In India, hyperthyroidism accounts for 5 per 10,000. The seriousness of thyroid disorders should not be underestimated as thyroid storm, thyrotoxicosis and myxedema coma can lead to death in a significant number of cases. In this study, 50 female patients of above 18-year-old were included in the study (Pre- and Post-menopausal), whereas patients who have undergone radioactive ablation and thyroidectomy were excluded. Blood samples were collected and thyroid tests like TSH, T3, T4 were performed by the method of chemiluminescence enzyme immunoassay. Complete Blood Count (CBC) is performed to check the values of Hb, RBC, WBC, Neutrophil, Basophil, Eosinophil, Platelet, Lymphocyte. Liver function tests like SGOT and SGPT were performed to find whether carbimazole induces any liver damage. Thyroid tests and CBC values were noted down at the time of diagnosis and during the course of treatment. Out of 50 hyperthyroidism patients, 2 patients (%) experienced Neutropenia and Agranulocytosis. According to a study done by Davies [6] Carbimazole shows rare adverse effects like neutropenia and agranulocytosis. In our study, 2 patients (6.8%) experienced neutropenia and agranulocytosis. They have symptoms like blisters in mouth and fever. When their CBC were done, it was found that their neutrophil count and WBC has reduced. When neutrophil count is reduced, body’s ability to fight off foreign body reduces and it ensures easy attack by micro-organism.

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.

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.

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.

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.

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.

Gastrointestinal duplications are rare congenital malformations that may vary greatly in presentation, size, location and symptoms. They can present as solid/cystic tumors, intussusception, perforation or bleeding. A high index of suspicion is needed in all such cases. Radiologic studies may not be enough for a diagnosis. We present a case of ileal duplication cyst in a 2 month old baby who presented with features of abdominal obstruction. Suspecting it to be an infected mesenteric cyst from radiological studies, surgical excision with anastomosis of the ileal segment was done. The histopathological examination of the resected specimen diagnosed it as an enteric duplication cyst.

The research analysis aims to determine whether technology and competition have an effect on the business development of SMEs in the Center for Integrated Business Services of the Cooperative for Micro, Small, and Medium Enterprises, North Sumatra. The data analysis technique used is the associative method with the help of the SPSS version 24.0 program. The population in this study were all UKM players who traded in the Center for Integrated Business Services of Cooperatives, Micro, Small and Medium Enterprises, North Sumatra, and a sample of 60 respondents. Primary data collection using a questionnaire. The results showed that technology partially had a positive and significant effect on the business development of SMEs in the Center for Integrated Business Services of Cooperatives for Micro, Small, and Medium Enterprises, North Sumatra. Partial competition does not have a positive and insignificant effect on the business development of SMEs in the Integrated Business Service Center for Cooperatives, Micro, Small, and Medium Enterprises, North Sumatra. Technology and competition simultaneously have a positive and significant effect on the business development of SMEs in the Integrated Business Service Center for Micro, Small, and Medium Enterprises, North Sumatra Cooperatives.

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.

The core function of deposit money banks today is purely the efficient management of their risks portfolio investments in order to maximize shareholders’ wealth, by guaranteeing safety, returns on depositors’ funds and confidence in the system. The study empirically investigated the effects financial risks on the performance of deposit money banks in Nigeria. More specifically, changes in financial performance were examined on the basis of the relative effect of credit risk, liquidity risk, market risk, operational risk and bank size. The study specifically focused on 18 deposit money banks listed on the floor of the Nigerian Stock Market for a period of 19 years both statistical and econometric techniques were applied in the analysis of the data used in the study. Panel data analysis technique was used in the estimation of the specified model. The fixed effects being the best performing effect in the relationships was adopted in the empirical analysis. The findings of this study revealed that the combined effects of financial risks do not influence banks’ performance negatively. More specifically, the results from the empirical analysis revealed that financial risk proxy by Credit risk does not have any significant relationship with financial performance of deposit money banks in Nigeria. Liquidity risk is a significant determinant of deposit money banks’ performance in Nigeria in the period under investigation. The effect of market risk, interest rate risk and Operational risk did not in any way affect bank performance significantly in Nigeria.