Thrombocytopenia is a group of heterogeneous disorders of varying etiology and involving deficiency of platelets. Platelet volume parameters are significant especially in the diagnosis of causes of thrombocytopenia. The platelet volume parameters have been widely available as part of full blood count profile on automated hematology analyzers. To evaluate the relationship between platelet volume parameters and causative process in thrombocytopenia Methods: PLCR of 500 cases of thrombocytopenia (TCP) and 300 control cases having normal platelet counts were recorded. The analysis was done by Sysmex KX 21 cell counter and every case was reassessed by Peripheral Smear (P.S.) examination and if necessary also by the manual method. Only those cases that had sufficient clinico-hematological work up were included in the study. Results: Cases were grouped according to the most predominant mechanism of Group A-Accelerated platelet destruction, Group B-Impaired platelet production, and Group C-Abnormal platelet pooling. The age range was from 1 day to 90 years. The commonest age group for thrombocytopenia was between 21-30 years accounting for 88(18%) cases. 75(15%) cases belonged to both 31-40 and 41-50 age groups. The mean platelet large cell ratio P-LCR % was 22.64 ± 7.13 and in Group A it was 31.68 ± 8.36 and in Group B was 19.50 ± 5.51 and Group C was 31.48 ± 9.09. The Z test was performed between A, B and C Group with the control group of all the parameters of the platelet count. The P-LCR of accelerated destruction Group A, B, C and Vs Control were all significant values <0.05. Conclusion: Platelet Large cell ratio and the Platelet distribution width showed a direct linear relationship in all groups of Thrombocytopenia as well as the control group. Decreased production of platelets in cases of thrombocytopenia can be differentiated from other two groups of thrombocytopenia with the help of all the three parameters MPV, PDW and P-LCR as the differences are statistically significant.

The study is aimed at determining the relationship between environment knowledge and self-efficacy with responsibility environment behavior in the city of Gorontalo. The method used in this research is a survey with correlational techniques. This method describes the phenomena on the relationship between variables. This study consists of two independent variables, namely knowledge of the environment (X1) and self efficacy (X2) and one dependent variable that is responsibility environment behavior (Y). The result of the research is the relationship between knowledge of the environment with responsibility environment behavior. There is a relationship between self-efficacy with responsibility environment behavior. There is a relationship between environment knowledge and self-efficacy simultaneously with responsibility environment behavior. Based on the results of the research it can be concluded that responsibility environment behavior is depend on knowledge of the environment and self-efficacy both partial and simultaneous.

The aim of this study was to determine critical predictive serum bilirubin value on first day (24 hrs) of life which can screen healthy term newborns at risk of developing significant hyperbilirubinemia. This was a prospective study conducted at "Maharaja Yashwant Rao Hospital Indore" between August 2008 and September 2009. Serum bilirubin estimation was done by Van Den Berg method to know total and direct reacting bilirubin. We believe that data from this study could be applied to babies at low risk and specially will help to screen babies who may develop neonatal hyperbilirubinemia (NNHB) inspite ruling out risk factors. This group mainly represent in which hyperbilirubinemia is due to- increased enterohepatic circulation, breast milk jaundice, hypothyroidism, drugs, galactosemia, Crigler-Najjar syndrome, Gilbert syndrome, infection etc.

This paper presents a review of the recent challenges on vapour-liquid condensation phenomena inside the annular tube. The condensation phenomenon is a main concern in nuclear power plant safety system. The condensation in annular tube is a complex phenomenon, which can classify into two categories: (i) condensation in liquid (Direct Contact Condensation) and (ii) condensation on the plate. In Newton’s Law Cooling, heat transfer surface area and surface temperature (i.e., bubble or plate) are the main parameters that need to be concerned. The heat surface area of condensation in annular tube can be determined by investigating void fraction for the desire flow pattern. In this article, the condensation phenomena are reviewed based on the amount of substantial research work conducted from the past decades to the present. Condensation phenomena in annular tube such as type of phase change, interfacial heat transfer, influence of flow structure and void fraction measurement method, are considered in the review. The future need and challenges of vapour-liquid condensation in an annular tube are also highlighted in this article.

Breathlessness and Paroxysmal Nocturnal Dyspnoea (PND) is a common cause of emergency visit in our country. Cardiomyopathy is among most common cause of Breathlessness and Paroxysmal Nocturnal Dyspnoea (PND). The disease is often misdiagnosed and mistreated. There are very few studies on Cardiomyopathies from India. To evaluate clinical and demographic profile of patients with cardiomyopathy. We undertook this study in a tertiary care Medical College of North India. It is retrospective observational study of 80 patients. Routine echocardiography was done to diagnose cardiomyopathy. Patients with DCM were then evaluated as per protocol. We had a total of 80 patients in our study with a male: female ratio of 50:30. Most patients were aged over 40 years. The most common type of cardiomyopathy is Idiopathic CMP

