Abstract: Syndrome Z is defined as the co-occurrence of obstructive sleep apnea (OSA) and metabolic syndrome. There is a paucity of information on the magnitude of syndrome Z in the community and the factors associated with it. Obstructive sleep apnea (OSA) has been linked to increased cardiovascular morbidity and mortality from both coronary heart disease and stroke [1-3] but whether this risk is due to coexistent known cardiovascular risk factors or specific effects of OSA remains to be established. In populations at risk of vascular disease, many patients who experience a cardiovascular event either do not have identifiable risk factors or have disease severity which appears to be out of proportion to their known risk factors. A lot of the variance in the incidence of vascular disease is therefore not explained by known risk factors. It is possible that OSA is a cardiovascular risk factor, previously largely unrecognized, which may account for some of the apparently unexplained variance in vascular risk. Systemic hypertension during daytime measurements of blood pressure is common in patients with OSA [8] but a causal link between these two conditions has been disputed [2, 3]. Sleep apnea has been shown to be common in patients with hypertension [8-11] and, conversely, patients with OSA have a high prevalence of hypertension [1, 5]. The frequency with which risk factors for hypertension such as increasing age and obesity coexist in patients with OSA has confounded identification of a causal relationship between OSA and hypertension.

The study is an ecotoxicological evaluation of commercial fish farm in Ogbogoro (OGB), Rivers State Nigeria using anatomical/macro morphological assessment of Clarias gariepenus, and African Aquaculture Centre (ARAC) as a the reference site. The sampling involved harvesting of table-sized fish: twenty fishes from OGB and ten fishes from ARAC. The gross anatomy (fish necropsy) involved the determination of Fish Biometry (Condition factor, CF and Organosomatic Indices, OSI) and Health assessment index (HAI). Showed that: fishes from OGB were less healthy based on the CF; OGB were less Healthier based on OSI; OGB fishes were less Healthier based on HAI when compared to fishes from ARAC. It was concluded from the study that the fishes from Ogbogoro fish farm had certain level of pollution though considered to be moderate at the time of the study.

Abstract: Lipoprotein (a) is independently associated with Atherosclerotic Cardiovascular Disease (ASCVD) and is referred to as the most atherogenic lipoprotein. It is synergistic with the effects of low density lipoprotein cholesterol (LDL-C). Unlike other major classes of lipoproteins that have a normal distribution in the population, plasma levels of Lipoprotein (a) / Lp (a) have a skewed distribution towards the lower end with 85% population having concentration <30 mg/dL. The aim of present study is to estimate the level of serum Lp(a) in cerebrovascular diseases or Strokes. The study was conducted in the Department of Medicine, Department of Biochemistry, Sushila Tiwari Memorial Hospital, the teaching hospital of Uttaranchal Forest Hospital Trust (UFHT) Medical College, Haldwani (Nainital), Uttarakhand, on patients of cerebrovascular disease (CVD) which included estimation of Lp(a) and lipid profile (TC, TG, HDLc, LDLc, VLDLc) test. Out of the 17 women and 36 men in whom Lp (a) was measured, 2 women (mean age63.5 years) and 21 men (59years) had CVD (CVD(+), while 15 women (50.13 years) and 15 men (52.33 years) had no CVD [CVD(–)]. As shown in Table 1, there were no significant differences between women with or without CVD in age and concentration of total plasma cholesterol. The study was based on a small sized cohort of 23 cases suffering from (CVD) out of which 21 were males and 2 were females. Thirty (30) healthy subjects were taken as controls, who were not suffering from any disease, which may affect serum lipid levels and without any history of cerebrovascular disease. Total-C, LDLc, VLDLc, Triglyceride, HDLc, LDL/HDL, Cholesterol/HDL and Lp(a) were estimated in all the cases.

This research aims to see the accountability of madrasah heads in carrying out the task to manage the education madrasah financing to be the best in implementing process of education and teaching in order to create quality students and able to compete in national and international forums. The management of education funds must be implemented properly and correctly because the fund is the key to success in an institution, so that the target funds of the institution being effective then the manager must be able to do budgeting, accounting, organizing and auditing so that the goal of education is achieved well. Research approach used is descriptive qualitative approach. Data collection techniques using observation, interviews, and documentation, data analysis using cress well model, spread miles Huberman model data analysis in progress or flow. Data analysis techniques using domain analysis, taxonomy, compositional, cultural themes and data presentation of data triangulation. This research is head of madrasah Jambi province which not fully accountable in management of education fund because to manage education fund is not run based on what have been determined.

