Introduction: Ectodermal dysplasia (ED) is a rare hereditary disorder involving two or more of the ectodermal structures. Palmoplantar keratoderma is a characteristic feature of hidrotic forms of ED. We report a case of Hypohidrotic ectodermal dysplasia associated with palmoplantar keratoderma. Case Report: A 4-year-old girl presents a chronic palmo-plantar dermatosis that started three years ago. The interrogation finds a history of hospital admission in the 2nd month of life for an unexplained fever. The dermatological examination finds a limited, diffuse erythematous palmo-plantar hyperkeratosis, associated with diffuse alopecia with light-colored brittle and slow-growing hair. The findings also include hypotrichosis and onychodystrophy. The rest of the examination revealed a facial dysmorphism with a light prominent forehead, flattened bridge of the nose, sunken eyes with periorbital hyperpigmentation and photophobia. Other abnormalities include a hypodontia with small teeth. Discussion: Our observation suggests a hypohidrotic ectodermal dysplasia. It is a genetic disease most often hereditary. The X-linked form or Christ Siemens Touraine syndrome is the most frequently encountered form. A male predominance is noted. Clinically it is characterized by the presence of all or several of the four typical clinical signs of the disease: Anhidrosis or hypohidrosis, dental hyoplasia, hypotrichosis, facial dysmorphism. Palmoplantar keratoderma is rarely associated as it is the case in our patient. The genetic study reveals abnormalities that can be found in the X chromosome for the X-linked forms, and at the level of the chromosomes 2q11-13 or 1q42 for the autosomal forms. Conclusion: Our observation illustrates the frequent diagnosis delay in this disease. It also emphasizes the importance of a detailed somatic examination in front of any palmoplantar keratoderma presented in children.

Sapropel being a unique natural organic product, which due to multicomponent composition, has a wide range of pharmacological activity. The resources of sapropel in Ukraine comprise approximately 74.5 million tonnes. Taking into consideration significant natural resources of sapropel in Ukraine as a promising raw material for preparing effective medicines products, sapropel was used as an active ingredient for the development of the cream composition. The anti-inflammatory activity of creams with sapropel extracts on the model of acute photodynamic skin inflammation in animals (UV erythema) was investigated. It is established that the creams with sapropel extracts have expressed anti-inflammatory properties, reduce the intensity of acute photodynamic inflammation and cut down the treatment duration. The anti-inflammatory activity of the studied medicinal products largely depends on the concentration of the active substance

One of the most notable congenital malformations in the head and neck include cleft lip, palate & alveolus. It may manifest as unilateral or bilateral and complete or incomplete. Reconstruction of the alveolar cleft is challenging and has ever remained controversial with regard to timing, graft materials, surgical techniques, and methods of evaluation. The primary goal of alveolar cleft reconstruction in is to provide a bony bridge at the cleft site that allows maxillary arch continuity, oronasal fistula repair, eruption of the permanent dentition into the newly formed bone, enhances nasal symmetry through providing alar base support, orthodontic movement and placement of osseointegrated implants when indicated. In addition to these it also enhances speech, periodontal conditions, establishes better oral hygiene, and limits growth disturbances. In order to rehabilitate oral function in patients with cleft lip and or palate, alveolar bone grafting is necessary. Secondary bone grafting is the most widely accepted method for treating alveolar clefts. Literature shows that autogenous bone graft is the primary source for reconstructing alveolar cleft defects and is currently the preferred grafting material. However, it is believed that the use of a membrane in conjunction with an autogenous bone graft for alveolar ridge augmentation provides superior results. Hence, this paper reviews the role of collagen membrane in alveolar bone grafting.

Objective: To evaluate medication adherence and analyse the prescribing pattern of cardiovascular disease patients in tertiary care hospital using a newly developed medication adherence scale. Methods: It is a multi centered retro prospective observational study, conducted for a period of 6 months involving around 300 cardiac patients. The level of adherence is measured using newly developed medication adherence scale and prescribing patterns in cardiovascular patients is assessed through case reports. Analysis of data was done. Results: Among 300 cardiovascular patients, 58% were male and 42% were female. Most commonly diagnosed diseases are ST segment elevated myocardial infraction (28.3%) and left ventricular dysfunction (14%). Drugs used for the treatments are aspirin (95%) and clopidogrel (85.6%). Major risk factor is alcohol (11.6%) consumption, Hypertension and Diabetes Mellitus (9.6%). Major indication of cardiac patients is chest pain (42%), nausea (41%).The diagnosis was performed using Echocardiogram (89%), 2D-Echo (52%). The maximum adherence is seen in the age group of 31-40 female and male. Age group of 51-60 are more non adherent compared to other groups in males, whereas in females age group of 61-70 are more non adherent. Overall study show that Females (62%) are more non adherent compared to males (58.6%). The major reason for reduction of medication adherence is long duration regimens, lack of clinical communication between patients and health care professionals, forgetfulness etc. Conclusion: According to the study there is a suboptimal adherence is seen in cardiac patients and requires clinical interventions, which include affordable medications, easy-to-use medication regimens with fewer daily doses, communication between patients and healthcare providers