The University Medical Center which currently runs a manual system for the management and maintenance of its critical information also operate an Outpatient Department in which non-urgent patients arrives for consultation with the problem of patients‘ long waiting time. This scenario has resulted to certain impediment ion terms of service rendering, including difficulty in accessing data due to improper keeping of patient details; delay in attending to patients on emergency which could lead to case complications as well as death of the patient; Lack of an effective Doctor-Patients appointment coordination; and more so, the few Doctors and Nurses could be overworked. The aim of this research project is to develop an Agent-Based Appointment Management System that will improve the medical center‘s efficiency in health services provision and reduce outpatient waiting time without adding extra resources. With the introduction of appointment system, the result has shown that average waiting time could be reduced by thirty-seven to forthfour percent as compared to the current status. Object Oriented Analysis and Design Methodology (OOAD) were adopted in the design for the Design and development of the proposed system. The proposed system was implemented using PHP, AJAX, HTML programming technologies. MYSQL was used as the database engine in XAMP server. The hospital appointment and scheduling system was tested using several test data by stakeholders and error correction was carried out.

Medication carrier systems are delineated as definitions intended to exchange a medication to the desirable territory of activity inside the body. Principle part of medication carrier is a proper bearer which shields the medication from fast degradation or clearance and along these lines improves concentration of drugs in the targeted tissues. In light of their biodegradable, biocompatible, and non-immunogenic properties, niosomes are promising nanoscale carriers that are formed by self-aggregation of non-ionic surfactants and cholesterol in a watery stage. As of late, various researches have been accounted for the capability of niosomes to fill in as a bearer for the conveyance of various kinds of medications. Niosomes make better substance and strength conditions other than lipid vesicles. Niosomes have been generally assessed for controlled discharge and focused on conveyance for the treatment of malignancy, viral contaminations and other microbial sicknesses. In this sense, the present work means to audit the principle niosomal approaches utilized for relationship of various medications and the fundamental accomplishments from utilizing this innovation

Cancer not only affects the physical body of the individual, but also the mind. Psychological Adjustment could be named as psychosocial adaptation and it is an ongoing process. The survivor who has optimum psychological adjustment manages his or her distress and problems well which helps them to manage the life events. It is a continuing process accompanied by multiple coping strategies. How the individual is trying to use the resources such as resiliency, support from the significant members in life, intra and inter personal relationships makes a lot of difference in how they cope. This research is an attempt to know those factors which helps the survivors to cope better in their life.

In Kenya, following the promulgation of the new constitution, county governments are implementing most policies and priorities in accordance with national development agenda. As a labour intensive enterprise, county governments require quality employees as it directly relates to how well the county performs. This paper investigates how county governments can utilize a combination of recruitment and selection practices, person organization fit and employment policies for improved employee performance. The study findings pointed that recruitment and selection practices, person organization fit and employment policies such as equal employment opportunity have a direct significant influence on employee performance at 5% level. However, the interaction among the factors (recruitment/selection practices, person organization fit and employment policies) does not influence employee performance. This study recommends that county governments should enhance their recruitment and selection process through better human resource planning, adopt appropriate organizational culture that can attract intended employees and job characteristics. Improvement of information provided during recruitment process, their ability to gauge employee job competencies and fairness of their selection in order to improve employee performance. In addition, efforts by county governments to accurately estimate the person-organization fit of their prospective employees and promote fair employment policies such as equal employment opportunities is critical because it influences employee performance.

Spinal tuberculosis (pott’s disease) is a common manifestation of extrapulmonary tuberculosis. Spinal langerhans cell histiocytois is also a granulomatous condition which can resemble pott’s disease in many aspects.In the tropics where pott’s disease is common, diagnosis of spinal langerhans cell histiocytois may be masked. We describe a case of recurrent langerhans cell histiocytosis with a long lag period whereas the first presentation was compatible with spinal langerhans cell histiocytosis on retrospective analysis. This case highlights the importance of high index suspicion of langerhans cell histiocytois in the tropical medicine.

Pancytopenia is the simultaneous presence of anaemia, leucopenia and thrombocytopenia. The etiology ranging from non-neoplastic, neoplastic to fatal leukemias. The management and prognosis depends both on the severity of pancytopenia and on the nature of underlying etiology. Thus identification of cause is the key to appropriate management. To study the clinical presentations, diagnosis and evaluation of various causes of pancytopenia by hematological parameters including bone marrow aspiration. It was prospective study. One hundred and fifty cases of Pancytopenia evaluated clinically with hematological parameters and bone marrow aspiration in a Yashoda hospital, Malakpet, Hyderabad, during period of January 2014 to February 2017. Out of 150 cases, age of patients ranged from 2 to 85 years with a mean age of 43 years. There was male preponderance. Fever and generalized weakness was common clinical presentation. The commonest physical finding was pallor and splenomegaly on systemic examination. The commonest peripheral smear was dimorphic picture & commonest bone marrow finding was hypercellular marrow with megaloblastic erythroid hyperplasia. The commonest cause for pancytopenia was Megaloblastic anemia (34%) followed by Hematolymphoid malignancy (26.6%). This study showed that clinical history, detail primary hematological investigations along with bone marrow aspiration, biopsy imprint in cytopenia patients are helpful to diagnose and to rule out the causes of pancytopenia. Megaloblastic anemia is commonest cause of pancytopenia in most indian and continent studies. Present study also shows increase in incidance of HLH (Hemophagocytic lymphohistiocytosis) and MDS are among emerging causes of pancytopenia and nutritional diet rich in vit B12 and folic acid prevents majority cause of pancytopenia in india.

