Background: Caesarean section is one of the common surgical interventions to save lives of the mothers and/or the newborns. However there is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. Due to a limited literature regarding this topic in the Indian scenario, the present study was done to assess the predisposing factors, indications of second stage caesarean section and its fetomaternal outcome. Material and Methods: In Present descriptive longitudinal study 211 patient’s undergone caesarean sections at full cervical dilatation were included as per inclusion and exclusion criteria. A pilot study was done for validation, practicality and applicability of questionnaire. Results: In present study most cases were in the age group of 26 to 30 years (38.38%). The most common indication for emergency second stage caesarean section was non-progression of labour followed by obstructed labour. Atopic PPH, hematuria was the commonest intraoperative complications while pyrexia, prolong catheterization was the predominant post-operative complications NICU admission needed for 16.11% babies due to birth asphyxia and respiratory distress. Conclusions: Caesarean section in the 2nd stage of labor is associated with maternal and neonatal morbidity and mortality. These factors needs to be anticipated to reduce mortality and morbidity associated with it. A proper judgment is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation.

The fact that blood groups can act as receptors/coreceptors for bacteria, viruses, and parasites demonstrates the importance of blood groups in infection. Blood group antigens also aid in cell adsorption, signal transmission, and/or membrane micro-domain retention. Furthermore, blood type can influence the innate immune response to infection. This data was compiled using the risk perception of blood transfusion scale, which is part of a larger risk perception questionnaire. Blood transfusion risk perception is measured on a 7-point Likert scale based on a set of qualitative characteristics; 119 participants in Hafr Al-Batin blood bank had a significant difference in risk perception of blood transfusion due to receiving blood, whereas those who had never received blood had no risk perception. as much risk perception of blood transfusion, and because of viral hepatitis infection, those who did not have viral hepatitis had more risk perception of blood transfusion, but there is no significant difference in risk perception of blood transfusion due to gender, age, educational level, and blood donation. The implementation of strict donor pre-screening and preventative measures to control infections in the general population, as well as the introduction of new, more sensitive screening tests, could significantly reduce transfusion-transmitted viral infections across eastern Saudi Arabia.

This paper analyzes the causes of the spiritual imbalance of the female characters Caddy, Mrs Compson and Dilsey in The Sound and the Fury from three aspects, namely ideological restriction, alienated existence and spiritual wasteland.

Introduction: Pregnancy is a physiological process. Preeclampsia is the commonest complication during pregnancy. This condition might severely affect the health of mothers and their newborns. Newborn of mothers with preeclampsia are more liable for intrauterine growth retardation and may be delivered prematurely. Aim of the Study: The aim of this study was to evaluate the platelet count and mean platelet volume in newborn of preeclamptic mother. Methods: This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. Total 60 newborns were included in this study. The subjects were divided into 2 groups. Group A (Study group): Thirty (30) newborns of preeclamptic mother and Group B (Control group): Thirty (30) newborns of healthy pregnant mother. The subjects were selected from Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. Five (5) ml. of cord blood was collected from each newborn after delivery and was analyzed for Platelet count and mean platelet volume. These parameters were estimated in the Department of Hematology, Dhaka Medical College Hospital, Dhaka. Data were collected in pre- designed structured questionnaire form by the researcher herself. For statistical analysis Unpaired Student’s “t” test, Chi Square test and Pearson’s correlation coefficient (r) test were performed as applicable using SPSS for windows version 16.0. p value <0.05 was accepted as level of significance. Results: The mean (± SD) platelet count was 164.77 ± 79.44 × 103/µl and 212.83 ± 54.04 ×103/µl in group A and B respectively. In this study, the mean (±SD) platelet count was lower in group A in comparison to that of group B which was statistically significant (p<0.001). The mean (± SD) platelet volume was 8.90±1.15 fl and 8.30±1.45 fl in group A and B respectively. In this study, the mean (±SD) platelet volume was higher in group A in comparison to that of group B which was not statistically significant. Maternal systolic blood pressure showed negative correlation (- 0.952) with platelet count of newborn in preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (- 0.960) with platelet count of newborn in preeclamptic mother, which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (-0.973) with mean platelet volume of newborn in preeclamptic mother, which was not statistically significant (p>0.05). Maternal diastolic blood pressure showed negative correlation (-0.964) with mean platelet volume of newborn in preeclamptic mother, which was not statistically significant (p>0.05). Conclusion: From the findings of the study, it can be concluded that the platelet count of newborn of preeclamptic mother was significantly lower in comparison to newborn of healthy pregnant mother but they were within normal range. This difference was significantly related to severity of maternal blood pressure. But there was no statistically significant difference in mean platelet volume between the groups. There was no statistically significant relation of mean platelet volume to maternal blood pressure.

