The repair of eyelid needs a good knowledge of reconstruction techniques. The goal of this work is to study epidemiological and technical aspects of eyelid defects in our context, and to evaluate their functional and aesthetic repair. We report cases concerned by loss of eyelid tissue operated between September 2011 and September 2016. Epidemiological, clinical and histo-pathological aspects are described, the repair processes and various surgical techniques are discussed. Among the identified cases of eyelid defects, 74% were malignant tumoral pathology, while 26% were benign. The repair techniques used were suture, direct healing, skin graft, flap of Mustardé with mucous chondro graft, frontal flap and sub-mental flap. The eyelid defects need functional and aesthetic valid repair, the various reconstruction means should begin from the simple ones to more complex.

Phyllodes tumors of the breast are rare fibroepithelial tumors in their malignant form, the gravity lies in high risk of local recurrence. We report two observations of patients admitted for the management of local recurrence of phyllode breast tumor. The average age of our patients was 39 years old. The size of the tumor ranged from 10 cm to 30 cm in diameter, with a localization exclusively on the right. Surgical management consisted of a enlarged tumor resection, followed by radiotherapeutic complement. Histologically, it was a phyllode tumor initially benign with slowly progressive evolution, to a phyllode sarcoma at one patient, and to a liposarcoma in the other. The evolution towards a malignant transformation can be explained in both cases by incomplete previous excisional gestures. This underlines the importance of early diagnosis and surgical management responding to oncological rules

Skeletal muscle metastases are an exceptional mode of revelation of broncho-pulmonary cancers, we report a case of a patient with lung cancer disclosed by skeletal muscle metastasis. The patient consulted for a painful mass of the left calf with significant weight loss, the medical imagery shows an intramuscular process and the ultrasonography guided biopsy shows an infiltration of the muscle with metastatic adenocarcinoma, immunohistochemical patterns suggested the pulmonary origin, the treatment included muscle resection and chemotherapy. Skeletal muscles metastases from lung cancer are rare and although indicative of a poor prognosis, the treatment is poorly codified and differs from case to case.

The purpose of this study is to investigate and analyze the significant promotion mix factors that have an effect on the outstanding lending decision and formulate a suitable strategy for Indonesia Exim bank. The type of research used is correlational research and if based on data type is quantitative research. The population of this research is the debtors from Indonesia Exim bank in the Medan region from 2012 to 2016, totaling 30 companies. Data analysis in this research uses multiple linear regression model. In the process of data processing, the authors are assisted using the Statistical Product and Service Solution (SPSS) data processing application. The results have found that advertising, personal sales, public relations, and direct sales simultaneously have an influence on lending decisions. Partially, advertising and public relations have a significant influence on loan decisions, while personal sales and direct sales have no significant effect on lending decisions

Fatigue is often cited as a contributing factor in air incidents and accidents. Usually, the words "fatigue" and "sleepiness" are used by aircrew to describe the same feelings, a questionnaire has been developed for subjective level assessment of fatigue and sleepiness among Moroccan aircrew. A 4-month prospective study including all aircrew (civilian, military) and air traffic controllers was conducted at the Aero-medical center of Rabat during their review visit. The questionnaire included the Pichot scale for fatigue and Epworth scale for sleepiness. It was filled anonymously. Out of more than 400 cards distributed, only 200 were exploitable. 23% of the subjects in the study had moderate fatigue. 6.5% of the sample presented moderate sleepiness and 4.5% had excessive daytime sleepiness. These two states seem to be preponderant in young aircrew population especially cabin crews. The occurrence of fatigue and daytime sleepiness in aircrew especially at the beginning of their career can be explained by the difficulty of adapting to aeronautical constraints. It is important to remember the countermeasures of fatigue to preserve aviation safety

Turnover Intention is the desire of the merchant to quit his job. The purpose of this study is to determine the direct influence of independent variables of leadership, compensation and workload of the dependent variable is turnover intention. This research was conducted at PT Karya Utama Perdana, with 113 respondents from total population of 162 employees. In determining the sample of this study, the authors use the formula slovin and data collection is done through interviews and questionnaires. Then on the data analysis, the authors used multiple linear regression analysis techniques that were processed using SPSS software version 24, so the results obtained further indicate that leadership has significant effect on turnover intention, compensation has no effect and not significant to turnover intention, and workload significantly influence to turnover intention.

Blood transfusion is a routine, life-saving medical intervention which is generally regarded as safe when done appropriately, but it is not absolutely free from adverse reaction. The aim of the study was to analyze the Adverse Transfusion Reaction (ATRs) as a part of Haemovigilance Programme of India at VIMSAR, Burla. This study was prospective and observational. All blood transfusions and adverse reaction which occurred due to transfusion at V S S Institute of Medical Science and Research (VIMSAR), Burla, between June 2018 and November 2018 were studied. The reactions were reported in a pre-designed transfusion reaction (TR) reporting form for blood and blood products as per the Haemovigilance software, PvPI. ATRs were also analyzed with respect to types of blood products. Total blood components issued by our blood bank to various departments and total ATRs during the study period were 13145 and 121 respectively. Majority of the reactions occurred with whole blood (0.71%), followed by packed red cells (0.17%). The most common ATR observed was allergy (80.16%) followed by febrile Non hemolytic TR (19.83%). Most of the ATRs were acute reactions. The study emphasizes the different reaction accompanied with blood transfusion, and how it can be minimised by proper laboratory technique so that quality and safety of transfusion therapy can be improvised.

