Background: The use of epidural catheters provides the best quality intra- and post-operative pain relief for various major thoraco-abdominal and lower limb surgeries. The process of placing an epidural catheter into the epidural space between the vertebrae can be challenging due to variations in spinal anatomy of different level, narrow intervertebral spaces and can cause catastrophic neurological complications. Though various studies have been shown to overcome the placement of epidural catheter using standard ultrasound method, using the pre-existing computer tomography depth correlate with loss of resistance in placing the epidural catheter would be a well adjunct tool for the procedure. Objectives: To correlate measurements taken from pre-existing computed tomography (CT) imaging to the loss of resistance depth as recorded during epidural placement. Methods: This Single procedural observational study was performed in Combined Military Hospital (CMH), Dhaka from 1st December 2018 to 30th November 2019. Fifty adult patients scheduled for lower abdominal and lower limb surgery under epidural anaesthesia (EA). The patient’s advised/routine abdominal CT film was inspected by a radiologist, who was blinded to the results of the actual needle length, to determine the distance from the skin to the ligamentum flava the corresponding level of L2 to L5 interspinous spaces. The distance on the CT film in the midline was measured using a ruler against the measurement scale, conventionally represented as a 5 cm-10 cm scale with 1-cm divisions. The CT-derived depth was calculated using the principle of Pythagorean triangle trigonometry. Result: In this study, Sixty eight percentages of patients (68%) Epidural- skin distance (ESD) had 4.7-6.8cm. Mean Epidural-skin distance 5.8±1.7cm. On evaluation of Loss of Resistance Depth, 46% of patients had 5.2-7.3cm depth of LOR, followed by 30% patients had 3.0-5.1cm and 12% patients had 7.4-9.5cm. Mean loss of resistance depth was 6.3±1.4 cm. It was evident from this study that positive significant correlation (r=0.941; p=0.001) between the CT-derived distance and Loss of Resistance Depth. Conclusion: It is conclude that using pre-existing CT-scan derived distance is helpful in prediction of the epidural space depth and it is correlates with actual loss of resistance epidural needle insertion depth placing the catheter in lumber region.

Adherence to (or compliance with) a medication schedule refers to the extent to which individuals take drugs as advised by their medical professionals. Many medical practitioners prefer the term "adherence" over "compliance," as the latter suggests that the patient is merely following orders from their doctor passively and that the treatment regimen is not founded on a therapeutic alliance or partnership between the patient and the provider. Particularly for chronic illnesses, maintaining commitment to a therapy regimen is challenging, which frequently hinders patients from reaping the full advantages of therapies. Negative health effects include treatment failure, more frequent hospital admissions, drug resistance in some circumstances (for example, in HIV or antibiotic regimens), and higher use of healthcare resources as a result of poor adherence. Effective chronic disease self-management and successful health outcomes depend on medication adherence. HIV patients, asthmatic patients, and hypertensive patients can enhance their adherence with the use of DATs. Further analysis of both short- and long-term effectiveness if the costs of these systems will be covered by better results, fewer ER visits, and fewer inpatient stays.

The role of microfinance institutions in the economy cannot be over emphasized. It cannot be disputed that microfinance institutions give the needed support to increase productivity among the targeted groups. This research work is aimed at assessing the impact of microfinance schemes to meet the challenging needs of women in human resource development in the Sagnarigu Municipality. The study adopted a descriptive cross-sectional survey for this purpose and both simple random method (lottery or chance method) and purposive sample technique were used to achieve representativeness. Data sources in this study include primary and secondary data, and, questionnaire and interview guide were used to collect data from 55 respondents. The findings indicate that microfinance assists very poor families and communities with basic needs and protect households, communities and most especially women against risk and decision making. The study recommended that; the processing of the microfinance loans should be timely to enable women utilize the facility when it is most needed.

