Introduction: Women's cardiovascular risk is not adequately addressed, particularly during the menopausal transition when the risk of cardiovascular events rises. Women die from cardiovascular disease (CVD) more frequently than any other cause. The study's objective was to evaluate pre-menopausal women's heart disease risk in connection to oral contraceptive tablets. Method: A comparative observational study was conducted at the department of cardiology, Prime Medical College Hospital, Rangpur, Bangladesh during the period of January 2020 to December 2020. A total of 140 participants were included for the study. Among them 70 women with HD (Heart Disease) were Group I and 70 women without HD (Heart Disease) were Group II. Respectively women were assessed exclusively using a case sheet that include age, full medical history, past medical history (mainly hypertension), family history, smoking history & the use of oral contraceptive pill (OCP) and duration of use. Statistical analyses were done by using SPSS 19.0 for windows Inc. Results: Mean age was 45.97 ±0.46 women with HD and 44.83 ±0.57 was women without HD. Women with HD age range 50-55 were 82.9 % (58) and 81.4% (57) were women without HD. Overweight & Obese were 66(94.3%) women with HD and 50(71.4%) were women without HD. Dyslipidemia were 69(98.6%) women with HD and 16(22.9%) were women without HD. Hypertension 65(92.8%)were women with HD and 16(22.9%) were women without HD. Use of OCP was higher among women with HD 61(87.1%) as compared with those without HD 29(41.4%). Duration of OCP was significantly longer in women with HD than women without HD. The effect of OCP use in women with Hypertension 40(61.33%) were women with HD and 6 (37.50%)were women without HD. The effect of OCP use in women with Smoking 10 (68.42%)were women with HD and 1 (25%)were women without HD. The effect of OCP use in women with Family history 34 (57.14%)were women with HD and 6 (33.33%)were women without HD. This study has confirmed the aforesaid findings in which the use of OCP increase the risk of HD in premenopausal women specifically in those who already have risk factors of HD. The effect of OCP use in women with Hypertension 51(61.5%) were women with HD and 6 (35.8%) were women without HD. Conclusion: The risk of heart disease was increased among women who used oral contraceptives. Cardiovascular events can be abridged by the management of risk factors. Mainly significant is the control of hypertension, lipids, and other factors contributing to the metabolic syndrome.

Celiac disease (CD) is an autoimmune enteropathy induced by gluten, characterized by a specific genetic genotype (HLA- DQ2 and HLA DQ8). The clinical manifestations are polymorphic with many atypical forms, this leads to difficulty in diagnosis. We report here the case of a patient with known carriers of portal hypertension on hepatic cirrhosis since her young age without any specified cause, admitted at the Gastroenterology Department for hemorrhagic decompensation of her portal hypertension. The immunological assessment and the histology of duodenal biopsies revealed a silent celiac disease.

The high cost of conventional feed ingredients for livestock and competition between man and his animals, necessitate the need for alternative and under-utilized plant materials in poultry nutrition. However, in doing so, it is important to ensure that such plant materials are not deleterious to the animals. This research therefore examines the effect of bush buck (Gongronema latifolia) leaf extracts as dietary supplements on haematological and serum biochemical parameters of broiler chickens. Fresh leaves (6kg) of bush buck (Gongronema latifolia) were after rinsing with de-ionized water air-dried for ten (10) days under room temperature and were ground in a hammer mill to pass through 0.5mm sieve. It was thereafter dissolved in de-ionized warm water (40oC) at 1kg per 5 litres of water and was left to settle for 1 hour before decanting the supernatant. One hundred and ninety-two (192) broiler chicks, after brooding for two weeks were divided into six (6) dietary treatment groups of thirty two (32) birds each. Birds on dietary treatment 1, had no vitamin/mineral supplement in water, while dietary treatment 2 birds had supplemental commercial vitamin/mineral premix (vitalyte extra). Dietary treatments 3, 4, 5 and 6 had Gongronema latifolia leaf warm water extract in the following ratios; 25, 50, 75, and 100ml/litre of water respectively. The vitalyte extra was administered (5g/l) once a week while the birds had access to feed and water/GLLE ad libitum. On the last day of the experiment, blood samples were collected from the birds for haematological analysis. All the assayed parameters such as packed cell volume (PCV), white blood cell (WBC), red blood cell (RBC), heterophil (H), lymphocyte (L), monocyte (M), eosinophil (E), basophil (B), haemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC) and mean corpuscular haemoglobin (MCH) were significantly (P<0.05) influenced by the dietary treatments. The analyzed serum biochemical indices such as total protein, albumin, globulin, creatinine, uric acid, aspartate aminotransferase, alanine aminotransferase, sodium and potassium were generally better in the 25ml/l GLLE. Glucose was significantly reduced in the vitalyte treatment while total cholesterol, high and low density lipoprotein were least in the 50ml/l GLLE treatment. In conclusion, the results above revealed that the Gongronema latifolia leaf warm (40oC) water extract of 50ml/l was safer and supported better health and wellbeing of the broiler chickens. This shows that Gongronema latifolia leaf warm (40oC) water extract could be used to wholly replace the conventional vitamins and minerals (vitalyte extra) in broiler diets without any adverse effect on growth and health performance of the birds.

