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...

The malignant hyperthermia is a rare autosomal dominant disease of the skeletal muscles. Triggered by volatile anesthetics and succinylcholine which leads to excess release of calcium from sarcoplasmic reticulum that leads to hypermetabolic status of the body and it could be fatal. The incidence between 1:10000 and 1:250000 anesthetics. It is more common in males than females, and the young more than old people. MH cause by mutation in RYR1, CACHA1S or STAC3 genes. Symptoms of MH are muscle rigidity, tachycardia, hypercapnia, hypoxemia and hyperthermia. The symptoms of MH could be mistaken by other conditions and therefore delay the treatment. Treatment is by stopping the triggering agent, symptomatic treatment to prevent complications and the only pharmacological agent that reverses the MH is Dantrolen. IVCT is the gold standard to diagnose MH but it is invasive. Genetic testing is less invasive and also help in diagnosis of MH and identification of the affected gene, but it does not replace IVCT.

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.

PLMA is a recent, complex, and ingenious development with some added features of Classic LMA like Modified dual cuff ,Drain tube, positive pressure ventilation at higher peak inspiratory pressure. Study was to evaluate and compare the use of Proseal laryngeal mask airway and endotracheal tube with controlled ventilation in patients undergoing gynecological laparoscopic procedure. 100 patients, ASA risk I & II, posted for elective laparoscopic were recruited in the study. All the patients between 18 to 45 yrs of age were randomly divided in two groups Group PLMA and Group ETT (50 patients each). Attempt of insertion of airway device, Leak pressure, pulmonary ventilation, Hemodynamic; heart & MAP, gastric distention were recorded. All patients were of middle age group, comparable in weight. Mean duration of laparoscopy was comparable in both the groups. Significant rise in heart rate and mean arterial pressure seen in group ETT after induction of anesthesia .Changes in the end tidal CO2 and peak airway pressure after induction of anesthesia, before & after peumoperitoneum were comparable in two groups. After head low position peak airway pressure is slightly raised in Group PLMA. Gastric distension was noted higher in Group PLMA (8%).Incidence of sore throat (22%), nausea vomiting (14) airway trauma (14%) was higher in group ETT. Hemodynamic stability was better in PLMA group at time of induction and comparable in two groups at time of pneumoperitoneum and trendelenburg position along with pulmonary ventilation. Post operative sore throat, nausea vomiting was higher with endotracheal tube.

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.

The choroidal macular neovascularisation (NVC) of the young subject is a serious condition that threatens visual function. The decrease in marked visual acuity is related to the foveolar or juxta-foveolar localization of the neovessels. The therapeutic management of idiopathic NVC of the young subject is difficult due to frequent recurrences despite the treatment. The use of anti-VEGF (vascular endothelial growth factor) represented a turning point in the management of this condition. The intravitreal (IVT) injection of bevacizumab appears to be effective and well tolerated.

Gender based violence is rising. Bangladesh stands second in the world in terms of violence against women in different forms like women battering, wife beating, domestic and dowry-related violence, acid attack, rape, physical and verbal harassment, fatwa, sexual harassment in the workplace, trafficking and prostitution, polygamy and child abuse. The rate of violence against women has dropped by 4.9 percent in between the years 2011 and 2015. Abusing rate was 87.1 per cent in 2011 which came down to 82.2 percent in 2015 and in the Daily Star newspaper came down to 80 percent in 2016. Around 72.6 per cent of women who are married in Bangladesh experience one or more such forms of violence it the hands of their husbands at least once during their marriage and 49.6 percent of lifelong married women suffered physical violence, 28.7 percent emotional violence, 27.2 percent sexual violence and 11.4 percent financial violence according to the Bangladesh Bureau of Statistics. Gender discrimination also leads to women having less opportunity. The literacy rate for women in Bangladesh is only 43.2%, while 61.0% of Bangladeshi men are literate. The unemployment rate for women is 70.7%, much higher than the 12.4% unemployment rate for men. Most of the victims, around 39.7 percent, of forced or coerced sexual intercourse, are aged between 15 and 19. Child marriage that legitimizes sexual abuse of minors must be stopped immediately. The government should enhance legal and criminal justice systems to prevent further violence and need interventions to change male attitudes.

