Background: Multiple pregnancies are prone to be associated with adverse maternal and perinatal outcome. The incidence of multiple pregnancies has shown a significant increase over the last decades. Aim of the Study: This study aimed to describe the maternal and perinatal outcomes in multiple pregnancies delivered in a tertiary care hospital, Bangladesh. Methods: This was a prospective observational study; 23 patients were enrolled and analyzed. The study conducted with 23 women with twin pregnancies, over 2 year’s months from January 2020 December 2021 in the department of Gynecology and Obstetrics, Chittagong Medical College and Hospital, Chittagong, Bangladesh. Result: Out of 23 cases, 8 patients had intrapartum complications like PPH, mal-presentation, cord prolapse, low-lying placenta, and placental abruption. In this, 4(23.53%) had mal-presentation, and only one had PPH. These intrapartum complications were also categorized according to their chronicity. Mal presentations were seen in 23.53% of DCDA and 33.3% of MCDA with p=0.47. Both were not statistically significant, as shown in Table 4. These twin-specific complications were noted according to their chronicity. Discordant twin was seen in 11.76% of DCDA and 16.67% MCDA. Single IUD in 7.9% of DCDA. The complications and outcomes of the study population; more than 65% of patients needed NICU. In our study, we noted 4 perinatal death caused by intrauterine death, twin-to-twin transfusion syndrome, birth asphyxia, and respiratory distress. Conclusion: Majority of the multiple pregnancy is high risk one. So, all multiple pregnancies need early diagnosis, adequate antenatal, intra-natal and post-partum care to improve the outcome and should have mandatory hospital delivery.

Under the background of the construction of the new liberal arts, the traditional curriculum system for foreign language subjects cannot meet the market demand. The development space of foreign language majors is increasingly compressed, and the quality of graduates is generally declining. The situation of foreign language majors in universities with Industrial Features is even more difficult due to the weakness of their disciplines, the limited teaching staff and the lack of language learning environment. In this paper, we use literature research and questionnaires to explore the development of "foreign language +" courses in universities with Industrial Features with industrial characteristics, by adjusting course hours, diversifying course settings and offering cross-disciplinary courses. This article provides some ideas and suggestions for the development of foreign language courses and curriculum reform in universities with Industrial Features.

The objective of the present study is aimed to formulate and evaluate sustained-release Mebeverine hydrochloride capsules using the Pelletization technique. Mebeverine hydrochloride, an anti-spasmodic drug is highly water soluble with a half-life of 2h and is suitable to develop sustained action for the treatment of irritable bowel syndrome. Mebeverine hydrochloride prolongs medication release in the GIT and, as a result, into the plasma, while reducing the frequency of drug administration, adverse effects, and patient compliance. Mebeverine hydrochloride were prepared by using polymers The drug-polymer and excipient compatibility was defined by the FTIR studies in the pre-formulation study. The calibration curve for the drug is plotted and checked the physicochemical properties. Six formulations (F1-F6) of Mebeverine hydrochloride pellets were prepared using different quantities of Ethylcellulose N 50 and other standard excipients. In vitro, drug release studies were performed for the pellets for 1.2, 4, 6, 8, and 12hrs. The optimized formulation F6 showed 76.8 % drug release after 12h showing that ethyl cellulose N 50 acts as a rate-controlling agent. The drug release of the chosen formulation follows first-order kinetics with a zero-order mechanism, according to absorption kinetics.

Dental complications are the main health problems worldwide and can cause harmful and irreversible loss to general human health. Therefore, there is a need to treat these problems. Most of the techniques for the prevention of these oral diseases are costly and lengthy; therefore, there is a need to introduce some effective, low-cost, and easy methods or medicine to deal with oral health issues. The combined mixture of extracts from T. chebula and A. nilotica proven to treat sore throat and ulcers of the mouth. Eucalyptol is one of the main compounds in the essential oil used for the preparation of an endodontic solvent and mouthwash. The important components present in the rhizome of the turmeric plant which can be used for the treatment of oral complications are essential oils (turmerones) and curcuminoids. Plant-based extracts can be used to prepare several types of mouthwash, toothpaste, and gel due to the presence of anti-microbial activities and a large number of beneficial compounds. This review paper aims to find the role of medicinal plants and their properties for the effective treatment of oral diseases in dentistry.

