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 Volume 6, Issue 3, September 2018

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Customer Mistreatment, Emotional Exhaustion and Work-family Conflict: The Moderating Role of Social Support
Yi Cao, Department of Management and Marketing
The University of Melbourne, Melbourne, Australia

Customer service providers are likely to react negatively to customer mistreatment, however, research has not yet fully discovered what coping strategies employees would apply to deal with customer mistreatment. Drawing upon conservation of resources theory, we examine the underlying mechanism between customer mistreatment and its unfavorable consequences (i.e. work-family conflict), as well as if social support can moderate the negative influence of customer mistreatment. The result suggests that customer mistreatment positively predicts employee’s work-family conflict via emotional exhaustion. Moreover, holding the strength of customer mistreatment constant, those who receive more social support are less likely to experience emotional exhaustion, thereby they are less likely to get involved in in work-family conflict.

Linguistic Variation as Marker of Regional Identity: A Sociolinguistic Perspective
Bushra Nawaz, M.Phil. Applied Linguistics & Lecturer
The University of Lahore, Pakistan

The present study investigates the dialectal differences among three distinct dialects of the Punjabi language namely Majhi, Jhangvi and Saraiki, spoken in Lahore, Jhang and Multan as their central speech regions respectively. This research focuses on the phonological and morpho-syntactic differences by hypothesizing that each of the dialects carries salient phonological and morpho-syntactic features which in turn mark a strong boundary for their speakers. The differences in the linguistic features of these dialects were investigated by recording the unstructured conversations of 5 men aging 50 years or above for 30 minutes for each dialect. The use of specific linguistic features was differentiated in the analysis. All the differences occurring in the phonetics and morpho-syntax of each dialect were compared and contrasted. The findings render the presence of salient phonological and morpho-syntactic features in the three dialects which in turn mark strong regional identity of their speakers.   

Awareness and Foot Care Practices Among Diabetic Patients In Riyadh Hospitals
Abdulrahman Shinan Al Shihry, MBBS 
General Practitioner Physician at King Salman Hospital
Riyadh. Saudi Arabia
Abdulrahman Mohammed Al-Bakiri, RN & Msc
Specialist Nursing at King Salman Hospital
Riyadh. Saudi Arabia

Background and Objectives: Diabetic foot complications are the most common cause of lower extremity amputations. Foot care education is recommended in all patients with diabetes to reduce the rate of diabetes-associated foot disease.

 The aims of this study were to assess patients awareness about risk factors for diabetic foot disease, to explore the knowledge and foot care practice among diabetic patients, and to correlate the level of knowledge and practice with socio-demographic and the patients’ risk of developing diabetic foot disease.

Methods: A descriptive cross sectional study was carried out among 350 adult diabetic patients in different Riyadh hospitals starting from November 2016 to April 2017. Data was collected through interviewing patients using a pre-designed questionnaire. It included data about socio-demographic, clinical, in addition to questions regarding  patient awareness and practices and the sources of foot care education.

Results: Regarding risk factors for diabetic foot disease, only 46.6%  were aware that smoking is a risk factor, (65.1%) and (62.6%) were aware that high blood pressure and high cholesterol level are risk factors respectively, while only half of them were aware that high HbA1C is a risk factor (50.6%).

As regard patient practice the least percentages were inspecting their feet daily (16%) and soaking their feet (17,7%). Concerning patients education, only less than half 42.6% had education about regular foot care, 28.9% had training about proper fitting footwear and 23.3% had training about how to check minor injuries.

Conclusion: The results of this study put emphasis on the inadequate level of awareness about the risk factors of diabetic foot disease, and poor foot care practice and the lack of professional podiatry educational services for diabetics in Riyadh hospitals. It highlights the need for planning education classes about diabetic foot disease for all diabetic patients.

Critically Review and Evaluate National Tuberculosis Control Program (NTP) of Pakistan
Ahsan Siddiqui, M.D, Msc (UK) Scholar & Assistant Professor
Ministry of Health Riyadh, Saudi Arabia

Background and Objectives:

This assignment will critically review and evaluate the National Tuberculosis Control Program of Pakistan (NTP) and will discuss the Health Needs Assessment (HNA) is completed or not in NTP of Pakistan, and what new policies and plans shall be included to improve the NTP in Pakistan and how the new policies shall help to facilitate community empowerment and partnership working.


