First trimester sonographic diagnosis traditionally focused on evaluation of growth by serial examination to differentiate normal from abnormal gestations. Current trends in ultrasound late in the first trimester focus on measuring nuchal translucency thickness combined with maternal age and biochemical tests to determine the risk of chromosomal abnormalities and structural anomalies. The objective of the study was to compare normal reference range of mean fetal nuchal translucency (NT) thickness among pregnant women who were coming to the clinic with international reference values. A cross sectional study was conducted in a private ultrasound clinic, Lahore, Pakistan in one year starting from April 2016 to April 2017, after approval from the Institutional Review Committee of the University. A total of 59 pregnant women at 11-14 weeks gestation, were included in this study after taking consent. All NT measurements were performed by a certified sonographer using the Fetal Medicine Foundation (FMF) recommended protocol. Descriptive statistics were presented in the form of range, mean and standard deviation. The mean maternal age and mean gestational age were (27.9 ± 4.4 years) and (11.8 ± 0.8 weeks) respectively. The mean calculated for nuchal translucency thickness, which ranges from (0.6-2.9 mm), is 1.77 mm. This study results show that normal range of NT thickness coincides with the normal range of mean Nuchal translucency found internationally.

Objective : This study aims at (1) validating the use of Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system in the medical intensive care unit ( MICU) for prediction of the risk for mortality, (2) to compare the predicted death rate with the observed death rate of the patients gender wise and age wise. Design: Hospital based prospective study. Setting: Hospitals in South India, affiliated to medical colleges. Methods: A total of 350 patients admitted in the MICU between the age of 18-57 were enrolled for this study. APACHE II score was calculated in each patient on the day of admission within 24 hours. The predicted mortality was calculated on the basis of this score. Results: The mean APACHE II score was 9.42 ± 3.4. The ICU mortality rate within 24 hours after admission was 14%. The area under the Receiver operating characteristic curve (ROC curve) was 0.8 indicating good discrimination. The standardized mortality ratio (SMR) was 0.9. Conclusion: The study validates that APACHE II can be a reliable tool in predicting the mortality rate in MICU patients of Indian population within 24 hours of their admission.

89 nonvigorous neonates with meconium stained liquor were followed in the immediate neonatal period. 41 neonates received endotracheal tube (ET) suctioning at birth and 48 neonates did not receive ET suctioning at birth. Of the 41 ET neonates 16 had meconium related morbidity /mortality at NICU stay and 25 was normal. Of the 48 non ET neonates 9 had meconium related mortality /morbidity, 39 were normal. Odds ratio of mortality/ morbidity is significantly high (2.77)in ET group with narrow confidence interval (1.063,7.234),P value 0.03.Relative risk of ET group of having nonfavorable outcome is 1.7.Tracheal suctioning of meconium in nonvigorous neonates at birth did not decrease the meconium related morbidity /mortality during NICU stay.

Background: Presently snakebite has become a serious health problem in India.The actual incidence of mortality and morbidity related to the snakebite are not reported properly. Furthermore, the most neglected part is the long term endocrine dysfunction in survivors of russel viper envenomation. Materials and methods: Forty five survivors of russels viper bite patients were selected for the study according to inclusion and exclusion criteria. Admitted patients were treated accordingly and discharged in stable condition. The hormonal status were analysed and they have been followed up after 3 and 6 months. Results: Significant decrease in serum cortisol and prolactin were observed in survivors of russels viper bite patients particularly in those patients whose mean serum creatinine was more than 1.2 mg/dl and systolic blood pressure is more than 110 mm of Hg and diastolic Blood pressure is more than 70 mm of Hg. Conclusion: Measurement of long term hormonal status like serum cortisol and prolactin can be beneficial in survivors of russel viper bite patients.