Background: Central Nervous System tumours are diverse group of neoplasms affecting brain and spinal cord and are graded from WHO grade I to IV from less to more severity. The incidence of CNS tumours has increased in recent years in both developed and developing countries. Materials and Methods: A total of 100 CNS cases were studied and evaluated from July 2014 to July 2016 in the Department of Pathology, K S Hegde Charitable Hospital. Patient’s data was retrieved from the records. The operated specimen was histopathologically evaluated and diagnosis of CNS tumour was made with WHO grading. The data collected was analysed using statistical tools by SPSS software version 21.0. Results: The study group consisted of 100 cases of CNS tumours. Intracranial tumours accounted for 84% and spinal cord tumours were 16%. The age distribution of the patients with CNS tumours ranged from 21 days to 78 years with mean age of 47.16 years. Males (59%) were commonly affected with male to female ratio of 1.44:1. Adults (93%) were more commonly affected than paediatric age group. In the study period from July 2014 to July 2016, a total of 7800 specimens were received in histopathology, among which 100 CNS tumours were encountered. Majority of them were in WHO grade I (66.67%). Local invasion and recurrence was seen in 22.2% (4 cases each). Metastasis (6 cases) (6%) was equally distributed between brain (50%) and spinal cord (50%).They were WHO Grade IV. The primary of the metastatic tumours to brain encountered were from breast, renal cell carcinoma and colon. Metastasis to spinal cord was from lung carcinoma and plasmacytoma. 20% were WHO Grade II and remaining 7.33% was WHO Grade III. Conclusion: The incidence of metastasis to CNS has been increasing in recent years. A general awareness of clinical manifestations of CNS tumours, along with usage of advanced radiological techniques lead to early precise diagnosis and proper management.

Rhizoctonia spp. which was earlier considered a minor disease causing pathogen under Punjab conditions now is a major threat to crops grown in Punjab. The present study investigated the morphological and cultural variations in Rhizoctonia population, pathogenic behaviour and extent of genetic differentiation between infecting populations of R. solani from different hosts. By species specific primers, Rhizoctonia species in Punjab were identified as R. solani (87.8 %), R. oryzae (11.1%) and R. oryzae-sativae (1.1 %). Morphological characterization of Rhizoctonia spp. based on the growth rate, colour of mycelium and sclerotial characters. A high degree of variation among these R. solani isolates was established. Potato isolates belonging to the different geographic areas of the state were clustered together and cotton isolates also related. R. solani isolates from maize, rice, wheat and chilli formed two major cluster groups. The molecular data on AG specific primers revealed that 46.8% of the isolates belonged to AG1-1A, while AG1-1B (10.1%), AG2-1 (13.9%), AG3 (12.7%). Using interspecific sequence repeat primers, isolates were clustered into three major groups (I, II, III). Group III consisted of isolates, mostly from Ludhiana irrespective of the hosts, indicating existence of genetic similarity among these isolates. Isolates were also found to partially group according to place of origin and the host. Further a partial relationship between the level of severity on rice was observed. The diversity and relatedness in hosts of R. solani isolates from Punjab indicates the need to consider the cropping pattern to reduce the inocula in the soil.

The plants are very important for living organisms, there would be no life on earth if plants did not exist. Furthermore, when animals or humans consume many plants, they can have negative consequences. Plant toxicity is associated with a multitude of chemical toxins such as alkaloids, glycosides, proteins, and amino acids. There are numerous examples of poisonous species present in different families, one of them Euphorbiaceae. Euphorbiaceae is one of the four largest cosmopolitan families of flowering plants with 313 genera and around 8100, species. Morphological, phytochemical properties and medical uses for 11 wild species of Euphorbiaceae growing in Saudi Arabia were collected in this paper. Two species (Euphorbia fractiflexa and Jatropha glauca) don’t have data for its chemical and medical properties and need a lot of study. For the species growing on the Saudi Arabia, all studied species need further study except for Euphorbia granulata and Ricinus communis.