Literature Review with Health Need Assessment and Planning - Planning Models were Applied to discuss and Critically Analyze the NTP National Tuberculosis control program of Pakistan. Strategic Planning with Ewles and Simnett planning model and Community empowerment and partnership working are the Main Methods to improve the NTP National Tuberculosis control program of Pakistan.


The National Tuberculosis control program of Pakistan (NTP) is not working affectively enough to reduce the incidence of T.B in Pakistan and the disease is still rising in Pakistan. The Ministry of Health Government of Pakistan is working altogether with international health agencies to reduce the incidence of T.B in Pakistan. The officials of NTP are adapting the modern and more effective strategies in NTP for the control of T.B in Pakistan. They are getting also more funds and aid for NTP to control the T.B in Pakistan.


It’s not easy to eliminate T.B from the country with in few years because T.B is a communicable disease and it needs a lot of affective strategies (for example health needs assessment), to change the model of the NTP, hard work, good management and affective treatment to reduce the incidence of T.B in Pakistan. It is easy to implement the strategies and choose a program to reduce the incidence of T.B in Pakistan but the success in the NTP is not possible until the cooperation of the local community including youth, elders, men and women altogether in villages and cities.

Tuberculosis in Adults in Pakistan: Its Epidemiology, Preventive Measures and Current Legislation
Ahsan Siddiqui, M.D, Msc (UK) Scholar & Assistant Professor
Ministry of Health Riyadh, Saudi Arabia

Tuberculosis rates were declining in Pakistan, but several complex social and medical factors causes TB morbidity to increase. At present, Pakistan ranked the sixth in WHO list of tuberculosis risk countries. Recently, the increased TB morbidity and mortality have placed additional pressure to act on state and local TB control programs, which already had been substantially weakened by inadequate staffing and funding support. This article describes a model for TB control program which contains the essential components of a successful TB control program, including three priority strategies for TB prevention and control: a) identifying and treating persons who have active TB, b) finding and screening persons who have had contact with TB patients to determine whether they are infected with Mycobacterium tuberculosis or have active TB; providing appropriate treatment, and c) screening populations at high risk for TB infection and development to isolate infected persons and providing therapy to prevent progression for active TB carriers. Furthermore, the essay also explores the factors responsible for the acceleration of the TB in Pakistan and the new changes needed in prevention and improvement of TB control program.

Strategies for the Prevention and Elimination of Vitamin A Deficiency
Ahsan Siddiqui, M.D, Msc (UK) Scholar & Assistant Professor
Ministry of Health Riyadh, Saudi Arabia

Vitamin A deficiency is a major contributor to child mortality. There is increasing evidence that it also raises significantly risk of maternal death.  Elimination of vitamin A deficiency as a public health problem should be considered as a principal element for child and women survival programs. This article discusses the problem of vitamin A deficiency diseases (VADD) in developing and under-developed countries as well as the magnitude of the VADD problem. In addition, this article also provides strategies for the prevention and elimination of the vitamin A deficiency. Recent years, Great progresses had taken place in many countries in combating vitamin A deficiency. However, urgent action was still needed to be taken to accelerate existing progress in order to rapidly increase the number of countries where this potentially lethal disorder was under control. Further, this research proposes that assessment of the VADD could be a key element to the acceleration of its prevention in some countries. Finally, this research also discusses some key assessment indicators and strategies for the prevention of VADD. The research result in turn proves that Vitamin A supplementation, vitamin A fortification, are all very reliable and effective way to combat vitamin A deficiency. As a result, they are the key factors in preventive program strategies which should be rapidly be implemented on a national scale.

How to Efficiently Reduce the Incidence of Tuberculosis (TB) Disease in Adults in Karachi Pakistan
Ahsan Siddiqui, M.D, Msc (UK) Scholar & Assistant Professor
Ministry of Health Riyadh, Saudi Arabia

Background and Objectives:

WHO's 2003 World Health Report states that the annual incidence of TB cases in Pakistan is 171 per 100,000 persons. Each year, at least 268,000 new TB cases are added to the existing patient population of around 1.8 million. Tuberculosis kills 64,000 people in Pakistan each year, accounting for 26 % of the nation's avoidable deaths (The Body, 2003). The reports also demonstrate that most patients are around 15 to 45 years old with 52% males and 48% females. This research aims to contribute to the improvement of health system in Pakistan by suggesting reliable and practical health proposals and policies, through which the incidence of TB could possibly be reduced in adults in Karachi Pakistan and thus the common people of Pakistan would receive better health services.