The aim of this study is to determine the effectiveness of corrugated rubber and tube drains in the management of Ludwig’s angina patients. This retrospective comparative study was designed for patients with Ludwig’s angina that presented to the Department of Oral and Maxillofacial Surgery, University of Benin teaching hospital, Nigeria between June 2008 and July 2018. Data collected from the case notes of the patients were age, gender, type of surgical drain, airway compromise, length of hospital stay, and retreatment. Descriptive and inferential statistics were performed with SPSS Version 17(SPSS Inc, Chicago, USA). All tests were 2-sided and P-Value less than 0.05 was considered statistically significant. Of the 55 patients studied, 32 (57.3%) had plastic tube drains while 23 (42.7%) had corrugated rubber drains. Their ages ranged from 19-72 years with a mean ± SD of 42.1 ± 13.7 years. There was significant higher incidence of airway compromise in patients that had corrugated rubber drains compared to those that had plastic tube drains inserted(P=0.03). However, the type of drain inserted was not an independent predictor of the presence of airway compromise in our patients. There were no significant differences between the two groups as regard retreatment and length of hospital stay. The insertion of open tube drain is as effective as the conventional corrugated rubber drain as it could decrease complications and improve the prognosis for patients with Ludwig’s angina.

Organizational citizenship behaviour (OCB) is a willingness to play an extra role regardless of whether or ungiven a formal award. This study aims to analyze how the influence of employees’ job satisfaction, organizational commitment, employees’ working period, and perceived quality relationship quality on OCB employees in PT KPPN. Formulating effective policies to address issues related to the still low OCB employees at PT KPPN. The independent variables in this study are employees’ job satisfaction, organizational commitment, employees’ working period, and perceived quality relationship quality. The dependent variable of this research is organizational citizenship behaviour (OCB). The subject of this research was 34 employees at PT KPPN. This study uses questionnaires in data gathering, whereas hypothesis testing uses F-test and t-test. The hypothesis analysis concluded that work satisfaction and organizational commitment have significant influence over OCB. These results show that the higher the job satisfaction and organizational commitment of an employee, it will increase the employee's OCB

Background: Acute onset seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes and its outcome from developing countries. Current study aims to find the common etiology of seizure and classify seizure types in various age groups. It was also aimed to find outcome in relation to diagnosis, abnormal imaging, EEG and requirement of monotherapy or polytherapy. Material and Method: This was a hospital based prospective study carried out in the department of Pediatrics, Calcutta National Medical College and Hospital from June 2016 to May 2017. Children aged 1 month to 12 years presented with acute onset seizure were enrolled. Variables collected were demographics, clinical presentation, laboratory tests, brain imaging, elect- roencephalography, diagnosis and therapy. The data was analysed using Statistical Package for the Social Sciences (SPSS) for Windows version 16.0 (SPSS Inc ; Chicago, IL, USA). Results: A total of 491 patients were admitted for acute onset seizure with 289(58.8%) males and 202(41%) females. Among these patient 280(57%) presented with fever and 55(10.9%) children presented with status epilepticus. Generalised onset tonic clonic was the most common seizure type, central nervous system infection was the most common etiology in all the age groups. Final outcome was made at the time of discharge as discharged without sequelae, dischaeged with sequelae and death. Patient with CNS infection had highest mortality. Conclusion: CNS infection and febrile seizure were common cause of seizure in fewer than 5 children. Group of children presenting with unprovoked seizure require long term follow up studies including neurophysiologic studies and neuroimaging for better understanding of childhood seizure disorder in developing countries.

This study is intended to analyze the performance of Sharia banks in Indonesia through the alleged influential factors, namely efficiency and finance to deposit ratio. This research to analysis (1) Efficiency (BOPO), Finance to Deposit Ratio and Returns on Asset at Sharia Commercial Banks in Indonesia in 2012-2017, (2) Effect of Efficiency (BOPO) and Financing to Deposit Ratios on Return on Asset at Sharia Commercial Banks in Indonesia. This study uses annual financial report data issued by each bank in 2012-2017. The total population in this study was 13 banks, after passing through purposive sampling, the number of samples used was 8 banks. The method used is the descriptive method and a quantitative method with panel data analysis. Based on the results of the research show: (1) Efficiency, Finance to Deposit Ratios and Returns on Asset at Sharia Commercial Banks in Indonesia from year to year which is being updated. (2) Efficiency has negative effect and significantly on Return On Asset while Finance to Deposit Ratio has positive effect and insignificant effect on Return On Assets. Keywords: Efficiency, Financing to Deposit Ratio, Return on Assets, Sharia Banks

