Aim and Background of the study: Subfertility is an intricate health problem which is rising dramatically. Patient’s demographic factors along with pelvic pathology significantly important for uprising trend. The aim of this study was to evaluate the demographic and clinical characteristics of patients with infertility specially identifying the ovulatory disturbance, tubal factors, pelvic adhesion and endometriosis by Laparoscopy. Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh from May, 2007 to October 2007. The sample size was 100.Result: In this study, among 100 patients 68% had primary and 32% had secondary infertility. 55.9% were within 20 to 30 years age group and 44.1% above 30 years age in primary subfertility. 21.9% were within 20 to 30 years age group and 78.1% above 30 years age group in case secondary subfertility. 58% patients were house wife. 42% of patients were service holder they were teacher and other professional personnel. In this study majority (77%) of patients are from upper-middle class and middle class family. Out of all patients of primary infertility 58.8% had regular, 44.2% had irregular cycle 30% had scanty, 20% had menorrhagia and 29.4% had dysmenorrhea. Within secondary infertility group 87.5% had regular, 12.5% had irregular cycle 25% had scanty, 21.4% had menorrhagia and 75% had dysmenorrhea. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4%right & 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right & 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases. In this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder. In this study, Pouch of Douglas was normal in 77% cases, 7% had endometriotic deposits 16% had adhesion and obliteration of Pouch of Douglas. In this study 74% of patient had normal size of uterus, 3% had uterus smaller than normal size and 23% had bulky uterus. 83% patient had freely mobile uterus and rest had restricted mobility. Conclusion: From analyzing the findings, we recommend that awareness developing program about the factors affecting infertility should be taken. Laparoscopy is more convenient, conclusive & more precise for diagnosing the cause of subfertility. Early diagnosis and treatment should be encouraged among couple.

Senegal has been plunged in resolving the health crisis of the COVID-19 pandemic since its appearance in March 2019 on Senegalese territory. All useful means such as communication are pointed up to cut the line of contagion of the virus. In this communication fight against the COVID-19 pandemic, we noted the presence and use of concepts, slogans and / or “sloganized” expressions of which understanding of their communicative values requires an operation of interpretation and decoding. The perception of the informative content of such speech acts is based on their context of use by the communicating subjects. In the pragmatic theory of language where the communicational approach is based on fundamental notions: the implied and the presupposed, the interpretation of the communicative value is done through a set of values, common to the communicating subjects, which guarantees the intercomprehension of messages. This article aims, from a pragmatic and enunciative angle, to enumerate the slogans and concepts created in the management of the pandemic and then to identify their new semantic particularities, and to decipher their preventive implicit content in the communication of the fight against COVID-19. Particularities that are similar to calls for awareness on the existence and seriousness of the disease.

Scholars carrying heavy backpacks incur misaligned vertebral posture and neuro-musculoskeletal discomfort and pain. This report intends to determine whether there is a compensatory inverse relationship between standing anterior pelvic tilt (SAPT) and craniovertebral angles (CVA) when heavy backpacks are carried. A male pubescent carried a backpack weighing 6.2kg (17.3% of his body mass) over both shoulders resting against his vertebral column. The pubescent CVA, SAPT, standing vertex height (SVH) was measure during unloaded, and three loaded phases. Each loaded phase approximately increased from 10%, 20% and 30% of the pubescent’s relative body mass. The incremental backpack masses reduced the SVH and increased the SAPT, while simultaneously reducing CVA. There was a positive relationship between increased backpack mass and SAPT (r=+0.9). Craniovertebral angle inversely attenuated in response to the heavy backpack loads (r=-0.9). These findings indicate that there is an inverse compensatory relationship between SAPT and CVA when carrying heavy backpacks.

Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) is a chronic, life taking and helpless condition that arouses due to compromised functioning of a person’s immune system. According to National Health Policy-2015 growth of HIV/AIDS should have been controlled by the year 2007 but we have failed drastically in achieving it. Corona Virus Disease (COVID-19) has added to the burden of it. In an attempt to prevent and control COVID-19 the whole of globe stopped functioning and even the health care services related to people living with HIV/AIDS came to a stalemate. Its an attempt through this article to summarise the risk and precaution to be taken by people living with HIV/AIDS during pandemic.