Blunt abdominal trauma presents a challenge for diagnosis because it may be associated with multiple organ injuries thus physical examination alone may result in an improper diagnosis. Ultrasonography is one of the important tools in the examination of such patients. The aim of the present study was to determine the accuracy of Focused Assessment Sonography for Trauma [FAST technique] in blunt abdominal trauma patients. Methods: The study involved 120 Abdominal trauma patients admitted to Prathima Institute of Medical Sciences and Hospital. Every patient was examined by abdominal sonography in those patients who required urgent management because of serious injuries were excluded from the study. All the patients based on clinical assessments were suspected of abdominal trauma. The sonographies were done using the FAST technique “Focused Assessment Sonography for Trauma" in which six areas of the abdomen were examined. Results: Out of the 120 patients 94 were diagnosed as positive after abdominal sonography out of which 73 were confirmed as positive by CT, DPL, and explorative laparotomy and remaining 21 were found to be negative. Similarly out of 24 diagnosed as negative by sonography 2 were found to be positive by CT, DPL, and explorative laparotomy. The mean sensitivity in all patients was found to be 97.33% with 95% Confidence Interval ranging from 90.70% - 99.68%, the specificity was 53.33% 95% CI 37.87% - 68.34%, the positive predictive value PPV was 77.66% range 71.73% - 82.64% the negative predictive value NPV was 92.31% range 74.85% - 97.98%, the overall accuracy was 80.33% and range was 72.64% - 87.44%. Conclusion: within the limitations of the present study it can be concluded that abdominal ultrasonography with FAST technique is fairly reliable and accurate method of evaluation in blunt abdominal trauma. Abdominal ultrasonography is a valuable tool after clinical examination of the patients with blunt abdominal trauma. It has a relatively high negative predictive value that prevents the patients from undergoing unnecessary tests after blunt abdominal injuries.

The production and consumption of building materials have increased to leaps and bounds in the past few decades due to tremendous increase in population. As the production of building materials gets increased, generation of waste materials such as fibers, granules, ashes, effluents etc. also gets increased. Nowadays wastes of different types are being used effectively in concrete either partially and fully which helps in making of green concrete. Fiber reinforced concrete is a special type of concrete in which natural or synthetic fibers with different aspect ratios are used to eliminate or reduce crack formation and to improve various mechanical strength properties when mixed along with fly ash, silica fumes etc. in optimal dosages. In order to study the influence of waste on various strength properties of cement concrete, different dosages of cement are replaced with fly ash and also with coconut fiber or wollastonite fiber were added. The compressive strength, split tensile strength and flexural strength were experimentally evaluated and modulus of elasticity was empirically determined. Based on the test results, the concrete with 20% replacement of cement with fly ash and fiber revealed effective results when compared to concrete without fiber. Coconut fiber along with minimum dosages of fly ash has greatly improved the flexural strength on the other hand it reduces other mechanical properties at higher dosages. Combination of Wollastonite fiber with fly ash helps in the improvement of overall mechanical strength of cement concrete.

The challenge for today is not just retaining talented people, but fully engaging them, capturing their mind and hearts at every stage of their work lives. Employee engagement has emerged as a crucial driver of business success in today’s competitive marketplace. Further, employee engagement can be a key factor in organizational success. Not only does engagement have the potential to significantly affect employee retention strategy, productivity and loyalty, it is also a key connect to customer satisfaction, company reputation and overall stakeholder value. Thus, to gain a competitive edge, organizations are looking to HR to set the agenda for employee engagement and commitment. Employee engagement is rightly a property of the relationship between an organization and its employees. An "engaged employee" is defined as the one who is fully absorbed by and enthusiastic about their work and so takes positive action to further the organization's reputation and interests. Employee engagement is a way ahead to business success. An engaged workplace is one encourages commitment, energy and productivity from all those involved to help improve and achieve business performance. Employee engagement is about linking on our employees’ knowledge and ideas to improve our products and services, and be innovative. Employee engagement is about indulging a deeper commitment from our employees so fewer leave, sick absence reduces, accident rates decline, conflicts and grievances go down, productivity increases. Employee engagement is about organisation actions that are consistent with the organisation’s values. This paper is an attempt to review the available literature in the field of employee engagement which are in the form of models and draw conclusions on the available gap. It is purely based on secondary data