This study aimed to assess the level of knowledge of nurses about the safety of patients after performing a cardiac catheterization process. Merowe Medical City) from August 2021 to March 2022. The study included 35 randomly selected nurses. 13-question questionnaire was designed and the data was analyzed using statistical analysis (SPSS) and presented in graphic forms. The study showed that most of the nurses (45%) have good knowledge regarding cardiac catheterization, and (8%) have poor knowledge about complications and (11%) of the nurses has poor knowledge of the time required for the patient to remain in bed after the operation. (83%) have knowledge of the time required to remove the cardiac catheterization. The study recommended conducting workshops inside the hospital on the care of cardiac catheterization patients after the operation, and the hospital administration should hold continuous training courses so that the nurses can deal with the cardiac catheterization patient after the operation and provide the best health care.

Persistent Left Superior Vena Cava (PLSVC) is the most common congenital abnormality of the thoracic venous system, it is usually diagnosed as an unexpected finding during attempts to left-sided venous catheterisation for intracardiac lead placement which can make more challenging and time consuming. Patients with this congenital malformation are at increased risk of developing various cardiac arrhythmias. It affects approximately 0.5 - 2% of individuals with normal heart, and up to 10 % in the presence of an established congenital heart diseases. We present two different challenging cases of persistent left superior vena cava incidentally discovered during device implantation

This study investigated education law and safety/health management. Education law is very important not only to teachers but to all who are involved in the education and circular world. The roles of safety/health in Nigeria and the world at large toward quality service delivery are never to be debatable. Countries and continents over years are faced with challenges of how to enhance the health, safety and security of lives and properties and citizens in the society. The issue of management was also looked at, as it concerns safety and health. Importance of safety and health were also highlighted. Challenges to effective management of safety and health were enumerated in this study. Conclusion was made followed by suggestions which some of them are (1) the rudiments of education law and safety and health management should be taught in schools (2) education law and safety/health management should be taken to other health sectors other than schools.

Polycystic ovarian syndrome (PCOS) is a complex condition. In PCOS the metabolic and endocrine components are affected. The PCOS is an evolving condition and therefore has variable ultrasound presentations. Inappropriate gonadotrophin secretion causes ovarian dysfunction. Increased level of plasma testosterone is a common feature in PCOS. Women with PCOS have abnormalities in the metabolism of androgens and oestrogen. PCOS is a genetically heterogeneous syndrome. The abnormal menstruation patterns in PCOS is attributed to chronic anovulation. Women with PCOS should be assessed for their cardiovascular risk. The lifestyle modifications such as reducing the weight, increasing the exercise and restriction of carbohydrate intake consistently reduce the risk of diabetes. Medical management of PCOS is aimed at the treatment of metabolic derangements, anovulation, hirsutism and menstrual irregularity. The surgical management of PCOS is aimed mainly to improve ovulation. PCOS has many long-term complications. Therefore the patients need regular follow-up with their physicians for early detection and management of any untoward sequelae associated with the syndrome.

Background: Pregnant women are considered vulnerable to be infected with Covid-19 and it is feared that this will result in unfavorable conditions for the baby and mother. Pregnant women with Covid-19 require special attention and care, because the viral infection caused by Covid-19 does not only attack the mother, but also the baby and adversely affects the outcome of pregnancy. Objective: This study aims to provide an overview of the characteristics of pregnant women with Covid-19 and delivery outcomes at Abdul Moloek Hospital Bandar Lampung. Methods: Searching the medical records of pregnant women with confirmed COVID-19 who gave birth at the Kasih Ibu Hospital in Surakarta.data is presented in the form of a distribution based on gravida, parity, Covid-19 symptoms, degree of Covid-19 symptoms, and delivery outcomes. Results: A total of 104 pregnant women with confirmed Covid-19 delivery at Abdul Moloek Hospital Bandar Lampung. Respondents who gave birth had experienced pregnancy more than once and had given birth two to five times. Of all pregnant women, most experienced asymptomatic symptoms, and 11.5% mild symptoms, of which only 9.6% experienced severe symptoms. Outcome of labor was found not to have preterm delivery. Conclusion: Further research is needed on the transmission of Covid-19 from mother to fetus.

