The purpose of this study is to explore the relationship between service quality and customer satisfaction at fitness facilities. This type of research is quantitative with a correlation method, sample selection using accidental sampling consisting of: 1) 64 respondents who train at the gym, 2) 114 respondents who train at a fitness studio (type of training: training zumba, pilates, yoga, calisthenics, poundfit, TRX, body combat), 3) 82 respondents who train at a swimming pool or sports field (type of training: soccer, fun football, futsal, badminton, basketball, tennis). The questionnaire on the indicators in Service Quality is Tangibility, Reliability, Responsiveness, Assurance, Empathy, then the indicators in Satisfaction are Complaints and Suggestions System, Comfort and Safety, Communication. The results of this study are that Service Quality has a positive effect on Satisfaction 0.000, then the correlation value is 1) facilities in the gym r = 0.636, 2) facilities in the fitness studio r = 0.687, 3) facilities in the swimming pool or sports field r = 0.504. The conclusion of this study confirms the importance of service quality in improving customer satisfaction in fitness facilities. For further research, it is recommended that the data collection time be extended. Then, broader research with a larger population is also needed to obtain more representative results.

Examining end-of-life care considerations within an Islamic context, the discussion delves into the intricate nuances surrounding ECMO patients. Drawing from Quranic teachings and Hadith principles, it underscores the sanctity of life and emphasizes compassionate decision-making. Advocating for integrating religious perspectives in healthcare highlights the importance of open dialogues, consultation with religious authorities, and respect for individual values. Islamic beliefs on life, death, and destiny shape the discourse on end-of-life care, focusing on dignity and quality of life preservation. Proposing a compassionate approach to ECMO discontinuation, the narrative emphasizes early consultations, transparent communication, shared decision-making, and advanced care planning for a dignified end-of-life journey.

Background: In the underdeveloped world, microbial infections constitute a serious public health concern. About half of all deaths in tropical nations are thought to be caused by infectious diseases. In addition, some well-known pathogens have assumed new epidemiologic importance by acquiring antimicrobial resistance. Some plants are known as medicinal because they contain active substances that cause specific reactions relating to the cure of human disease. Acacia nilotica, commonly known in Sudan as Garad or Sunt, has many medicinal uses. Objectives: This study used the agar diffusion method to study the antibacterial activity of the different concentrations of ethanolic extract of the medicinal plant Acacia nilotica pods against selected gram-negative bacteria. Methodology: A cross-sectional study was done in Shendi Town, River Nile State, at the microbiology laboratory at Shendi University. Eighty-five wound swabs and urine specimens were collected from patients with symptoms of urinary tract infection and wound infection who attended Shendi Teaching Hospital and Almek Nimir University Hospital from February to March 2023; bacteria were isolated and identified using colonial morphology, Gram stain, and biochemical tests. Using the agar well diffusion method, we tested the Acacia nilotica extract at 100%, 50%, 25%, and 12.5% w/v concentrations. Results: This study found infection was persistent in patients aged 26–34. Escherichia coli was a primary isolate. According to gender, out of 85 specimens, 26 (30.6%) were males, whereas 59 (69.4%) were females. The ethanolic extract of Acacia nilotica pods was screened for their antimicrobial activity against clinical isolates of Escherichia coli, K. pneumoniae, Pseudomonas aeruginosa, Enterobacter, Citrobacter, Serratia, Providencia, and Proteus vulgaris. The antimicrobial effect of the extract was compared with the standard drugs. Crude extracts of Acacia nilotica inhibited the growth of various bacteria and showed its broad spectrum antimicrobial potential, which may be employed in managing microbial infections. Conclusion: The fruits of Acacia nilotica were the subject of these investigations, demonstrating its potent in vitro activity against clinically isolated bacteria and its potential as a treatment for various bacterial and viral infections.

Tuberculosis (TB) TB disease is still a health threat both worldwide and in Indonesia. Cases of TB disease in Majalengka District continued to increase in 2020, with as many as 9,497 cases; in 2021, as many as 12,692 cases; and in 2022, a significant increase of 21,956 cases. This study aims to determine patient characteristics, level of adherence, and effectiveness of TB treatment, as well as the relationship between adherence and effectiveness of TB treatment in a hospital in Majalengka District in West Java. The research method used was descriptive observational analysis with retrospective data collection based on TB patient treatment cards. Adherence data was collected by completing the MMAS-8 questionnaire, and effectiveness data were collected by recording sputum examination results using SITB software. The sample is the total population according to the criteria. The technique used to draw this sample was total sampling, namely the total number of TB patients in a Hospital from November 2023 to April 2024, which was 45 patients. Data analysis was done using the Chi-square test. A total of 95.6% had a high level of adherence, and 4.4% of patients had moderate adherence. The efficacy of TB treatment was 100%, with 97.8% cured status and 2.2% complete treatment. There was a significant relationship between adherence and TB treatment effectiveness, with a p-value of 0.044 (sig<0.05).