This article, which shows the relationship between the metaphysical principles of natural science and phenomenology, shows precisely how Immanuel Kant, through these principles, contributed to the establishment of the phenomenology of perception. Thus, this article which first shows how Immanuel Kant was able to interpret and understand nature from its metaphysical principles, shows precisely and finally how the phenomenology of perception only became possible through the understanding of its principles. This is why the article then shows how these metaphysical principles of natural science are set up as the condition of possibility of the phenomenology of perception in Husserl and Merleau-Ponty.

This article reviewed the contributions of Tertiary Education in Sub-Sahara Africa. It extols the impact of the global application of education in social, economic and political development in sub-Sahara Africa. The paper highlighted the Aims of tertiary education in sub-Sahara Africa such as Production of the much-needed high-level manpower essential for the nation’s growth and development, provision of centers of excellence in teaching, research and storehouses of knowledge for nurturing the manpower needs of the nation, promotion and encouragement of scholarship and community services, teaching and research and development. The Conceptual Links of the contributions of tertiary Education in sub-Sahara Africa were succinctly analyzed in the paper. Similarly, the Crux of Tertiary Education in sub-Sahara Africa was meticulously explained in the review. Some African Countries with concrete commitments to Tertiary education such as Burkina Faso, Burundi, Cameroon, Chad, Djibouti, Guinea, Madagascar, Malawi, Mali, Mauritania, Niger, Senegal and Uganda were showcased in the study. It further unveiled the Challenges of tertiary Education in sub-Sahara Africa such as inadequate funding, inadequate teaching staff, poor policy implementation, lack of resources, lack of information communication technology facilities, frequent labour disputes and closures of tertiary institutions, brain drain and poor leadership. The paper was recapped by putting forward the prospects to effective tertiary education in sub- Sahara Africa.

Non-steroidal anti-inflammatory drugs (NSAIDs) like Ketorolac Tromethamine are frequently prescribed to alleviate pain associated with osteoarthritis, ankylosing spondylitis, acute sciatica, rheumatoid arthritis, and low back pain. Hydrogels are polymeric three-dimensional networks that are able to consume significant volumes of water and remain insoluble in water due to their physical and chemical crosslinking. They respond to temperature, pH and ionic strength. They can be prepared by using natural polymers such as dextran, pectin, alginate, or synthetic polymers such as polyvinyl alcohol, polyethylene oxide, and poly–hydroxy ethyl methacrylate. Hydrogels are used to deliver several drugs. Today, hydrogels have found a wide range of applications due to their non-toxic nature and low cost. The purpose of the current research was to formulate and assess a topical gel based on hydrogel that contained Ketorolac Tromethamine to treat inflammation and pain while reducing the gastrointestinal side effects associated with oral treatment. According to the FTIR analysis, Ketorolac Tromethamine doesn't interact with other excipients in a significant way. The physical characteristics, pH level, extrudability, spreadability, swelling property, in-vitro drug release study of hydrogel formulations were assessed. Using a dialysis membrane and a phosphate buffer solution with a pH of 7.4, in vitro and ex vivo release studies were conducted on the Franz diffusion cell. Among all formulations, HF4 showed high spreadability of 25.2 ±0.3 gm./cm/sec, extrudability, swelling index, in vitro drug release, and ex vivo drug diffusion. HF4 hydrogel showed no signs of skin irritation. The final formulation HF4 hydrogel shows an equal analgesic and anti-inflammatory effect as standard Ketorolac gel. It was found from the drug release kinetics that the Topical Ketorolac hydrogel HF4 drug release mechanism follows the Higuchi model and zero order.

