No matter what type of surgery you choose, you can rest assured that you are in the hands of the most experienced and skilled doctors because laparoscopic or robotics both are operated by a surgeon only. Most patients and physicians would agree that minimally invasive surgery is preferred over traditional open surgery techniques. However, sometimes patients have the choice between two minimally invasive surgery techniques: robotic surgery and laparoscopic surgery. Most surgeons and patients would agree: minimally-invasive surgery is preferable to open surgery. There’s often less post-operative pain, hospital stays are shorter and recovery is easier. Only you and your doctor can decide which is best in your case. But we need to be through on to learn the basics and what to expect with both methods. This review explains about connection in laparoscopic and robotic surgery

Introduction: Breast cancer is the most common malignancy in women, accounting for 56% of all female tumors. it is one of the leading causes of death in female. Metaplastic carcinoma is another rare carcinoma, with incidence accounting for 3-6 % of breast carcinoma. Early treatment management has better prognosis. Aim: To detect the importance of immunohistochemistry studies in detecting breast carcinoma. Material and Methods: Among 75 total mastectomy specimens received in Sree Balaji Medical College in department of Pathology 57 cases reported as ductal carcinoma insitu, Metaplastic carcinoma 5 cases, Papillary carcinoma 10 cases and Neuroendocrine carcinoma 3 cases. Among 5 Metaplastic carcinoma cases, Immmunohistochemistry staining was done with tumor marker CD68 and CK to find the expression of the markers in tumor cell and to find rare variants in the carcinoma. Results: Out of 5 cases of metaplastic carcinoma of breast, 3 cases were positive for CD68 and CK. CD68 and CK has a sensitivity of 86% and specificity80% in detecting variants in breast carcinoma. Conclusion: Molecular genetic analysis should be done in breast carcinoma in large number of cases to know the onset of this rare variant and early treatment management gives better prognosis.

All dental procedures carry the potential for adverse events. Dealing with the sequelae of the complications and errors that arise in the course of normal practice is therefore part and parcel of a dentist’s working life. The challenges and stresses that this creates are now well recognized, although dental training has, until recently, done little to help dentists prepare for such events, and ongoing professional and personal support is limited

DNA fingerprinting as emerged to be an excellent valuable tool in the field of forensics, unique identification of person and paternity disputes and issues. Genetics are the base criteria of identification. Microbiology runs hand to hand in evaluating these scenarios by the microflora detected. This review explains about the basics, methods, sequencing and role of microbiologists and their perspective in DNA fingerprinting

Introduction: Peruvian food is diverse and has established itself as a fundamental part of the country's tourist offer, but we have not found in the literature the concentration of restaurants in Peruvian territories. Aim and Objectives: The objective was: a) to know the territories where the catering and hotel companies are located and b) to know the size of these companies. Materials and methods: This is a cross-sectional, observational and retrospective study. We use the International Standard Industrial Classification version 3.0 and the database of the Peruvian Ministry of Production regarding the classification of companies from January-December 2015. Results: In 2015, the Ministry of Production of Peru registered 3700 restaurants and 545 hotels. 3054 (82%) restaurants were located in Lima, 74 (2.0%) in Callao, 61 (1.6%) in Lambayeque, 49 (1.3%) in Cusco and Ancash. 363 (66.6%) hotels were located in Lima, 16 (1.3%) in Apurímac, 15 (2.8%) in Junín, 14 (2.6%) in Cusco and La Libertad. Due to the size of the company, we found 3671 (%) and 542 (99.45%) microenterprises corresponding to restaurants and hotels. Conclusions: It is necessary to promote and improve the registration of business economic units dedicated to gastronomy and hotels, as well as to continue promoting the formalization and improvement of the quality of service of companies within the country.