Topical drug administration is a localized drug delivery system anywhere in the body through Optimized invasomal formulation was sealed in 10ml glass vial and stored at refrigeration temperature (4 - 8°C) and room temperature for one month. Entrapment efficiency, physical appearance was determined at regular intervals ophthalmic, rectal, vaginal and skin as topical routes. Skin is one of the most readily accessible organs on human body for topical administration and is main route of topical drug delivery system. Invasomes are considered an inventive drug delivery system for the transdermal route. It improves the permeability of drugs across the skin layers which limits the absorption of poorly permeated drugs. It is also used for enhancing the efficacy and duration of action for drugs that had first-pass metabolism in the liver requires multiple daily doses. Invasomes contain unique components (Phospholipids, terpenes and ethanol) that act as safe and effective drug permeation enhancers across skin layer. Bacitracin is a cyclic polypeptide antibiotic used to prevent wound infections, treat pneumonia and empyema in infants, and to treat skin and eye infections. Bacitracin (200mg) was loaded in to invasomes by mechanical dispersion technique using Phospholipon 90H, terpene (Limonene) and ethanol, The optimized Bacitracin -loaded invasomes was incorporated into carbopol 934p (0.5 to 2%) solution to get a hydrogel for improving convenience in superficial application. FT-IR studies revealed no interaction between the drug and excipients. The formulated hydrogel formulation was evaluated with parameter pH, viscosity, gel strength, drug content, spreadability, in-vitro release test, washability, extrudability study and stability studies. The formulation IG-2 showed a drug content of 98.74% and drug release of 99.85% in 12hrs, which contains carbopol 934p concentration 2%w/w. The present work also focuses on making the formulation more pharmaceutically acceptable.

Enhancing the quality of care for children after cardiac surgery is vital to assist caregivers in making informed choices regarding diagnosis and treatment. Cardiac surgery is a significant event for families, necessitating comprehensive aftercare to support the child’s recovery and reintegration into normal life. The post-surgical outcomes depend heavily on effective management during the recovery phase, as different cardiac conditions may require lifelong monitoring or further interventions. Recognizing early clinical indicators of complications is crucial for improving both short- and long-term prognosis. This review emphasizes the importance of structured postoperative care for children, offering a framework for caregivers and healthcare providers to address potential challenges and optimize outcomes.

COVID-19, caused by the SARS-CoV-2 virus, has resulted in nearly 7 million deaths globally as of 2023 and remains a significant health challenge. Many patients continue to suffer from long-term complications, commonly known as "long COVID," for which no definitive cure has been found. This has prompted a surge in research on potential underlying mechanisms of immunity. In addition to scientific advancements, holistic approaches to recovery are gaining attention. This study explored the application of the Guan Yin Citta Dharma Door, a Buddhist practice, in addressing both COVID-19 infection and its post-infection sequelae. By presenting a case study using this method, we examined the role of karma and collective retribution in the manifestation and healing of COVID-19. The findings suggest that integrating Dharma practices may complement conventional medical treatments, providing a holistic path to recovery for COVID-19 survivors.

The challenges before humanity are, and always have been, to uphold the sanctity of life in equal form without any discrimination, whether based on race, religion, nationality, color, or gender. This paper investigates one such practice affecting half of the world's population: the presence of a gender gap in employment. Social and religious practices are barriers that women need to overcome to reduce the gender gap. Liberal societies have fewer barriers and a lower gender gap but still face problems of sexual harassment in varying magnitudes, depending on the prevailing social and psychological stigmas in those societies. The current research discusses how Islamic and developing countries can benefit from women's employment and how their contribution can boost GDP, especially by exploring opportunities in developing countries. It also elaborates on how the fear of sexual harassment affects socio-religious cohesion and contributes to the gender gap.