Social Entrepreneurship has significantly progressed and is well appreciated globally. It is the way of pursuing innovative solutions to societal problems. Social entrepreneurs act as the change agents for society like traditional entrepreneurs change the profile of the business. They tirelessly pursue opportunities to create and sustain social value to serve the community. This paper builds on the literature to study the concept of social entrepreneurship, examines the various challenges faced by social entrepreneurs, discusses the scope of social entrepreneurship and puts forward the initiatives taken by disparate social entrepreneurs.

The main aim of this study was to develop hydrogel based controlled drug delivery system of Saquinavir mesylate as hard gelatin capsule which are able to deliver the drug at prolonged rate. The hydrogel was prepared by crosslinking HPMC 15 cps and Carbopol 971P and then granules are developed using MCC as diluent. Drug excipient compatibility was studied by FT-IR. The prepared hydrogels formulation are evaluated for Swelling index. Drug release from hydrogel was performed by using Franz diffusion cell. The prepared granules are evaluated for pre formulation studies (Bulk density, Tapped density, Angle of repose). The Saquinavir hydrogel capsule are evaluated for weight variation, Drug content uniformity (95%), Disintegration time (11 mins). In-vitro drug release studies are conducted for 12hrs by using USP type I apparatus which is showing drug release of 98%. From the drug release kinetics, it can be determined that the saquinavir hydrogel capsules drug release mechanism follows both the zero-order and Higuchi models. For all metrics, the formulation SHCF4 has demonstrated the best performance in accordance with pharmacopoeia standards.

The main aim of this research article is to Formulate and Evaluate the S-SNEDDS of Darunavir. Darunavir is an anti-retroviral protease inhibitor which is in use from long time, but it has poor bioavailability because of poor aqueous solubility and extensive first pass metabolism, when used in the form of conventional dosage form. As it is a BCS Class II drug, which shows low solubility and high permeability. The S-SNEDDS of Darunavir was prepared to improve its oral bioavailability and its release rate was evaluated by in vitro release. The solubility of Darunavir in various oils was to decide and identify the oil phase of formulations. Different oils, surfactants and co-surfactants were screened for their ability to emulsify the selected oil. The pseudo ternary phase diagram was used to know the self -emulsification region of formulation. The optimized S-SNEDDS formulation contain Darunavir (150mg), Caproyl®90(50mg), Labrasol® and Transcutol® mix (45 mg). The data of the FTIR confirms that there is no interaction observed and the drug and excipients was compatible with each other. The developed SNEDDS formulations were examined for nano emulsifying capabilities, and the resulting nano emulsions were investigated for self-emulsification efficiency, dispersibility and in-vitro dissolution. Centrifugation tests, particle size distribution, heating cooling cycle, zeta potential, and freeze thaw cycling were performed on the optimised formulations to establish the stability of the produced SNEDDS formulation. Further produced S-SNEDDS micromeritics studies were done. The formulation was shown to significantly improve drug release, with total drug release occurring within 60 minutes. Darunavir self-emulsifying formulation was thus effectively produced.