Objective: Unsafe abortions among the various age groups of women due to unintended pregnancy and socio- economic constraints have a deleterious effect on their reproductive and mental health. Hence, review and modification of safe abortion practices are crucial, owing to the rampant availability of over-the-counter MTP kits and D&C by unskilled professionals resulting in Maternal Mortality and Morbidity. This study provides an estimate of the outcomes of unsafe abortions. Methods: WHO [1] defines unsafe abortion as the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. The present study is a cross-sectional descriptive analysis of outcomes of unsafe abortions at a tertiary care center, GGH Kadapa. The study data includes all the women admitted to the emergency obstetric unit and treated for unsafe abortions between January 2019 to June 2020. Age group of the selected population is between 15-45. The sample included 342 cases of recent induced abortions. The primary outcome of the study is to emphasise the burden, causes, setting and the morbidity of unsafe abortions. Results: Total number of deliveries that occurred between Jan 2019 to June 2020 is 13787 and the total number of induced abortions during this period was 342. Out of which, 211(61.7%) were unsafe abortions. Among them, 53 women (25.11%) presented with shock. 89 women (42.1%) needed blood transfusions. 8 (3.79%) women went into DIC. One woman had a uterine rupture, and underwent uterine rent repair. Four women had uterine perforation with associated bowel injury. Bowel repair was done in 1 case, and a colostomy was required in 3 cases. Emergency laparotomy was performed in these 5 cases. Conclusion: Unsafe abortions are one of the leading causes of maternal mortality and morbidity in a developing country like India. This is mainly attributed to socio-economic constraints, poor awareness of contraception, and cultural beliefs against sterilization forcing the pregnant women to indulge in unsafe abortion practices. Creating contraception awareness in reproductive age group, strict laws against unsafe abortion practices are to be implemented to reduce the maternal morbidity and mortality due to unsafe abortions.

The formation of the Libyan Stock Market (LSM) has been greatly affected by instability in the country. The stock market has been active, inactive, active and inactive since its inception in 2006. On the other end, there has been a growing concern and existence of constant pressure to activate the stock market for the benefit of the economy. The factional disagreements and a weak security environment that persist pose heavy challenges for developing and re-activating the stock market. The economic outlook for Libya remains uncertain. It remains difficult to forecast economic outcomes with any degree of confidence because of high uncertainty linked to political and security developments. The times when the stock market was active, significant contribution was brought to the economy, and such has been confirmed by many stakeholders. If re-activated the LSM is expected to play vital role in capital supply for investment, which in turn drive economic development in Libya. For effective contribution, LSM should be established on strong and stable foundations.

Milk is an excellent source of proteins, fats and carbohydrates along with minerals and vitamins. It is the balanced diet for all age groups. In Pakistan consumption of milk is increasing day by day. Milk from different animal sources has quality and nutritional differences. Pasteurization found to be increased the milk quality and shelf-life stability by reducing microbial load. The objective of study is to evaluate the differences among the raw and pasteurized milk in terms of safety and microbial distribution. The proximate and quality analysis including moisture, crude protein, crude fat, total soluble solid, pH, acidity, lactose composition, solid-not-fat (SNF) and specific gravity were done for the milk samples. The microbial tests were performed for Total Plate Count and Total Coliform Count before and after pasteurization process. The collected data was analysed statistically to estimate the level of significance. Pasteurized milk of buffalo showed high value for pH 6.65, lactose composition 5.964, crude fat 7.974%, crude protein 6.453%, SNF 6.672%, Total solids 12.646% while pasteurized cow milk showed low value as compare to buffalo milk samples as pH 6.60, lactose composition 4.732, crude fat 4.744%, crude protein 4.353%, SNF 6.128%, Total solids 10.872%. Total Coliform count (TCC) for raw and pasteurized milk of cow was 3.320 CFU/ml and 1.2600 CFU/ml respectively, whereas for buffaloes it was 2.604 CFU/ml and 1.0900 CFU/ml respectively. In case of TPC it was 2.834CFU/ml and 1.132 CFU/ml for raw to pasteurized milk of cow while it was 2.0320 CFU/ml and 1.0720 CFU/ml in buffaloes. Result revealed that pasteurized milk is safer to use and pasteurized milk has low microbial count as well as authenticity in safety and quality when compared with unpasteurized milk.