Spinal trauma is very common in orthopedic practice. There is a debate as to whether the surgical or conservative approach is more effective in the treatment of spine fractures. We in the present study tried to evaluate the outcomes of patients with spinal fractures treated with the conservative treatment and surgical treatment and overall outcome of treatment in the patients. Methods: In this prospective cross-sectional study conducted in the Department of orthopedics, MGM hospital attached to Kakatiya Medical College. A total of 30 patients were included in the study of which (n=15) patients were treated with conservative treatment based on the presentation of fractures and similarly (n=15) were taken for operative treatment depending on the type of fractures. A Detailed history of the injury was obtained they were clinically and radiologically evaluated for the thoracolumbar fracture. The radiographs included the anteroposterior and lateral views. Laboratory investigations were carried out before the surgery. CT and MRI scans were carried out to evaluate the relationship and instability of the spine. Results: The L1 vertebra was the most common to get fractured and most of the fractures (74%) were appeared at T12 and L1. AO type, A fractures were only studied with the majority of the fractures (66.6) were falling into AO type A3 (burst fractures). DENIS pain scale scores in conservative treatment, category 8 (53.3%) of patients were in the P3 category similarly in operative treatment 46.67 % of patients were in P1 category...

Mental health disorder is one of the major health problems, which requires early & effective treatment. WHO global burden of disease 2001 estimates four main psychiatric causes leading to disability, which is Depression, Alcohol abuse, Schizophrenia & Bipolar disorder. Although current psychotropic medicines have remarkable effect on mental illnesses, their utilization in clinical practice needs to be done regularly hence, current study aims to observe the utilization and prescribing pattern of various drugs used in department of psychiatry, according to various WHO drug use indicators. It is a prescription based prospective, observational study conducted on 1200 prescriptions of patients attending department of psychiatry for 18 months. Total of 3632 drugs were prescribed in 1200 prescriptions analyzed, where 48.4% (581) were males and 51.6% (619) were females, majority of the patients 56.25% (675) belonged to age group of 21-40yr, 85.67% (1028) individuals were married. Out of total drugs prescribed 2971 (81.80%) were psychotropic drugs. Average no. of total drugs & psychotropic drugs prescribed per encounter was 3.03 & 2.48 respectively. 1680 (46.26%) drugs were prescribed from the WHO EDL formulary (2016), all the drugs were prescribed by brand names, percentage of prescriptions with injectable drugs accounted for 4.75%. Polytherapy (>5drugs) was observed only in few prescriptions 26 (2.17%). This study advocated an overall rational utilization of psychotropic drugs with fewer deviations due to the prescription practices of healthcare providers, which needs an improvement, to ensure rational use of drugs.

The basic aim of our study was to develop and evaluate the polyherbal soap by using different extracts (extracts of neem leaves, papaya leaves, aloe leaves, turmeric and tulsi leaves) having greater antioxidant and antimicrobial potential. Pre-eminently, basic soap was prepared using Coconut oil and NaOH (lye) and the different extracts were incorporated into the basic saponification reaction. The herbal formulation thus prepared was then consigned for the evaluation testing for the analysis of pH, Moisture content, foaming ability, foam retention time, saponification, Total Fatty Matter determination and antimicrobial activity. The results demonstrated that pH 7.5 – 8, moisture contents 8.6%, foam retention time 1.20 minutes, Saponification value was 210.375 mg/ml, 30% TFM for polyherbal soap. Also the evaluation tests showed that the poly herbal soap has satisfactory antimicrobial results as compared to standard antibiotic. Some human infections which are majorly caused due to wounds, acne or blisters; these strains of microorganisms are of greater benefit. Moreover, oils and extracts used are added to treat various skin infections and are perfect for daily usage.

