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.

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.

HPV being the most important risk factor, needs to be evaluated in all the regions of the country since the prevalence of HPV and its genotypes are different in the populations from different geographical regions. Its assessment at various stages of the disease will also be helpful in understanding its role in cervical cancer pathogenesis. The present series of work entitled as “Study of cytodiagnosis of discharge per vaginum with specific reference to HPV and HSV at Index Medical College, Indore” was undertaken to detect cervical lesions of female genital tract and prevalence of HPV and HSV by means of exfoliative cytology. Out of 1542, 9 cases showed cytomorphological features of HPV and 2 cases showed cytomorphological features of HSV. All 11 cases were found to be associated with multiple risk factors. In this study, epithelial cell abnormality are more common in hindu (85.19%). In muslims, it is only (14.81%).

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%.

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

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.

The purposes of this research are to empirically analyse and examine the cost recovery impact on national budget (APBN) and state shared fund (DBH).The analysis of this research unit is on upstream of oil and gas industry which is managed by the Indonesian government with Production Sharing Contract for 44 companies. The population of this research comprises operators of Production Sharing Contract and the body of government that manages oil & gas or that is called “SKKMIGAS” consisting of 62 persons of manager level, 51 professionals, and 18 researchers from a university. The researcher also uses secondary data obtained from “SKKMIGAS” in 1984 to 2014 documents. The results of this research indicate the variable which has big impact on state shared fund is recovery cost, and the variable which does not have any impact on national budget is recovery cost.

Leprosy is a skin disease affecting also the nerves was caused by Mycobacterium leprae. Multidrug therapy (MDT) cures the infection, but immunological reactions may occur and neuropathy may lead to disability and deformity. The current study aimed to understand the immune status of the patient before and after treatment by correlating histological subtype and peripheral blood lymphocyte count. Total number of 35 cases was studied. Blood samples were taken from the patients and complete blood picture was done before instituting the MDT including TLC and DLC. After 6 months of treatment, patients were followed up with complete blood picture. In lepromatous leprosy group (BL+LL) total mean WBC count was increased with 11,414 (range 7,000- 22,600 mm3) above the range of normal limits before treatment. It was in the mean normal range after treatment with 8514 (range 5,900- 11,000mm3). Lymphocyte count has increased after treatment. After the treatment, there is considerable increase in lymphocyte count. It was in the range of 34% to 42% with a mean value of 38.1%.

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.

Surgical resection of gall bladder is a common surgery and the most common indication for it, is inflammation. Incidental diagnosis of malignancy in such specimens changes the entire perspective of future management for the patient as gall bladder carcinoma is a malignancy with poor prognosis and high fatality. The aim of the study is to study the clinicopathological to study the clinic pathological correlation of the cholecystectomy specimens received in our pathology laboratory. This was a retrospective study over a period of 2 years from June 2015 to May 2017. The case reports were reviewed and data collected. The age and sex incidence, the presenting complaint with duration, the investigations done, the clinical diagnosis and histological diagnosis were analysed. A total of 200 cases of gall bladder were received in the lab during the study period. About 65% were women and the age group commonly involved was 40 to 60yrs. The most common presenting symptom was right upper quadrant pain. The clinical diagnosis correlated with the histopathological diagnosis in 99% of patients while it was different in two cases (1%). Both the cases were adenocarcinoma of gall bladder diagnosed incidentally during histopathological examination. Though the two patients had had CT done preoperatively, gall bladder malignancy was diagnosed histopathologically only. This stresses the importance of meticulous examination of gall bladder specimens and the importance of examining the surgically resected margins of the gall bladders.

The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Further clonidine also reduces intraoperative requirement of opioid analgesics as compared to normal saline group. Total amount of rescue analgesia needed in 24 hour was also significantly less in clonidine group as compared to placebo group. Intraoperatively more fentanyl required in placebo group as compared to clonidine group (p<0.05).

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.