Background: Although ticagrelor is more potent than clopidogrel, it is associated with higher risk of bleeding and dyspnea. Since elderly patients are at higher risk of bleeding there is a concern of whether they should be prescribed clopidogrel instead of ticagrelor and a shorter duration of DAPT or even a monotherapy antiplatelet. Additionally, guidelines recommend being cautious when prescribing ticagrelor to COPD and asthmatic patients, yet, it is unclear whether patients with respiratory conditions are at higher risk of dyspnea from ticagrelor. This scooping review is conducted to assess the safety and efficacy of ticagrelor versus clopidogrel in elderly ≥75 years and patients with respiratory conditions. Also, to investigate the most suitable antiplatelet duration for elderly patients ≥75 years. Method: EMBASE, MEDLINE, and Cochran library were systemically searched. Studies were included if they were published in English; included adult patients diagnosed with ACS; are ≥75 years old or diagnosed with respiratory disease (asthma, COPD); treated with DAPT including clopidogrel or ticagrelor or monotherapy antiplatelet; reported quantitative data regarding bleeding or dyspnea. Studies were excluded if they were published prior to 2006. Outcome of interest were cardiovascular events, bleeding, and dyspnea. Results: 13 articles met the inclusion criteria and were included: 5 RCTs, 1 non-RCT, and 7 subgroup analyses. Two studies compared the safety and efficacy of ticagrelor versus clopidogrel in COPD patients (one of the studies included asthmatic patients), 3 studies compared safety and efficacy of ticagrelor versus clopidogrel in elderly, and 8 studies compared the duration of DAPT in elderly. Conclusions: Available data suggests that COPD and asthmatic patients are not at higher risk of dyspnea from ticagrelor and might benefit more from ticagrelor since they are at higher risk of ischemic events, yet, it is associated with higher discontinuation rate. Additionally, there was no difference between clopidogrel and ticagrelor in elderly patients in regard to cardiovascular endpoint while clopidogrel might lower the risk of bleeding. Shorter duration of DAPT might also minimize the risk of bleeding in elderly. However, data regarding DAPT in elderly and respiratory disease patients is limited, and evidence regarding the most appropriate regimen remains inconclusive.

Introduction: The incidence of rheumatic fever is decreasing day by day in Bangladesh. Recent advances in the diagnosis and management of Rheumatic fever are demanding a review of the cause of Rheumatic fever. The illness may present itself in several ways, such as carditis, arthritis, chorea, subcutaneous nodules, and the recognizable erythema marginatum rash [2]. Aim of the Study: The aim of the study was to observe the rate of sore throat in patients with rheumatic fever. Methods: This retrospective study was carried out at the National Centre for control of Rheumatic fever and heart disease, Sher-c-Bangla Nagar, Dhaka. The study period was 11 months, starting from January 2019 to November 2019. The study was performed on recorded data of 300 patients with Rheumatic fever. Result: The present study showed that 30 (10%) patients out of 300 came with an acute sore throat, 216 (72%) patients with a history of sore throat, and 54 (18%) patients with no history of sore throat either acute or past. Rheumatic fever is undoubtedly a morbid one but can be prevented at its beginning by primary prophylactic measures. Conclusion: Rheumatic fever is a disease, which usually follows streptococcal infection of the throat. The study's underlying presumptions appear to overstate rather than understate the dangers of non-antibiotic sore throat treatment. Low socio-economic status, poverty, illiteracy; overcrowding, low levels of nutrition and non-immunization status were the predisposing factors in the causation of rheumatic fever.