The purpose of this research is to determine the perceptions of practitioners, auditors, scholars, and students on Islamic banking and conventional banking in Palu City. This research is a qualitative research with a phenomenological approach. This research was conducted in Palu City. Informant in this research amounted to nine (9) people, consists of four people as practitioners, two students, two representatives of scholars, and one representative from the Financial Services Authority (OJK) Central Sulawesi. The results of the research are very clear awareness that from the aspect of business mechanism and object, namely anti usury and anti gambling, investment aspects namely halal while in conventional banking that is not anti usury and anti gambling, and investment can be halal or haram. Student information states that the emphasis of the concept of Islamic banks namely Islamic banking activities in accordance with the principles of Islamic law, which are based on the Qur'an and hadith. There is an awareness that the products produced by Islamic banks in addition to the form or name of the product, which are needed to be considered are the Islamic principles used by the product concerned in the contract (agreement), and not just the name of the product as conventional bank products. The research conclusions are the essence and characteristics of Islamic banks are different from conventional banks, and Islamic banks encourage people to transact non-usury or not contrary to Islamic teachings

The duodenal diverticulum is a hernia of the duodenal wall. Its frequency varies from 2 to 20%. The symptomatic forms are rare but particularly serious because often revealed by a complication. The discovery is most often fortuitously on the occasion of a Cholangio Endoscopic Retrograde Pancreatography. The purpose of our work is to study the clinical endoscopic and therapeutic epidemiological aspects of duodenal diverticula. Materials and methods: This is a retrospective descriptive study conducted in the department of diseases of the digestive system "Medicine C" at Ibn Sina Hospital in Rabat. We collected all patients with duodenal diverticulum over a 12-year period (November 2005 to June 2016). Patient data were exploited from the Cholangio Endoscopic Retrograde Pancreatography (ERCP) registers. Results: Between November 2005 and June 2016, 664 ERCP were performed, 41 duodenal diverticula were observed; that is 6.2%. The average age of our patients was 68.6 years with extremes ranging from 38 to 85 years; 58.5% of the subjects were over 70 years of age with a clear predominance of women (34 women, 7 men) and one sex ratio F / H = 5. Clinical symptomatology was caused by cholestatic jaundice, cholangitis, acute pancreatitis. A liver test predominantly exhibited cytolysis associated with cholestasis. All our patients benefited from a radiological assessment including abdominal ultrasonography, CT, bili-MRI, echoendoscopy and Kehr drain cholongiography; the diagnosis of a lithiasis of the bile duct was raised in 80% of cases. ERCP performed in all our patients has a fortuitous discovery of duodenal diverticula. The characteristics of these diverticula were revealed by ERCP: a single diverticulum was observed in most cases (36 patients or 88%), two diverticula in 4 patients (10%) and three diverticula in one patient (2%). All the diverticula were juxta-papillary (at the level of D2). The papilla was paradivecticular in the majority of cases (30 patients, 73%), intradiverticular in 7 patients (17%) and interdiverticular in 4 patients (10%). The presence of duodenal diverticula had an impact on the feasibility of ERCP: catheterization of the papilla was difficult in 6 patients (14%) but managed in 8 patients (19%), 5 patients had paradiverticular papillary, 2 interdiverticular and one intradiverticular. Endoscopic treatment of bilio-pancreatic pathology associated with duodenal diverticula was performed in 23 patients: 16 patients underwent computed extraction of the hand bile duct. Seven patients were referred to surgery. Conclusion: The duodenal diverticulum is the second most common site of digestive diverticula after the colon. The absence of specific signs makes the positive diagnosis difficult.

There has been an exponential increase in the number of countries that have adopted offset policies as a means to develop a capable, ready and cost-effective aerospace industry. Offset transactions generates billions of dollars annually, prompting aerospace companies to increase their compliance systems and economic models (Jurgen and Paul, 2004). This purchasing and sales arrangement is used by numerous governments around the world to negotiate high-tech public procurement contracts and has also been adopted by most private organizations. This research noted that for private businesses, offsets are instrumental in establishing global development capabilities and access to emerging markets. For buyers, especially in emerging countries, offsets are a way to accelerate industry and businesses development. The main purpose of this study is to critically analyze the role of offsets and offset management within the aerospace industry. The study conducted thirteen (13) interviews with Offset Managers from most of the prominent firms in the prime contractor and supplier ranks. The key findings of this study indicate that prime contractors view offsets as a major issue for their firms but the majority of supplier companies do not have this view. Results show that offsets organizational structures follow a decentralized, narrow, and functional focus. Offset satisfying activities are well aligned to achieve the goals of the foreign governments that procure aerospace products. The study pointed out that suppliers are not fully engaged in the aerospace industry offset process. It also identified opportunities for improving offset practices in the aerospace industry. The study enhances insight into understanding buyer and seller alignment on the business and strategy; a long-term approach to the relationship; good communication and transparency; and having a single government agency responsible for offsets in order to avoid confusion, corrupt practices, and conflicting demands.