Background: Staphylococcus aureus is a pathogen worldwide with large disease burden. Methicillin resistant staphylococcus aureus (MRSA) is prevalent in hospital care settings and community. Timely diagnosis and treatment is essential to avert further complications of this infection as compared to Methicillin sensitive Staphylococcus aureus (MSSA). Aim of the study was to determine the prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) from pus samples in a tertiary care hospital and to analyze the antibiotic susceptibility patterns of MRSA isolates. Methodology: A cross sectional study which was done in a tertiary care hospital from Jan 2018-June 2018. Various clinical specimens were cultured and staphylococcus aureus was isolated and identified using standard biochemical tests and CLSI guidelines. Results: Out of 1090 pus samples processed 597 were growth positive and among these 196 were gram positive. Out of 196 gram positive isolates 119 were staphylococcus aureus of which 56 were MRSA & 63 were MSSA. All MRSA isolates were sensitive to Vancomycin and Linezolid and moderate sensitivity to Gentamicin and Co-trimoxazole. Conclusion: In hospital setting MRSA infection cause of worry due to resistance to commonly prescribed drugs. Regular surveillance and robust Antimicrobial stewardship can help to limit these infections.

We investigated the effect of vanadium citrate in the amounts of 0.125, 0.5 and 2.0 μg/ml of water on the indicators of lipid metabolism in the blood plasma of rats with alloxan induced diabetes. Blood plasma was extracted using chloroform-methanol mixture according to the Folch method. The total amount of lipids was determined by weighing the dry residue (gravimetric method). The division of lipids into classes was performed by thin-layer chromatography on silica gel. During the research, we found that the total amount of lipids, phospholipids, non-esterified cholesterol, triacylglycerols, non-esterified fatty acids, as well as the cholesterol-to phospholipid ratio increased in the blood plasma of rats with alloxan induced diabetes. However, the level of diacylglycerols and esterified cholesterol decreased. Given the consumption of vanadium citrate, the total levels of lipids, phospholipids, non-esterified cholesterol, triacylglycerols, and non-esterified fatty acids in the blood decreased, but the level of diacylglycerols and esterified cholesterol increased compared to the rats with experimentally induced diabetes. It was found that lipid metabolism is normalized in the blood of rats with experimentally induced diabetes that were watered with the solution of vanadium citrate in the amount of 0.125 μg/ml of water.

Background: Leukaemia is a complex form of blood malignancy characterized by a high mortality rate, despite significant improvement in cancer treatments. The consumption of fruits and vegetables are inversely related to the incidence and mortality of cancer, as a result of the high level of polyphenols found in some fruits that has been reported to be potentially chemotherapeutic and having a considerable effect on haematological malignancies. Objectives: To explore the effect of Imatinib, Doxorubicin, and/or polyphenols (emodin, rhein, apigenin and cis-stilbene) on the proliferation, and apoptosis of myeloid and lymphoid leukaemia cells compared to non-tumour cells. Methods: one myeloid (K562), one lymphoid (CCRF-CEM), a leukaemia cell line and one non-tumour normal cell line (CD133) were treated with Imatinib, Doxorubicin, and/or different doses of polyphenols. The activity of leukaemia cell proliferation was assessed by Cell Titer-Glo® luminescent assay; the morphological changes of apoptosis, which includes DNA fragmentation and nuclear condensation, were detected by DAPI staining. Results: Emodin, cis-stilbene, apigenin and rhein showed different levels of effect on inhibition of ATP level and inducing apoptosis in K562 myeloid cells, CCRF-CEM lymphoid cells and CD133+ normal cells when these types of polyphenols used separately and combined with Imatinib or Doxorubicin. Generally, the CCRF-CEM lymphoid leukaemia cell line was more sensitive to polyphenol treatments alone and when combined with Doxorubicin compared to the K562 myeloid leukaemia cell line and CD133+ non-tumour cells. Conclusion: These results suggest that polyphenols have different effects according to the type of cell and polyphenol. The variant effect between leukaemia cells and non-tumour cell suggests that polyphenols are a potentially therapeutic agent for leukaemia. Polyphenols can enhance the effect of chemotherapy and reduce the required dose to induce cell death in cancer cells.