Introduction: Preeclampsia is a hypertensive disorder during pregnancy which may severely impact the health of mothers and their newborns. The newborn of preeclamptic mother should be carefully monitored and managed for the purpose of reducing perinatal mortality and morbidity. Aim of the Study: The aim of this study was to evaluate the changes in cord blood total count of WBC and absolute neutrophil count in newborn of preeclamptic mother. Methods: This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. Total 60 newborns were included in this study. The subjects were divided into 2 groups. Group A (Study group): Thirty (30) newborns of preeclamptic mother and Group B (Control group): Thirty (30) newborns of healthy pregnant mother. The subjects were selected from Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. Five (5) ml. of cord blood from each newborn was collected in EDTA tube after delivery and haematological test for total WBC count and absolute neutrophil count was done. These parameters were estimated in the Department of Hematology, Dhaka Medical College Hospital, Dhaka. Data were collected in pre-designed structured questionnaire form by the researcher herself. For statistical analysis Unpaired Student’s “t” test, Chi Square test and Pearson’s correlation coefficient (r) test were performed as applicable using SPSS for windows version 16.0. p value <0.05 was accepted as level of significance. Results: In this study, the mean (±SD) maternal systolic blood pressure of the study group A and control group B were 173.00 ± 19.73 and 114.83 ± 11.72 mm Hg respectively. In this study, the mean (±SD) maternal systolic blood pressure was significantly (p<0.001) higher in group A in compared to group B. The mean (±SD) maternal diastolic blood pressure of the study group A and control group B were 108.33 ± 9.52 and 73.33 ± 9.07 mm Hg respectively. In this study, the mean (±SD) maternal diastolic pressure was significantly (p<0.001) higher in group A in comparison to that of group B. The mean (± SD) total count of WBC was 9.62 ± 1.86 × 103/µl and 17.38 ± 3.31 × 103/µl in group A and B respectively. In this study, the mean (±SD) total count of WBC was lower in group A in comparison to that of group B which was statistically significant (p<0.001). In this study, mean (±SD) Absolute Neutrophil Count (ANC) was 5.76±2.01 ×103/µl and 10.45±1.90 ×103/µl in group A and B respectively. In this study, the mean (±SD) absolute neutrophil count was lower in group A in comparison to that of group B which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (- 0.953) with total count of WBC in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (-0.957) with total WBC count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (- 0.951) with absolute neutrophil count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (-0.953) with absolute neutrophil count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Conclusion: The total WBC count and absolute neutrophil count in the cord blood of the newborn of preeclamptic mother were lower than those of healthy pregnant mother, but they were within the normal range, it can be inferred after studying the study's findings. These changes were significantly related to severity of maternal blood pressure.

When it comes to the provision of medical services, quality is crucial. It entails changing healthcare so that actions, not just words, reflect values. Additionally, there is a change from quantity to quality. The outcome of treatment is more crucial than how many patients a doctor sees in a day. The standard of care can be raised by being aware of numerous internal and external factors. Organizational leadership and management must comprehend these elements and incorporate them into the provision of services. This cross-sectional research seeks to determine the critical internal variables needed to raise the caliber and effectiveness of healthcare services provided by Hafr Al Batin hospital. It sought to learn the healthcare team's perspectives on internal factors and how to steer patients toward the best results. In favors of the patients, Hafr Al Batin hospital's healthcare team surveyed 66 respondents. Twenty-one respondents believe that the healthcare team needs more education to raise the standard of care provided in hospitals. The best way to improve medical performance, in the opinion of 38, is through communication skills, which 34 people believe can be learned by attending expert lectures. According to 25 respondents, raising salaries is the most crucial step that can be taken to improve the standard of healthcare services. While 63 respondents agree that healthcare services and equipment are equally important, 3 respondents disagree. Improvements must be made to internal organizational factors and healthcare service quality to achieve improved performance. by increasing the healthcare team's knowledge through lectures from knowledgeable members, improving communication and leadership skills, using more cutting-edge equipment, and paying higher salaries to inspire employees.

