Background: Using an evidence-based guideline for obstetric risk assessment in the primary and secondary healthcare settings in Nigeria has been shown to aid appropriate referral cascade of patients to tertiary centres. Aim: To assess the impact of inappropriate obstetric risk assessment and late referral to tertiary care facilities in Rivers State on perinatal morbidity and mortality. Material and methods: The study was of prospective cross-sectional design involving 475 patients who were referred from primary and secondary healthcare facilities to the labour ward of Rivers State University Teaching Hospital in Nigeria. The appropriateness of their obstetric risk assessment and referral cascade to a tertiary centre was assessed, using a preformed evidence-based guideline and the results were associated with the perinatal morbidity and mortality. Data were analysed using Epi Info 2020. Results: The perinatal outcome in women that needed to be referred in the first trimester to tertiary centres was worse than that in those women who were appropriately referred and the differences were statistically significant in terms of birthweight less than 2500 grams [170(54.66%) versus 8(24.24%), X2 = 9872 p<0.002]; birth asphyxia [78(19.02%) versus 0(0%), X2 =7.926 p<0.0003]; admission to SCBU [85(20.73%) v 0(0)%); X2=8.916 p<0.0001] and foetal death [77 (18.78%) v 0(0%); X2=7.787 p<0.0003r]. The differences were also worse in terms of the number of patients who had preterm birth at 28-37 weeks, FGR and large for date (LFD) babies but the differences were not statistically significant. Furthermore, the perinatal outcome in women that needed to be referred in the first trimester to tertiary centres was also worse than that in those who needed an earlier referral to tertiary centres and the differences were statistically significant in terms of birth asphyxia (X2=2.341, p<9.045); admission to SCBU (X2=2.699, p<0.055) and foetal death (X2=2.291, p<0.047). The differences were also worse in terms of the number of patients who had preterm births, neonatal birth weight, LFD babies and FGR but not statistically significant. Conclusion: Perinatal morbidity and mortality were worse in patients who needed to be referred to a tertiary centre from a primary and secondary healthcare facilities than in those who were appropriately referred and those that needed an earlier referral. There is therefore an urgent need for adoption of evidence-based guideline for obstetric risk assessment and referral cascade in Nigeria.

Article 88 of Law Number 19 of 2003 jo. SOE Minister Regulation Number PER-02/MBU/7/2017 stipulates that BUMN companies (State Owned Enterprises) are required to implement PKBL (Partnership and Community Development Programs). The obligation to implement PKBL is basically intended to be able to contribute in the effort to empower micro and small businesses in Indonesia. This study discusses the effectiveness of the implementation of PKBL at PT Jasa Raharja (Persero) Lampung Branch and the obstacles faced in implementing PKBL in an effort to empower micro and small businesses in Lampung. This research is an empirical normative legal research with a descriptive type of research as well as an applied normative approach (applied law approach). The results of the study indicate that in the context of empowering micro and small businesses, PT Jasa Raharja (Persero) Lampung Branch has implemented a Partnership Program (PK) which is distributed in 2 (two) forms, namely loans to finance business capital and guidance to fostered partners. Meanwhile, the Community Development Program (PBL) has also been implemented and distributed in 3 (three) forms, namely in the fields of education and training, community social assistance, and worship facilities. In the implementation of PKBL, obstacles were found, namely the problem of refunding funds from several fostered partners that were not smooth. Another obstacle is the distance between the place of business or the location of the program which is quite far from the office of PT Jasa Raharja (Persero) Lampung Branch so that it results in not being able to optimally carry out field surveys or provide guidance to each fostered partner or to all fostered partners.