Pre-pregnancy mother's body mass index plays a role in increasing or decreasing maternal weight. Maternal body mass index is a prominent indicator for the nutritional status of pregnant women who can be at risk of increasing the occurrence of births with low birth weight babies. This study aims to analyze the relationship between pre-pregnancy body mass index and the occurrence of low birth weight babies at Abdul Moeloek General Hospital Bandar Lampung, Indonesia. This study uses an observational analytic research design with a cross sectional approach. The population in this study were all post-partum mothers who gave birth at the Abdul Moeloek Regional Hospital in Bandar Lampung and involved a sample of 79 respondents who were taken using the consecutive sampling technique. Sampling was carried out based on inclusion and exclusion criteria that met the research criteria until the desired number of samples was met. Analysis of the research data is the chi-square test and logistic regression test. The results showed that the two independent variables, namely the pre-pregnant mother's body mass index and weight gain during pregnancy, had a significant relationship to the baby's birth weight. The significance of body mass index is p-value=0.004 and the significance of weight gain during pregnancy is p-value=0.000. Thus the body mass index of pre-pregnant women and weight gain during pregnancy can affect low birth weight babies at Abdul Moeloek Hospital Bandar Lampung.

Background: Rhinosporidiosis refers to a granulomatous inflammation of mucocutaneous sites caused by Rhinosporidium Seeberi, presenting most frequently as polypoidal lesions in the nose and nasal cavity. Involvement of sites like the conjunctiva, trachea, nasopharynx, skin, and genitourinary tract are rare. Cases of nasal rhinosporidiosis with satellite skin nodules around head and neck region has been reported. Primary cutaneous involvement is however extremely rare [1]. We report the case of a 58 year old male who came with complaints of anterior chest wall swelling since 2 months with sudden increase in size. The patient was sent for FNAC with a clinical diagnosis of a soft tissue tumor. FNAC however revealed sporangia of varying sizes with endospores along with foreign body giant cell reaction. Histopathological examination confirmed the diagnosis. Cutaneous rhinosporidiosis may mimic a soft tissue tumor. FNAC being a minimally invasive and less expensive procedure gave a definitive diagnosis, and also aided to initiate prompt management of the condition.

Background: To contribute to a midwife's and nurse's career longevity, midwives and nurses working in today's dynamic, changing healthcare system need personal resilience, a strong sense of structural empowerment, and the necessary skills to respond to workplace challenges. The current study demonstrates the importance of the relationship between structural empowerment, resilience, and intent to stay. Method: A cross‐sectional, correlational design was utilized to achieve the aim of the current study. Result: The total sample size was 200 midwives and nurses. A Pearson's Product Moment correlation coefficient was used to predict the strength of the statistical relationship between the variables. There was a moderately strong relationship between structural empowerment and intent to stay; a low relationship between resilience and intent to stay and a moderately strong relationship between resilience and structural empowerment. Conclusion: The study concludes that structural empowerment, resilience, and intent to stay are variables related to midwives' and nurses' growth in the organization, which provided for further intervention plans by the Saudi ministry of health to assess the workplace environment to enhance midwives' and nurses' empowerment and resilience.