E-governance refers to the use of information and communications technology (ICT) in the realm of governance. It is an endower o transfer how the government works and improve the system of service delivery mechanisms through the use of technology. Even though it is something that entirely modifies the conventional method of governing, it is an exercise. The fundamental components of good governance are the rule of law, transparency, efficacy, efficiency, effectiveness, accountability, and public engagement. The government faces difficulty in addressing the problem of providing enough public services. This paper aims to accentuate the role of e-Governance for Good Governance and the Satisfaction level of people in rural areas toward e- services delivery by the Mean of Common Service Centres.

Dabigatran Etexilate (DE), a prodrug of dabigatran, is a strong oral, reversible, and direct thrombin inhibitor with low oral bioavailability because of active efflux via intestinal P-glycoprotein receptors. By creating a self-emulsifying drug delivery system, the current work largely focused on improving the solubility of dabigatran. Dabigatran is a BCS class II medication with high permeability and poor water solubility. UV-spectroscopy was used to determine Dabigatran's saturated solubility in different oils, surfactants, and co-surfactants. Based on their maximum solubility and compatibility with Dabigatran, the excipients were chosen. Different oils, surfactants, and co-surfactant combinations were used to create SEDDS formulations of dabigatran (4:1 and 3:1). Pseudo ternary phase diagrams were created, and the nano emulsification area was assessed using these. Formulations were created utilising different ratios of oil (Capmul MCM NF), surfactant (Labrasol ALF), and co-surfactant (Transcutol HP) based on the pseudo ternary phase diagram. The produced formulations were chosen, and the 4:1 formulation underwent optimization and was subjected to additional tests, including self-emulsification time, phase separation and stability tests, thermodynamic stability studies, droplet size and zeta potential, and in vitro drug release investigations. According to the report's results, Dabigatran SEDDS are a viable system to increase Dabigatran's solubility.

Background: The instance of a patient already in hospital wishing to leave against clinician’s advice is referred to as self-discharge or discharge against medical advice. DAMA is a relatively common problem in health care systems. Because lengths of stay (LOS) are commonly several days, these patients often remain acutely ill at the time of self-discharge, and they may remain exposed to the risk of inappropriately treated medical problem, resulting in the need for readmission. It is not surprising that DAMA poses a major problem for many clinicians who treat inpatients, particularly those with cardiac problems because incomplete therapy in conditions such as ischemic heart disease may exert a negative impact on health outcome. Additionally, consequent care will be probably associated with more challenges and higher overall costs over time. Avoiding DAMA is, thus, likely to be beneficial for both patients and health systems. Methods: Study Design -Non-experimental, cross-sectional research design which will identify the reasons influencing DAMA among inpatients with cardiac problems is CCH. The study will describe the reasons by using a quantitative method. Setting of the study - The research will be conducted in Cardiac Center Hail, Ha’il Region, Kingdom of Saudi Arabia, and will focus on inpatient departments. Sample - In order to get accurate result of study, all discharged patients will be asked to participate in this study optionally. Data collection procedures - After getting approval from ethical committee in CCH and Hail Health Cluster, the questionnaires will be kept in nursing station, and explanation of a purpose of study will be demonstrated to all participants. Then, a collection box of questionnaires will be provided in the nursing office. Thereafter, data will be stored within one week from distribution to be ready for analysis. Data analysis - The ‘Patient Satisfaction Survey - DAMA form’ was designed on the basis of the reasons cited by patients in the past for self-discharge and the potential reasons are provided in this form. Demographic information was comprised of such biological characteristics as age, gender, and nationality. Finally, the prospectively collected data were analysed. The data are presented as n = % for the quantitative variables and are summarized by absolute frequencies and percentages for the categorical variables. Results: For approximately 45-day period, there were 102 discharges, of which 19 (18.63%) were cases of DAMA. Analysis was conducted in 17 patients after the exclusion of 2 patients due to missing data. Modes of admission were the emergency department, hospital transfer, and routine or elective admissions. The most prevalent reason cited by the study was feeling well (88.24%), followed by the desire to be transferred to other hospital (5.88%) and financial problems (5.88%). The baseline characteristics of the DAMA cases, for male and female separately, are depicted in Table 1. The range age of study population is above 18 to over 60 years with a male to female ratio of 16:1. Nearly one third of the study patients were in the age group of 51-60 years. The most common age group was 51-60 years in the men and over 60 years in the women. Conclusion: The most frequent self-reported reasons for DAMA in inpatient cardiac patients included feeling well, desire to be transferred to another hospital and financial problems respectively. We believe that explaining the importance of proper medical treatment and benefits versus risks of medication compliance may lessen impulsive decision of DAMA. Providing strategies for decreasing the rate of DAMA by analysing the current circumstances and developing effective interventions may benefit both patients (improving their health) and health care systems (decreasing unnecessary readmissions). There will be a continuous monitoring of the patient satisfaction survey both in regular and monthly basis by the Nursing Service Department. Proper coordination with social health workers, medical and nursing staff will be done. Multidisciplinary collaboration through regular committee meetings shall be implemented.