The research aimed at describing the legal protection concept geographical indication in supporting the economic right of geographical indication holders, the contribution of geographical indication in improving the prosperity of geographical indication holders, and the legal protection of the economic rights of geographical indication about the use of a sign that is similar to a registered geographical indication. This research encompasses the normative legal analysis and empirical research methods. The first problem statement used the normative legal research method, which analyses how the legal protection concept of geographical indication supports the economic rights of geographical indication holders. The empirical research method was used for the second problem statement, which analyses how registered geographical indication contributed to improving the prosperity of geographical indication holders and was also used for the third problem, which analyses the legal protection of the economic rights of geographical indication holders about the use of a sign that is similar a registered geographical indication. The research results indicate the following: (1) the legal protection concept of geographical indication that is integrated into the law of trademark and geographical indication has not supported the economic rights of geographical indication holders, either from the substance aspect or with regards to the stipulated legal sanction; (2) the economic rights of geographical indication holder relation to production monopoly right, sign use, and product marketing has not contributed to the improvement of their prosperity; (3) the legal protection of the economic rights of geographical indication holders about the use of a sign that is similar to a registered geographical indication is still weak, both in the private and public legal enforcement aspects.

Introduction: Fistulas are abnormal connection between two body parts that is not supposed to be there. Differenc types of fistulas can occur among both male and female, but obstetric fistulas are more common among women. Because of the physical, psychological, and social repercussions of urine leakage, people with Vesicovaginal Fistula become severely incapacitated. These fistulas are typically caused by hindered labor and trauma. The most prevalent kind of fistula is vesicovaginal fistula, which is a serious condition that can bring physical, emotional, and social issues for both the afflicted and their family. Fistulas are more common in underdeveloped nations. The study's goal was to look at the socio-demographic features of fistula patients in a specific area. Aim of the study: The aim of the study was to observe the social demographic characteristics of fistula patients of Rangpur region. Methods: This prospective descriptive study was conducted at the Department of Obs and Gynae, Rangpur Medical College Hospital, Rangpur, Bangladesh. The study duration was 2 years, from September 2006 to September 2008. A total of 50 patients were selected for the present study following the inclusion and exclusion criteria. Result: 60% of the patients were between the age of 21-30 years, and 38% were between 31-40 years. 62% of the precent study participants had low socio-economic status. 72% of the women were of smaller stature (≤145 cm). 84% of the patients had vesicovaginal fistula, 12% had mixed type of fistulas. 24% had associated complications. Successful outcome was observed in 84% of cases. Conclusion: The study showed that obstetric fistula is more common among the women of lower social economic class with low availability of medical facilities. Women of small stature are at higher risk of fistulas, and among the different types of fistulas, vesicovaginal fistulas are the most common.

Background: Abortion is defined as the loss or termination of a pregnancy before 20 weeks of gestation or when the fetus weighs less than 500 g. Induced abortion is defined as the use of medications or surgical intervention to stop pregnancy after implantation but before the embryo or fetus has become independently viable. The purposeful termination of a pregnancy, known as induced abortion, is one of the most common gynecological treatments. In this study, attempts have been made to show the clinical presentation, management, and outcome of patients. Aim of the study: The study aimed to assess the outcome of a patient after induced abortion. Methods: It was a prospective observational study. The study was conducted at the Department of obstetrics and gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during May-Oct'2007 from all induced abortion cases admitted in different maternity units, 80 cases are randomly selected for the study. Proper ethical consent was taken from the concerns. All necessary investigation was done, and necessary pieces of information were noted in a preformed data collection sheet. Finally, the results were analyzed and presented in different tables using a computer and the SPSS database. Result: In this study, it has been seen that around 45.5% of gynecology patients are of abortion, and the incidence of induced abortion was 16% among all gynecological admission. The majority of abortion cases (58.75%.) were conducted by untrained persons. Among the patients, 8.75% had adequate knowledge about MR, while 51.25% had unreliable or incorrect information regarding MR. 55% of cases had used contraceptives. A total of 76.25% of patients got admission within 1 month of their complications. Among all cases, 92.5% were improved while the death rate was 7.5%. Amongst 23 specimens of high vaginal swab culture 15 (65.22%) patients showed growth of Escherichia coli, 3 (13.5%) of staphylococcus, 3 (13.5%) of pseudomonas, 1 (4.34%) of protus, 1 (4.34%) of klebsiella. Conclusion: All this can be reduced by improving socioeconomic condition, educational status, popularizing family planning, and modernization of existing laws in relation to abortion.

