Undiagnosed cyanotic heart disease - A challenge to emergency medical professionals

Cyanotic heart disease characterized by pulmonary hypertension with reversal or bidirectional shunt associated with atrioventricular septal defects or patent ductus arteriosus is known as Eisenmenger syndrome. Pregnancy-associated decreased systemic vascular resistance increases the degree of right to left shunting and hypoxemia, thereby increasing substantially both the maternal mortality and fetal wastage which is reported to be as high as 70%. Ideally, this is a contraindication for conceiving but if there is strong desire of pregnancy, it should be a supervised antenatally by multidisciplinary team. We present a case of a young primigravida who had cesarean delivery under subarachnoid block at 37 weeks of gestation and was referred after fall in oxygen saturation. It can be a challenge to manage these cases at a peripheral unit if the condition is undiagnosed.

Perangkat Keras Komputer

Perangkat keras (hardware) adalah bagian dari sistem komputer sebagai perangkat yang dapat disentuh dilihat secara fisik dan bertindak untuk menjalankan intruksi dari perangkat lunak (software). Perangkat keras komputer adalah semua bagian fisik computer, dibedakan dengan data yang berbeda didalamnya atau yang beroperasi didalamnya sedangkan perangkat lunak merupakan perangkat yang dapat dilihat namun tidak dapat disentuh secara langsung oleh manusia. Perangkat lunak yang menyediakan intruksi buat perasngkat keras untuk menyelesaikan tugasnya. Perangkat keras komputer adalah salah satu komponen dari sebuah komputer yang sifat alatnya adalah berbentuk nyata, yang berfungsi untuk mendukung proses komputeisasi. Berdasarkan fungsinya perangkat keras komputer terbagi menjadi: input device (unit masukkan), process device (unit pemrosesan), output device (unit keluaran), backing stroge (unit penimpanan), dan peripheral (unit tambahan).

Perangkat Keras Komputer

Perangkat keras merupakan salah satu perangkat yang dibutuhkan dalam menjalankan komputer. Perangkat keras komputer adalah seluruh bagian fisik komputer yang dapat disentuh dan dilihat secara langsung serta bertindak untuk menjalankan instruksi dari perangkat lunak. Perangkat keras komputer berperan secara menyeluruh terhadap kinerja suatu sistem komputer. Secara fisik, komputer terdiri dari beberapa komponen yang bekerja sama membentuk suatu kesatuan dalam menjalankan fungsinya. Pada prinsipnya sistem komputer selalu memiliki input divice (unit masukan), Process device (unit Pemrosesan), Output device (unit keluaran), Backing Storage ( unit penyimpanan) dan peripheral ( unit tambahan).

Stratigraphy and Toarcian marine fauna (ammonites and brachiopods) of the South Rifian Ridges, northern Morocco

The South Rifian Ridges (25 km north of Meknes) corresponds to several small to medium size massifs with Triassic to Middle Jurassic (Bojocian) deposits widely covered by upper Miocene marls. Faugères (1978) has distinguished in this area three lithostratigraphic units equivalent to three paleogeographic domains, which are from the periphery to the center of the Jurassic basin: Peripheral unit, consisting of two formations: red silty clays with evaporates of Triassic (100m) and Liassic neritic limestones (100m); Intermediate unit, more complete, showing in addition of the two previous formations, a thick series (300m) of Toarcian to Middle Bajocian, constituted of silty marl-limestones, sandstones and bioclastic or oolitic limestones, often with benthic fauna; and Central unit, corresponding to the axial zone of the South Rifian basin, showing pelagic deposits from the lower Pliensbachian to the Middle Bajocian. In this unit, particularly to the east and the west of Jbel Dehar En Nsour anticline, Faugères (1974, 1978), and Elmi and Faugères (1974) reported some Toarcian ammonite specimens. For its pelagic facies often rich in ammonites, we were interested in the study of the Toarcian sequence and faunal assemblages of this unit. More than ten outcrop sections were sampled bed-by-bed. The main collected ammonite species: Calliphylloceras nilssoni, Cleviceras aff. exaratum, Dactylioceras laticostatum, D. simplex, D. (Orthodactylites) semicelatum, Juraphyllites (Meneghiniceras) lariense, Lioceratoides serotinus, Maconiceras soloniacense, Neolioceratoides schopeni, Protogrammoceras paltum and Harpoceratinae indet., allowed characterizing the Mirabile and Semicelatum subzones of the Polymorphum Zone and have already been described and illustrated in Bardin et al. (2015). Belemnite specimens: Passaloteuthis bisulcata and P. zieteni of the same stratigraphic levels were also the subject of the article, Sanders al. (2013) and a palynological study on the same sections was realized by Chahidi et al. (2016). Recent investigations allowed to collect a new interesting paleontological material composed of lower Toarcian pyritic ammonites and middle to upper Toarcian brachiopods (Rhynchonellidae, Zelleridae, and Terebratulidae), currently under study.

