The stomach is one of the frequent sites of metastasis from invasive lobular carcinoma of the breast. The clinical presentation and the endoscopic findings for metastasis carcinoma are nonspecific and may mimic that of a primary gastric tumor. The distinction between these two neoplasms may be very difficult but essential as the basis of the treatment is different. Histological and immunohistochemical analyses are the gold standard for establishing the diagnosis of the primary site. We report the case of a 68-yearold patient with metastatic breast cancer mimicking a primary stomach cancer.

The research aimed at describing the legal protection concept geographical indication in supporting the economic right of geographical indication holders, the contribution of geographical indication in improving the prosperity of geographical indication holders, and the legal protection of the economic rights of geographical indication about the use of a sign that is similar to a registered geographical indication. This research encompasses the normative legal analysis and empirical research methods. The first problem statement used the normative legal research method, which analyses how the legal protection concept of geographical indication supports the economic rights of geographical indication holders. The empirical research method was used for the second problem statement, which analyses how registered geographical indication contributed to improving the prosperity of geographical indication holders and was also used for the third problem, which analyses the legal protection of the economic rights of geographical indication holders about the use of a sign that is similar a registered geographical indication. The research results indicate the following: (1) the legal protection concept of geographical indication that is integrated into the law of trademark and geographical indication has not supported the economic rights of geographical indication holders, either from the substance aspect or with regards to the stipulated legal sanction; (2) the economic rights of geographical indication holder relation to production monopoly right, sign use, and product marketing has not contributed to the improvement of their prosperity; (3) the legal protection of the economic rights of geographical indication holders about the use of a sign that is similar to a registered geographical indication is still weak, both in the private and public legal enforcement aspects.

Introduction: Breech is the commonest mal-presentation where increased perinatal and maternal mortality and morbidity are reported compared to cephalic presentation. This unwanted outcome can only be prevented by planned delivery methods. The aim of the study was to compare fetal outcomes in all delivery methods among the primiparous and multiparous women and thereby helping in preparing appropriate delivery protocol in breech presentation. Methods: This prospective study was done at the Department of Obstetrics & Gynecology of Rangpur Medical College with a total of 104 pregnancies. Appropriate cases of breech presentation were included and all necessary information was noted including predictive factors, management details, and outcome of the delivery. Result: Among the 104 participants of the study, 53 were primiparous pregnancy, and 51 were multiparous pregnancy cases. In total, 28 out of 104 had vaginal deliveries, and 76 had a delivery through cesarean section. The cesarean section had a much higher prevalence (81.13%) among primipara cases. 22 of the primipara and 20 of the multipara cases had planned for vaginal delivery, but successful vaginal delivery was observed to be 22.7% in primiparous women and 45% among multiparous women. The mean age was 24.58 years among the primiparous women and 28.9 years among the multiparous. A higher percentage of multiparous cases (80.4%) had no fetal complications compared to primiparous cases (71.7%). Among neonatal complications, birth traumas were significantly more frequent in the primiparous compared with multiparous. 43.4% of neonates needed admission from the primipara group compared with 33.3% in multipara. Among maternal complications, a higher percentage of multipara women suffered from different morbidities compared to primiparous, which was statistically significant as a whole. Conclusion: Proper planning of delivery methods is important to decrease both maternal and fetal morbidities and mortality irrespective of parity. Primiparous mothers with breech presentation are more prone to undergo cesarean deliveries and thereby develop postoperative complications. But multiparous mothers have more complications during the delivery process. Overall neonatal complications especially birth traumas are more common among the babies of primiparous mothers.

Background: Use of several anesthetic agents to induce anesthesia is not new and they are used to achieve different effects such as sedation, muscle relaxation and pain relief. Propofol has been accepted as an alternative to thiopentone for intravenous induction and is commonly used as an inducing agent and its action is more rapid. Objective: To compare co-induction with a small dose of ketamine is a better option compared to midazolam in reducing induction dose of propofol. Methods: This was a prospective, randomized, double-blind and interventional study conducted at Department of Anaesthesia, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh from January to December-2019. Fifty two adult patients undergoing elective surgery to be performed under general anesthesia were randomized to receive 0.3 mg/kg of Ketamine or 0.03 mg/ kg of Midazolam intravenously as co-induction agent. A minute after administration of co-induction agent, anesthesia was induced with Propofol 40 mg bolus then 10 mg every 10 seconds until the loss of verbal response. The hemodynamic response at 0, 1, 2, 5 minutes respectively and the induction dose of Propofol were noted. Results: A total of 52 patients (n=26 in each group) who met the inclusion criteria were included in this study. The patients where between age group of 20 years to 71 years and weight of 40 kg to 80 kg and had ASA physical status 1. As there were no significant differences in age, sex, weight and ASA physical status of patients, between the two groups, both of the groups were comparable. The mean arterial pressure heart rates were significantly lower at 1, 2 and 5 minutes in midazolam group. However, mean arterial pressure and heart were within the physiological range in both the groups. Propofol dose requirement for induction between the two groups was similar (p>0.05) but co-induction significantly decreased the induction dose of Propofol as compared to standard recommended dose for induction. Conclusion: Our study showed that hemodynamic variables were maintained within the physiological range with midazolam and ketamine co-induction. However, lesser degree of decrease in mean arterial pressure was seen with ketamine but the heart rate was higher. A similar reduction of induction dose of propofol was achieved with both the drugs.