Partial Androgen Insensitivity Syndrome (PAIS), a 46XY disorder of sexual differentiation where there is partial loss of function of androgen receptors (AR). The spectrum of clinical presentation can vary in adult from phenotypic female with mild virilization to under virilized male with or without genital ambiguity. Case description: A 25 years old woman presents with primary amenorrhea, ambiguous genitalia and features of mild virilization like hirsutism and voice change. After admission in Reproductive Endocrinology and Infertility Department of Bangabandhu Sheikh Mujib Medical University, she underwent genitoplasty, vestibuloplasty and bilateral gonadectomy. Histopathology of the atrophic testes revealed Sertoli cell tumor. Conclusion: Partial Androgen Insensitivity Syndrome (PAIS) is presented clinically as ambiguous genitalia, as predominant female to male phenotype with varying degree of virilization. Multidisciplinary approach of management aims at appropriate sex assignment, reconstructive surgery, gonadectomy to prevent tumor genesis and hormone replacement therapy.

The World Health Organization (WHO) is a agency which works for international public health. It is headquartered in Geneva, Switzerland, with six semi-autonomous regional offices and 150 field offices worldwide. The WHO has prio role in several public health achievements, most notably the eradication of smallpox, the near-eradication of polio, and the development of an Ebola vaccine. The WHO generated an Incident Management Support Team on 1 January 2020, one day after Chinese health authorities identified the organization of a cluster of pneumonia cases of unknown etiology. Many countries are affected because of COVID-19 breakthrough and fighting with available resources. WHO has aligned branch OpenWHO which is interactive, web-based, knowledge-transfer platform offering online courses to improve the response to health emergencies. OpenWHO has created online courses to educate healthcares. So they more than thirty courses to learn and understand COVID 19 all aspects. These courses are online and we have to invest some time to learn via many videos and presentations. We can complete courses from minimum 1 hour to 10 hours depend on which course we choose. They provides us certificate after completion of 85% course.

Background and aim: There are limited and confidante data about the effect of antiepileptic drugs in liver function. The aim of this study is to assess of carbamazepine, sodium valproate and phenytoin on plasma liver enzymes in epileptic Sudanese patients. Methods: This is an analytical case control study, conducted at National Center for Neurological Diseases and Sciences, Omdurman, Bahri and Academic Teaching Hospitals. A total of 64 epileptic patients were categorized into two groups, group I epileptic patients on antiepileptic drugs for more than one years and group II newly diagnosed epileptic patients and not started antiepileptic drugs. Analysis of AST, ALT, ALP activate and TP, Alb concentration was done by full automated machine. Results: The study showed that among group (I) there was significant increase in mean serum concentration AST 41.4±33.7, ALT 24.8±12.65 with (p-value 0.975 and 0.016) respectively, compared with mean values of control (II) who reported AST 41.2±20.5, ALT 16.8±9.66. There was significant decrease in mean plasma concentration of ALP (62.4±39.9) in Group (I) compared with mean values in group (II) (76.1±32.5) (p-value 0.137). Significant decrease in mean plasma albumin concentration 3.89±1.01 in group (I) in contrast to group (2) 4.55±1.05 (p-value 0.014). No significant change in total protein 7.36±1.08, total bilirubin 0.91±0.84, direct bilirubin 0.17±0.09, between the two groups (T.B0.63±0.49), (D.B0.18±0.12). Conclusion: The study revealed that antiepileptic drugs had significant effects in increasing liver enzymes and this necessitate continuous screening of liver function and do of drug monitoring test among epileptic patients to overcome the adverse effects of these drugs on liver.

Background: Infection with high-risk genotypes of Human papillomaviruses (HPV) is the major factor in the pathogenesis of cervical cancer. HPV genotypes 16,18,31,45 causes 90 % of cervical cancer and these high-risk HPV genotypes cause nearly 100% of invasive cervical cancer. Cervical cancer can be prevented by vaccination against HPV high-risk genotypes. Effective cancer treatment programmes can improve survival rates for cervical cancer. Materials and Method: This study was aimed to evaluate the prevalence of HPV high-risk genotypes, so that high-risk individuals could be targeted, and specific genotypes associated with cervical cancer to be included in the vaccine preparations. Symptomatic patients visiting Gynaecology OPD of tertiary care hospital in India were recruited and Conventional PCR assay was done for detection of High-Risk genotypes of HPV causing cervical cancer. Statistical Analysis was done with PASW 18.0 (Predictive Analysis Software) by statistician. P value obtained by Chi Square test and p<0.05 was considered significant. Results: Out of the 72 symptomatic cases PCR was positive in 17 patients (23.6 %). In asymptomatic cases PCR positivity was 10.7%. Out of the100 patient’s PCR was positive in 20% of the cases. Among the symptomatic PCR was positive in 17 cases. HPV -16 (9.7 %) was the most common genotype among them. Infection with multiple genotypes 16 and 18 was positive in 6 cases (8.3 %), HPV -31 &45 was positive in 2 cases (2.8 %.) HPV -18 was positive in 2 cases (2.8 %) Among the asymptomatic HPV 16 in one case (3.5%), HPV-31 in one case (3.5 %), HPV -31&45 in one case (3.5 %). Conclusion: Our study results suggested inclusion of HPV 31 and 45 genotypes in HPV vaccine available and marketed in India.

