The term "evidence-based medicine" was coined in the 1980s to describe a method of determining the optimal treatment based on scientific evidence. In the early 1990s, the evidence-based practise movement began in England. Evidence-based medicine (EBM) or evidence-based practise (EBP) is the careful application of the best available evidence in making decisions regarding a patient's care. Evidence-based practise is both a philosophy and a methodology. The concept is based on the ethical principle that clients are entitled to the most effective interventions available. The approach of EBP is the way we go about finding and then implementing those interventions.

Wolff-Parkinson-White (WPW) syndrome is a relatively rare cardiac rhythm disorder entity encountered during pregnancy. However, its exacerbation under this physiological condition could be responsible, in certain cases, for life-threatening arrhythmias compromising both maternal and foetal prognosis. We report the observations of 03 pregnant women, without past medical history, presenting to the emergency room for palpitations related to a Wolff-Parkinson-White syndrome, complicated in one case with foetal death. The substantial severity of the WPW syndrome during pregnancy requires a prompt and adequate management strategy, based on a multidisciplinary cooperation between obstetricians, cardiologists and neonatologists.

anticoagulation therapy would be the removal of this arrhythmia and any future recurrence, a goal often difficult to achieve.The aim of this work is to evaluate the efficacy of atrial fibrillation cardioversion as well as the success predictive factors of sinus rhythm maintenance at one year following a successful cardioversion. Materials and methods: 50 patients with non-valvular atrial fibrillation underwent cardioversion: 70% by electrical shock and 30% by pharmacological means, the clinical characteristics of the patients the results of cardioversion and follow-up were collected and analyzed. Results: The average age of our patients was 53 years with a sex ratio of 2. 30% of patients had hypertensive heart disease, 8% ischemic heart disease, 8% dilated cardiomyopathy and the rest had no underlying heart disease. The average diameter of the left atrium was 41 mm and the average surface area was 20 cm². Primary success rate of cardioversion was 82% with better efficacy of electric shock compared to pharmacological cardioversion. The maintenance rate of sinus rhythm at 1 year was 70%. Predictive factors of failure and / or recurrence at 1 year were old atrial fibrillation and significant dilation of the left atrium. Conclusion: This study confirms the interest of atrial fibrillation cardioversion and underlines the importance of preliminary selection of the patients, such a selection must be made on the basis of the predictive factors of success usually recognized in the literature.

The present paper is concerned with the seismic risk assessment of buildings in the Kingdom of Saudi Arabia. A critical review of the existing literature is presented to identify the shortcomings of extant studies. None of the extant studies considered nonlinear action of the beam-column joint (BCJ) but rather they dealt with BCJ as a rigid element for simplicity and the only plastic hinging has been considered in beams and/or columns. Hence the main focus of this paper is to demonstrate the significant effects of the nonlinear action of BCJ in the pushover analysis and in turn the inadequacy of all previous studies which overlooked such effect. In this study, nonlinear static pushover analysis is performed on two-dimensional RC frames of existing buildings in Jeddah city, with and without using macro node elements and pushover curves are compared. The beam-column joint modelling approach adopted in this study is through macro node element which accounts for failure due to shear collapse of the joint, concrete crushing, flexural and/or shear plastic damage of the beams or columns connected and bond-slip failure. The results clearly indicate that the RC frame in which the beam-column joints were modeled using a macro node element, tends to have lesser base shear values and higher displacement capacity when compared to the RC frame modeled without using the macro node. Furthermore, the status of plastic hinges developed in building frames modeled without using macro node element was found to be within the Immediate occupancy (IO) performance level, but this hinge status drastically changed to Collapse prevention (CP) performance level when BCJ was modeled using macro node. Hence, the results highlight that the nonlinear action of beam-column joint has a significant effect on the nonlinear response of a structure.

The Dabska tumor also known as Endovascular papillary angioendothelioma is a rare, low-grade angiosarcoma that often affects the skin and subcutaneous tissues of children is characterized by intraluminal papillary endothelial structures. EPA has an overall favorable prognosis. The malignant potential of this tumor should not be ignored and close follow-up should be maintained.

To better the quality and efficiency of education, and to enable education and training to become a top-level national policy, the foundation and driving force for national industrialization and modernization, our Party has advocated a comprehensive reform of education and training, especially a full awareness of Ho Chi Minh's educational philosophy in the on-going educational revival. This paper presents some of Ho Chi Minh’s important philosophies of education, and the current application of those philosophies to renovate the management of general education for ethnic minority areas by some mountainous provinces in Northern Vietnam.

The motive of this research is to understanding the effect of company Social duty on company value, and knowing whether or not Human Capital can slight the effect of company Social responsibility on firm price. This take a look at makes ue of secondary records obtained from the Indonesia stock trade (IDX) in the form of economic reviews on consumer goods groups in the 2015-2019 length. The information might be analyzed the usage of moderated regression evaluation (Moderated Regression analysis). The effects of this examine found that CSR has no impact on firm price and human capital cannot mild the connection among CSR and firm value.