Introduction: Fistulas are abnormal connection between two body parts that is not supposed to be there. Differenc types of fistulas can occur among both male and female, but obstetric fistulas are more common among women. Because of the physical, psychological, and social repercussions of urine leakage, people with Vesicovaginal Fistula become severely incapacitated. These fistulas are typically caused by hindered labor and trauma. The most prevalent kind of fistula is vesicovaginal fistula, which is a serious condition that can bring physical, emotional, and social issues for both the afflicted and their family. Fistulas are more common in underdeveloped nations. The study's goal was to look at the socio-demographic features of fistula patients in a specific area. Aim of the study: The aim of the study was to observe the social demographic characteristics of fistula patients of Rangpur region. Methods: This prospective descriptive study was conducted at the Department of Obs and Gynae, Rangpur Medical College Hospital, Rangpur, Bangladesh. The study duration was 2 years, from September 2006 to September 2008. A total of 50 patients were selected for the present study following the inclusion and exclusion criteria. Result: 60% of the patients were between the age of 21-30 years, and 38% were between 31-40 years. 62% of the precent study participants had low socio-economic status. 72% of the women were of smaller stature (≤145 cm). 84% of the patients had vesicovaginal fistula, 12% had mixed type of fistulas. 24% had associated complications. Successful outcome was observed in 84% of cases. Conclusion: The study showed that obstetric fistula is more common among the women of lower social economic class with low availability of medical facilities. Women of small stature are at higher risk of fistulas, and among the different types of fistulas, vesicovaginal fistulas are the most common.

In recent years, Twak Vikar (Dermatological manifestations) are common and more so frequent in the elder age. There is a definite increase in its incidence especially, in the tropical region and developing countries like India due to various reasons like unhygienic environmental conditions, poverty, poor sanitation, illiteracy, malnutrition, improper skin care etc. The patients of skin disease are additionally prone to experience physical, emotional & socio-economic embarrassment in the society due to disfigured appearance. Dadru is one of the commonly occurring skin diseases which can be defined as an entity manifested by intractable itching, scaling, erythema with the lesions discoid in shape. Dadru, is a Kapha (Energy that forms the body’s structure) Pitta (Body’s metabolic system) Pradhan (prominent) Vyadhi (Disease). Acharya Charak has placed Dadru under Kshudra Kushth (Minor skin disease) but Acharya Sushrut and Acharya Vagbhata kept it under Mahakushth (Major skin disease). Acharyas did not explained separate Nidan (causative and diagnostic factor) for Dadru Kushth. The knowledge of Nidan is helpful for proper Diagnosis, prevention and treatment of disease.

Background: Partograph is a simple, of low cost but most important tool for record of progress of labour In the developing country like ours, where both pregnancy and maternal mortality rate is so high, the use of this inexpensive partograph is essential. Objective: To assess the importance of partographic control of labour in preventing prolongs labour and its consequences, thereby decreasing maternal morbidity and mortality and improvement of neonatal outcome. Method: This study was done in the Obstetrics and Gynaecology department of Institute of Child and Mother Health, Matuail, Dhaka. Total 196 patients were included in this study. Data were collected by predesigned data collection sheet. Data were analyzed by using Statistical Package for Social Science (SPSS) version 14. Result: 74% of these patients had spontaneous vaginal delivery, 7.14% required assisted delivery (forceps or ventouse) and 18.9% needed caesarean section. Caesarean section was done in 18.9% patients because of fetal distress (32.4%) and prolonged labour (67.6%) due to malrotation and cephalopelvic disproportion. Patients with non-engaged head in labour required more intervention than who had engaged head. With the use of partograph, unnecessary interventions were reduced. It was found that 66.7% of the patients were delivered within 7 hours and all patients were delivered within 10 hours from active phase of labour. Thus prolonged labour and its consequences, such as obstructed labour and ruptured uterus, can be avoided by using partograph. In 100% of the patients, crossing the action line in partograph required interference, but 92.5% within alert line of partograph delivered vaginally spontaneously and 7.5% required assisted delivery (forceps or ventouse). When IDR was 1 cm/hr 85.1% women delivered spontaneously. When IDR was <0.4 cm/hr, 100% of patients required some kind of interference. Thus, the maintenance of partograph in labour enables the obstetricians to recognize very early dystocic labour and act accordingly. Conclusion: With the help of a partogram, time of delivery can be estimated and if the progress is slow, an appropriate interference at the right time can be instituted before the labour becomes dangerously protracted. IDR very helpful in making early decisions about the prognosis for the type of labour. With the use of partogram and its scientific application, the result showed that operative interventions were reduced, duration of labour was within normal limit and there was no obstructed labour and no maternal or perinatal mortality.