This paper devoted to the results of Helicobacter pylori infection spreading in Uzbekistan, its molecular-genetic characteristics, antibiotic resistance. It is shown that Uzbekistan belongs to the regions with a high degree of infection of the population of the HP. Pathogenic Cag positive bacterial strains were associated with chronic Helicobacter pylori associated gastritis. The resistance of HP to clarithromycin in the region was 13.3%. The effectiveness of the 7-day eradication triple therapy was 65%. Prolongation of the period of eradication therapy to 14 days and the inclusion of a complex of therapies of bismuth preparations allowed increasing the effectiveness of therapy to 95%.

Enteric fevers are a common occurrence in pediatric patients especially in rural and tribal areas where the conditions of sanitation are generally poor. The common causative organisms are gram-negative bacteria Salmonella Typhi and Salmonella Paratyphi A. There is a limited data regarding the burden of the disease in Tribal Adilabad region. With this background, we in the present study tried to evaluate the prevalence of enteric fever in pediatric patients with RIMS Adilabad. Method: The data were collected from the Department of Pediatrics, Rajiv Gandhi Institute of Medical Sciences [RIMS], Adilabad from August-October 2017. All the febrile patients attending the pediatric OPD, Rajiv Gandhi Institute of Media [RIMS] presenting with clinical signs and symptoms of typhoid fever and the fever were lasting for more than 3 days. They were not on antibiotic therapy. A total of [n=66] 34 male and 32 female patients aged 0-14 years were found to have positive cultures for S.typhi. Patients were treated with ceftriaxone IV dosage based on the 100 mg/kg IV 24h for 10-14 days Results: the Most important symptom of typhoid is fever which was seen in all the 66 (100%) of cases involved in the study. The next common symptom was headache in 37 (56.06%) of cases followed by hypotension 22 (33.33%), diarrhea 21(31.81%), Abdominal pain 19 (28.79%), constipation 18 (27.27%), vomiting 14 (21.21 %) and only 7 (10.60%) and 6 (9.0 %) presented with cough and bradycardia. Maximum 45.45% patients get rid of typhoid fever after one week of medication. 22.73% of patients get rid of typhoid fever in two weeks of medication. 9.0% were cleared of infection after 3 weeks of medication. Conclusion: Typhoid fever is common in this group of the population especially in children. Fever, diarrhea and abdominal pain were the major clinical symptoms. No multi-drug resistant S.typhi was found in this population. Increase awareness regarding hygiene maintenance, sanitation and vaccinations in the population is required to reduce the burden of the disease in this area

Xanthogranulomatous inflammation is an unusual destructive chronic inflammatory process that involves various organs & tissues particularly gallbladder (xanthogranulomatous cholecystitis) & kidney (xanthogranulomatous pyelonephritis). Xanthogranulomatous appendicitis (XA) is a rare form of appendiceal inflammation that has been regarded as an unusual healing pattern of appendicitis associated with delayed or interval appendectomy. It poses a significant diagnostic challenge because it can mimic clinically, radiologically, & even pathologically malignant tumors as well as other inflammatory processes of appendix. Little information has been written in the literature regarding this entity. In this review article, data have been collected from all the previously reported cases in the literature including my observation in a XA case I have diagnosed.

There are 10 (ten) intervention villages studied, there are 4 villages located in Muaro Jambi regency such as Rondang Village, Londrang, Rukan and Desa Manis Mato. While 6 (six) villages studied and located in Tanjung Jabung Timur Regency include: Parit Culum Village, Koto Kandis Dendang, Rahayu Catur, Jati Mulyo, Rawa Sari and Dawam Bay Village. The aim of study is to determine the condition of rural land around Londrang peatland, the socioeconomic condition of local villagers, the value income of the villagers associated with the Food and Non Food Poverty Line, and the value of the Community Contingent on the basis of willingness to pay/WTP and willingness to accept/WTA.The data of research were obtained from secondary data collection, followed by primary data collection, visiting villagers to conduct interviews packaged in group discussion activities and direct observation of the socioeconomic phenomena of the villagers.Based on the results of research, it is found that generally have the same livelihood from the agricultural sector. They are still in the primary sector and have not moved in the secondary stage in the form of agricultural processing activities. The economic condition of the villagers in the villages of Tanjung Jabung Regency Timur is relatively better than the economic condition of the villagers in Muaro Jambi Regency. The villagers researched and located in Tanjung Timur Regency are generally transmigration residents, at the same time villagers residing in Muaro Jambi District are local indigenous people with the condition of natural carrying capacity or land between 2 (two) areas in regency also different physical condition. Almost all of the studied villages above the poverty line according to BPS criteria, except for 1 village that is Manis Mato village in Muaro Jambi Regency is still below the poverty line. On average, all villagers still want the value of environmental sustainability, if measured is still from the high value of willingness to accept/WTA compared to willingness to pay/WTP.