Methodology and Methods: From Three Main Types of Methodologies (Quantitative, Qualitative, and Action Research) I have chosen Action Research and Phenomenology as methodologies and I will discuss my research question under both methodologies. I will discuss Diaries and Interviews with data collection and analysis, as these are the most appropriate Methods to achieve the goal and these Methods do not require many resources, an important factor for some research in developing countries.  

Results and Conclusion: This research design assignment has explored the methodological issues relating to the research question about how to improve the health infrastructure and the health system in Pakistan and how to reduce the incidence of tuberculosis in adults in Karachi Pakistan. The most suitable methodology I find for my research question is ACTION RESEARCH which tells us the way to make new and good as well as fruitful policies to improve the health system in Pakistan & to reduce the incidence of T.B in adults in Karachi Pakistan. It is not easy for a developing country like Pakistan to increase its health budget to buy more drugs for the patients of T.B and other diseases. Regarding the paradigm question about the chosen research question the Positivist paradigm is more helpful than constructivist because it gives more scope for recording people experiences. I can give better solutions regarding my research question under the Positivist paradigm. Finally, the chosen method (Diaries, Interviews with Data collection and analysis) enables me to explain the chosen research question and give the answers and the solutions of the problems.  

The Effect of Youth Bulge in Nigeria: An Overview of the Socio-economic Implications Along With Consequences
Grace Oluseyi Oshinfowokan, Ph.D. & Research Fellow in NIPSS
National Institute for Policy and Strategic Studies, Nigeria

Dele Ishaka, Ph.D. (in view) & Part Time lecturer
University of Abuja, Nigeria

Humphrey Ukeaja, Research Scholar
University of Abuja, Nigeria

This study examines the effects of youth bulge on the economic milieu of the Nigerian State. Whilst investigating the role of youth empowerment via harnessing youth bulge in the attainment of the demographic dividend vis-à-vis its economic implication in the Nigerian environment. It identifies the challenges facing a typical Nigerian youth and the various ways of investing in the youth bulge. It finds that the challenges facing the Nigerian youth ranges from the problem of youth unemployment, limited access to educational and lack of economic opportunities, lack of access to basic education, high HIV prevalence rate to high poverty rate. It posits that contrary to expectations, increase in the population of the youth may undermine development if the challenges facing the youths are not addressed. The study adopted the youth bulge theory and the secondary method of data collection. Furthermore, the study recommends that the government should create employment and economic opportunities, provide educational and health facilities, and combat poverty in order to ensure that the bulging youth population translates into economic growth and development, else if this bugle is neglected, and the recommendations of this study are not implemented, then Nigeria and sub Saharan should be expecting its own version of an “Arab Spring”.

National Political Discourse Addresses the Iraqi Mind
Mohammed Ahmed Ali AlFuadi, M. A. & Assistant Instructor
Open Educational College , Iraq

This article discusses a public political discourse as presented on statements. The approaches to the study of the political discourse are characterized as analysis of the topic, main opponents, tonality and performative meaning of communication. Usually, orators emphasize the priorities of humankind when analyzing the local political situation but sometimes they make the accent on the problems of their own country or regional interaction. The tonality of political speech is the most important priority indicator of possible practical actions the local powers may take in their national policy. Stylistics speeches speakers are not corresponding in some cases to the canons of diplomatic speech. The tone of the speech was in clear crystal words woo the patriot feelings of people, deliberately goes beyond these senses, which proves that media discourse with its entertaining techniques gradually infiltrates new areas of communication. The findings revealed that the use of conceptual addressing in the political tweets induces specific understanding of how political activities throughout the election are conceptualized and expressed in denoting particular ideological stances.