Thyroid gland is a highly vascular endocrine gland consists of two lobes connected by an isthmus present in the anterior midline of the neck against vertebrae C5, C6, C7 and T1. Many study have indicated the morphometric differences of this important gland. This study puts in an effort to study the morphological and morphometric variations of thyroid gland.

Background: Many patients diagnosed with autoimmune connective tissue disease cannot be categorised easily into one of the established clinical entities such as systemic lupus erythematosus, dermatomyositis, or systemic sclerosis. The term overlap syndrome is used to identify such patient and is useful in terms of clarifying prognosis and facilitating disease management. Methods: This was a retrospective study of the patients diagnosed with connective tissue diseases. The study was done among patients attending the outpatient clinic of a teaching hospital in the South Western Nigeria. The study spanned from July 2013 to June 2016. Data on clinical characteristics, diagnosis, age at onset of disease, and gender were extracted from their files. Results: Five hundred and two patients attended the rheumatology outpatient clinic over the study period. There were 41(8.2%) cases of connective tissue disease. Systemic lupus erythematosus constituted 29.3%, undifferentiated connective tissue disease 19.5%, and scleroderma 14.6%. Others were secondary Sjogren's syndrome 14.6% and overlap syndrome 7.3%. There were 3 overlap syndromes and all were females. A case of rheumatoid arthritis/systemic lupus erythematosus (RA/SLE), SLE/polymyositis, and Scleroderma/Polymyositis. Patients were aged 18 to 64 years, and the mean age was 42±5 years. Female constituted 85.4% of the total population with a female to male ratio of 5.8:1. Conclusion: There is the need to detect an overlap syndrome early. An early classification will guide the management plan of such patients. The traditional high dose steroid for the treatment of SLE and inflammatory muscle disease may be hazardous in overlap syndromes.

The transesterification process using heterogeneous catalysts has been widely studied to replace the role of homogeneous catalysts. ZnO doping into metal oxides can increase activity of heterogeneous catalyst in transesterification reaction. This study was conducted to provide information on the effect of ZnO concentration doped into calcium oxide (CaO) to the transesterification reaction of avocado seed oil with high free fatty acid (ALB) to methyl ester, at 65 0C, methanol ratio: oil = 10: 1 , for 1.5 hours, using a reactor. Research variable is ZnO concentration doped into CaO, that is: 0%, 1%, 2%. The test parameters are methyl ester content obtained from the results of transesterification reaction with gas chromatographi analysis. In this study, ZnO/CaO nanocatalysts were synthesized and doped with sol gel method and calcined at 450 0C in air for 60 min. The synthesized ZnO/CaO nanoparticles were characterized by XRD. From the experiment, the highest yield of methyl ester was obtained on ZnO/CaO 1% catalyst with yield of 90,8820%.

Fresh seeds of Piper nigrum were procured from the botanical garden of Kokan Krushi Vidyapeeth, Dapoli, Ratnagiri. The ethanolic extract of the seeds was carried out by soxhlate extraction method. Sixty four (64) Sprague- Dawley rats (average weight 150 - 240 g) of either sex were used for the experiment. The ETH and PAS drugs and Piper nigrum were given to respective groups daily for 28 days. At the end of study various biochemical parameters were analyzed from serum such as of Serum Albumin, Urea, Creatinine, Total proteins and Blood Urea Nitrogen (BUN). The kidney tissues were analyzed for Histopathology. Graph Pad Prism 7 was used for statistical analysis by one way variance (ANOVA). The value p< 0.05 considered as significant. Ethanolic seed extract of Piper nigrum (Linn.) was administered independently as well as in combination with ETH and PAS drugs. It is found that the pretreated test groups with Piper nigrum ameliorated the toxic effect of the drugs. Piper nigrum (.Linn) also showed the normalization of histoarchitecture of the kidney by confirming nephroprotective activity against ETH and PAS drugs. Based on the above results it is concluded that the Piper nigrum act as nephroprotective agent and a good bio-enhancer against nephrotoxicity induced by ETH and PAS drugs in Sprague-Dawley rats.