Technological advances in three-dimensional (3D) imaging, computer-assisted surgical planning and simulation in the field of medicine are now regularly being used for analysis of craniofacial structures. It also gained ingress in prediction of surgical outcomes in orthognathic surgery. A variety of patient-specific surgical guides and devices have been designed and manufactured using 3D printing technology, which rapidly gained widespread popularity to improve the outcomes. The article presents an overview of 3D printing technology and its applications in orthognathic surgery with emphasis on treatment feasibility and patient outcome.

Congenital diaphragmatic hernia is exceptional in children. It is defined by the presence of an abnormal diaphragmatic defect causing the abdominal cavity and the thoracic cavity to communicate. It usually manifests itself at birth through respiratory distress, or sometimes through sepsis requiring urgent treatment. We report the rare case a girl with cholestatic jaundice secondary to a left antero diaphragmatic hernia with visceral content (hail and colon).

Recent innovations and scientific inventions have been applied successfully in teaching and learning. It is always known that for a newer approach to be implemented successfully there are always hurdles. At this moment it is also understood that people will not accept the changes until they are familiar with the technologies. It is always known that the eyes see only those things that are well familiarized. Even if it is universally accepted there may be hurdles that have to be passed successfully by each and every individual. This article examines the faculty and the student’s attitude towards the E-Learning programme

Background: This study was undertaken in a tertiary care teaching hospital in Kolkata to comparatively analyse the non-pharmacological supportive care interventions for reducing stress and pain in preterm and term newborns. Methodology: A prospective observational study conducted on 100 newborns of gestational age 34 weeks and above who weighed more than 1.5kg admitted in NICU at the Department of Paediatrics, of Dr B C Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India from January 2018- December 2018. All the patients experienced moderately painful heel lance procedure and comparative analysis of four non-pharmacological supportive care interventions namely swaddling, facilitative tucking, kangaroo mother care (KMC) and non-nutritional sucking (NNS) for reducing stress and pain were studied using Premature Infant Pain Profile (PIPP)scales. Results: Present study had 52% female newborns. 69% were term babies with a mean weight of 2.59kg. Non-pharmacological supportive care interventions significantly (p-value < 0.001) reduce stress and pain in preterm and term newborns. Mean PIPP score was statistically significantly lower with each intervention; swaddling (4.27), facilitative tucking (3.43), KMC (1.84) and NNS (0.78) as compared with control (7.21). Non-nutritional sucking followed by Kangaroo mother care, facilitative tucking and swaddling were effective in reducing pain and stress in that order. Conclusion: Non-nutritive sucking, a non-pharmacological supportive care intervention is significantly effective and the best intervention in reducing stress and pain in preterm and term newborns

In the field of maxillofacial surgery, digital photographic documentation plays a crucial role in clinical practice. The main advantage of digital photography is the possibility of immediate reappraisal of the photographs for alignment, brightness, positioning, and other photographic settings, which aids in avoiding errors in addition to permitting the instant repetition of photographs if and when required. This paper gives an overview of the evolution from analog to digital in photography and highlights the significance of digital photography in orthognathic surgery

Environmental Management (UKL) and Environmental Monitoring (UPL) efforts are specific to each type of business or activity associated with its impact. Therefore, the technical guidelines of UKL and UPL are set by agencies responsible for sectoral activities that are directly related to the technical activities of the business concerned. The sugar Mill in Kwala Madu is one of the factories of PT Perkebunan Nusantara II, where is located in the village of Kwala Begumit, Stabat Sub-District, Langkat Regency. Mill production produces white and hatched crystalline sugar. In July 2018, it was a period of repair and service of Mill machines which will be re-operated in the 2019 milling year. After the overhauled, Mill's operations are expected to produce much production than before. The research method used is the normative jurisprudence by analyzing legal materials through literature study. The present study is expected to obtain a detailed and systematic overview of the problem. The sugar Mill at Kwala Madu is a sugar Mill located in North Sumatra. Kwala Madu sugar Mill is operated once a year after the cane harvest. In drafting the Environmental Impact Analysis study, the initiator can ask the consultant to compile the Environmental Impact Analysis document.