The Construction of Inter Gender Studies in J.M. Coetzee’s’ “Waiting for the Barbarians”
Aamir Inayat khan, MS English & Research Scholar
E& SE Dept KP, Pakistan

Women in the novel were usually treated and described as marginalized ones. The way magistrate treated the woman was considered as a barbaric approach, that is; to exploit her for his personal sexual desires and then look down upon her as a dispensable creature. It reflects behind his thinking about woman is the narrative of modernity and Empire in a practical form. That is also the reason people around the world tried to find the remedy in postcolonial and postmodern dynamic.

Implementation and Compliance of Solo Parents' Welfare Act (R.A. 8972) in Cebu City
Eugene E. Toring, Ph.D. & VP- Operations and Research Director
Indiana Aerospace University, Philippines

Solo parents love to provide his or her children with the basic necessities of life, including food, clothing and shelter and medical care. Since, the presence of the children is very much valued by solo parents. Assessing the solo parent program implementation and compliance to learn about the extent of implementation of the solo parent program in the aspects of livelihood services and trainings, labor and employment, educational benefits, housing and health benefits; the extent of compliance to the solo parents program as implemented by local and national support agencies; the significant relationship between implementation and compliance; the problems encountered by the beneficiaries and implementers; the factors that restrain and facilitate the compliance and implementation of solo parent program and lastly; the policy recommendations which have been implemented fairly by the local and national government. The extent of implementation and extent of compliance to the Solo Parent Program was not significant while several problems encountered by the local and national support agencies in the implementation and compliance of the solo parent program and restraining factors. To enhance the well-being of the solo parents, improvement of  the budget for livelihood services and training in order to hire competent instructors for health benefits to cater to the increasing number of solo parents, build hospitals with better facilities; housing programs, educational scholarship and training programs and short-term courses, strict monitoring on labor and employment.

Increasing Rigor to More Challenging Cognitive Processes
Lleuvelyn Cacha, Ph.D. & Associate Professor
Universiti Sultan Zainal Abidin, Malaysia
Abrizah Abdullah, Ph.D. & Professor
Universiti Malaya, Malaysia

This paper highlights the importance of ensuring empirical rigor consistent to the level of emphasis that captured the multiple realities of graduate students’ analytical information processing ability and understanding relevant conception as they heightened critical thinking skills. Assessment tools are required where students are empowered to challenge ideas, authentic searches for complex information problems, and look for workable solutions integrating information technology capabilities. The repeated measures design is one of the more practical ways to detect effect of repeated assessment, change, improved cognitive performance, an outcome that is not due to chance. To corroborate quantitative outcomes from multiple cognitive skills assessments, the researchers used qualitative approaches like open-ended survey questions, critical reflection, interviews and review of learning e-portfolios to verify intellectual efforts that can take place in an innovative way. The activities also served as validity checks between the quantitative outcome and the researchers’ analysis to interact with students’ understanding by allowing them to have a voice through their contextual interactive account of their involvement and cognitive experience during assessment. The students’ qualitative feedback are useful as they have made up for the lack of salient points in the quantitative course of investigation.

Design, Development and Implementation of Patient Information Leaflets (PIL’s) for Selected Pharmacist Only Medicines, Prescription Only Medicines and Selected Diseases in Outpatient Pharmacy Department of Ibrahim Bin Hamad Obaidullah Hospital in Ras Al-Khaimah, UAE.
Mian Shahid Muhammad, Pharm.D, MSCP, & Inpatient Pharmacist
Sheikh Khalifa Specialty Hospital, United Arab Emirates

Aim: 1. To design, develop & implement Patient Information Leaflet for selected pharmacist & prescription only medicines 2. To observe the impact of Patient information leaflet on medication adherence. 3. To observe the effect of counselling of pharmacist on quality of life.

Methodology: It is a six month observational and interventional study. Data was collected for most common diseases where Pharmacist Only Medicines (PhOM) & Prescription Only Medicines (POM) were used. A total of 100 patients were enrolled (50 control & 50 intervention) in the present study based on inclusion/exclusion criteria and their prescriptions were reviewed. PIL’s designed in English and Arabic were distributed to the patients in interventional group only for selected medicines & diseases. For follow-up, two groups of patient were made. Out of which interventional group of patients received PIL’s about the selected PhOM,POM & selected diseases as well as pharmacist counseled them on how to improve their quality of life by following these PIL’s while control group did not receive PIL’s.PIL’s designed in English & Arabic were vetted by expert Doctors, Pharmacists & Faculty members for content suitability, simple language, font size, font type and other relevant information.