Stratigraphy and Toarcian marine fauna (ammonites and brachiopods) of the South Rifian Ridges, northern Morocco

The South Rifian Ridges (25 km north of Meknes) corresponds to several small to medium size massifs with Triassic to Middle Jurassic (Bojocian) deposits widely covered by upper Miocene marls. Faugères (1978) has distinguished in this area three lithostratigraphic units equivalent to three paleogeographic domains, which are from the periphery to the center of the Jurassic basin: Peripheral unit, consisting of two formations: red silty clays with evaporates of Triassic (100m) and Liassic neritic limestones (100m); Intermediate unit, more complete, showing in addition of the two previous formations, a thick series (300m) of Toarcian to Middle Bajocian, constituted of silty marl-limestones, sandstones and bioclastic or oolitic limestones, often with benthic fauna; and Central unit, corresponding to the axial zone of the South Rifian basin, showing pelagic deposits from the lower Pliensbachian to the Middle Bajocian. In this unit, particularly to the east and the west of Jbel Dehar En Nsour anticline, Faugères (1974, 1978), and Elmi and Faugères (1974) reported some Toarcian ammonite specimens. For its pelagic facies often rich in ammonites, we were interested in the study of the Toarcian sequence and faunal assemblages of this unit. More than ten outcrop sections were sampled bed-by-bed. The main collected ammonite species: Calliphylloceras nilssoni, Cleviceras aff. exaratum, Dactylioceras laticostatum, D. simplex, D. (Orthodactylites) semicelatum, Juraphyllites (Meneghiniceras) lariense, Lioceratoides serotinus, Maconiceras soloniacense, Neolioceratoides schopeni, Protogrammoceras paltum and Harpoceratinae indet., allowed characterizing the Mirabile and Semicelatum subzones of the Polymorphum Zone and have already been described and illustrated in Bardin et al. (2015). Belemnite specimens: Passaloteuthis bisulcata and P. zieteni of the same stratigraphic levels were also the subject of the article, Sanders al. (2013) and a palynological study on the same sections was realized by Chahidi et al. (2016). Recent investigations allowed to collect a new interesting paleontological material composed of lower Toarcian pyritic ammonites and middle to upper Toarcian brachiopods (Rhynchonellidae, Zelleridae, and Terebratulidae), currently under study.

Design, synthesis and structure of novel G-2 melamine-based dendrimers incorporating 4-(n-octyloxy)aniline as a peripheral unit

Background: 4-(n-Octyloxy)aniline is a known component in the elaboration of organic materials with mesogenic properties such as N-substituted Schiff bases, perylene bisimide assemblies with a number of 2-amino-4,6-bis[4-(n-octyloxy)phenylamino]-s-triazines, amphiphilic azobenzene-containing linear-dendritic block copolymers and G-0 monomeric or dimeric dendritic liquid crystals with photochromic azobenzene mesogens. The present ab initio study explores a previously unknown use of 4-(n-octyloxy)aniline in the synthesis, structure and supramolecular behaviour of new dendritic melamines. Results: Starting from 4-(n-octyloxy)aniline, seven G-2 melamine-based dendrimers were obtained in 29–79% overall yields. Their iterative convergent- and chemoselective synthesis consisted of SN2-Ar aminations of cyanuric chloride and final triple N-acylations and Williamson etherifications (→ G-2 covalent trimers) or stoichiometric carboxyl/amino 1:3 neutralisations (→ G-2 ionic trimers). These transformations connected G-1 chloro- and amino-termini dendrons to m-trivalent cores (triazin-2,4,6-triyl and benzene-1,3,5-triyl units) or tripodands (central building blocks), such as N-substituted melamines with 4-hydroxyphenyl or phenyl-4-oxyalkanoic motifs. Owing to the diversity of cores and central building blocks, the structural assortment of the dendritic series was disclosed by solvation effects (affecting reactivity), rotational stereodynamism and self-organisation phenomena (determining a vaulted and/or propeller macromolecular shape in solution). DFT calculations (in solution), (VT) NMR and IR (KBr) spectroscopy supported these assignments. TEM analysis revealed the ability of the title compounds towards self-assembling into homogeneously packed spherical nano-aggregates. Conclusions: The (non)covalent synthesis and step-by-step structural elucidation of novel G-2 melamine dendrimers based on 4-(n-octyloxy)aniline are reported. Our study demonstrates the crucial influence of the nature (covalent vs ionic) of the dendritic construction in tandem with that of its central building blocks on the aptitude of dendrimers to self-organise in solution and to self-assembly in the solid state.

Experiences of a Peripheral Unit in Using a Tripolar Constrained Acetabular Component for Recurrent Dislocations following Total Hip Joint Replacements

Primary total hip arthroplasty is a successful procedure, although complications such as dislocation can occur. In certain patient populations if this is recurrent, it can be difficult to manage effectively. We present a retrospective analysis of our experience of using a capture/captive cup over an 8-year period for frail elderly patients who presented with recurrent hip dislocations. Our findings show no redislocations in our cohort and a survival analysis demonstrates just less than half surviving at 2 years after surgery. Furthermore, Harris Hip Scores were generally calculated to be good. A constrained acetabular component provides durable protection against additional dislocations without substantial deleterious effects on component fixation. Such components should be considered especially in a group of patients with comorbidities or those who are fragile, elderly, and low-demand in nature.