Background: The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year. An intention to quit is an important preliminary step for the behavioral change and it is highly associated with attempting to quit and with quitting. Therefore, this study examines the predictors of intention to quit and previous quitting attempts in Bahrain. Aim: To improve the overall quality of smoking cessation services in Bahrain. Objectives: 1) To study the prevalence of intention to quit smoking among adult smokers attending primary health care in Bahrain. 2) To explore predictors of an intention to quit and predictors of previous quitting attempts among adult smokers in Bahrain. Study design: Cross-sectional study. Settings: Data was collected from two primary care health centers in each health region in Kingdom of Bahrain using validated questionnaire. Participants 502 adult smokers aged ≥18 years, who were attending primary care within 10 days period in February 2018 (1st – 14th February), were included. Data was analyzed by using SPSS version 23.0. Results: We found that more than half of the smoker population (51.4%) are seriously thinking of quitting smoking in the next 12 months., while (70.9%) of them had previous quitting smoking attempts. Predictors noted to be significant in this study, include being a male, married, lower level of education, having shortness of breath and gastrointestinal symptoms. Conclusion: Results indicate high intention to quit smoking rate and along with the significant predictors found in this study, there is a great need to develop preventive and therapeutic interventions addressing these predictors to ensure higher rate of success and support the current tobacco smoking cessation services according to what predictors showed.

The purpose of this study is to examine the effect of stakeholder power and profitability on firm value with corporate social responsibility disclosure as a moderation variable. The populations of this study were SRI-KEHATI Index listed in BEI in period 2013 – 2017. Samples were determined by purposive sampling method with 18 samples. The result has shown that: 1). Government power had no significant effect on firm value, 2). Creditor power had no significant effect on firm value, 3) Profitability had significant effect on firm value, 4) Corporate social responsibility (CSR) disclosure as a moderating variable are not able to moderate the effect of government power and firm value, 5) Corporate social responsibility (CSR) disclosure as a moderating variable are not able to moderate the effect of creditor power and firm value, 6) Corporate social responsibility (CSR) disclosure as a moderating variable are not able to moderate the effect of profitability and firm value.

In this study, the bacteriological quality of bottled water in Mandalay, Myanmar was detected by the use of MPN method. Nineteen brands of Bottled Drinking Water (BDW) samples were analysed for total coliform count as the primary presumption of coliform contamination. 7 water samples were contaminated in a range from 6 MPN/ 100ml to 16 MPN/100ml. The faecal coliform, the indicator bacterium Escherichia coli was detected in 5 out of 19 samples by confirmation on EMB showing metallic sheen and completed tests were re-confirmed by further biochemical reactions. Antibiotic sensitivity and plasmid DNA extraction from the E.coli isolates were examined. (40%) of 2 out of 5 strains contained plasmids with molecular weights of more than 23kb. The overall results showed that 63.15 % among the subjected bottled water in Mandalay were noted to be microbiologically clean and safe for drinking.

With the advancement in science and technology, Cosmetic dental treatments have been revolutionized. Tooth discoloration appears as a significant cosmetic problem that might require bleaching procedures. Intrinsic discoloration is commonly observed in endodontically treated teeth. The objective of this review was to discuss the clinical recommendations of using different internal bleaching techniques for treating intrinsic tooth discoloration based on the available evidence in the literature. Non vital bleaching technique is a minimally invasive procedure to treat intrinsic discoloration of endodontically treated tooth. However, certain protocols and precautions are necessary to minimize post operative complications. Further prospective researches are required to improve the quality of evidence.

Leiomyomas of the uterus are benign tumours that occurs due to overgrowth of smooth muscle and connective tissue present in the uterus. A clinical study of 50 cases of fibroid uterus was made in the Sambhram Medical College and Research Institute, from January 2018 to June 2018. The cases are selected by random allocation. In the present study, leiomyomas are most commonly seen in the women of child bearing age, most commonly occurring in the 3rd decade. Menstrual disturbances were seen in 71% of cases, Dysmenorrhea was seen in 22% of the cases. White discharge per vaginum was seen in 10 % of the cases. Pain abdomen was seen in 40% of the cases. Presence of a mass was complained in 23% of the cases.Urinaryproblemswerenoticedin25%ofthecases and infertility in 25% of cases.Intramural fibroid were the commonest variety comprising about 66% of the cases, 10% submucous, and 8% cervical. The present study shows, proliferative endometrial in 55% of cases, secretary changes were noted in 20%, atrophic endometrial occurred in 15%.