Introduction: Gastrointestinal infections are one of the leading causes of morbidity and mortality throughout the world, particularly in the immunocompromised. Gastrointestinal PCR appears to be the technique of choice for establishing the molecular diagnosis of pathogenic gastrointestinal agents. The aim of this study was to establish the epidemiological, clinical and evolutionary profile of gastrointestinal infections and to study the impact of molecular diagnosis on the choice of a targeted therapy. Methods: This is a retrospective study carried out in the Microbiology Department of Arrazi Hospital of the Mohamed VI University Hospital Center, including all immunocompromised patients treated for a gastrointestinal infection and needing a hospitalization in the various departments, over a period of 15 months. Results: During the period studied, 124 patients were collected. The average age of the patients was 22 years. Signs of gastrointestinal infection were present in all patients. Of the patients sampled, 95.2% received probabilistic antibiotic therapy. Gastrointestinal infection has been documented in 57.26% of patients. A bacterial etiology was found in 76.81% of patients. A viral etiology was found in 13.04% of the patients and a parasitic etiology was found in 10.15% of the patients. Enteropathogenic E. coli was the most common infectious agent detected (19.53%). Co-infections were found in 29.84% of patients. Following PCR results, management was changed in 70 patients (56.45%), including initiation or modification of antibiotics in 40 patients (32.26%) and discontinuation of antibiotic therapy in 30 patients (24.19%). Conclusion: The diagnosis of gastrointestinal infections by multiplex PCR allowed us to provide optimal patient care with a reduction in the unnecessary use of antibiotics and an improvement in the course of care.

Herpes Zoster Ophthalmicus (HZO), also known as Ophthalmic Zoster, caused by the reactivation of the Varicella Zoster Virus (VZV), VZV reactivation commonly affects the ophthalmic division of the trigeminal nerve and subsequently the eye. HZO is considered an ophthalmologic emergency. The most common complication of HZO is postherpetic neuralgia (PHN). HZO is a diagnosed based on history and cutaneous findings. Antivirals medications such as acyclovir, valacyclovir and famciclovir remain the mainstay of therapy for HZO. HZO represents approximately 10 to 25% of all cases of herpes zoster. Here, we report an interesting case of HZO and it's complication PHN in a 61 years old male patient.

Background: Piperacillin/Tazobactam(Pip/Taz) is a broad-spectrum antibacterial covering aerobic, and anaerobic microorganisms. Pip/Taz plays a major role in treating sepsis, respiratory infection, and intraabdominal infection. Many studies showed inappropriate use of Pip/Taz might increase the risk of resistance. This study aimed to evaluate the appropriateness use of Pip/Taz prescribing in pediatric patients in Peidatric Intensive Care Unit (PICU) at a major tertiary hospital. Method: A retrospective and observational study was conducted to evaluate the appropriateness use of Pip/Taz in PICU. The study included all neonates and pediatrics less than 14 years old in the PICU setting who had received at least dose of Pip/Taz during their admission for the period between Jan 2020 and Jan 2021. Assessment of antimicrobial appropriateness was evaluated according to Infectious Diseases Society of America (IDSA) guidelines. Data were retrieved from the hospital’s Electronic Medical Records (EMRs) and exported to Excel spreadsheet. Results: Of 124 Pip/Taz prescriptions, 34% were inappropriate. The common indications for using Pip/Taz empirically were with sepsis and suspecting of pneumonia. The reasons for inappropriate use of Pip/Taz were due to continue using the drug based on clinical condition even the results of cultures had no growth of organisms 71%, then starting the drug without taking culture 14%, then the drug continued without justification despite culture resulted with no growth 10%, and finally continued without following sensitivity 5%. Conclusion: This study showed that there was inappropriate use of Pip/Taz at PICU. The inappropriate use was attributed to not following the lab results, culture sensitivity and not requesting microbiology culture.