Anti-neoplastic drugs are known to have teratogenic effects on the fetus. In this case report we are presenting a case of a patient who got operated for breast carcinoma, conceived while on chemotherapy and underwent termination of pregnancy in the second trimester. Fetal haemorrhage and ecchymosis lead to further evaluation of the case, which revealed fetal thrombocytopenia, a rare teratogenic effect of the anti-neoplastic drugs.

Background: Acinetobacter species has emerged as an important pathogen globally in various infections especially in hospital acquired infections. Objectives: This study was conducted to determine the antibiotic resistance pattern of Acinetobacter species from wound swab samples. Materials and Methods: A Cross sectional study was undertaken in Department of Microbiology, Rajshahi Medical College (RMC), Rajshahi, Bangladesh from period January 2014 to December 2014. A total 13 Acinetobacter were collected from 292 wound infection patients of surgery word and its allied brances in Rajshahi medical college hospital (RMCH). Isolation, Identification and sensitivity of Acinetobacter species were performed by manual method. Results: Out of 292 patients 13(4.4%) patients showed growth of Acinetobacter species. Resistance observed to Meropenem was 38.46%, Piperacillin -Tazobactum 61.53%, Amikacin 53.84%, Ceftazidime 76.92%, Gentamicin 61.53% and Levoflaxacin 67.23%. This data suggest that Acinetobacter isolated from hospital exhibits resistanace to multiple antimicrobial drugs. Conclusion: The study will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns of Acinetobacter species in our region.

Article 88 of Law Number 19 of 2003 jo. SOE Minister Regulation Number PER-02/MBU/7/2017 stipulates that BUMN companies (State Owned Enterprises) are required to implement PKBL (Partnership and Community Development Programs). The obligation to implement PKBL is basically intended to be able to contribute in the effort to empower micro and small businesses in Indonesia. This study discusses the effectiveness of the implementation of PKBL at PT Jasa Raharja (Persero) Lampung Branch and the obstacles faced in implementing PKBL in an effort to empower micro and small businesses in Lampung. This research is an empirical normative legal research with a descriptive type of research as well as an applied normative approach (applied law approach). The results of the study indicate that in the context of empowering micro and small businesses, PT Jasa Raharja (Persero) Lampung Branch has implemented a Partnership Program (PK) which is distributed in 2 (two) forms, namely loans to finance business capital and guidance to fostered partners. Meanwhile, the Community Development Program (PBL) has also been implemented and distributed in 3 (three) forms, namely in the fields of education and training, community social assistance, and worship facilities. In the implementation of PKBL, obstacles were found, namely the problem of refunding funds from several fostered partners that were not smooth. Another obstacle is the distance between the place of business or the location of the program which is quite far from the office of PT Jasa Raharja (Persero) Lampung Branch so that it results in not being able to optimally carry out field surveys or provide guidance to each fostered partner or to all fostered partners.

Background: Abortion is defined as the loss or termination of a pregnancy before 20 weeks of gestation or when the fetus weighs less than 500 g. Induced abortion is defined as the use of medications or surgical intervention to stop pregnancy after implantation but before the embryo or fetus has become independently viable. The purposeful termination of a pregnancy, known as induced abortion, is one of the most common gynecological treatments. In this study, attempts have been made to show the clinical presentation, management, and outcome of patients. Aim of the study: The study aimed to assess the outcome of a patient after induced abortion. Methods: It was a prospective observational study. The study was conducted at the Department of obstetrics and gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during May-Oct'2007 from all induced abortion cases admitted in different maternity units, 80 cases are randomly selected for the study. Proper ethical consent was taken from the concerns. All necessary investigation was done, and necessary pieces of information were noted in a preformed data collection sheet. Finally, the results were analyzed and presented in different tables using a computer and the SPSS database. Result: In this study, it has been seen that around 45.5% of gynecology patients are of abortion, and the incidence of induced abortion was 16% among all gynecological admission. The majority of abortion cases (58.75%.) were conducted by untrained persons. Among the patients, 8.75% had adequate knowledge about MR, while 51.25% had unreliable or incorrect information regarding MR. 55% of cases had used contraceptives. A total of 76.25% of patients got admission within 1 month of their complications. Among all cases, 92.5% were improved while the death rate was 7.5%. Amongst 23 specimens of high vaginal swab culture 15 (65.22%) patients showed growth of Escherichia coli, 3 (13.5%) of staphylococcus, 3 (13.5%) of pseudomonas, 1 (4.34%) of protus, 1 (4.34%) of klebsiella. Conclusion: All this can be reduced by improving socioeconomic condition, educational status, popularizing family planning, and modernization of existing laws in relation to abortion.