Aim: To evaluate the platelet indices in differentiating reactive and clonal thrombocytosis. Study Design: Observational study Place and Duration of Study: Department of Pathology, Saveetha Medical College, Chennai, and the duration of study is one year. Methods: This is an observational study conducted at our college for a one-year duration. A total of 100 patients with thrombocytosis of platelet count over 4.5 lakhs/mm3 will be included in the study. The study sample consists of cases with thrombocytosis of over 4.5 lakhs. The utility of platelet indices Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) for the differential diagnosis of thrombocytosis were analysed and assessed. Results: Out of the total 100 cases, 94 were reactive thrombocytosis, and 6 were confirmed to be clonal in origin. Infectious and reactive aetiology was significantly more compared to clonal thrombocytosis. Patients with reactive thrombocytosis showed a lower mean platelet volume and platelet distribution width compared to primary thrombocytosis. In reactive thrombocytosis, MPV ranged from 8.0 - 9.0 fl with mean MPV of 10.6 fl and PDW ranged from 8.4 – 10.1 % with mean PDW of 10.26 %. In clonal thrombocytosis, MPV ranged from 8.2 –1 1.1 fl with mean MPV of 9.5 fl and PDW range was 8.9 – 11.2 % with mean PDW of 10∙1%. Conclusions: The findings of our study favour a reactive cause in thrombocytosis when MPV and PDW are in the lower range and clonal causes had a high MPV and PDW in comparison to reactive causes.

Introduction: A relatively new type of ectopic pregnancy is cesarean scar pregnancy (CSP). This is related to the increasing number of cesarean deliveries and to the advances in imaging. There are 2 types of CSP; CSP with progression to cervicoisthmic space or uterine cavity (type I, endogenic type) or with deep invasion of scar defect with progression towards bladder and abdominal cavity (type II, exogenic type). The endogenic type of CSP could result in a viable pregnancy; yet with a high risk of bleeding at the placental site. The exogenic type could be complicated with uterine rupture and bleeding early in pregnancy. As early diagnosis and treatment is important for the best outcome, every pregnant woman with history of cesarean delivery should be screened early in the first trimester of pregnancy. Diagnosis can be achieved with ultrasound and Doppler imaging. To date there have been only 5 randomized studies on CSP and evidence based management remains unclear. Until then, treatment should be individualized according to many factors including clinical presentation, β-hCG levels, imaging features, and the surgeon’s skill. We report a case of cesarean scar pregnancy successfully managed in our university hospital center.

Introduction: The neutrophil-lymphocyte ratio (NLR) is an economically accessible tool useful in cases of Type II Diabetes Mellitus (T2DM). It can be utilized as a laboratory index, indicating systemic inflammation. The sensitivity of NLR to HbA1c must be validated to utilize for its prognostic potential. Correlation of HbA1c with NLR and other parameters have been analyzed to assess the utility of NLR in chronic cases of T2DM, thereby evaluating the utility of NLR as a marker of systemic inflammation in diabetes. Place and Duration of study: Department of Pathology, Saveetha Medical College, Chennai, One year. Objectives: 1. To compare levels of NLR and other parameters in diabetics with those of healthy people and observe the nature of correlation between HbA1c and other parameters.2. To find the linear relationship between HbA1c and other parameters in the diabetic population. Material and methods: An observational study conducted at our Institute from January to October 2020. Blood profiles of 240 T2DM patients and 100 healthy controls were recorded. Results: The NLR (5.35) of T2DM group was significantly elevated (p 0.001) compared to NLR of control group (2.16). Urea and creatinine levels had positive regression coefficients with HbA1c indicating susceptibility of diabetic patients to diabetic nephropathy. Conclusion: NLR showed significance in T2DM. Increased NLR is associated with elevated HbA1c and poor glycemic control in patients with T2DM. It can be used as a prognostic tool during the follow up of diabetic patients.

Collision tumors of the thyroid gland are a rare entity. Primary squamous cell carcinoma of the thyroid (PSCCT) is a malignant epithelial tumor, composed entirely of cells with squamous differentiation and accounting for less than 1% of all malignancies of the thyroid gland. PSCCT arises from other thyroid diseases such as Hashimoto’s thyroiditis, tall cell variant papillary carcinoma, follicular carcinoma, and anaplastic carcinoma1. We describe a patient with the combination of a well-differentiated squamous cell carcinoma and follicular carcinoma of the thyroid.