Background: Palliative external beam radiotherapy (PRT) had been reported as an indispensable tool for an effective pain relief in cancer patients with metastatic bone pain. Although many scholars reported a link between pain perception and ethnic background of an individual, but its role in cancer patients with interplay of other tumour factors needs to be evaluated to ascertain the actual impact it may have on pain perception and responses to radiation analgesia. Methods: We retrospectively reviewed patient’s data of breast cancer with metastatic bone pain between 2015 and 2018. Patient’s demographic factors like age, sex, ethnic group, tumour histology, RBS grade and sites of metastasis were extracted and grouped accordingly. Other Radiotherapy doses used for palliation of pain were extracted. Visual analogue pain assessment scale (0-10) was used by doctors (majority from Hausa-Fulani ethnic origin) to asses’ pain at presentation and four weeks post-irradiation. SPSS version 23 was used for data analyses; univeriate and multivariate analyses were conducted to test for any significant associations between predictive factors and dependent variables. Results were presented in pie-charts, bar-charts and tables. Results: A total of 161 patients reviewed during the study period, 159 (99%) were females and 2(1%) were males with mean age of 45.2 years, the age groups of 20-29 yrs presented with highest pain score. Among the three major ethnic groups, Yoruba constituted 31.7% with mean pain score of 7.5 ±1.4, followed by Igbo (26.1%) with mean pain score of 7.1 ±1.4. The commonest histology were invasive ductal (IDC) and invasive lobular (ILC) carcinoma with each having 7 as the highest mean pain score. Patients with grade 2 and 3 were the commonest and presented with mean pain score of 6.9±1.4 and 6.7±1.6 respectively. Patients with spinal cord compression (5.6%) presented with highest mean pain score of 7.3±1.3, followed by metastasis to long bones with pain score of 7.0±1.5. Pain alone was the highest presenting symptom (92.5%) from bone metastasis and Conventional X-ray was the common imaging modality used in confirmation of metastatic sites (68.3%). Common palliative radiation doses used were 11-20Gy in 4-6# (60%). Overall mean pain score at presentation was 6.8 ± 1.5 and 0.6 ± 0.7 four weeks after irradiation. In univariate analysis (binary comporason) only ethnicity was highly significant (p-0.001) in pain perception pre-radiotherapy and the significance exist after controlling other influential factors using multivariate analysis (p< 0.001). In post-irradiation using univariate analysis, ethnicity and metastatic sites shows significant association with pain relief, after multivariate analysis when influential factors were controlled, it appeared only metastatic sites with p-value of 0.008. Conclusion: Ethnicity of three major tribes in Nigeria played a role in pain perception from bone metastasis at presentation, with Yoruba higher pain perception compared to Hausa-Fulani and Igbo. But ethnicity appeared insignificant in response to radiation analgesia. Similarly, tumour factors appeared in significant in pain perception and response to radiation analgesia. However, metastatic sites influence response to radiation analgesia, with good pain relief in patients with metastasis to ribs and long bones.

Introduction: Insular carcinoma is a rare tumour with frequent tumour necrosis and micro follicles. Materials and Methods: Female patients with swelling in front of neck, USG and FNAC were carried out. FNAC showing follicular neoplasm were followed up with histopathology and 2 cases are presented here. Observation: Two female cases with swelling in front of neck with cytology depicting follicular neoplasm were studied. Discussion: Insular carcinoma of thyroid arises from follicular epithelium hence have abortive follicles with necrosis. Its prognosis lies between well and poorly differentiated thyroid carcinoma. Conclusion: It is necessary to recognize the tumour for better prognosis.

Background: Stabilization of weather factors especially temperature, pressure and humidity in bunkers that housed the Linear accelerators is necessary for safety of equipment and their efficient function for our patients. Daily variation of such factors can lessen the performance of Linear accelerators resulting to an error in their output and wrong dosimetry. Sokoto centre being located in the North-Western region of Nigeria with three unique seasons (Dry hot, Harmattan winter and Wet raining seasons) require a study of this kind to ascertain the influence of those harsh environmental factors on bunker's internal air condition. Methods: Daily records of Linac bunker temperature and pressure were measured using Precision mercury-in-glass thermometer and Opus barometer (OPUS 10 THI) from January 2019 to December 2021. Similarly, the corresponding daily external environmental temperature and pressure for the study period were obtained from Nigerian Meteorological Agency. The values were grouped according to the months of year, mean values of temperature and pressure for each month of the year were generated and graphs and bar-charts were plotted for both bunker and external environment. Similarly, an overall mean score for both temperature and pressure of each month of the three years period were generated and graphs were plotted with those values for bunker and external environment. Results: The overall mean external temperature for the study period was 35.7°C, ± 3.82 as standard deviation (SD) and with a range of 26.0 – 43.6 °C, while for the overall mean bunker temperature it was 27.1°C ±1.7 SD and a range of 23.1 - 31°C. For the external environmental pressure, the overall mean value was 78.1hpa ± 1.5 as SD and a range of 68.1– 83.1hpa, while for the bunker it was 977.2 hpa ± 2.55 as SD and a range of 966.9 – 988.7 hpa. Using the pearsons correlation, it indicate that there is a significant association between environmental and bunker temperature (p-value=0.002). Conclusion: External environmental temperature showed a significant influence on bunker temperature despite the presence of chillers. But for environmental and bunker pressure, the relationship is complex and non-significant. Similarly, the seasons of the year also influenced bunker temperature.