In recent years, Twak Vikar (Dermatological manifestations) are common and more so frequent in the elder age. There is a definite increase in its incidence especially, in the tropical region and developing countries like India due to various reasons like unhygienic environmental conditions, poverty, poor sanitation, illiteracy, malnutrition, improper skin care etc. The patients of skin disease are additionally prone to experience physical, emotional & socio-economic embarrassment in the society due to disfigured appearance. Dadru is one of the commonly occurring skin diseases which can be defined as an entity manifested by intractable itching, scaling, erythema with the lesions discoid in shape. Dadru, is a Kapha (Energy that forms the body’s structure) Pitta (Body’s metabolic system) Pradhan (prominent) Vyadhi (Disease). Acharya Charak has placed Dadru under Kshudra Kushth (Minor skin disease) but Acharya Sushrut and Acharya Vagbhata kept it under Mahakushth (Major skin disease). Acharyas did not explained separate Nidan (causative and diagnostic factor) for Dadru Kushth. The knowledge of Nidan is helpful for proper Diagnosis, prevention and treatment of disease.

This study validates the relevance of Lean strategy in Nigerian pharmaceutical companies in Anambra State. Specifically, the study ascertained the effect of lean manufacturing approach on efficiency of pharmaceutical companies in Anambra State and determine the effect of lean manufacturing approach on competitiveness of pharmaceutical companies in Anambra State. The study adapted a descriptive survey research design since the study is to distribute questionnaires to the respondents. The population of the study consists of 80 staff of 6 selected pharmaceutical companies in Anambra State. Data were collected through the questionnaires administered to respondents. T-test statistical tool was used to test the two hypotheses with the aid of SPSS version 20. 0 at 5% level of significance. The study revealed that lean manufacturing approach has effect on operational efficiency of Pharmaceutical Companies in Anambra State. Findings of the study provided support that lean contributed in integrated value chain supply and competitiveness in manufacturing companies. Therefore, the study concluded that lean manufacturing approach has effect on efficiency and competitiveness of pharmaceutical companies in Anambra State. Based on the findings, the study recommended that manufacturing companies should strive to adopt lean thinking approaches, principles and practices so as to reduce inherent variations with suppliers and demand from customers for greater effectiveness of the company.

Formalin is the most widely used preservative in anatomical embalming. It produces consistent results in terms of the prevention of autolysis and putrefaction at an affordable cost. It is a known carcinogen having several health hazards. Strict adherence to safety protocols is required to minimize its toxic effects. Regular monitoring of formaldehyde concentration in the dissection hall and embalming room will ensure remedial measures at the earliest. In the face of growing health concerns, several alternative preservatives are being studied. Apart from it, methods like cryopreservation, plastination can be used instead of embalming. Post-mortem toxicological analysis of formalin-fixed cadavers is of importance for forensic investigation. This article will review the overall advantages and disadvantages of formalin and its alternatives in the process of embalming and will guide the anatomists in choosing the proper options for the purpose.

