with passage of time, gastrointestinal bleeding and unemployment. Increased prevalence of relax by patients are more likely to be due to the low acceptance of disease prognosis

Islamic Finance and Banking in Malaysia with Special Reference to Sukuk Industry

Malaysia is seen as a success story of rapid growth and structural change with equity The country has enjoyed a stable macroeconomic environment with low unemployment and inflation rates for decades However due to the recent 2008 global financial crisis the economy has experienced a slowdown in the growth rate The government has introduced the New Economic Model of 2010 NEM2010 to shift the country from a middle-income economy to a high-income economy by 2020 In support of these goals the government has taken steps to liberalize its financial sector since Malaysia is one of the key players in Islamic finance The present chapter looks into the Islamic finance landscape of Malaysia by focusing on the sukuk industry as well as prospects and challenges facing the industry By examining sukuk market behavior it is hoped that policymakers may utilize sukuk as key financial tools to drive the domestic financial sector and demonstrates its bearings on equitable growt

Clinical severity spectrum of re-infected cov-19 patients in Khyber Pakhtunkhuwa (KPK)

Background: Re-infection is infection likely to occurred second time. Recently due to increase in the pandemic of SARS COV-2 there were increased in cases of re-infection but the clinically severity spectrum of re-infection is unknown. This study is design to determine clinical severity of re-infected COV-19 patients. Material and methodology: This comparative cross-sectional study was conducted in pathology department of Rehman Medical Institute Peshawar Pakistan and Leady Reading Hospital Peshawar within duration of 6 months (February-July 2021). Inclusion criteria: Patients who were re-infected by SARS COV-2 and having duration between primary infection and re-infection are > 30 days were included. Exclusion criteria: Unwilling patient to give data and patients having duration between primary infection and re-infection is<30 days were excluded from the study. Sample size: Total 32 samples were collected by designing proper Questionnaire according to the criteria of (World Health Organization). The collected data will be analyzed through SPSS version 22. The frequencies, mean, standard deviation of data was performed by descriptive statistics in SPSS. Result: Out of 32 primary SARS COV-2 infected individuals, 20 have mild infection while in same 32 re-infected SARS COV-2 individuals 19 individuals have severe symptoms in its secondary infection with mean age (32years) of individuals. Conclusion: In current study by comparing primary symptoms of SARS COV-2 infected individuals with symptoms of Re-infected individuals, symptoms are mild and severe respectively. Hence, re-infection cause by SARS COV-2 is more severe than primary infectio

Effect of different cooling strategies on surface quality and power consumption in finishing end milling of stainless steel 316

In this paper, an experimental investigation into the machinability of AISI 316 alloy during finishing end milling operation under different cooling conditions and with varying process parameters is presented. Three environmental-friendly cooling strategies were utilized, namely, dry, minimal quantity lubrication (MQL) and MQL with nanoparticles (Al$_{2}$O$_{3}$),and the variable process parameters were cutting speed and feed rate. Power consumption and surface quality were utilized as the machining responses to characterize the process performance. Surface quality was examined by evaluating the final surface roughness and surface integrity of the machined surface. The results revealed a reduction in power consumption when MQL and MQL + Al$_{2}$O$_{3}$ strategies were applied compared to the dry case by averages of 4.7% and 8.6%, respectively. Besides, a considerable reduction in the surface roughness was noticed with average values of 40% and 44% for MQL and MQL + Al$_{2}$O$_{3}$ strategies, respectively, when compared to the dry condition. At the same time, the reduction in generated surface roughness obtained by using MQL + Al$_{2}$O$_{3}$condition was marginal (5.9%) compared with using MQL condition. Moreover, the results showed that the improvement obtained in the surface quality when using MQL and MQL + Al$_{2}$O$_{3}$ coolants increased at higher cutting speed and feed rate, and thus, higher productivity can be achieved without deteriorating final surface quality, compared to dry conditions. From scanning electron microscope (SEM) analysis, debris, furrows, plastic deformation irregular friction marks, and bores were found in the surface texture when machining under dry conditions. A slight smoother surface with a nano-polishing effect was found in the case of MQL + Al$_{2}$O$_{3}$ compared to the MQL and dry cooling strategies. This proves the effectiveness of lubricant with nanoparticles in reducing the friction and thermal damages on the machined surface as the friction marks were still observed when machining with MQL comparable with the case of MQL + Al$_{2}$O$_{3}$

