Background : The hepatopulmonary syndrome (HPS) is defined as the triad of liver disease, arterial deoxygenation, and pulmonary vascular dilatation. The reported prevalence of HPS in cirrhotic patients varies between 5% -17.5%.Objective : To estimate the prevalence of hepatopulmonary syndrome among patients with chronic liver disease and portal hypertension and to study the correlation between HPS and the severity of liver disease.Patients and methods : Thirty patients were studied for the presence of HPS using transthoracic contrast echocardiography for detection of pulmonary vasodilatation. Arterial oxygen saturation (SaO2) was determined in erect and supine position using a pulse oximeter , (SaO2 ≤ 92 % in supine position and/or a decrease of ≥ 4% after change from supine to upright position) to detect hypoxia and ortheodeoxia.Result : Eleven of thirty patients (36.6%) with chronic liver disease and portal hypertension were found to have contrast echocardiographic evidence of intrapulmonary right-to-left shunting. Arterial oxygen desaturation was present in 3 patients (27.3%) of those with intra-pulmonary right-to-left shunting ,they were considered as clinically significant HPS ,the remaining 8 patients were considered as subclinical HPS. Dyspnoea was more often present in patients with clinically significant HPS (100%) compared with subclinical HPS (25%), and patients without HPS (9%). HPS correlated significantly with severity of liver disease according to the Child-Pugh score.Conclusion: hepatopulmonary syndrome is not uncommon , the prevalence of clinically significant hepatopulmonary syndrome (in this study) was 10% of patients with chronic liver disease and it correlated with disease severity according to the Child-Pugh score
There is a global shortage of health care providers needed to address all levels of primary and specialty care. The recent COVID-19 pandemic also highlights the importance and added value of health professionals with specialty training in infectious diseases. In the United States, advanced practice providers (APPs) are being engaged to meet the expanding demand for generalist and specialist patient care. The history and development of advanced practice registered nurses (APRNs) and physician assistants (PAs), are discussed as collaborative healthcare providers to promote better understanding of the ways they can be incorporated into a healthcare system. An example of how APPs are utilized to provide both inpatient and outpatient
... Show MoreIn this study, dead and live anaerobic biomass was used in biosorption of Pb(II), Cr(III) and Cd(II) ions from a synthetic wastewater. The biosorption was investigated by batch adsorption experiments. It was found that, the biosorption capacities were significantly affected by biosorbent dosage. The process follows Langmuir isotherm (regression coefficient 0.995, 0.99 and 0.987 for Pb(II), Cr(III) and Cd(II) ions, respectively, onto dead anaerobic biomass) model with uniform distribution over the biomass surface. The experimental uptake capacity was 51.56, 29.2 and 28 mg/g for Pb(II), Cr(III) and Cd(II), respectively, onto dead anaerobic biomass, compared with 35, 13.6 and 11.8 mg/g for Pb(II), Cr(III) and Cd(II), respectively, onto live
... Show MoreThis research was distributed into two sections, the first section was concerned with the concept of value for De Saussair and its methodological impact on his linguistic structural conceptions with respect of the distinction between synchronism and diachronism, the value role of linking function between the sounds and the though, the basing of his theoretical conception on the language being a form and not a material according to this principle and the value impact on the demonstration that the linguistic element acquires its functional importance from the relations inside the language system. It also stopped at the methodological impact of value on defining the analytical linguistic unit and the value role in semantics through the prin
... Show MoreCommunicative-based textbooks are developed and disseminated throughout the country.
However, it is difficult for teachers who themselves have learnt English through the traditional
approaches to suddenly be familiar with CLT (Communicative Language Teaching) principles
and teach communicatively. Therefore, many teachers remain somewhat confused about what
exactly CLT is and others familiar with CLT but unable to achieve communicative classroom
teaching. Consequently, those teachers need to be introduced to the CLT principles and they need
training in how to put CLT principles into practice. Accordingly, this study aims to find out the
effect of combining video lectures and Kolb experiential learning on EFL student-t
The aim of this work covers the synthesis and characterization of the new tertra dentate ligand (H4L) containing (N and O) as donor set atoms kind (N2O2) where: H4L=Bis-1,2 (2,4- dihydroxybenzylediene phylinediamine . The preparation of ligand contains reaction 2, 4 - Dihydroxy benzaldehyde and o-phenylene diamine . Schiff base was reacted with some metal ions in the presence of methanol to give the complexes in the general formula [M (H2L)] where: MII = Co, Ni, Cu, Zn, Cd. All compounds were characterized by spectroscopic methods I.R , U.V.-Vis, metal content and molar conductivity measurements, showed that the complexes are non-electrolyte. The proposed geometry for all of the proposed complexes was a tetrahedral while Ni complex was squa
... Show MoreFour electrodes were synthesized based on molecularly imprinted polymers (MIPs). Two MIPs were prepared by using the diclofenac sodium (DFS) as the template, 2-hydroxy ethyl metha acrylate(2-HEMA) and 2-vinyl pyridine(2-VP) as monomers as well as divinyl benzene and benzoyl peroxide as cross linker and initiator respectively. The same composition used for prepared non-imprinted polymers (NIPs) but without the template (diclofenac sodium). To prepared the membranes electrodes used different plasticizers in PVC matrix such as: tris(2-ethyl hexyl) phosphate (TEHP), tri butyl phosphate (TBP), bis(2-ethyl hexyl) adipate (BEHA) and tritolyl phosphate (TTP). The characteristics studied the slop, detection limit, life time and linearity range of DF
... Show MoreA total of 48 experiments were conducted to investigate the impact of slit weir dimensions and locations on the maximum scour depth and scour area created upstream. The slit weir model was a 110 mm slit opening, and it was installed at the end of the working section in a laboratory flume. The flume was 10.0 m long, 30 cm wide, 30 cm deep, and almost middle. It includes a 2 m working section with a mobile bed with 110 mm in thickness. In the mobile bed, two types of nonuniform sand (with a geometric standard deviation of 1.58 and 1.6) were tested separately. The weir dimensions and location were changed with flow rates. Then dimensions of the slit weir were changed from 60 x 110 mm to 60 x 70 mm (width x height), while th
... Show MoreTeachers play a critical role in planning, organizing, coordinating, monitoring, and instructing, hence the topic of leadership styles receives a lot of attention. As a result, the physical education school is regarded as the most significant component of the educational process because it has the ability to weave together the teaching and educational skills, attitudes, and capacities that its students develop. Fits into their identities through her relationship with them. Teachers play a critical role in planning, organizing, coordinating, monitoring, and instructing, hence the topic of leadership styles receives a lot of attention. As a result, the physical education school is regarded the most significant aspect in the educational proces
... Show MoreThe present study aims to give some details about the normal anatomical and histological structure of the liver, pancreas and gall bladder in Cyprinus carpio Linnaeus, 1758 and Mesopotamichthys sharpeyi (Günther, 1874). Anatomical results revealed that the liver of C. carpio is a reddish-brown in color, located in the anterior part of abdominal cavity and dispersed between most of the intestines, which is divided into two lobes; while in M. sharpeyi the liver is light brown in color located in the anterior part of abdominal cavity and extends to the end of the intestinal tract with two lobs. The gallbladder situated in the right side of the liver in both species. Histological results in both species showed that the liver consists
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