Completion of county funded construction projects in Kitale town, Trans Nzoia County records dissatisfying views on the schedule performance of most of the projects. The study investigated how funding activities influence completion of county funded construction projects in Kitale town, Trans Nzoia County. This study is grounded on Goal-setting theory. The study adopted a descriptive survey research. The target population for this study comprised of 508; County Administrators and Project managers who are responsible for Bus Park, stadium and hospital construction and Beneficiaries of the projects and the sample size were 223 respondents. The study used a semi structured self-administered questionnaire to collect data from the managers in the housing and urban development. The study also used an interview guide to obtain responses from representatives in the Ministry of Land and Planning. The collected data were analyzed using both quantitative and qualitative data analysis methods. Quantitative method involved descriptive and inferential analysis. Descriptive analysis such as frequencies, percentages were used to present quantitative data in form of tables. Data from questionnaire were coded and logged in the computer using Statistical Package for Social Science (SPSS V 20.0). Content analysis were used for the qualitative data and then presented in prose. Quantitative data was analyzed using simple linear regression model to establish the relationship between the variables. The study findings based on funding activities objective showed that 87.36% (mean=4.37, Std. Dev=0.899) of the respondents accepted funding for the construction projects are delayed because most of the county budgetary allocated money are delayed from the national government, poor management of resources by the managers in charge, prioritizing salaries paid to workers and failing to give similar weight to the construction of projects and also, some contractors may lack enough money to facilitate the completion of the projects. Inferentially, funding activities attributed to (β=.227 p<0.036) on completion of county projects thus a unit increase in funding activities improved completion of the county funded construction projects by 22.7%. The study concluded that poor funding schemes delayed completion of construction projects. Project may be delayed or be unsuccessfully completed; when flow of funds to a project is not steady then there were on and off activities on site, resulting into contract delay. The study recommends to the members of the county assembly to pass proposed bills that are viable and fruitful to the development of the county. Project completion time should be checked to ensure efficiency.

Patient-Centered Medical Homes (PCMH) is a patient-centric healthcare model that puts the patient’s satisfaction and overall well-being in the first place. It establishes a strong connection between the patient, nursing staff, and provider with the Primary Care Physician (PCP) leading the task force. This is important as it helps carry out a wholesome diagnosis considering all abnormal bodily activities, rather than treating only a few symptoms that arise time by time. Coordination between the patient and the physician, alongside all correlated healthcare personnel, can significantly reduce costs in the long run while also preserving better fitness and mental health. The three most prominent purposes the PCMH model serves are: a. Improving the quality of healthcare services. b. Forming strong patient relationships. c. Reducing costs by expanding delivery and access options (American Academy of Actuaries, 2014) [1].

High quality, collaborative and patient-centered care is essential in the modern healthcare industry. The Hospital Value-Based Purchasing (VBP) Program is a CMS initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to people. It is expected for the on-deck years that VBC will be practical and effective and help provide the organizational incentive necessary to recognize a need for change in the way healthcare business is currently conducted. There are several healthcare settings, but not all provide patient-centric care facilities. The value-based care model invests many of its resources on the nursing staff, thereby creating a home-like ambiance for the patients. Nurses remain in direct communication with the patients at all times and monitor their health trends thoroughly. This develops a relationship of trust between the nursing staff and the patient. When nurses are welcoming and polite, the patients begin to feel that they are being cared for, which helps them recover faster.