Background: Like in other developing countries, cancer of cervix is one of the leading malignancies in women in Nepal. In Nepal cervical pap-smear screening is not done my most of woman due to lack of awareness. The objective of this study is to find the prevalence of abnormal cervical epithelial lesions. This was a retrospective study of 396 conventional cervical Pap smears reported from the Department of Pathology, Birat Medical College in Biratnagar, Nepal. The time period was from March 2016 to March 2018. We used Bethesda system to report our all our slides. We used the pap stain to use the slide. All the case was reviewed by consultant pathologist of Birat medical college. Total cases were 396 in two year period in which 396 cases were satisfactory for evaluation and 20 cases were unsatisfactory for evaluation which is due to thick neutrophilic exudates, mucous, degenerative cells and hemorrhage. Out 0f 396 cases 7 cases is ASCUS that is 1.76%,4 cases is LSIL that is 1.01%,3 cases is HSIL that is 0.75%,1 cases is SCC that is 0.25%.Negative for intraepithelial lesion and malignancy is 381 that is 98.21%

The purpose of this research is to analyze the business model of waste bank through partnership as bank agent to increase: the business competitiveness, member's income and management, and profitability of waste bank. The method used is the analysis of Strength-Weakness-Opportunity-Threats ( SWOT ) using IFAS, EFAS and SFAS matrices as well as query analysis and then build an existing model of financial information and development a models using Business Model Canvas (BMC) consists of Customer Segment, Customer Relationship, Customer Channel , Revenue Streams, Value Proposition, Key Activities, Key Resource, Cost Structure, and Key Partners. The research result of waste bank condition in quadrant III (third) mean Company faced bigger market opportunity, but there is internal constraint, company focus is to minimize internal constraint by giving management training, entrepreneurship, accounting, finance, production and marketing, and exploiting opportunity to become as a bank agent.

Oncogenesis is a very complex and multistep process with many factors involved. Among the various cancers viral oncogenesis constitutes about 12%. The human population has been plaqued by viruses particularly viruses with oncogenic potential. Worldwide, viruses cause numerous miseries ranging from flu to complex cancers. A noteworthy few among them are caused by oncoviruses such as Human papilloma virus, Hepatitis B, Hepatitis C, HTLV-1, EBV. Among these viruses Human papilloma virus and Human T Lymphocyte virus have direct oncogenic potential whereas HIV, EBV, Hepatitis B and Hepatitis C have indirect oncogenic potential. In this review, we aim to discuss briefly about the pathogenesis of the most commonly 6 occuring oncoviruses and their oncogenic potential.

This study investigates the effect of tax audit and investigation on the revenue generating capabilities of Federal Inland Revenue Services (FIRS), a study of Port Harcourt branch of Federal Inland Revenue Services. The two research questions that guided the research include; to what extent does functional tax audit and investigation department of FIRS influence its revenue generating capabilities; and to what extent does ineffective tax audit and investigation exercises affect the revenue generating capacity of Federal Inland Revenue Service. The population of the study consists of the staff members of the Federal Inland Revenue Service, and professional accountants Port-Harcourt. A Simple random sampling technique was adopted in distributing 100 copies of questionnaire, out of which 80 copies were returned. Presentation and analysis of primary data collected with questionnaire were done using tables and simple percentages. The study revealed that functional tax audit and investigation department, to a considerable extent influences the revenue generating capabilities of Federal Inland Revenue Service. Besides, ineffective tax audit and investigation exercises, to a great extent, weaken revenue generating capacity of Federal Inland Revenue Service. The study recommends the need to strengthen tax audit and investigation department and to ensure its optimal performance, a degree of autonomy should be granted to this department to enable it carry out its responsibilities effectively as specified in Federal Inland Revenue Service Establishment Act 2007.Thorough, regular, effective and efficient audit and investigation exercises should be put in place through the employment of competent professionals considering the importance of tax audit and investigation processes. The study equally concluded that effective and efficient audit and investigation exercises together with functional tax audit and investigation department would strengthen considerably the generating capabilities of Federal Inland Revenue Services (FIRS).