Suicide is a multifaceted issue that presents a significant challenge to public health worldwide, impacting individuals, families, and communities. This article offers a thorough examination of the occurrence, factors contributing to, and methods of preventing suicide, focusing specifically on the Indian context. Despite continuous endeavors, suicide rates in India persist at concerning levels, underscoring the necessity for cohesive interventions and cooperative prevention approaches. Through an analysis of current research and programs in this area, this article seeks to enhance comprehension of suicide prevention endeavors in India and guide forthcoming tactics to address this critical public health concern.

Objective: The objective of this study to evaluate the efficacy of perioperative oral antibiotics in the prevention of acute infective endophthalmitis (IE) after cataract surgery. Methods: This prospective study of patients undergoing uncomplicated SICS was conducted. Group A was given post-op oral ciprofloxacin for five days, whereas Group B was not. Both groups received 5% povidone-iodine (PVI) preparation for three minutes in the conjunctival cul-de-sac preoperatively as prophylaxis. The minimum post-operative follow-up period was six weeks. Results: Out of 1856 patients, 896 (48.27%) were included in Group A, and 960 (51.72%) were included in Group B. No significant difference in anterior chamber (AC) reaction was found on day 1 (p = 0.69), day 14 (p = 0.06), or day 42 (p = 0.1). One patient developed acute post-operative infective endophthalmitis (0.04%) and one patients developed toxic anterior segment syndrome (TASS) from Group A. The non-oral antibiotic group had no serious complications. Conclusions: Perioperative oral antibiotic use in routine clinical practice is not recommended for the prevention of acute post-operative infective endophthalmitis. Pre-operative conjunctival PVI 5% for five minute was proven to be effective prophylactic measures in our study.

In this paper the author tried to find out the long run association between unemployment rate, GDP growth rate and income inequality in the post independent period in India from 1951 to 2023 by applying cointegration and vector error correction model. The paper found out that there is one cointegrating equation among the three variables where VECM implies that the change of unemployment rate and GDP growth rate is inversely related while the change of unemployment and the change of income inequality is positively related in the long run. The former is significant and the latter is insignificant in case of cointegrating equation which is convergent towards equilibrium with a speed of adjustment of 2.4% per year. There is short run causality between unemployment rate, GDP growth rate and income inequality. The VECM is stable and non-stationary having autocorrelation and multivariate normality problems.

Background: Human Immunodeficiency Virus (HIV) infection has been known to impact both motor and cognitive systems and cause motor and cognitive alterations (MCAs). Transcranial direct current stimulation (tDCS), mainly when applied to the prefrontal cortex, has shown promising results in improving gait, balance, and executive functions in individuals with HIV. Previous studies suggest that integrating a task designed to stimulate higher cognitive centers in combination with tDCS could potentially enhance these effects. Purpose: The objective of this study was to investigate whether the combination of tDCS with a tracking task, when applied to the prefrontal cortex, effectively enhances reaction time and HIV dementia scale (HDS) scores (motor-cognitive) components in individuals living with HIV. Methods: The study involved nine female and one male participants living with HIV, with an average age of 58.9 ± 4.3 years. To assess the impact of tDCS on RT and motor cognition, each participant was evaluated both before and after the administration of tDCS with the HDS. Participants' primary goal for the reaction time components was to respond quickly and accurately to color changes by tapping the pod that lit up green. This task was performed while applying tDCS to the prefrontal cortex, allowing researchers to focus simultaneously on cognitive reaction speeds and the physical effects of neuromodulation. Results: Upon analysis, significant differences were noted between pre and post-tDCS of the HDS scores. The data further revealed substantial improvements in reaction time, hits, and strikes after the tDCS application. Conclusion: The results of this study demonstrated that tDCS can potentially improve neurocognitive and motor function in individuals with HIV. However, the study recommends that tDCS treatments be applied over a more extended period than in this study.