The improvement from baseline visit till last visit (8 weeks) in medication adherence, compliances and quality of life  was observed in interventional  group of patients. While in control group of patients, no significant changes from baseline till last visit were observed in medication adherence and quality of life. Patient’s prescriptions were accessed through medical records and documented in the patient data collection form, designed for the study purpose. All other relevant details were documented in respective forms.

Results:  :  In the control group of patients, the medication adherence from base line visit till last visit remained the same as it was in the beginning of the study [(49) 98%].There was no beneficial change in the medication adherence from baseline till last visit. However, a  significant improvement was observed in medication adherence in the interventional group of patients from baseline till last visit (8 weeks) after counselling them about their medications and quality of life. In the initial of the study, in the interventional group, out of 50 patients,49(98%) were non-adherent to their medications who became adherent at the end of study [(43)86%]. Interventional group of  patients (50),were assessed for their medication adherence using a standardized questionnaire of Morisky Adherence assessment Scale. A significant improvement in medication adherence was found at the last visit after these patients have been counseled by the pharmacist. Out of 50 patients,43 (86%) patients were adherent to their medications. All of these patients were also assessed for WHO Quality of life. A significant improvement (p<0.01) was observed in all WHO Quality of Life domains from baseline visit to last visit (after 8 weeks) in interventional group of patients.

Conclusion: In the current study, it was observed that Patient Information Leaflet (PIL) about the medicines & diseases, pharmacist effective professional counselling, has a beneficial impact on the medication adherence as well as quality of life. In the initial of the study, all of the 50 (0%) patients were non- adherent to their medications. While after 8 weeks of education sessions and follow-up,43 (86%) of the patients were adherent to their medication. Similarly, a significant improvement (p<0.01) in the quality of life has been seen with special reference to their physical and psychological health. The results indicates that Clinical Pharmacist has an important role in health care system to improve medication adherence, compliances &  quality of life in chronically ill patients with Diabetes Mellitus, Hypertension & Hyperlipidemia.

Large Iatrogenic Vesicovaginal Fistula Following a Lower Segment Cesarean Section: A Case Report
Fatimah A. Alshiokh, SSC-OG, ABOG, MBBS, Senior Registrar
Ministry of Health, Maternity and Children Hospital, Dammam, Saudi Arabia
Sali Talab, SSC-OG, ABOG, MBBS
Security Forces Hospital, Riyadh, Saudi Arabia
Lateefa O. Al-Dakhil, Assistant Professor and Consultant
Department of Obstetrics and Gynecology 
King Saud University/King Khalid University Hospital, Saudi Arabia

 A vesicovaginal fistula (VVF) is an abnormal fistulous tract extending from the bladder to the vagina that results in the continuous involuntary discharge of urine into the vaginal vault. It is rare in developed countries, but in developing countries it is a common complication of abdominal gynecological surgery. A 28-year-old Saudi woman was referred to the King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia from a rural area. She had a case of a large VVF and 2 months prior to her referral, she had undergone a lower segment cesarean section (LSCS) because of uterine and bladder ruptures. Her primary complaint was of continuous urine leakage from her vagina since the surgery. On examination, her vitals were stable. Serial investigations were ordered, but the results were not a clear indication of the likelihood of a VVF.  A cystourethrogram showed a very large, grade 3, VVF on the left side. Laparotomy was performed and surgical repair was achieved. Another cystourethrogram was performed prior to discharge and it showed normal insertion of the ureters bilaterally with an intact bladder wall.

Strengthening the Professional Competency of FCMS Nursing Graduates Through Enhanced Internship Year Plan: Crafting the Transitional Competency Enrichment Framework
Jefferson Garcia Guerrero, Ph.D NS., DNS, RN & Assistant Professor
Fakeeh College for Medical Sciences, KSA
Rock Parreno Cordero, MSN, RN, REMT, RMT & Lecturer
Fakeeh College for Medical Sciences, KSA
Nada Hassan Gomma, MSN & Lecturer
Fakeeh College for Medical Sciences, KSA
Shaza Karim Almowlad, MPH & Lecturer
Fakeeh College for Medical Sciences, KSA
Nadia Eltohamy, Ph.D Nursing & Assistant Professor
Fakeeh College for Medical Sciences, KSA
Mohammed Sabatin, BSN & Clinical Instructor
Fakeeh College for Medical Sciences, KSA
Rino De Sagun, Ph.D, RN & Assistant Professor
Fakeeh College for Medical Sciences, KSA