PENDUGAAN UMUR SIMPAN COOKIES AMPAS KECAP FREE GLUTEN DENGAN MENGGUNAKAN METODE ASLT

Penelitian ini bertujuan untuk menduga umur simpan cookies coklat ampas kecap free gluten. Manfaat penelitian ini adalah untuk memanfaatkan limbah dari sumber daya pangan lokal serta mengurangi ketergantungan terhadap tepung terigu. Metode penelitian ini dilakukan dalam dua tahap, yaitu penelitian pendahuluan dan penelitian utama. Penelitian pendahuluan yang dilakukan yaitu analisis kadar NaCl pada ampas kecap yang direndam selama 24 jam dan penentuan formula cookies terpilih. Penelitian utama yaitu menentukan titik kritis menggunakan metode ASLT yang kemudian dilakukan perhitungan pendugaan umur simpan menggunakan metode Arrhenius serta analisis kadar air dan TPC selama masa penyimpanan. Hasil penelitian pendahuluan menunjukan kadar NaCl pada ampas kecap sebesar 1,14%, sampel F2 (1,5 : 0,5) merupakan sampel terpilih berdasarkan keunggulan dari segi warna, rasa, aroma, tekstur, dan after taste pada produk yang disukai panelis. Hasil penelitian utama menunjukan cookies coklat ampas kecap free gluten yang dibuat dari perbandingan tepung mocaf dan tepung ampas kecap memberikan korelasi positif (+) terhadap respon kadar air dan laju jumlah total mikroba. Kata kunci : Perbandingan tepung mocaf dan tepung ampas kecap, Cookies free gluten, Umur simpan

Two-phase frictional pressure drop with pure refrigerants in vertical mini/micro-channels

Environmental concerns have urged a search for eco-friendly refrigerants in the refrigeration industry to overcome ozone depletion and global warming problems. Therefore, current research emphasizes frictional pressure drop during flow boiling of environment-friendly refrigerants (GWP\u3c150), isobutane, HFC-152a, HFO-1234yf were tested against commonly reported HFC-134a. The data presented here was collected under heat flux-controlled conditions; the test piece was a round tube (1.60 mm diameter). The data collection was performed at 27 and 32 °C with mass velocities in 50-500 kg/m2s range. Effects of critical controlling parameters, like heat flux, mass velocity, exit vapor quality, operating pressure and medium, were studied in detail. It was observed that pressure drop increases along with mass velocity increment in the test piece and increases with exit vapor quality increment. The same was noticed to decrease with saturation temperature increment. Parametric effects and prediction of assessment methods are reported

PEMANFAATAN KOHE UNTUK BUDAYA LELE ORGANIK DI WONOSALAM KABUPATEN JOMBANG

Motivasi dan minat para pertani di Kecamatan Wonosalam  sangat tinggi untuk maju akan tetapi dalam berproduksi belum dapat mengoptimalkan potensi yang ada. Seperti melimpahnya terkait  kotoran sapi yang belum dimanfaatkan untuk dapat diolah menjadi pakan lele organik.  Sehingga agar peternak lebih produktif maka perlu dilakukan pemanfaatkan kotoran sapi untuk diolah  sehingga dapat dipakai sebagai pakan  lele yang  aman dan sehat  dikonsumsi. Ikan lele adalah salah satu komoditi yang sangat diminati masyarakat untuk memenuhi kebutuhan konsumsinya. Masalah terbesar dalam budi daya lele adalah biaya makan yang tinggi untuk itulah maka diperlukan adanya terobosan baru dalam penyediaan pakan lele yaitu dengan memanfaatkan kotoran sapi  untuk  pakan lele organik yang aman dan  dikonsumsi. Program ini berhasil apabila didukung dengan teknologi tepat guna yang memadai  untuk merubah kotoran sapi menjadi pakan lele. Terkait dengan program tersebut maka dalam mengatasi ketersediaan pakan lele dilakukan pelatihan kepada kelompok mitra. Banyak keuntungan yang diperoleh yaitu dari limbah air budidaya lele organik dapat dijadikan pupuk sehingga tanah menjadi subur untuk dijadikan area pertanian atau perkebunan termasuk untuk memupuk rumput sebagai pakan sapi

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020