Background: Maternal obesity in pregnancy is generally recognized as one of the most common risk factors for unfavorable maternal and neonatal outcomes. Obesity has become a prominent issue in obstetrics practice. Objective: To evaluate the maternal outcomes during labor and the immediate postpartum period in overweight mothers. Materials and Methods: This cross sectional analytical study was conducted on the admitted patients with full term singleton pregnancy in labour in the Department of Obstetrics & Gynecology of Sir Salimullah Medical College and Mitford Hospital from July 2020 to January 2021. A total of 150 pregnant women with full term singleton pregnancy in labour were selected fulfilling the inclusion and exclusion criteria. Informed written consent was taken from each respondent. All data relevant to variables of the study was collected in a data collection sheet. Results: Caesarean section rates were considerably higher in overweight/obese patients compared to the normal weight group (p=0.002). The overweight/obese group had atonic PPH (p=0.04). Macrosomia neonate was substantially higher in the overweight/obese mother group than in the normal weight group (OR=10.09, p=0.009). Overweight/obese individuals had significantly increased rates of low APGAR scores (<7 at 1 minute) (p=0.041). The overweight/obese group had slightly increased rates of intrauterine mortality, stillbirth, and low APGAR score (<7 at 5 minutes), although the differences were not statistically significant (p=0.315, p=0.311, and p=0.190). Macrosomia necessitated neonatal critical care, and moms who were overweight or obese had a 4.03 times higher risk (OR=4.43, p=0.026). The obese neonates had a substantially higher mean birth weight (3.22±0.54 kg) compared to the control group (2.95±0.46 kg). Conclusion: Postpartum pregnancy problems such as atonic PPH have been described in overweight or obese pregnant mothers. Increased birth weight, stillbirth, macrosomia, and NICU hospitalizations were also identified in the overweight/obese population.

Background: Early detection of the nature of the tumor is crucial for the management of patients with ovarian tumor. The type of an ovarian tumor can be determined using serum markers, color doppler USG, and a CT scan. These assist clinicians in diagnosing and managing patients with ovarian tumors, as well as establishing treatment plans. Objective: To compare the accuracy of color doppler ultrasound with CT scan for detection of malignant ovarian tumor. Materials and Methods: It was a cross sectional analytical study that conducted in the Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and National Institution of Cancer Research & Hospital (NICRH), Dhaka. Total 65 consecutive patients attending at the inpatient department of BSMMU and NICRH with ovarian tumor were enrolled for the study. All the patients were selected by clinically, ultrasonography findings and serum marker (CA 125, CA 199, CEA, Alfa fetoprotein and LDH) study. For all these patients color doppler USG and CT scan were done. Patients then undergo laparotomy with frozen section biopsy and taking the histopathology report as a gold slandered. Level of significance was assumed at p value <0.05. Results: The sensitivity of Color Doppler USG and CT scan are 96.9% and 87.5%, respectively. The specificity of Color Doppler USG and CT scan are 60.6% and 57.6%, respectively and the accuracy of Color Doppler USG and CT scan are 78.5% and 72.3%, respectively. The positive predictive values of Color Doppler USG and CT scan are 70.5% and 66.7%, respectively. The negative predictive values of Color Doppler USG and CT scan are 95.2% and 82.6%, respectively. Conclusion: The results of the Color Doppler USG are compared to those of the CT scan results. Results found that the diagnostic accuracy of color doppler ultrasound and CT scan are almost similar for detection of ovarian tumor whether it is benign or malignant.

Background: Osteoporotic proximal humerus fractures pose significant challenges due to reduced bone quality and healing potential. PHILOS plates offer angular stability, but long-term prospective outcome studies are limited. Objective: To prospectively evaluate the efficacy of PHILOS plates in managing osteoporotic proximal humerus fractures, focusing on functional recovery, complication rates, and patient satisfaction. Methods: This prospective study was conducted at the Department of Orthopaedic Surgery, North East Medical College, Sylhet, also with multicentered study from June 2022 to July 2024, involving 358 patients with osteoporotic proximal humerus fractures. Patients underwent open reduction and internal fixation using PHILOS plates. Functional outcomes were assessed using the Constant-Murley Score (CMS) and DASH score at 6, 12, and 18 months postoperatively. Complications, including screw perforation and avascular necrosis, were systematically recorded. Data analysis included mean score changes, percentages, and ANOVA for repeated measures. Results: The study reported a 94% follow-up rate. At 18 months, 83.5% of patients achieved good to excellent outcomes based on CMS. The mean CMS improved from 30.2 preoperatively to 76.8 at 6 months, 81.4 at 12 months, and 83.9 at 18 months (p < 0.001). The DASH score significantly decreased from 58.1 to 18.5 over 18 months. Complication rates included screw perforation in 6.7%, avascular necrosis in 5.3%, and hardware failure in 4.2%. Patients <70 years showed a mean CMS of 86.1 compared to 77.5 in older patients (p = 0.02). Conclusion: PHILOS plates provide reliable fixation for osteoporotic proximal humerus fractures, yielding excellent functional outcomes and manageable complication rates in a prospective setting.