Background: Blood transfusion services play a vital role in the modern healthcare scenario, and blood and its components requirements widely outstrip the supplies therefore a stringent guidelines for transfusion, blood donations and utilization should be laid down and adhered. This study analyses the causes for discard of blood and its components. Materials and Methods: This was a retrospective study of various causes of discard of blood and blood components carried out in blood bank unit of a tertiary care hospital from the data collected from the blood donations by the voluntary donors from January 2014 to May 2017. Results: A total of 3442 blood bags were collected of which 3378 (98.14%) were from male donors and 64 (1.85%) were female donors. majority of the donors were in the age group of 21-30 years (55.37%). a total of 5453 blood /blood components were prepared of which 393 units of blood /blood components were discarded with an overall discard rate of 7.22%. discard rate for WB, PRC, FFP and platelets were 9.22%,4.12%,7.9% and 28% respectively. Conclusion: To prevent wastage of blood a proper coordination should be present between the clinicians and blood bank personnel. An updated software and automation, proper training of staff and a properly implemented blood transfusion policies would go a long way in reducing wastage of this vital body resource

Introduction: Acute appendicitis is the surgical emergency that occurs most often in pregnant women with a prevalence of 0.05 to 0.1%. It is a clinical entity that gives in to diagnostic problems. The treatment of appendicitis in pregnant women is surgical. The use of the laparoscopic route depends mainly on the age of pregnancy, the location of the appendix and the presence of complications. The prognosis is maternal and fetal and the mortality varies from 0.5 to 1.5%. Material and Methods: This is a retrospective study of 15 cases treated in the general surgery department B of the Rabta hospital from 2011 to 2018. Results: This is a series of 15 patients whose average age was 27 years with extremes of 20 and 39 years. Among our patients, 2 had a caesarean section median, 2 had a right subcostal for cholecystectomy, and one patient had a umbilical hernia plate replacement. The age of pregnancy was in the 2nd trimester in 8 patients. The duration of evolution of the symptomatology was on average 2 days. Pain in the right iliac fossa was present in 8 patients. A fever was observed in 2 patients. Vomiting was noted in 6 patients. A biological inflammatory syndrome was present in 7 patients. Abdominal ultrasonography, performed in 10 patients, made it possible to retain the diagnosis in 6 patients. Tocolysis was performed in all cases. The appendectomy was performed laparoscopically in 9 patients. Seven of them had a term less than 20 SA. The least advanced pregnancy was 8 SA and the most advanced 24 SA. The Mac Burney pathway was performed in 5 patients and one patient was operated on by median laparotomy. The appendix was inflammatory in 2 patients, phlegmonous in 5 patients, gangrenous in 4 patients and perforated in 4 patients including an appendiceal abscess in 3 cases and peritonitis in one case. Drainage was performed in 4 patients. The postoperative courses were marked by a wall abscess in 3 patients, Premature delivery for one and a spontaneous abortion for one. Conclusion: Acute appendicitis in pregnant women is a diagnostic problem mainly in the 2nd and 3rd trimesters of pregnancy. The laparoscopic approach has been described at any age of pregnancy, but it is far from being considered a gold standard for appendicitis in pregnant women; studies are underway to assess the long-term course of children whose mothers have had laparoscopic appendectomy.

Gastrointestinal lesions are the major group of specimens received in the surgical pathology department. This includes endoscopic biopsies from gastric and duodenal mucosa, appendicectomies, cholecystectomies and colonoscopy biopsies. This study was a retrospective analysis done between January 2015 and December 2017 which included 838 biopsies, both mucosal and resected specimens. These biopsies were fixed in 10% buffered formalin, routinely processed and paraffin embedded sections were taken and stained with Hematoxylin and Eosin. The stains were interpreted and statistical analysis of the data obtained was done. The most common specimen received was appendix which accounted for 49%, followed by cholecystectomies accounting to 38%, 5.5% biopsies from rectum and anal canal, 3%gastric mucosal biopsies, 3% biopsies from colon, 1% mucosal biopsies from small intestine, 0.5% mucosal biopsies from esophagus. In this study it was observed that appendix was the most common specimen received, followed by gall bladder. The most common tumor of esophagus was squamous cell carcinoma. The most common tumor of stomach was adenocarcinoma. Inflammatory lesions were more common in small intestine. Histopathological analysis of gastrointestinal lesions helps the clinicians for proper follow up and specific treatment. This study gives an overview of the various histopathological specimens received in the pathology department.