In the nursing curriculum, the internship year provides an excellent opportunity for the nurse interns to be exposed to different aspects of the hospital environment. Work routine guided by patient care models and building the smooth interpersonal relationship with the health care professionals will be observed. It also provides them clinical experiences to advance their clinical skills and competencies, as well as enhance their critical thinking, clinical reasoning, and clinical judgment. There are four phases of FCMS’ framework: the preparation phase, the implementation phase, the monitoring phase, and the evaluation phase. The preparation, which is cyclical by nature, includes series of orientations, assessment tests both theoretical and simulation, updated policies and guidelines shared to the interns, selection of selected preceptors, and clinical placement and rotation plan. Basically, at this juncture, the curriculum and program begin with what is needed in every internship program, in competency-based education. In the light of the results, this study exemplifies that the Transitional Competency Enrichment Framework, the adapted model for FCMS was found to have its strengths such as they are more engaged in what they are doing individually and independently and they tend to know their own strengths and weaknesses in performing specific nursing skills.

Factors Affecting Saudi Employees' Job Satisfaction in Ministry of Health  Hospitals in Hail City
Fares Alshammari, Ph.D. & Associate Professor
University of Hail, Saudi Arabia

Background: Job satisfaction surveys can allow employees to indicate areas in which improving is needed. Therefore, measuring and examining employees’ satisfaction is critical for improving performance.

Objectives: The objectives of the study are to investigate job satisfaction among employees in Ministry of Health (MOH) hospitals in Hail city and to explore factors impacting employees’ satisfaction.

Methodology: This study has a quantitative research design via a self-administered questionnaire survey instrument. In this study a descriptive design, using a collective cross-sectional census survey was used to address the research objectives. The study population consisted of all Saudi employees working in four hospitals in Hail city and the sample size was n=266.

Results: Overall the means scores of female respondents are higher on main scale and sub-scales and the difference are statistically significant thus indicating higher levels of dissatisfaction among female workers as compared to male workers.  The results showed that gender, age, level of education and years of experience appeared as significant predictors (p<.05) when tested in separate models. However, in multiple regression analysis only gender significantly predicted lack of work satisfaction (β = .20, p<.05).  

Conclusion: The level of dissatisfaction among healthcare workers is influenced by nature of work, conditions of work and relationship with seniors.  Besides women are more vulnerable to experience dissatisfaction hence, these women need to be adequately supported to ensure their well-being and help them to contribute as productive employees through improved work satisfaction.

Association of Treatment Protocol and Prolactin Level with Pregnancy Among Women Underwent IVF and Managed at King Fahad Medical City Women Specialized Hospital, Saudi Arabia
Gwahir Alkhaldi, MBBS, MD 
Specialist of Obstetrics and Gynaecology
King Fahad Medical City – Women Specialized Hospital, Saudi Arabia
Dr. Dania Jaroudi, MBBS, MD 
Consultant Reproductive endocrinologist
King Fahad Medical City – Women Specialized Hospital, Saudi Arabia

Background: Infertility is a public health problem with global concern and it's of highly valued in most cultures and the wish for a child is one of the most basic of all human motivations.

Objectives: In this study we sought to identify whether IVF outcomes were associated with prolactin level and pregnancy in women seeking IVF treated with different protocol either antagonist, short or long protocol in King Fahad Medical City Women Specialized Hospital, Saudi Arabia.

Patients and methods: This is a prospective cross sectional hospital-based study conducted in the period from January to December 2016. We consider all women had been diagnosed as hyperprolactinemia and considered as a candidate for IVF at King Fahad Medical City. The inclusion criteria included hyperprolactinemia, IVF candidate those signed to accept to participate. Basic evaluation according to standard and hospital protocol. Prolactin was measured in the mid and late follicular phases of the cycles. During the study period, 24 pregnancies occurred. The numbers of follicles seen, the number of eggs retrieved, or the incidence or outcome of pregnancy. Ethical clearance was obtained.