Introduction: Fallopian tube patency, morphology of the uterus and cervix can be assessed by Hysterosalpingogram. Hysterosalpingography is still a commonly used investigation in the evaluation of female infertility. Objectives: The objectives of the study is to evaluate the structural abnormalities of the uterus and fallopian tubes in infertile women. Methods: A retrospective review of 110 patient in whom hysterosalpingography was performed for infertility between Aug 2017 to July 2018 in the Department of Radiology. Clinical notes and radiological finding were analyzed for demographic data, uterine, tubal and pelvic pathology. Results: The commonest age group seen was 20-25 years. Primary infertility was commoner than secondary infertility. On hysterosalpingography 8 patients had congenital uterine anomalies. In 3 cases there is filling defect due to fibroid. Related to tubal findings among 110 patients 71 had normal fallopian tube with bilateral spillage. Conclusion: Tubal and uterine pathologies play major role in female infertility. HSG is important tool in detecting birth canal pathologies

A total of two hundred ears of CSOM cases in different age groups & sexes were subjected to bacteriological and clinical studies in the Department of Microbiology & ENT, Patna Medical College & Hospital. The ears were further subdivided into group I where ear swabs were studies for aerobic organisms and cultural & sensitivity pattern. In group II 50 swabs were studies for anaerobic organisms and culture and sensitivity pattern. The commonest organisms isolated in group I were Staphylococcus aureus followed by Pseudomonas aeruginosa while pepto-streptococci species were found in group II. Ciprofloxacin was found to be the drug of choice for most of the organisms followed by Norfloxacin,cefexime Cefoperazone & Gentamycin

A research was conducted to determine the anti-microbial susceptibility of some Escherichia coli isolates against common anti-microbial agents and Multi Drug Resistance (MDR) indices. The Escherichia coli isolates (n=51) obtained from cattle faeces and manure in abattoirs, cattle farms and livestock markets of Bauchi, Darazo and Katagum local governments of Bauchi state, Nigeria were screened for anti-microbial susceptibility against 12 common anti-microbial agents. The susceptibility test was carried on all the 51 isolates to determine their antibiotic resistant profiles using the disc diffusion method developed by Kirby – Bauer and standardized by the World Health organization (WHO), commercially available antimicrobial disks impregnated with the different antibiotics were then tested. The results revealed highest resistances of the isolates to Cephazolin (86.2%), followed by Sulfamethoxazole (82.4%) and Enrofloxacin (78.4%). The research also revealed that the highest level of susceptibility of the isolates to the antimicrobial agents was found against chloramphenicol (78.4%), followed by gentamycin and Imipenem with (68.6%) and Ceftriaxone (58.8%) respectively, the results further indicated 50(98%) of the isolates resistance to 3 or more of the antibiotics. All isolates showed Multi-drug resistance pattern (MDR), some among the isolates showed resistance against up to 8 antimicrobial agents belonging to 7 different groups of the antimicrobial agents. The MDR indices of E. coli strains indicated resistance against the antimicrobial agents at various levels of antibiotic groups

Diabetes mellitus and thyroid diseases are the two most common endocrinopathies encountered in clinical practice. Thyroid hormone abnormalities are frequently associated with diabetes and remain unidentified. Thyroid dysfunction could negatively impact Diabetes and its complications. Thyroid hormone replacement is associated with a decrease in Glycated Hemoglobin (HbA1c) level. The present study was undertaken to study association between thyroid profile and glycated Haemoglobin (HbA1c) in Type 2 Diabetes Mellitus patients. A case control study was done at Shri Krishna Hospital in Karamsad city .100 cases of Type 2 Diabetes mellitus and 100 healthy controls were taken. Blood samples were collected and analyzed for thyroid profile, HbA1c, Fasting Blood Sugar and Renal Function Test. We found that there was a positive correlation between TSH (Thyroid stimulating hormone) and HbA1c levels, and a negative correlation between Thyroid hormones [Triiodothyronine (T3) & Thyroxine (T4)] and Glycated Haemoglobin (HbA1c) in cases of type 2 Diabetes Mellitus. There is a significant decrease in TT3 (Total Triiodothyronine) and TT4 (Total Thyroxine) and significantly increased TSH in cases of Diabetes mellitus as compare to healthy Controls. We found that out of 100 cases of type 2 Diabetes Mellitus, 31% patients showed thyroid disorders. There is a high prevalence of thyroid disorders in Diabetic patients. If not diagnosed early, it could negatively affect diabetes and its complications. Therefore, routine screening of thyroid profile in diabetic patients is advisable to improve quality of life and reduce morbidity rate.