Introduction: Mullerian ducts are the primordial analogue of female genital tract. They differentiate to form the fallopian tubes, uterine body, cervix and upper part of the vagina. A wide variety of malformation occur when this system is disrupted. The range from uterine agenesis, duplication of uterus to minor cavity abnormalities. All these congenital anomalies have been implicated as a potential cause for impaired reproductive outcome. Our aim was to evaluate the association between different types of congenital anomaly and various reproductive outcome. Material & Methods: This cross sectional descriptive study was conducted at the Department of gynae and obstetrics in Dhaka Community Medical College and Hospital (DCMCH), Ad-din Women’s Medical College and Hospital and Gonoshasthaya Samaj Vittik Medical College and Hospital during the period of March 2012 to September 2022.The study subjects were women with uterine anomalies who were diagnosed during evaluation of causes for bad obstetric history, during infertility work up or incidental findings during antenatal investigations or during Carsarian section . Reproductive outcomes were observed in the form of infertility, miscarriage, preterm delivery, ectopic pregnancy, intra uterine growth retardation (IUGR) and post-partum haemorrhage (PPH). These were recorded in a standard research questionnaire. Data were analyzed regarding types of uterine anomalies and their reproductive performance. Results: During the study period total 84 patients were recruited with uterine anomalies. Regarding distributions of uterine anomalies in study subjects the most common uterine anomaly was bicornuate uterus (n-32,38%), followed by arcuate uterus (n-18,21%), septate uterus (n-16,19%), unicornuate uterus (n-12,14%), and uterine didelphys (n-6,7. 1%).Women with bicornuate uterus was associated with miscarriage (37.25%), term delivery (31.25%) and preterm delivery (25%). Therefore, bicornuate uterus was found more evident with miscarriage. Only two cases of ectopic pregnancy were observed in the study which was found with bicornuate uterus. And in arcuate uterus percentage of preterm delivery was 44.4%, term delivery 33.3%, miscarriage only 22.2%. Therefore, arcuate uterus was more associated with preterm delivery. In septate uterus miscarriage was maximum (37.5%) followed byl term and pre term delivery, 12.5% each We found 12 cases of unicornuateuterus, where pregnancy continued to term in 6(50%) cases,2 aborted and 4(33.3)were delivered before term. Infertility was more associated with canalization defect, 6 cases with septate and 2 with didelphys uterus. Among live births (preterm and term deliveries,) malpresentation (breech, transverse) was more common in bicornuate uterus (44%).PPh was found in 2 cases of didelphys and two of bicornuate uterus. One case of septate and one from bicornuate uterus were associated with IUGR. Conclusion: The study makes clear that congenital uterine anomaly is associated with poor reproductive outcome. The exact effect is dependent on the type of anomaly.

Introduction: Infertility affects approximately 10%-15% of reproductive-aged couples. Ovarian reserve describes the number of good-quality oocytes remaining within the ovaries. As a women ages, her ovarian reserve declines, principally due to apoptotic loss of primordial follicles. Serum AMH level is being considered a possible testing method for determining ovarian reserve. The aim of the study was to observe any association between serum Anti- Mullerian Hormone (AMH) level with patient age among subfertile patients. Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Infertility Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study duration was 14 months, from October 2011 to December 2012. The present study was conducted with 86 women of the reproductive age group with subfertility. Result: There was a gradual linear decline of AMH observed with an increment of age. The mean value of FSH and LH gradually increased in the higher age groups of 40-45 years than in the lower age group of 21-30 years. The mean BMI levels were almost similar in all age groups, and no remarkable difference could be discerned. The difference in AMH levels among the different age groups was statistically significant. a statistically significant negative correlation between age and serum AMH was observed, while a significant positive correlation was observed between FSH and age. Conclusion: As the age of a women advances, the AMH level decreases. The serum AMH is negatively correlated with age and serum FSH is positively correlated with age.

Introduction: Urinary tract infection (UTI) is the third most common infection during childhood and considered as an important risk factor for the development long-term complications. It was aimed to look into the demographic characteristics, clinical presentations, and antimicrobial resistance among children hospitalized for UTI. Methods: This cross-sectional observational study was conducted at the Inpatients Department of Uttara Adhunik Medical College and Hospital, Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019, during which period, a total of 90 children with urinary tract infection visiting the study place were included in the study, following the inclusion and exclusion criteria. Result: The age of the participants ranged from over 1 months to 5 years., with majority (55.56%) being between the age of 2-5 years. The male to female ratio was 1:1.73. Fever was the commonest presenting symptom in participants, with 87.78% prevalence, followed by vomiting in 80% of the participants. The commonest organism cultured in this study was E. coli (80%), followed by Klebsiella spp. (20%). Isolated pathogens were highly sensitive to Amikacin (100.0%), Meropenem (100.0%), Imipenem (97.0%) and Nitrofurantoin (90.9% - 100.0%), moderately sensitivity to third generation Cephalosporine and highly resistant to Ampicillin (75.0 - 78.8%), Amoxiclav (72.7% - 87.5%) and Cephalexin (81.1% - 87.5%). Conclusion: The proportion of urinary tract infection in females was higher than males. Most patients presented with more than one symptom but most commonly presented with fever. E. coli was the most common isolated bacteria in hospitalized children with a principal diagnosis of UTI. Most of the isolated pathogens were highly resistant to ampicillin, cotrimoxazole, and highly sensitivity to amikacin, nitrofurantoin and meropenem.