Main results: Data was retrieved for 1797 cases. Statistically significant correlation was reported age, body mass index. The association of treatment protocol and prolactin level with pregnancy by three types of management protocols; antagonist, short and long protocol. Pregnancy with high level Prolactine> 500 a achieved in 245/477 (51.4 %). In antagonist 79 (43.9 %), short 15 (40.5 %) and long protocol 151 (58.1 %). Pregnancy with low levels of prolactine (≤ 500) was achieved in 688/1295 (53.1 %). In antagonist 271 (50.0 %), short 27 (31.0 %) and long protocol 151 (58.1 %). The associations showed no significant results with all protocol used

Conclusion: Measurement of the serum prolactin concentration is useful for predicting the outcome of IVF outcome. However, the value of routine endocrine testing in an infertility population and especially an in vitro fertilization population has been questioned.

I Am not Mistreated, but I Feel Bad: Service Providers’ Reaction to Witnessing Customer Mistreatment
Jiuming Chen, Ph.D. Student
RMIT University, Australia

This study proposes to investigate if witnessing customers’ misbehaviors have negative influences on employees’ organisational citizenship behaviors. Drawing upon conservation of resources theory, we proposed a theoretical model in which witnessing customers’ misbehaviors is positively related to burnout which predicts reduced organisational citizenship behaviors toward customers. Moreover, we proposed that co-worker exchange is able to strengthen the negative relationship between witnessing customer mistreatment and burnout

Use of Cardiac Resynchronization Therapy (CRT) as a Bridge for Mitral Valve Surgery in Organic Mitral Regurgitation, Case Report and Literature Review Experience from Saudi Arabia
ELRASHEED MOHMMED, MD & Consultant Cardiologist and Echocardiographer
Prince Sultan Cardiac Centre (PSCC), Riyadh, Saudi Arabia
A. Al Fagih, MD, Consultant Cardiologist & Electrophysiologist
Prince Sultan Cardiac Centre (PSCC), Riyadh , Saudi Arabia
Navin C. Nanda, MD, Professor & Consultant Cardiologist
Alabama University, Birmingham, USA
Dr. Moheeb Al Abdullah, MD & Consultant Cardiologist & Interventionist
Director of Prince Sultan Cardiac Centre (PSCC), Riyadh, Saudi Arabia
A. Haroun, MD & General Physician
Bahri Teaching Hospital, Sudan

A cardiac resynchronization therapy (CRT) was used in a fifty year-old female with rheumatic severe mitral regurgitation, complete left bundle branch block and poor left ventricular ejection fraction of 15% and NYHA class III-IV heart failure on optimal medical therapy. Given a very high surgical risk, she was considered for cardiac resynchronization therapy after which she improved dramatically in terms of reduction in  symptoms to NYHA class I, an increase in the left ventricular ejection fraction to 40% and decrease in mitral regurgitation to moderate from severe. This improvement lasted for two years. At that time, she began to have symptoms which progressed rapidly to NYHA class III heart failure, during which she was accepted for surgery with a mild surgical risk, and she improved following mitral valve replacement. The role of a multidisciplinary team was highly acknowledged and appreciated.

Racial Tension and Identity Conflict in Diasporic Fictions of Uwem Akpan, Helen Oyeyemi, Chika Unigwe and Ekow Duker
Abayomi Awelewa, Ph.D. & Lecturer
McPherson University, Nigeria

Contemporary African literature is marked by movement of authors from their original homelands to new spaces and creation of a new genre known as diasporic African fiction. Studies in this area are developmental. Selected for this paper are Uwem Akpan, Helen Oyeyemi, Chika Unigwe and Ekow Duker, whose works: Say You’re One of Them, The Icarus Girl, On Black Sisters’ Street and White Wahala, respectively reflect  racial tension and identity conflict in the new diasporic African setting and circumstances that give birth to them. Applying postcolonial and psychoanalytic theories, this paper examines how the different nations of Africa and the social classes in the “imagined communities” portrayed in the texts have fared in their responses to the challenges of “arrested decolonization” in postcolonial Africa. The paper discovers that racial tension and identity conflict in Africa are a common  problematic concern that arises due to colonial and postcolonial dynamics and that authors of African origin are worried, hence the commitment nature of their fiction, which tends to be psycho-therapeutic. It concludes that diasporic African literature serves as a custodian of African consciousness.

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