Introduction: Both tobacco smoking and tuberculosis are major global public health problems. Tobacco smoking has been linked as a risk factor for TB. This study was aimed to find the association between smoking and pulmonary TB. Materials and methods: Pulmonary TB patients aged between 17 and 85 years were enrolled over a period of 9 months. All patients had two consecutive sputum smears examined for the presence of acid –fast bacilli (AFB) using Fluorescence Microscopy technique at the initiation of treatment and repeated as per recommendations of the RNCTP. Response was determined in terms of sputum conversion at the end of intensive phase and final treatment outcomes. Results: Out of total of 124 current smokers, a very high number of patients 83(66.7%)were found to have a high load of TB bacilli(3+), these smokers with sputum 3+ grade showed less response to TB drug treatment. Out of 83 patients, only 15 patients (18.7%) showed smear conversion at the end of intensive treatment. 45 patients who had cavitary disease , 30 (66%)patients had cleared at the end of IP and 15 patients showed persistence of cavitation in smokers while 76% of non smokers showed clearance of cavity(P<0.05). Cure rate among smokers, ex smokers and non smokers were 52.5%, 78% and 84%, respectively. Conclusion: Smokers during initial presentation, as well as at end of the treatment indicate more radiological findings, cavitary disease, and worse sputum AFB smear grading. Smokers also had a poorer outcome in terms of treatment success rate as compared to non smokers. This was largely due to high percentage of default rate among smokers implying treatment adherence issues among smokers as a main confounder to treatment success. Focus needs to be made to reduce defaulters which are more common among smokers

With the development of internet, people became rapidly familiar with the e-commerce concepts and tended to shop online rather than personally visit stores. Online shopping refers to electronic commerce which allows consumers to directly buy goods or services from a seller over the internet using a web browser. Even though internet usage in Sri Lanka is very high, online shopping is not much accepted in Sri Lanka yet. Therefore, the purpose of this study is to investigate the relationship between the factors which may influence online shopping and consumers’ attitude on online shopping. The quantitative survey method was conducted by distributing the questionnaires to western province people of Sri Lanka as the population. 500 people were selected to distribute the questionnaire from the districts of Gampaha, Colombo, and Kalutara to collect the data. 350 questionnaires were collected. Close-ended questions with 5 point Likert Scale was used throughout the study. The data was interpreted using analytical tool SPSS. The Multiple Regression Model was used as the key analysis tool. The study found that the consumer life style and vendor/service product characteristics significantly affecting to consumer attitude on online shopping and those two predictors showed negative relationship towards the consumer attitude on online shopping. The other two predictors (previous online shopping experience and website quality) showed positive but insignificant relationship towards consumer attitude on online shopping in western province of Sri Lanka. Hence, policy makers should pay attention to those factors and should try to minimize the negative attitude regarding online shopping in Sri Lanka. In this study, the impact to the attitude regarding online shopping by using four independent factors was found out. Therefore, future researcher can increase the research scope by adding factors such as online shopping intention and consumer online shopping behavior additionally to the four dimensions.

Steroid drugs for external use can relieve inflammation but cannot kill bacteria. Topical steroids have been used for about 50 years and their introduction was a milestone in dermatology. Steroids led to the adverse reaction such as skin irritation, blackness, pimples, redness, skin eruption etc. According to the constituents of marketed cream which are mentioned on the label there is no any information about steroidal constituents in preparation. In present investigation, by applying chemical test in marketed preparation and in pure steroidal preparation, an attempt was made to evaluate the presence of steroid in various marketed topical preparation. Adverse reaction produced by the marketed topical preparation led to the starting of this research work and evaluated different marketed preparation for the presence of steroid. Salkowaski reaction, Liberman Bruched reaction, Liberman reaction had been applied to test the presence of steroid. From this research it can concluded that many marketed preparation which promises instant fairness, glowing, brighten skin have a dreadfully negative side and show serious side effect on the skin due to presence of steroid