Learning Arabic speaking skills depends on the teacher's teaching to his students by choosing learning media according to the needs and goals of a teacher to realize Arabic speaking skills to his students. The purpose of this research is the implementation of the learning activities of hand puppet media to improve the speaking skills of Sungai Tarab State Islamic Elementary students. Then, hand puppet media can improve the speaking skills of Sungai Tarab State Islamic Elementary students. This study uses two rounds of classroom action research. Each round consists of four stages: planning, implementation, observation and reflection. The research population was all students of Islamic Elementary School Sungai Tarab, while the sample was class Three Islamic Elementary School Sungai Tarab, totaling 35 students. Data collection techniques using interview, observation and documentation methods. At the same time, the analysis technique used in analyzing is data reduction, data presentation and conclusion drawing. The results of this study indicate that the use of hand puppet media in learning Arabic can improve the ability to speak Arabic for the third-grade students of Islamic Elementary School Sungai Tarab in learning activities.

Ischemic colitis (IC) is a rare adverse effect of antipsychotic medications and is most commonly associated with the phenothiazine class of neuroleptics. Different cases reported in patients without other obvious risk factors led to the link between taking neuroleptics and acute ischemic colitis. The severe form is acute necrotizing colitis. This entity is characterized by sudden onset of abdominal pain and bloody diarrhea, progressing rapidly to produce severe illness with general peritonitis and shock.We report a case of a 26 years old Moroccan man, treated for four years for chronic psychosis, admitted to the emergency for abdominal pain and diarrhea. Clinical examination showed a conscious patient, tachycardia at 120 beats/min, febrile to 38.5 ° C, with generalized abdominal defense. Laboratory tests revealed: GB 33400, CRP 290 mg/l, abdominal tomography revealed colonic distension. The patient was prepared and admitted to the operating room. During the intervention, a colonoscopy was performed and shown ulcerated lesions with a purplish background without interval healthy mucosa. A subtotal colectomy with ileostomy and sigmoidostomy were performed. The histological examination of the surgical specimen showed superficial and extended ulcerations without interval healthy mucosa. Thus, no factors for IC were detected by appropriate workup other than the long-time use of neuroleptics. The restoration of continuity by ileorectal anastomosis was achieved two months later with a good clinical outcome, and the patient was recommended for psychiatry to reevaluate his antipsychotic regimen given the association with IC.Our case supports that neuroleptics can promote IC in patients under antipsychotic medications. It should alert physicians who prescribe neuroleptics and colorectal surgeons to the possibility of intestinal ischemia. Although the clinical presentation is non-specific, abdominal pain and distension should be headed, and endoscopy carried out. A better knowledge of this condition should promote earlier diagnosis and improve management.

BACKGROUND: Evidence informing providers and payers regarding the appropriate management of women with reproductive potential continues to grow and was primarily stimulated by the FDA's Pregnancy and Lactation Labeling Rule. The objective of this analysis was to examine the unmet clinical needs of patients with Crohn's disease (CD) during pregnancy. METHODS: CD patients with pregnancies resulting in live births were identified in the MarketScan® database (1/2010-9/2016) using ICD-CM/CPT/MS-DRG codes. The estimated conception date (index date) was calculated based on the gestational age indicated by the diagnosis or procedure code for delivery. Continuous enrollment from the baseline (BL) period (6-months pre-index) through the postpartum period (6-months post-delivery) was required. Clinical proxies were developed to assess flares during the study period: (1) At least 2 ICD-CM codes for CD-related symptoms: abdominal pain, blood in stool, diarrhea, fatigue, fever, loss of appetite, weight loss, rashes; (2) ICD-CM code for CD-related complication: abscess, anal fissure, arthritis, bowel obstruction/stricture, fissure, fistula, gallstone, inflammation of the eye/mouth, kidney stone, liver disease, ulcers; (3) CD-related hospitalization/ER visit; (4) 60% increase in CD-related outpatient visits from BL; (5) addition or potency increase of oral corticosteroid from BL; (6) addition or dose increase in biologic therapy from BL; and (7) addition of other CD indicated therapies from BL. An assumption was made that only a single flare could occur within 30 days. RESULTS: 1,726 successful pregnancies among CD patients were identified. The mean age was 30.3 years, mean (SD) Deyo-Charlson comorbidity index was 0.1 (0.4), most patients had commercial PPO coverage (63.4%), and the most prevalent comorbid condition was infection (42.5%). There were no significant differences in BL characteristics between pregnancies with and without flares. Among the 1,726 pregnancies, there were a total of 5,074 flares (1,268 flares [25.0%] during the BL period, 2,227 flares [43.9%] during the pregnancy period, and 1,579 flares [31.1%] during the post-partum period). To account for differences in the duration of each peri-pregnancy period (baseline [6.0 months], pregnancy [9.2 months], postpartum [6 months]), average monthly flare rates were calculated. The rates were 211.3, 241.7, and 263.2 flares/month, respectively, for the BL, pregnancy and post-partum periods. The most frequent clinical proxies for flares during the BL period were an increase in CD-related outpatient visits from BL (23.7%) and CD-related symptoms (23.0%). The most frequent clinical proxies for flares during both the pregnancy and postpartum periods were the addition or increase in dose of CD-indicated therapies (45.6% pregnancy period, 35.8% postpartum period) and CD-related complications (25.0% pregnancy period, 35.4% postpartum period). CONCLUSION(S): The consistently high risk of flares during the peri-pregnancy period demonstrates the need for optimizing the management of CD. While sole reliance on claims data is a limitation in assessing poor CD control, the use of clinical proxies to explore national trends in CD disease control might help uncover unmet needs. Healthcare professionals should aim for disease control prior to pregnancy and have a treatment plan during and after pregnancy to optimize clinical outcomes and minimize CD-related complications for women.

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On March 11, 2020, the WHO declared that the epidemic of COVID-19 had become a pandemic, and this disrupted all the regulated operative programs. On the other hand and by its urgent nature, the emergency surgery was maintained with particularity in some situations, an association with infection by COVID-19. The circumstances of diagnosis of the association of infection by COVID-19 and surgical emergency are based on clinical, radiological, and biological criteria. In this work we report the experience of the University Hospital of Tangier concerning the management of three patients with the particularity of associating a covid infection and a digestive surgical emergency, we will discuss through these cases, the necessary protective measures in intraoperative and the impact of the covid infection on the morbi-mortality Concerning the impact of covid infection on postoperative morbidity and mortality, there are generally two situations: When the covid infection is benign, the prognosis depends on the severity of the surgical emergency and in this situation the prognosis is the same as for patients not infected by covid, this is the case of the first and third cases. The second situation; when the covid infection is severe, it has a great impact on the prognosis and the postoperative care in intensive care. With this publication, we are trying to provide information to help surgeons better manage this category of patients, especially in view of the panic caused by the pandemic, and the difficulty of adapting to the new patient circuit, but more studies recruiting more cases are needed to confirm our findings.