This study aims to comparative analyze performance ratio of PT. Permata Bank Tbk. The method used in this study is paired t test. The result are Performance of PT Bank Permata Tbk are had 8 data increasing are Minimum Capital Requirement (KPMM), Problematic productive assets and non-productive assets of total productive assets and non-earning, Problematic productive assets against total earning assets, Non-Performing Loan (NPL) net, Return on Assets (ROA), Net Interest Margin (NIM), Return on Equity (ROE) and Loan to Deposit Ratio (LDR ). Ratio Performance of bank are had 3 data decreasing are Reserve for impairment losses (CKPN) of financial assets to earning assets, Non-Performing Loan (NPL) gross and Operational Expenses on Operating Income and (BOPO) but there are not difference significant between Performance Ratio of Bank Permata in 2018 and Performance Ratio of Bank Permata in 2017.

Desmoplastic fibroma (DF) is considered as an extremely rare locally aggressive bone tumor with the clinical presentation of pain and swelling in the affected site most likely the metaphysic of long bones. Most of the times, a clinical confusion may occur due to the histological and biological similarity with extra abdominal desmoids tumor of soft tissue. In this case report, we define the clinico-pathological and radiographic features of DF of the mandible in a 15- year-old male, who presented to the Outpatient Department with swelling and pain over right wrist. Thus, we present a classic case of DF exhibiting characteristic features along with a review of the literature.

Aim: This article assesses the student’s insight about simulation base skills learning. Back Ground: Simulation is a teaching style which is appropriate for professional skills learning because it is parallel to real situation. In nursing education it is being used in many ways to train learner in professional skills. In 1960 first health-care simulation manikins were presented (Jeffries et al., 2015). A study reveals that students expressed that simulation is helpfulness, comfort and a Clinical simulation is important approach for professional skill learning programed (Padilha, Machado, Ribeiro, & Ramos, 2018). Method: A cross-sectional descriptive study design was used. This study evaluates the student’s insight about simulation base skills learning in nursing education. 133 participants filled the Simulation Evaluation Survey (SES) form. A study setting was a private sector university. In this study random sampling technique was used. Results: Study results revealed that this approach enhances learner knowledge and skill performance. Quantitative Survey data facts regarding simulation experience revealed the students feedback that simulated body approach can Amplified knowledge about relevant content for practice, which have been utilized (96.9%). During the debriefing session of practice, participant felt that the faculty involve in this approach was Knowledgeable (98.5 %). After simulation session students’ knowledge Increased about content discussed, (97%). Survey data facts explore that students feel better prepared for real patient care after simulation practice (94%). Conclusions: This study concluded that through simulation base learning, students get improvement in different aspects, like enhancement in knowledge, confidence, and performance. This study reveals that students feel confident, skillful and can give better performance in real clinical setting.

Resistant bacteria are emerging worldwide as a threat to the favorable outcome of common infection in community & hospital settings. Beta-lactams remain a cornerstone for antimicrobial chemotherapy of a large number of bacterial infections. The most common cause of bacterial resistance to β- lactam antibiotics is the production of β- lactamases, followed by ESBL’s and then the emergence of MBL activity which is one of the most feared resistance mechanism, because of its ability to hydrolyze virtually all β- lactams, including cabapenems. However MBL’s are unable to hydrolyze monobactams & are not inactivated by β- lactamase inhibitors like clavulinic acid, sulbactam and Tazobactam. In any nosocomial settings, carbapenems are used as the last resort for treatment of MDR gram negative bacterial infections. MBL producing gram negative bacteria often exhibit resistance to additional classes of drugs and behave as multidrug resistant bacteria. Hence the present study was undertaken for detection of MBL producing gram negative bacilli and to help treating physicians to select appropriate antibiotic in our hospital. It was a prospective study conducted from April 2018 to July 2018 after IEC clearance. The Gram Negative isolates were first screened for MBL production with ceftazidime disc, & were further tested by Combined Disc Test Method (CDT) and Modified Hodge Test (MHT). Total 300 gram negative isolates were studied. In these, the MBL producers were 43.6%, majority of the isolates were from pus (19.3%), followed by urine (14.3%). Amongst these, E. coli was the most common organism isolated (16.3%), followed by Klebsiella pneumoniae(11%) and Pseudomonas aeruginosa (6.6%).By combined disc test a total of 131 MBL producing strains were isolated and 126 strains were detected by MHT. The exposure of bacterial strains to a multitude of β- lactams has induced mutation of β- lactamase in many bacteria, expanding their activity even against carbapenems, by the production of MBL resulting into fewer therapeutic alternatives. Hence detection of MBL is very important in respect to the treatment plan and sparing use of antibiotics to avoid their spread in the hospitals.