Background: Acne vulgaris is a common dermatological problem. Acne is most commonly found in adolescents, caused by increased androgens in both sexes. It is usually caused due to Propionibacterium acnes. Minocycline is a newly introduced drug in treating acne vulgaris. On the other hand, it is assumed that azithromycin having a long half-life like can be very effective with better compliance in treating acne vulgaris. But we have not enough research-based comparative data regarding this issue. Objective: The objective of this study was to compare the efficacy and safety of azithromycin pulse therapy with minocycline in treating acne vulgaris. Methods: This was a prospective, comparative study and was conducted in Department of Dermatology, Naogaon Medical College, Naogaon, Bangladesh, during the period from January 2021 to December 2021. In total 80 patients with moderate-to-moderately severe (Grade II and III), acne vulgaris were included in the study population. Patients were randomly assigned to two treatment groups of group A & group B respectively. In group A, there were 25 patients received 500 mg azithromycin once a day for 3 days per week as pulse therapy along with 0.05% topical tretinoin for 3 months whereas in group B, there were another 25 patients received 50 mg minocycline twice a day along with 0.05% topical tretinoin for 3 months. All data were processed, analyzed, and disseminated by SPSS version 23.0 and MS Office program. Results: In this study, group A (Azithromycin) between baseline and final score distribution we found a significant correlation (P=0.023). On the other hand, in group B we did not find any significant correlation (P=0.073). In analyzing the changes in severity score of acne from baseline to the final assessment of both groups we observed, in group A at baseline 15%, 38%, and 48% of participants had the score points 2, 3, and 4 respectively whereas in the final stage 63%, 30%, and 8% participants had the score point 1, 2 and 3 respectively. So, in group A between baseline and final score distribution, we found a significant correlation (P=0.023). On the other hand, in group B at baseline 10%, 40%, and 50% of participants had the scored points 2, 3, and 4 respectively whereas in the final stage 65%, 28%, and 8% of participants had the score point 1, 2 and 3 respectively. In group B between baseline and final score distribution we found P value 0.073. Conclusion: In this study, the efficacy of both azithromycin pulse therapy and minocycline was found satisfactory. But as per the findings regarding the safety profiles, we can conclude that minocycline is safer than azithromycin pulse therapy in treating acne vulgaris.

Every tooth in the dentition can show very unique root anatomy along with variation in the number of canals in each root. The failure rate of nonsurgical root canal treatment is higher in the mandibular premolars due to difficulties in finding accessory canals explained in numerous studies. Clinicians should be aware and keep abreast with the complete assessment of the anatomy and morphology of the root canal system for a favorable treatment outcome. This case report illustrates root canal treatment for a rare case of a C-shaped with four root canals in the mandibular second premolar identified under a microscope and cone-beam computer tomography (CBCT) scan. This incidence has never been reported in the literature so far.

The article reviews economic security as an important aspect of the country's economic development. The article analyzes one direction of economic security - energy security. Within the framework of energy security, the importance of setting up LNG terminals is discussed. The article explores the challenges facing European countries in the supply of energy resources and the opportunities for diversifying energy markets. In the above context, the possibilities and perspectives of arranging LNG terminals are discussed, which will help Europe to improve its energy independence and economic security.

Economies with more active stock markets develop faster over successive decades. Such development remains attainable even after adjusting for various other factors underlying economic growth. Sierra Leone is one country whose stock market is now more than a decade old but remains poorly active. The number of listings as well as participation in the stock market remains low and insignificant. The study made a light review of the development path of the stock market in an effort to identify the derailing issues and suggesting ways to resolve. Through the review, it was obtained that there exist combinations of factors hindering the growth of the stock market. Inadequate support from the government has been identified, the privatisation concept was never implemented to the expected level, nature of business in the economy being mainly family-oriented and single proprietors, low levels of awareness of the general populace to issues of stock exchanges, limited participation by foreign investors, and high levels of corruption all are impacting factors. Significant reforms have to be made in the regulatory environment. Privatisation journey should be pursued effectively to improve listing by large firms. Foreign participation in the stock market elevated to some significant levels. The economy should continue to address issues of corruption so as to minimise its impact to institutional development. Public awareness should be enhanced to improve stock market participation by natives. Policies that promote foreign direct investment should be implemented. Management of political climate remains crucial for investors to have confidence and trust in their investments thereby attracting more for further development. Policy makers should walk the talk and demonstrate highest levels of commitment.