General anesthesia (GA) is one of the pharmacological modalities used in the treatment of pediatric dental patients. This study aims to assess the rate and associated factors of repeated dental rehabilitation under general anesthesia in pediatric patients; The electronic health records of three- to 12-year-old children who received dental treatment under GA between 2015 and 2019 were identified and analyzed. Subjects were classified into cases with repeated dental treatment under GA within 5 years and controls who had dental GA once. Each case was matched to three controls based on gender and age. The collected data included the child's age at the first and second dental GA, gender, health status, Type, and the number of dental treatments provided. A total of 2376 patients had dental treatment under GA. Forty-five controls were matched to 15 cases in a 3:1 ratio. The prevalence of repeated dental GA over 5 years was 0.63%. The number of restorations, pulp therapies, and extractions showed no statically significant differences except for the number of crowns, which was higher in controls compared to cases (p=0.011). Treatment of patients under GA requires a more aggressive course of treatments compared to local anesthesia. Consequently, it is advisable to choose full-coverage crowns rather than composite or amalgam restorations.

Formalin is the most widely used preservative in anatomical embalming. It produces consistent results in terms of the prevention of autolysis and putrefaction at an affordable cost. It is a known carcinogen having several health hazards. Strict adherence to safety protocols is required to minimize its toxic effects. Regular monitoring of formaldehyde concentration in the dissection hall and embalming room will ensure remedial measures at the earliest. In the face of growing health concerns, several alternative preservatives are being studied. Apart from it, methods like cryopreservation, plastination can be used instead of embalming. Post-mortem toxicological analysis of formalin-fixed cadavers is of importance for forensic investigation. This article will review the overall advantages and disadvantages of formalin and its alternatives in the process of embalming and will guide the anatomists in choosing the proper options for the purpose.

Daily, seasonable and annual variation on precipitation should be carried out properly to enhance the better relaxation caused by damaging drain structure, hydraulic parameters and even climatic disorder. In order to incorporate all these needs and to enhance the existing research theories and even on developing new theories, this study will surely provide basic framework. The problems for the researcher as well as meteorological department for the further study of climatic change action and to provide basic knowledge to the farmer and agricultural department to yield seasonal wise crops without consideration of hydrological analysis (i.e. precipitation data) associates problems like flood risk and drought causing loss of lives and property. For the hydrological study, daily and monthly rainfall data was obtained from meteorological station from the year 1991-2020. The monthly and daily precipitation concentration were determined using Time series analysis, single mass curve analysis, coefficient of variation and spatial analysis and were represented using Histogram chart, Spreadsheet and GIS tool. With this, daily, monthly, seasonal wise variation on precipitation with respect to location wise (Spatial) as well as Time wise (Temporal) was obtained. The temporal characteristic shows that peak month of rainfall were July and August for all the regions. Considering Total Annual, the maximum value is at Beni Bazar i.e. more than 200000mm and least in the Ranipauwa i.e less than 10000mm. The mean annual rainfall of 30 years indicating that the Beni Bazar, Myagdi region has the highest rainfall and Ranipauwa, Mustang the least. Similarly, trend analysis shows that there are increasing (+ve), decreasing (-ve) and somewhat constant trends for the different stations. Furthermore, results from variability and reliability data shows that that Ranipauwa has the highest annual variability (138.86%) and Lumle has the least annual variability (15%) in which in turn implies that the rainfall at Lumle is more reliable than other areas. The computed Spatial and Temporal variation on rainfall has been developed as a basic tool for further research. It will also help farmers to know seasonal wise crops production as well as analysis of storm water for the construction of drainage system. These findings can be considered for monitoring extreme weather events like; erosion and floods. This would therefore contribute significantly to the effective management and sustainable development of the Gandaki Province and region having similar topographical features, which are rain dependent.

Ovarian vein thrombosis is a rare pathology, which can be encountered postpartum or postabortum. Its severity is linked to the risk of extension to the vena cava and therefore to the resulting risk of pulmonary embolism. Its diagnosis remains difficult due to the existence of misleading signs, but is currently facilitated by new imaging data: ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). The treatment is mainly medical, combining heparin therapy and antibiotic therapy, surgery being reserved for complicated forms. We report a case of postpartum ovarian thrombosis at the Suissi maternity hospital in Rabat in a woman with a sparkling picture of appendicitis.