The aim of this study was to find out the philosophical values for the judge constitutional court in implementing the principle of shame (principle al-haya’) as a review of Indonesian impeachment. This research uses the method of (nomative legal research), namely: a research that is done with the purpose to find the principles and philosophical basis (dogma or doctrine) of positive law, and the research of legal discovery in concreto that is appropriate to solve a case law such as the impeachment of the president in his profession using the pricple of al-haya’. This research approach used in this research is statute approach, conseptual, historical approach, comparative approach, and philoshopy approach. Data types and sources, namely primary sources or outhorities, secondary sources or authorites, and tertiary sources or authorites. The result of this research, formally juridical Implementation of the principle of al-haya’ as a review of the impeachment of the Indonesian President by a Constitutional Court judge (MK-RI) based on the provisions of Article 5 juncto Article 10 of act Law Number 48 of 2009 concerning philosophical power to fill in the incompleteness, obscurity and emptiness of legal norms in the 1945 Republic of Indonesia Constitution and establish a national legal system. Technically, by the judges of the Constitutional Court (MK-RI) can be approached through the legal reasoning of induction and deduction. The method of implementation on shame principle (principle of Al-haya’) by the judges of the Constitutional Court (MK-RI) was done by deductive advance, means that the principle of specialty is devoted again to the legal field is concerned, the new rules do basically the deduction of law is concerned. Then deducted again into the substantive rules, and rules deducted longer be the case. After that is done in the case of the implementation of the rules of concrete case by the judge.

Programmed cell death 1 (PD-1), and its ligand programmed cell death-ligand 1 (PD-L1), is important for tumor-immune escape. Expression PD-L1 was observed in various solid tumors, including breast cancer (BC). The aim of this study is to examine the expression of PD-1 in tumor infiltrating lymphocytes (TILs) and PD-L1 in tumor cells (TC) in BC cases, to analyze the association between PD-1 and PD-L1 expression and clinicopathological features, as well as to correlate their expression with overall survival (OS). This is a retrospective study that was conducted on 110 cases of BC. Immunohistochemistry was performed to evaluate PD-1 and PD-L1 expression in TILs and TC respectively. There was no significant association between PD-1expression in TILs and clinicopathological variables. The presence of PD-1+ TIL was positively associated with PDL-1 expression in tumor cells; however, this association was not statistically significant (p = 0.062). On the other hand, PD-L1 expression in TC was significantly associated with lymph node involvement (P <0.0001), advanced stage (P = 0.035), high grade (P <0.0001), high TIL (P = 0.009), and negative ER (P = 0.01). BC cases with PD-L1 expression had a significantly worse OS (HR = 0.201; 95% CI [0.048 - 0.112], p <0.000). PD-L1 expression was an independent prognostic factor in multivariate analysis (HR = 0.195; 95% CI [0.058 - 0.655], p =0.008). In conclusion, PD-L1 expression is associated with advanced tumor stage, aggressive subtypes of BC, lymphatic infiltration, and poor OS in BC.

An earthquake is the result of a sudden release of stored energy n the Earth’s crust that creates seismic waves. In term of the earthquake, this study aimed to cluster which areas were the most affected by earthquake occured in Java Province in 2017. The algorithm used in this study was Self Organizing Maps algorithm (SOMs) with Cohonen as a type of Artificial Neural Networks (ANN) that is trained using unsupervised learning in decision making. In addition, the clustering results through its algoritm are functioned as a base of determining the eartquake pattern criteria and which areas often occurred in order to be able to mitigate earthquake that causes fatal impacts.

Primary lymphoma of breast is an uncommon tumour that constitutes 0.04% to 0.5% of malignant breast neoplasms [1]. Here, we present an interesting case of a 28 years old lady who presented with ascites alongwith past history of lumpectomy breast. Her ascitic fluid cytology showed monomorphic malignant tumour cells of poorly preserved morphology. Being suspicious of tumour type, we reviewed the clinical details and past histopathology records of the patient.