Relationship marketing, service quality, customer satisfaction, and customer loyalty are very important in the banking world. With the relationship marketing and high quality service quality will achieve customer satisfaction and make customers loyal to the company. To improve customer satisfaction and customer loyalty must first be known whether the services provided in accordance with customer expectations, in this study variables are used to see the expected service of customers using variable relationship marketing and service quality. If the service provided is in accordance with expectations then the satisfaction felt and customer loyalty also increases. On the contrary, if the service provided is not in accordance with the hope then the satisfaction and customer loyalty also decreases. The purpose of this study was to determine the effect of relationship marketing and service quality on customer satisfaction and customer loyalty in the Mitra Bisnis Segment of Bank BTPN Kalimantan. The study was conducted using 100 respondents. The analytical tool used is SPSS Version 24. Data analysis was performed by path analysis. The results of the F test in the study obtained a significance level of 0.000 in model 1 and model 2. Where the value is smaller than the alpha level 0.05. The coefficient of determination (R2) shows that customer satisfaction is influenced by relationship marketing and service quality by 49.1%, and customer loyalty is influenced by relationship marketing, service quality and customer satisfaction by 68.6%. The results showed that relationship marketing has a positive and significant effect on customer satisfaction, service quality has a positive and insignificant effect on customer satisfaction, relationship marketing has a positive and significant effect on customer loyalty, service quality has a positive and significant effect on customer loyalty, customer satisfaction has a positive and significant effect significant towards customer loyalty, relationship marketing has a positive and significant effect on customer loyalty through customer satisfaction and service quality has a positive and insignificant effect on customer loyalty through customer satisfaction.

The study focused at the Constraints to effective Utilization of Information, Communication and Technology (CICT) in Technical Colleges in Rivers State. There are two purpose, research questions and hypotheses that guided the study. The study actually was carried out in Rivers State using a survey research design. The targeted population of the study was 1000 respondents which comprise 200 technical college teachers and 800 technical college students in Rivers State. A cluster sampling technique was used to divide the technical colleges into two clusters; the researcher further used random sampling technique to sample 50 technical college teachers and 200 students making the total sample of 250 respondents. A structured questionnaire was used to collect data for the study titled ‘Constraints to effective Utilization of ICT Facilities in Technical College Questionnaire (CEUICTFTCQ), and instrument was face validated by three experts, Cronbach Alpha was used for reliability coefficient to determine the internal consistency of the instruments to give a value of 0.81. Findings of the study revealed that ICT skills are required in Technical Colleges in Rivers State. It was recommended that (1) since ICT facilities are available for usage, skills should be acquired with as to make use of the facilities provided, (2) Teachers and students of Technical colleges should be competent in the use of the facilities fully as to enhance their teaching- learning situation.

This study aims to find and analyze what causes domestic violence (KDRT) in Indonesia which mainly directed at women who become victims and whether it is necessary to reconstruct the law based on Islamic justice values. This research is non-doctrinal legal research or socio-legal research law which uses a statute approach, a case approach, and a comparative approach where the research took place in Klaten and Sukoharjo religious court.The results showed that the religious courts in Klaten and Sukoharjo regarding domestic violence cases in the form of divorce and legal divorce were caused by problems of family neglect, thus the protection of the Domestic Violence Law cannot be in effect. Research in other countries shows high attention to victims of domestic violence with the protection of victims which when compared to Indonesia currently, The weakness of the PKDRT Prevention Law which is not yet fully pro-KDRT victims, especially women, needs to be reconstructed with the addition of articles on the provision of compensation in the form of compensation or restitution for victims of domestic violence. The author concludes that compensation and restitution are needed as an implementation of the values and benefit of Islamic justice as a form of legal protection for victims of domestic violence.

It is well known that nurses are the largest manpower in healthcare delivery system of any country. Though, they spend sleepless nights in caring and curing the sick one but continuously striving for professional honour and dignity what they actually deserve. Instead of getting recognition, respect and reward, this profession face exploitation, struggle for existence, discrimination, humiliation from their own persons and even from medical colleagues. There is a negative portrayal of this professional image as feminine, menial, subservient roles with low intellect, taken for granted and assistance of physician only. The term “Oppression” has been described for nurses who represent powerlessness, submissiveness and domination. Nurse leaders often talks about qualities of self-esteem, assertiveness, accountability, control over practice, self-advocacy and autonomy but in contrary nurses in below hierarchy reported higher levels of dominancy, lack of initiative and fear of retaliation. Negative consequences of oppression resultant decreased workforce performance, dissatisfaction, self-hatred behaviour, submissive aggressive syndrome, horizontal and lateral violence, workplace bullying and poor retention of nurses in the same workplace. Therefore, this article is aimed to pinpoint & bring insight on those major challenges faced by nurses due to oppression and propose remedial strategies to reshape and uplift this profession as a prestigious one.