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.

Cerebral sinus venous thrombosis is a very common condition and it is an important cause of stroke especially in the peripartum setting and is one of the common causes of stroke in young patients. The present study has been undertaken to describe the clinical profile, diagnosis, and prognosis of CSVT. Methods: This cross-sectional prospective observational study was conducted in the Department of General Medicine, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar. Based on the diagnosis 50 patients were included in the study, meticulous history, clinical examination, laboratory investigations including complete blood count, ESR, RBS, serum urea, serum creatinine, LFT, serum electrolytes, Urine electrolytes, ECG, CSF analysis were done in addition to imagining of the brain. Results: Out of 50 patients 25(50%) belong to the puerperal group and 25 (50%) belong to a non-puerperal group. Out of 25 non-puerperal patients 5 were female and 20 were male patients. The 25 puerperal cases the CSVT was seen in 18 cases in the first 10 days post-parturition and 5 cases were between 11-20 days and 1 case each of 21 -30 days and > 30 days were seen. In the present study, 24 (48%) of CSVT had a sub-acute presentation followed by 18 cases (36%) with an acute presentation. The clinical signs were hemiparesis and papilledema in 20(40%) of cases and pallor in 16(32%) and dysphasia was in 9(18%) of cases. In the study out of 50 patients, 17 were anemic, accounting for 34% and the mortality was higher when the degree of anemia was severe. Anticoagulant therapy with subcutaneous LMWH in 33 cases and intravenous unfractionated heparin infusion in 17 cases and later changed to oral anticoagulants. 5 patients required decompressive craniotomy out of which 1 patient died. Additional treatment included antiepileptics in 33 patients and anti-edema measures in 38 patients. Conclusion: CSVT is not an uncommon condition. Clinical presentation is extremely varied and symptoms may evolve over hours to few weeks. Neuroimaging plays a pivotal role in diagnosis MRI with MRV is the current diagnostic modality of choice. Management with unfractionated heparin, LMWH, and oral anticoagulation is appropriate. Surgical decompression is helpful in the cases of continuing deterioration, in spite of maximum medical management

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.

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.

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.

Since 2014, the crude oil market has experienced declining oil prices around the globe. Speculations are that there has been over-supply in the market and lower demand than expected. In particular, the oil industry's oil industry in the United States took analysts and experts to surprise and the crude oil supply was not calculated in the forecasts. The production of this resource was preceded by the US, which gained extensive experience in the development of oil shale. Consistent developments in mass oil production coupled with the development of new technologies, which ensured a significant growth in the production of this hydrocarbon resource is believed to have significantly affected the global crude oil market. This article seeks to foster better understanding to the nexus of oil shale production and its impact on crude oil prices, as previous scientists have studied dating from the year 2002 to 2018 streamlined towards articles related to the impact of shale oil production on global crude oil prices. The study findings reveal that while some studies postulate that indeed US shale oil have negative impact on global crude oil prices, other studies also show that current lower crude oil prices could be attributed to several factors other than the mass production of US shale oil. Adversely other studies were indifferent with their findings and attributed the lower crude oil prices to both relatable factors such as the growth of US shale oil production, the slowdown of global oil demand, reduced cohesiveness of the OPEC cartel and production ramp-ups in other non-OPEC countries.

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.

This study is to examine and analyze the influence of internal factor and external factor on devidend payout ratio and the impact on stock return. The internal factor in this study consists of liquidity (current ratio), solvability (debt to assets ratio), profitability (return on equity), activity (total assets turnover) and firm size,while external factor consists of GDP growth rate. The population of this research is all companies listed on The Indonesian Stock Exchange during 2012 until 2015. From a population of 521 companies, with purposive sampling as samples determining methods, 43 companies meet the criteria to be the sample. The result shows that debt to assets ratio, return on equity, and firm size have significant influence on devidend payout ratio, while the other variables have unsignificant influence. It also shows that debt to assets ratio, return on equity, firm size, and GDP growth rate have significant influence on stock return,while the other variables have insignificant influence. The result of this study also shows that devidend payout ratio have insignificant influence on stock return.