This research was conducted to examine the effect of earning per share, liquidity, investment opportunity set (IOS) on dividend payout ratio in consumer goods industry listed on the Indonesia stock exchange. The purpose of this study was to analyze the effect of earnings per share, liquidity, investment opportunity set (IOS) on the consumer goods industry listed on the Indonesia stock exchange in 2015-2017. The sample used was 12 consumer goods industry companies listed on the Indonesia stock exchange for the period 2015-2017. This study uses purposive sampling. The research data is taken from the Indonesia Stock Exchange (IDX). This study uses the panel regression. The results of this study are investment opportunity sets (IOS) that apply negatively to dividend payout ratio (DPR). While the EPS and CR variables do not affect dividend payout ratio. The author advises investors to pay attention to information taken by companies in making decisions.

Introduction: Bronchoscopy is a valuable diagnostic tool and has a significant clinical impact on the management of pneumonia, especially ventilator-associated pneumonia in ICU patients who fail to respond to standard, guideline-based therapy. The investigation of bronchial alveolar lavage (BAL) specimens involves an extensive laboratory work. Currently, there are very few published studies evaluating the diagnostic benefit of collecting multiple BAL specimens during bronchoscopy. These redundant specimens result in a significant workload increase for the diagnostic microbiology laboratory. Objective: To investigate the optimal number of specimens for bacteriology, virology, mycology, Pneumocystis jirovecii (PJP) and Legionella penumophila specimens in order to optimize the utility of BAL specimens with the aim of minimizing harm to the patient and optimizing resource utilization for the laboratory. Method: BAL specimens collected at an academic institution in Southern Ontario were reviewed retrospectively over a 15 month period for bacteriology, 16 months for virology, one year for mycology, and three years for L. pneumophila and P. jirovecii. Results: One thousand sixty-three BAL specimens were ordered for bacterial culture, yielding positive results in 45.5%. Among them, a concordance rate of 97.1% was found between two or more specimens acquired from different lung lobes. The concordance rate of multiple virology samples was 98.6% among patients in whom 2 specimens were collected per procedure, and 100% among those with 3 specimens per procedure. To study whether one specimen is sufficient for the detection of filamentous fungi, we reviewed 43 BAL samples which grew Aspergillus fumigatus between. A concordance rate of only 60% was found between two specimens obtained from different lung lobes. A concordance rate of 100% was found among multiple specimens ordered for L. pneumophila and P. jirovecii with positivity rates of 0.14% and 0.92% respectively. Conclusion: We recommend a single specimen per BAL be sent from the most purulent lung segment for bacteriology and viral PCR. Single specimens may also be appropriate for L. pneumophila and P. jirovecii, however further study is needed. Multiple specimens should be submitted for mycology investigations. By eliminating duplicate specimens laboratory utilization can be optimized and patient morbidity may be decreased.

This study aims to comparative analyze between before (2016) and after (2017) the implementation of the Financial Services Authority's circular letter number 14 / SEOJK.03 / 2017 concerning the health level of PT Bank Mega Tbk. The method used in this study is paired sample t-test. The results are not difference significant between Performance Ratio of Bank Mega in 2016 (before the implementation of the Financial Services Authority's circular letter number 14 / SEOJK.03 / 2017) and Performance Ratio of Bank Mega in 2017 (after the implementation of the Financial Services Authority's circular letter number 14 / SEOJK.03 / 2017).

Introduction: Candida is a genus of yeast which is the most common cause of fungal infection. Candida albicans is most important fungal opportunistic pathogen. The candiduria refers to the presence of yeast in urine either by the microscope observation of budding pseudohyphae, or by the growth of fungi in culture. Aim: To find the prevalence of candiduria in tertiary care Centre. Materials and Method: This was a study conducted at Saveetha medical college from January 2018 to December 2018, the total number of urine sample collected were 10194 out of which 2500 showed various microbial growth, out of which 50 Candida strains were isolated. Speciation was done according to standard protocol. Result: The prevalence of candiduria caused by Candida non-albicans species (1.24%) is more than that caused by Candida albicans species (0.76%). The prevalence is more in female (66%) than male (34%). Among the age group the prevalence is more in the age group between 21-30 years (50%). Candiduria cases are common among the NON-ICU cases with 92%. Candiduria is prevalent among the non-diabetic patients with 92%. Conclusion: Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Candida albicans is the most common cause of nosocomial fungal urinary tract infections; however, a rapid change in the distribution of Candida species is undergoing. Simultaneously, the increase of urinary tract candidiasis has led to the appearance of antifungal resistant Candida species.