Lower extremity amputation is performed to remove ischemic, infected, necrotic tissue or locally unresectable tumor, and at times, is a life-saving procedure. Peripheral artery disease, alone or in combination with diabetes mellitus, contributes more than half of all amputations; trauma is the second leading cause. Lower extremity amputations are common debilitating complications in patients with diabetes mellitus. Our aim was to analyse the various causes for lower extremity amputations, assess the complications and amputation rates in patients with diabetes mellitus and to identify risk groups for lower extremity amputations that can be focussed for preventive treatment at Vydehi Institute of Medical Sciences and research centre, Bangalore. This retrospective audit was conducted jointly in the Dept of General Surgery & Dept of Medicine, VIMS&RC, a super speciality teaching hospital in south India, between Jan 2011 and Dec 2014. Case files of patients who underwent lower extremity amputations were retrieved from the institution medical records section and data analysed for demography, clinical presentation of diabetics, other causes for amputation such as vascular disorders, kidney disorders, malignancy and diabetic ulcer/ infections of the foot, and post-operative morbidity and mortality. 137 patients were amputated, of which 120(87.59%) males and 17(12.40%) females (table-1, fig-1). 82(59.85%) patients were diabetic and 55(40.14%) non diabetic patients which included twenty three peripheral vascular disease (16.78%), osteosarcoma 16(11.67%), crush injuries 9(6.56%) and elephantiasis 3(2.18%) (fig-3). Of the 82 diabetics males were 65(79.26%) and females 17(20.73%) (Table-2). Foot infections and chronic renal disease preceded amputation in patients with diabetes. Diabetic women were older than the men when amputated, diabetic men underwent multiple amputations both minor and major, had severe foot infections compared to the women. 90 % of all diabetes-related amputations were preceded by foot ulcers leading to ischaemic gangrene. Various interventions the patient underwent ranged from wound debridement to revision amputation ( table-3,fig-4)The number of diabetics attending the diabetic foot clinic increased over the years showing the impact of awareness programmers and counselling about the disease (fig-2).The complications of diabetic foot infections ranged from cellulitis to gangrene (table-4,fig-5) There was 50% reduction in the rate of amputations performed above the ankle in patients with diabetes during the year 2014( table-6)) as most of them were referred to the multidisciplinary foot team in our diabetic clinic prior to the decision of amputation. There was no mortality in the study. The gradual decrease in rate of major amputations is due to an active implementation of the consensus guidelines of foot care in the diabetic clinic and awareness of the patients to get themselves examined and treated for foot problems early. Diabetic foot complications and diabetic nephropathy when identified early in diabetics can prevent major lower extremity amputations.

As we have known from the Ancient History of Human Beings that for their survival of Life, People are always live closely to the water. It is because water is a basic need for Human Beings. For this reason, People build their houses along the River's banks or on the beaches. Based on this Philosophy, we have seen along the Kahayan's River Bank at the Central Kalimantan in Indonesia, there are the settlements on it. For having more accurate data, we also made some interviews to the People, who live in this settlement. We also made some Interviews to the some officials of the Local Government of Central Kalimantan. We also have made Library Research for having more clearly of its Research and to make it accomplished. We have found that, in this Urban Settlement, there are Three Characteristics Houses at the Kahayan's River Bank – Central Kalimantan. Due to the Natural Conditions, the People of its region have built their houses by adopting its surrounding/natural conditions. The Houses are the Floating‟s Houses located really on the River; The Scaffolding‟s Houses/the Upraised Platform Houses located between the River and the Land/ Water and Soil; The Ordinary‟s Houses located on the earth/ground/soil. Focusing on how the People of this Region fulfill their needs in adopting the Nature's/Environment's condition. We have tried to understand and distributing this knowledge by explaining their characteristics of the houses from these elements, such as the Location; the Materials of the Buildings; How People Live in it; the Layout of the Houses; the Infrastructure; the Transportation; Trade and Commerce; the Problems of the Settlement and also the impact to the River. We give also the solution of the problems. The purpose this report we would like to sharing our knowledge to the German alumni, UKI, University of Palangka Raya and also we would like to give this report to the local‟s government authority.

The public sectors play an active role through its involvement in the execution and delivery of public projects in order to improve the quality of life of the citizens. The kind of procurement method used in securing a project is vital to the success of a given project. The stakeholder’s input should be taken in accordance with their particular concern on different project definition elements, so that their involvement reflects the degree of their importance and relevance to the project. This review sought to establish the role of stakeholder engagement in project procurement in the Kenyan public sector. The study found that stakeholders are vital to the ethical decision making in project procurement and ultimately the successful completion of a project because their unwillingness to continuously support the vision or objectives of the project leads many projects to fail. Therefore, there is a need to engage the stakeholder in the project as early as possible to determine the need and capture stakeholder inputs in such projects.