HIV-related cutaneous manifestations are very common and can be easily detected. If studied systematically, they can serve as diagnostic and prognostic markers. It is aimed to study the skin biopsies of various dermatological manifestations that occur in HIV seropositive patients attended to a tertiary care centre. This is a prospective study of cases of 104 were studied histopathologically who were Seropositive for HIV. Majority are of 31- 40 years (32.69%), and closely followed by the age group 21-30 years (28.84 %). Patients of both sexes were affected with males females ratio of 1.19:1. The most common cutaneous manifestation observed was Papulosquamous lesions with 37.5% cases and in this 53.84% cases were pruritic papular urticaria. Infections observed were 25%, among which majority were of bacterial infections. Drug reactions were observed in 15.3% of cases and majority of patients presented with Stevens Johnson syndrome. Dermatitis was seen in 11.53% of patients and seborrheic dermatitis is the common non-infectious dermatosis. Other cutaneous manifestations like vascular involvement, neoplasms contributed minority of cases. Most of the patients presented with cutaneous manifestations having CD4 count in the range of 350-500. It was conclude that the dermatological lesions are extremely common and may present with early, severe, unusual and atypical manifestations in the course of HIV infection. Awareness of the varied pattern of these manifestations would help in the early diagnosis and management of HIV infection, which would in turn decrease the morbidity and improve the quality of life of HIV-infected patients.

Abstract: Glucose 6 phosphate dehydrogenase (G6PD) deficiency and Neonatal Hyperbilirubinemia. The Prospecutive study was conducted between June 2017 to June 2018 among icteric neonates in Maternity and Children Hospital, Nejran, Saudi Arabia. A total of 200 icteric neonates were included in study, who were admitted in nursery during study period. Each baby was tested for Complete blood count, Reticulocyte count, ABO and Rh blood types, Direct antiglobin test and quantitative G6PD estimation. Out of 200 icteric neonates 56( 28%) were found to be G6PD deficient and 144 (72%) had normal enzyme activity.38.7% were males and 12.3% were females among G6PD deficient neonates. Fisher exact test is 0.00 which is highly significant as p<0.001. None of them had kernicterus. Haemoglobin and Reticulocyte count in G6PD deficient neonates is statistically significant as p<0.01as compared to G6PD normal neonates. Since the Prevalence of G6PD deficiency in our neonates was relatively high. Early detection of this enzymopathy regardless of sex and close surveillance of affected newborn may be important in reducing the risk of severe hyperbilirubinemia.

This study examined the ecotoxicological evaluation of commercial fish pond in Mgbuoba, Port Harcourt, Rivers State Nigeria using water quality and gross anatomical assessment of Clarias gariepenus, using African Aquaculture Centre (ARAC) as a reference site. In this research the following were done: Gross anatomical assessment of the farmed fish which comprised of condition factor (CF), Organo-Somatic Index (OSI) and Health Assessment Index (HAI) and physico-chemical properties of pond water. The chemical assessment involved environmental water quality index (EWQI) and heavy metal assessment. The gross anatomical assessment involved the sampling of twenty table-sized fish harvested from the Mgbuoba commercial fish pond which were compared with ten table-sized fishes of the same specie harvested from an aqua-cultured centre, ARAC. The EWQI of the commercial fish pond was considered to be of a fair quality, condition factor recorded showed that fishes from Mgbuoba were in better condition than that of ARAC, health assessment index was poor in fishes harvested from ARAC. The organosomatic index showed that Mgbuoba fishes had a high mean values for Gills and Liver respectively. Using one-way Anova statistical analysis, no significant difference (p>0.05) were noted between Mgbuoba commercial fish pond and ARAC. It is suggested that at intervals the health status and water control should be examined/analyzed to keep a suitable habitat for the fishes and make consumption safe humans.

The development of tourism is essential since it increases the foreign exchange. The adequate attention to the tourism drives the progress of tourism related products and services. Several studies have shown that the role of destination image influence the tourists to visit. The purpose of this study is to determine the forming components of destination image with a quantitative approach. The research population consists of the most visited destinations in Indonesia. Questionnaires are distributed in three cities that represent the most visited places by tourists in Indonesia. According to the statistical calculation, the amount of sample that can be used is 167 people. The results reveal that some aspects significantly influence the destination image. The influencing aspects are lodging facility, quality of food and relaxation experiences. This finding implies that there should be some improvements in lodging facilities, the quality of food and relaxation experiences to enhance the destination image.