Daily, seasonable and annual variation on precipitation should be carried out properly to enhance the better relaxation caused by damaging drain structure, hydraulic parameters and even climatic disorder. In order to incorporate all these needs and to enhance the existing research theories and even on developing new theories, this study will surely provide basic framework. The problems for the researcher as well as meteorological department for the further study of climatic change action and to provide basic knowledge to the farmer and agricultural department to yield seasonal wise crops without consideration of hydrological analysis (i.e. precipitation data) associates problems like flood risk and drought causing loss of lives and property. For the hydrological study, daily and monthly rainfall data was obtained from meteorological station from the year 1991-2020. The monthly and daily precipitation concentration were determined using Time series analysis, single mass curve analysis, coefficient of variation and spatial analysis and were represented using Histogram chart, Spreadsheet and GIS tool. With this, daily, monthly, seasonal wise variation on precipitation with respect to location wise (Spatial) as well as Time wise (Temporal) was obtained. The temporal characteristic shows that peak month of rainfall were July and August for all the regions. Considering Total Annual, the maximum value is at Beni Bazar i.e. more than 200000mm and least in the Ranipauwa i.e less than 10000mm. The mean annual rainfall of 30 years indicating that the Beni Bazar, Myagdi region has the highest rainfall and Ranipauwa, Mustang the least. Similarly, trend analysis shows that there are increasing (+ve), decreasing (-ve) and somewhat constant trends for the different stations. Furthermore, results from variability and reliability data shows that that Ranipauwa has the highest annual variability (138.86%) and Lumle has the least annual variability (15%) in which in turn implies that the rainfall at Lumle is more reliable than other areas. The computed Spatial and Temporal variation on rainfall has been developed as a basic tool for further research. It will also help farmers to know seasonal wise crops production as well as analysis of storm water for the construction of drainage system. These findings can be considered for monitoring extreme weather events like; erosion and floods. This would therefore contribute significantly to the effective management and sustainable development of the Gandaki Province and region having similar topographical features, which are rain dependent.

The Research Paper ‘Application of the Strict Liability Rule in Rylands v Fletcher to Oil Spills in Nigeria’, is a robust and timely evaluation of the legal concept of Strict Liability as it applies to the recurrent problem of oil spillage in Nigeria. For several decades now, crude oil production sites have regularly spilled oil and other petroleum-related chemicals, into the riverine communities of the Niger-Delta region of Nigeria. This has sometimes devastated the fishing and farming livelihoods of the poor villages within the vicinity of such spillages, and agricultural productivity is greatly reduced. This is in addition to air pollution, wildlife decline and overall environmental degradation. This paper looks at efforts to hold accountable those responsible for such degradation using the concept of Strict Liability. In order to obtain justice and compensation for the riverine communities, it must be proven that the offending oil companies were guilty of nuisance and negligence, as described by the Rule in Rylands v Fletcher. The companies are expected to know that their activities are reasonably likely to cause far-reaching destruction to the environment. Concluding, the paper makes recommendations to further tackle the problem of oil spillage in Nigeria.

Introduction: Dichlorvos (DDVP), an active ingredient of Sniper insecticide, is commonly used in Nigeria to control insects by killing them thereby preventing the spread of diseases. However, it can be highly toxic to humans when inhaled into the respiratory system which could elicit oxidative stress and cause respiratory infections. Vitamin C is known to be an anti-oxidant, capable of inhibiting oxidative stress. This study was aimed at investigating the ameliorating effect of vitamin C on dichlorvos-induced toxicity of the rat lung. Materials and methods: Forty (40) male wistar rats (weighing 150 – 200g) were recruited and randomly grouped into five (5) groups of eight (8) rats each. A group was the control; two groups were exposed to graded concentrations of DDVP while the last two groups were treated with vitamin C. Body weights were obtained before and after the period of 21-day exposure. After 21 days, histopathological and biochemical analysis were carried out to examine the level of toxicity of DDVP and effect of vitamin C treatment on the lung tissues. Results: Rat groups treated using vitamin C administration had significant improvements in body weights compared to DDVP-exposed groups. MDA levels as well as CATA and SOD activities increased significantly on vitamin C-treated rat groups (p < 0.05). Post treatment of rat groups with vitamin C showed that the lung histoarchitecture significantly improved. Conclusion: It can be concluded that Vitamin C could be a supplementary remedy in organophosphate (dichlorvos) poisoning through inhalation.

Chancroid is a sexually transmitted disease (STD) caused by the Gram-negative bacterium Haemophilus ducreyi and is characterised by necrotising genito-perineal ulcers which may be accompanied by inguinal lymphadenitis or bubo formation with possible spread to the thigh. We presented a rare case of a 23year old polytechnic undergraduate who presented to the hospital with complaints of extensive painful ulcer in her vulva for over ten (10) days. On culture of the swab from the ulcer, Haemophilus Ducreyi and E Coli sensitive to Ceftriazone, Ofloxacin and Gentamycin were isolated. Patient was treated with IV Ceftriazone for 5 days and Ciprofloxacin for 10 days with good recovery. The case highlighted the need for increased vigilance in managing genital ulcers in contemporary clinical practices and for carefulness in the choice of a sexual partner and practices among adolescents and young girls.