Complicated UTIs (cUTIs) are one of the leading causes of the gram negative bacteraemia which occur in patients who have a functionally, metabolically, or anatomically abnormal urinary tract. The primary objective of this study was to compare efficacy of Piperacillin/Tazobactam (PT) and Cefoperazone/Sulbactam (CPS) combinations in complicated Urinary Tract Infections. At entry, total 92 patients admitted in the hospital due to cUTI were enrolled. Among of 92 patients, 49 patients were given PT while 43 patients were given CPS combinations. Clinical symptoms were registered and scored as mild (1) moderate (2) or severe (3). The follow-up were done daily till the patient is discharged. Thereafter, one follow up visit was done within 4 to 9 days of after discharge, termed as test of cure (TOC). Furthermore, one late follow up visit after 6 to 8 weeks was done, known as late follow up visit (LFU). Clinical assessments and microbiological analysis were done at the time of TOC and LFU. The mean baseline clinical score for PT and CPS were 10.89 ± 2.23 and 10.28 ± 2.33, respectively. At TOC visit, PT and CPS groups, clinical scores were 0.86 + 2.35 and 1.36 ± 3.48, respectively; suggesting significant improvement from baseline (p< 0.001). Rate of clinical improvement at TOC visit was 92.68% and 87.50%, while microbiological cure rate was 87.80% and 93.75% with PT and CPS groups respectively. While, at LFU visit, clinical scores in PT and CPS groups were 1.32 + 3.37 and 1.65 + 3.56, respectively, suggesting significant improvement from baseline (p < 0.001). Clinical cure rate at LFU visit was 87.80% and 87.75% while microbiological cure rate at LFU visit was 82.92 and 77.00% in PT and CPS groups, respectively. These results suggest that both regimens have no significant difference for the treatment of cUTI. PT and CPS, both the combinations, are equally efficacious in treatment of cUTI.

The purpose of this study is to find out how the perception of price, process and quality of Product influences purchasing decisions with a case study of sharia KPR financing products in PT Bank Permata Syariah Business Unit. There was significant gap between target and sharia KPR finance realization achievement until August 2018 because the target was not achieved. In addition, the ranking of Bank Permata Syariah which is still far below shows that the contribution of KPR financing is not yet high. This is caused by many factors including the price / margin factor offered to customers who are still less competitive, the financing process and product quality that still need to be improved. The design of this research is explanatory. The samples taken in this study were the customers of Bank Permata Syariah in the South Tangerang Region who already had Sharia KPR financing and filled out questionnaires. They were taken by using the accidental sampling method with some specified criteria. The sampling technique was Purposive Sampling Method on 1504 of total population of customers of Bank Permata Syariah in the South Tangerang Region. By using the Slovin formula, 100 customers was obtained as samples. Analysis method of this research was qualitative method with Multiple Linear Regression as analysis tool, and helped by SPSS version 23.0. Before the analysis was carried out, the questionnaire instrument test was carried out with validity and reliability tests and classic assumptions. After that, it was analyzed by Multiple Linear Regression followed by a test of determination analysis (RSquare), partial hypothesis testing (t test) and simultaneous (F test) with a 5% error tolerance level. The results showed that there was an influence of price perceptions on purchasing decisions partially, the process of purchasing decisions partially, product quality on purchasing decisions partially and perceptions of price, process and product quality simultaneously influenced purchasing decisions for Sharia KPR financing products at Bank Permata Syariah

The aim of the study was to study effectiveness of inhalation sevoflurane with the laryngeal mask airway (LMA) in children undergoing surgeries below umbilicus. Thirty premedicated children 3-12 years old with the American Society of Anaesthesiologists physical status of I to II were enrolled and received induction with sevoflurane 7% by face mask and maintained with 50% oxygen and 50% nitrous oxide mixture followed by 1.7% sevoflurane with LMA. Demographic data, induction time, number of attempts, LMA insertion, removal and recovery times, haemodynamic parameters, complications, Aldrete score and child’s behaviour score were recorded. LMA insertion was successful at the first attempt in 93% with sevoflurane. LMA insertion, removal and recovery times were (1.26±0.36, 2.76±0.51, 5.16±1.6 minutes respectively). Perioperative minor complications were there. Recovery milestones including Aldrete score in the group was (9.03) t 5 minutes and comparable at 15 and 30 minutes. There was a greater incidence of excitatory phenomena with sevoflurane. Haemodynamics were studied. Sevoflurane provided short LMA insertion, removal and recovery times in children undergoing minor surgeries below umbilicus with little perioperative complications. Agitation was seen with sevoflurane.

In this paper, we compare the difference of non-monotone strategies to solve the wedge trust region method for derivative-free optimization. The wedge trust region method based on traditional trust region which is designed for derivative-free problems. Considering the effectiveness of the non-monotone strategy compared with monotone ones, we combined the non-monotone strategy into wedge trust region methods. The computational results show that the both two strategies have their respective advantages.

This study evaluated the tendency for Cocos nucifera juice to be effective in management of hepatic and renal anomalies in a human design. 180 male subjects were used for this study. With treatment A as the control, Cocos nucifera juice was administered in 3 doses; B, C, D-50ml, 100ml and 150ml respectively. The experimental period lasted for 42 days. The biochemical assay protocols were aimed at investigating changes relating to hepatorenal function. Biomarkers assayed for include aspartate transaminase, alanine transaminase and alkaline phosphatase for liver function biomarkers, creatinine, cystacin-3 and interleukin-18 for kidney function biomarkers. There was a dose dependent change in both liver and kidney function biomarkers. This study revealed an inverse relationship between Cocos nucifera juice ingestion and the serum level of these metabolic biomarkers. There was also a time dependent reduction as well as a progressive decrease in harmonic mean of the assayed biomarkers for all dose treatments. Cocos nucifera has the potential to be applied in the management of hepatic and renal dysfunction.