Background: Many advanced radiotherapy techniques had been employed in breast cancer teletherapy, purposely to significantly reduce dose to organs at risk (heart and lungs) with marginal or no compromise in planning target volume (PTV). Majority of used techniques yielded rewarding results in developed countries where facilities, manpower and skills are available. In Nigeria, significant number of post mastectomy breast cancer patients received chest wall irradiation using manual hand planning, therefore, the dose distributions to target volume and organs at risk (OAR) were uncertain. Sokoto centre being the first in the country to use treatment planning system (TPS) focused on identifying planning skills (normalization points) with good 95% dose coverage to PTV, and minimizing dose to OAR. Methods: Eighteen post mastectomy patients (ten rights and eight lefts chest walls) were simulated via computed tomography scan (CT-scan) in supine position with breast board and fudicial markers to demarcate tumour bed borders. Planning target volume (PTV chest walls) and OAR were contoured from the acquired CT images and bi-tangential portals were applied. The energy used from Elekta précised Linac was 6 MV, and dose of 50Gy in 25# was prescribed to each patient. The Upper 1/3rd normalization point (UNP), Lower 1/3rd (LNP) and Inter-field (INP) were sequentially applied as dose normalization points on each planning CT image, dose to PTV and OAR were evaluated using Clarkson and pencil beam calculation algorithms. Statistical analysis was conducted using SPSS Software to study dose distributions of the normalization points. Results: Patients simulated were between the ages of 29-56yrs with mean age of 42yrs. The mean percentage doses from normalization points on left chest walls ranged between 81.7-107.7% to PTV, 13.3-17.8% to the lung and 5.5-6.8% to the heart, the reported hot spots were between 110.7 to 141.5%. Similarly, the mean doses from normalization points on the right chest walls ranged between 81.5-108.8% for PTV, 17.8-23.5% to the lung and 2.7-3.7% to the heart, with hot spots of 108.8-137.9%. The statistical differences using independent-t- test for the normalization points on both left and right chest walls shows p-value < 5%. Conclusion: The three normalization points influenced dose distribution to PTV and OAR differently. The UNP and LNP showed a desired dosimetry with marginal compromise in 95% PTV coverage compared to INP.

Background: The haematological changes are common in cirrhosis of liver the cause of which is multifactorial. It should be correlated by determining the underlying pathology accordingly. Objective: The objective of the study was to evaluate the pattern of change in Haematological indices in Cirrhosis of liver. Methods: This is a cross sectional prospective study conducted on purposely selected (non-probability) hospitalized patients admitted to Medicine, Gastroenterology and hepatology departments of Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 100 cases of cirrhosis were selected as per inclusion and exclusion criteria. After selection clinical history, meticulous physical examination and rational investigations were done. Data were collected as per a structured standard questionnaire and checklist. Data analysis was done using statistical software package SPSS 22.0 and was compared with other studies. Results: Anaemia was found in 81 cases out of 100 patients. Anaemia was morphologically normocytic in 46% patients which is the highest number in this study group. It was microcytic in 40% patients and macrocytic in 14%. Regarding Leukocyte count it was normal in 70(70%) patients, Leukopenia in 12(12%) and Leukocytosis in 18(18%) patients. Regarding platelet count it was normal in 46(46%), thrombocytopenia in 51(51%) but thrombocytosis in 3(3%) of cases. The average platelet count in thrombocytopenic patients was 90 X 1091 ± 23 X 109/L. Lastly, pancytopenia was present in 14(14%) patients. Among them, 10 patients (71%) had splenomegaly. Iron Profile was done in all patients of microcytic anaemia and it revealed 68% of them were iron deficiency anaemia. Prothrombin time was done in all patients and it was prolonged in 54 (54%) and its average value was 16.13±.2.9 seconds. Conclusion: Haematological changes are common in cirrhosis of liver, the cause of which is multifactorial. Iron deficiency anaemia is the common type (68%).Prolong prothrombin time (54%) and thrombocytopenia (51%) are the common features.