General anesthesia (GA) is one of the pharmacological modalities used in the treatment of pediatric dental patients. This study aims to assess the rate and associated factors of repeated dental rehabilitation under general anesthesia in pediatric patients; The electronic health records of three- to 12-year-old children who received dental treatment under GA between 2015 and 2019 were identified and analyzed. Subjects were classified into cases with repeated dental treatment under GA within 5 years and controls who had dental GA once. Each case was matched to three controls based on gender and age. The collected data included the child's age at the first and second dental GA, gender, health status, Type, and the number of dental treatments provided. A total of 2376 patients had dental treatment under GA. Forty-five controls were matched to 15 cases in a 3:1 ratio. The prevalence of repeated dental GA over 5 years was 0.63%. The number of restorations, pulp therapies, and extractions showed no statically significant differences except for the number of crowns, which was higher in controls compared to cases (p=0.011). Treatment of patients under GA requires a more aggressive course of treatments compared to local anesthesia. Consequently, it is advisable to choose full-coverage crowns rather than composite or amalgam restorations.

Background: Laparoscopic management of hydatid cyst in the liver is now becoming popular with the introduction of modern devices like Pallanivelue Hydatid Cyst Cannula System that makes the procedure easier, safe, and acceptable. The laparoscopic approach is not only a cosmetic issue; it also prevents the recurrence rate by preventing spillage and complete removal of endocyst. Objective: Here we assess the Laparoscopic management of hydatid cyst in the liver of 30 cases at the Department of General Surgery. Methods: It is a prospective study having ages ranging from 18 to 65 years were included in this study, from April 2015 to March 2020. Laparoscopic endocystectomy was performed in all cases with deroofing of the cyst wall and observed the outcome of the procedure. All the cases were diagnosed clinically and confirmed by ultrasonography and CT scan. Results: A total of 30 patients, 13 males, and 17 were females. The most common presenting complaints were pain in the abdomen in 20(66.66 %), a lump in the right upper abdomen in 18(60 %), jaundice 2(10 %). Hepatic Hydatid cyst diagnosed by USG, CT scan, and serological test were included in this study. The distribution of cyst sizes was: 1-5 cm 3; 6-10 cm 8; 11-15 cm 10; > 15 cm 9 patients. Abdominal ultrasound and CT scan were done to confirm the diagnosis of hepatic hydatid cyst in all patients. The right lobe was involved in 25(83.33 %), left lobe in 4(13.33 %) with both lobes in 1(3.33 %). Intraoperative complications 5(16.66%). Per operative bleeding 1(3.33%), spillage 2(6.66%), and cystic biliary communication 2(6.66%). The main operating time was 95(60-120) minutes. The mean duration of hospital stay was 5.22(3-10) days. Conclusion: The laparoscopic cyst evacuation and omentoplasty using PHS are safe for treating the hydatid cyst of the liver in the selected patients, while addressing all the conventional surgical principles of treating the hydatid cysts, like aspiration, prevention of spillage, sterilization of cysts, and partial deroofing. It aids early recovery with good cosmetic results. PHS is an ideal method for single or multiple hydatid cysts of the liver with minimal complications and morbidity.

Ovarian vein thrombosis is a rare pathology, which can be encountered postpartum or postabortum. Its severity is linked to the risk of extension to the vena cava and therefore to the resulting risk of pulmonary embolism. Its diagnosis remains difficult due to the existence of misleading signs, but is currently facilitated by new imaging data: ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). The treatment is mainly medical, combining heparin therapy and antibiotic therapy, surgery being reserved for complicated forms. We report a case of postpartum ovarian thrombosis at the Suissi maternity hospital in Rabat in a woman with a sparkling picture of appendicitis.