“O Captain! My Captain!”, written by Walt Whitman, one of the most talented poets in American history, is an elegy on the death of Pres. Abraham Lincoln. It portrays Lincoln as the captain of a sea-worn ship, which implies the Union triumphant after the American Civil War. By drawing on multimodal discourse analysis and its theoretical framework of Halliday’s systemic functional grammar, this paper seeks to explore its meaning from both literary and non-literary aspects. The ideational function of the poem presents readers largely material processes, which post a whole dynamic scene. Whitman calls the captain “captain”, “my captain” and “father”. The change indicates that the author’s mourning seems to transcend the sorrow of a citizen for the assassination of a leader to become more like that of a son for his father. Cohesive markers of conjunction glue everything together and make the poem ship-like. To connect literature with linguistics and multimodal discourse analysis provides a new way to interpret Whitman’s poem and helps to understand the poem better.

Background: During triage in the emergency room, observations of vital signs and identification of organ failure are increasingly frequently employed to diagnose systemic inflammatory response syndrome (SIRS) and sepsis. However, there is less emphasis on early detection technologies of systemic inflammatory response syndrome (SIRS) in the critical care unit. Method: This is A prospective research design study, A convenience sample technique utilized consists of (45) nurses working in the intensive care unit at King Khalid general hospital, KSA. Participants completed the electronic questionnaire sheet to assist knowledge of nursing staff about Systemic Inflammatory Response Syndrome by pre, immediate, and post educational program consisting of twenty questions. Results: The findings show a highly statistically significant increase in the mean score in a knowledge level of knowledge before and immediately after the educational program, then it slightly decreases one month after the educational program. There was no statistically significant relationship between the total knowledge of studied nurses and their Sociodemographic Characteristics. Conclusion: Criteria for systemic inflammatory response syndrome (SIRS) are very important to know and, unfortunately, they are not well used in ICU. It is recommended that educational programs be provided for intensive care nurses to help them with the detection of sepsis in the early stages.

Nurses in the kingdom of Saudi Arabia work in a significantly challenging work environment. This research explored difficulties experienced by psychiatric nursing in mental health hospitals and clinics and their relationship to performance improvement. The study followed the correlation, the descriptive design, the study sample was randomly selected (201) participants from the psychiatric hospitals in Saudi Arabia – Hafar Al –Batan. The researcher used two questionnaires to answer the study questions and achieve their objectives. The first one is the Nurses Work Functioning Questionnaire (NWFQ) it consists of fifty items self-reported survey it contains seven subscale to measure the obstacle arises in work due to common mental illness. The other questionnaire is to measure difficulties and problems it consists of nine items and the scoring system is a five-scale point. Data were analyzed using SPSS 26 version. Results showed that 56% were males while 44% were females. The large percentage according to age was 47.8% to the range age group from 20-29. Then the age group from 30–39 with total number 42 and percentage 20.2%. regarding study sample years of experience, the high percentage was from 5 years- 7 years with 57%. Also , showed that nurses faced a lot of difficulties such as depression, stress and anxiety during their work shift. These symptoms can adversely affect work performance and care quality. But in the current research in general, the results indicate that there is no statistically significant relationship between the overall degree of the mental health scale and the professional performance scale.