Solanaceae is family of plants widely used in food, sauce and herbal medicine because its members are rich in carbohydrates, proteins, fats, vitamins, mineral salts and other trace and essential nutrients like phenols and flavonoids that retard degenerative diseases and stress. Knowledge on purposeful use of solanaceae in food and medicine in Uganda is low. Aqueous extracts of dry leaves of three selected solanum genera growing in Kabale were compared for their polyphenol and flavonoid contents and antioxidant properties. Total polyphenol (TPC) and total flavonoid (TFC) contents were determined by the Folin-Ciocalteu and aluminium chloride colorimetric methods respectively. Antioxidant properties and radical scavenging were determined using DPPH, hydrogen peroxide, thiocyanate-iron (III) complex and iron (II)/(III)-linoleic acid systems. The polyphenol content of dry leaves of S. anguivi was 1750 ± 0.70, that for S. macrocarpon was 104 ± 0.45 and S. nigrum was 97.80 ± 0.15 GAE/g yet the flavonoid content was 7.40 ± 0.30, 35.00 ± 0.60 and 16.40 ± 0.40 mg/QE/g for S. anguivi, S. macrocarpon and S. nigrum respectively. The DPPH scavenging at IC50 were 7.80 ± 0.25; 45.60 ± 0.30 and 42.90 ± 0.20 respectively yet hydrogen peroxide scavenging at IC50 stood at 6.89 ± 0.15; 27.00 ± 0.35 and 17 .90 ± 0.20 μg/mL in the respective order for S. anguivi, S. macrocarpon and S. nigrum. The available data suggests the plants are very good food supplements of high nutritive and chemotherapeutic values. However, there is need to perform in vivo and vitro experiments to deduce their efficacy on mammals.

Days of Abandonment, Ferrante’s most frequently read novel in English world before My Brilliant Friend, witnesses the establishment of Ferrante’s unique voice. It relates the psychological and physical turmoil of its female protagonist Olga who has been abandoned by her husband. By drawing on Freud’s theory of mourning and loss, as well as Judith Butler’s theorization of ungrievable loss, this paper seeks to lay bare the process of the reconstruction of female subjectivity in Days of Abandonment. It is argued that, by conducting a proper mourning process for the loss of her boundedness with the patriarchal order as represented by her husband Mario, Olga has managed to step out of the patriarchal order and reestablish her connection not only with other human subjects, but also with nonhuman actors as well. And in this posthuman intra-action with materiality of the world, she has rebuilt her identity that initiates her into a more rewarding life.

Background: The auricle is a complex part of the sensory organ, and is made of cartilage that is covered with skin. Its function is to capture sound. This study was aimed at knowing the auricular dimensions in Okrika tribe in Rivers state. Methods: Auricular parameters from 401 Okrika indigens from 18 years and above were measured using standard Vernier calliper. The Parameters were ear height (EH), ear width (EW), lobular height (LH) and the lobular width (LW) for both right and left ears with the head of the subject in Frankfort horizontal plane. Results: Data was analyzed using SPSS version 23.0. All the measured parameters were higher in males compared to females in both left and right ears, implying sexual dimorphism. The mean values of all measured parameters in males were higher on the right compared to the left. Except ear index (T = 0.83; P = 0.41), side differences were observed in all other parameters at P < 0.05. Hence auricular parameters are said to be asymmetrical. In females, the mean values of all measured parameters were higher on the right compared to the left. Except ear index (T = 0.95; P = 0.34) and lobular index (T = 1.30; P = 0.19), side differences were observed in all other parameters at P < 0.05. Conclusion: In this study, we observed that all measured parameters were higher in the right ear than in the left and also larger in males than females. This sex related differences were said to be sexually dimorphic. Therefore this study has provided anthropometric data for the okrika tribe, which will be useful in forensic science and ear reconstructive surgeries.

Herbal teas contain bioactive compounds which have been reported to have beneficial effects in the prevention of various metabolic diseases. Hence, the current study was conducted to assess the qualitative and quantitative phytochemical composition, functional properties and sensorial attributes of different formulations of mango leaf teas supplemented with Moringa oleifera and ginger powder as supporting and activating herbs using standard analytical methods of Association of Official Analytical Chemist. Data was analyzed using one way analysis of variance and results expressed as mean ±standard deviation of triplicate determinations. The qualitative phytochemical analysis indicated the presence of tannins, flavonoids, terpenoids and cardiac glycoside. While quantitative analysis revealed that flavonoids ranged from (0.17-0.52 mg/g), tannins (0.07-0.11 mg/g), cardiac glycoside (1.08-1.89 mg/g) and terpenoids (50%-70%). The results obtained for functional properties revealed that pH ranged from (5.94-6.62), reconstitution index (4-6.6 g/cm3), swelling index (0.33-1.33cm3/g), wettability (3.08-3.14 mins), bulk density (0.25-0.29 g/cm3) and water absorption capacity (27.3-31.9). Mean scores of sensory evaluations for taste ranged from: (7.2-8.9), color (7.6-8.5), flavor (7.3-8.3), consistency (7.3-8.4) and overall acceptability (7.9-8.7). Based on the results of this study, it can be concluded that mango leaf teas supplemented with Moringa oleifera and ginger powder are good sources of bioactive compounds with potential nutritional and health benefits.

Carbon monoxide poisoning is a leading cause of mortality among accidental intoxications, it is responsible for severe tissular hypoxia leading to life-threatening complications. Pregnant women are more at risk to develop severe forms of intoxication due to their physiological changes and their higher oxygen requirements as well as for possible adverse fetal outcomes. We present two cases of monoxide intoxication in two pregnant women with acute heart failure and variant complications with different fetal outcomes.