The essential step in the assessment of patients for a probable bleeding disorder is to evaluate the severity of bleeding symptoms. To improve the compilation and precision of the patients with history of bleeding symptoms, several Bleeding Assessment Tools (BAT) have been anticipated. A structured questionnaire was approved by the ISTH/SSC-BAT together in year 2010. In our study, data from 99 normal adults (42 females and 57 males) from Uttarakhand were analysed this score (ISTH/SSC- BAT). Mean age of the adult population was 29 year. Normal range obtained were 0–3, 0–5 for males and female respectively after removing the outliers. The median BAT score was 0 in adult males and 1 in adult females. This information may now be used to evaluate the history of bleeding symptoms as a normal or abnormal in the state of Uttarakhand. We aim to standardize this score system in the population of Uttarakhand in our study and improve diagnostic accuracy at a low cost and grass root level.

Background: Prevalence of Acute Myocardial Infarction (AMI) in younger age is increasing in worldwide and it has been reported that 60% of AMI in young age is due to genetic causes. SNP inPAI-1 4G/5G plays major role and there is a need to authenticate its effectiveness and sensitivity. The aim of this study is to ascertain SNP in PAI-1 (4G/5G) as an independent biochemical marker for the South Indian young AMI patient’s less than 45 yearsand to find its association with other risk factors of AMI. Methodology: This cross sectional study subjects includes40 Patients aged less than 45 years with AMI withtypical chest pain, ST Elevation in ECG and a rise in serum CK-MB, without any other known risk factorsand age and sex matched 40 control. ARMS-PCR was done with separated DNA. Remaining Serum was used to analyze Urea, HDL, CK-MB and other factors. Finally statistical analysisis done using SPSS-20.0. Result: Statistical analysis showed significant variation of SNP inPAI-1(P ≤ 0.001) between patients and controls. Further, positive significant changeswere observed between patients and controls in Serum Urea: P ≤ 0.001, Serum Glucose: P ≤ 0.04, Serum AST: P ≤ 0.001, Serum CK-MB: P ≤ 0. 001. A significant inverse association was observed in SNP of PAI-1 and Serum HDL. Conclusion: This study confirms the independent association between STEMI and the 4G/5G allele polymorphism among South Indian euthenics and an inverse association of 4G/5G polymorphism with Serum HDL-cholesterol levels.

Frozen section provides a rapid diagnosis intra or perioperatively that guides the surgeon to make a therapeutic decision for the patient’s health benefit. The comparison between the frozen section diagnosis and permanent section diagnosis is an integral part of quality assurance in surgical pathology. This study was performed to assess the diagnostic accuracy of frozen section at different anatomic sites assuming histopathology as a gold standard. This prospective cross sectional study was performed in the Pathology laboratory adjoining the operation theatre and Department of Pathology S.M.S Medical College and Hospital, Jaipur, during a period of 2 years from January 2017 to December 2018. The results of 170 cases of frozen section were compared with their permanent section diagnosis and analysed. A total of 224 frozen section specimens from 170 cases were studied. The diagnoses were deferred in 4 (1.79%) specimens. Out of remaining 220 specimens, the concordant and discordant diagnostic frequencies were 215 (95.98%) and 5 (2.23%) respectively. Discrepancies were mainly related to misinterpretation, sampling and technical errors. The overall diagnostic accuracy was 97.73%. The sensitivity, specificity, positive predictive value and negative predictive value were 92.68%, 98.88%, 95% and 98.33% respectively. The average turn-around time calculated was 20 minutes. Our study concurred that the frozen section is a rapid, reliable and an accurate technique to guide the surgeons in deciding the best therapeutic approach for the patients. The accuracy rate can be further improved by regular monitoring of frozen section performance.

Primary leiomyosarcoma of the broad ligament is an extremely rare tumor with very few cases reported in literature. We herein report a case of postmenopausal lady, diagnosed pre-operatively on ultrasound and CT as a degenerated fibroid/ ovarian tumor. Post operatively histopathological diagnosis proved to be a leiomyosarcoma. The patient was treated with adjuvant radiotherapy with a dose schedule of 50 Gy in 25 fractions over 5 weeks. Patient is on monthly follow up since 6 months with no complaints

Remittance is one of the key locomotives of economic growth and poverty reduction in developing countries because it serves as development finance needed for investment purposes. This study sheds new light on this question by examining the impact of remittances on private investment in Nigeria. Data on remittance inflow in Nigeria was retrieved from World Development indicator. Error correction and Ordinary least squares is applied for this purpose. The result reveals that remittances increase the rate of private investment in Nigeria and the previous investment is a determinant of the current investment. It is therefore recommended amongst others remittance-receiving households should be encouraged to invest remittances in small and medium scale enterprises rather than use it for the consumption of goods and services.

Background: There is evidence that support the use of high sensitive C-reactive protein (hs-CRP) to monitor cardiovascular risk in diabetic and non diabetic individuals. This study aims to assess hs-CRP level in Sudanese with type 2 diabetes mellitus (D.M) and obese individuals; as a risk factor for cardiovascular diseases. Materials and methods: This cross-sectional study was conducted in Khartoum-Sudan from April to December 2018, 50 diagnosed Sudanese patients with diabetes mellitus attending Alarbaeen hospital in Khartoum state and 50 obese Sudanese individuals were enrolled in this study. Blood samples were analyzed for cholesterol and hs-CRP levels using Mindray BS-200 automated analyzer. Results: There were no significant differences in hs-CRP and total cholesterol levels in type 2 D.M when compared with obese. Both diabetic patients and obese had high levels of hs-CRP and total cholesterol. hs-CRP and total cholesterol levels revealed no significant difference when male compared with female in type 2 D.M as well as in obese. The majority of the study participants were found to have hs-CRP level more than 3 mg/L, which indicate a high risk to have cardiovascular diseases according to American Heart Association. There was no correlation between hs-CRP levels and total cholesterol levels in the study subjects. Age showed inverse significant correlation with hs-CRP levels in type 2 D.M and no correlation among obese. In conclusion: The higher levels of hs-CRP with higher levels of total cholesterol may be a predictive factor for developing of CVD in Sudanese with type 2 D.M as well as in obese.

Ischemic colitis goes unrecognized as a complication in intestinal neoplastic disorders because of their unique morphological features which vary depending upon haemodynamic status. The two cases presented here show even though ischemic pathogenesis is the underlying factor responsible for this condition; morphologically they are heterogenous and they are described in detail.

PPAR-γ plays a critical role in glucose homeostasis and is a molecular target of insulin sensitizing drugs called thiazolidinediones which are PPAR-γ ligands. PPAR-γ ligands also upregulate expression of adipocyte glycerol kinase, resulting into improved insulin action in target tissue such as liver and muscle. PPAR-γ ligand also shown to augment glucose disposal in peripheral tissues by increasing expressions of the glucose transporter genes, GLUT-1 and GLUT-4. Majority of the Diabetes Mellitus Type 2 (DM type 2) patients (80%) are obese, but all obese persons do not develop DM type 2. Serum adiponectin level should be determined by level of PPAR-γ activity in adipocytes. Therefore it will be of interest to explore the difference in the level of serum PPAR-γ level between obese subjects with DM-2 and without DM-2, as both the insulin sensitizing factor’s adiponectin, and vistafin are synthesized in response to FFA. PPAR-γ complex receptor activity. Estimation of serum PPAR- γ level alongwith FBG was done in 90 cases, of which 30 were normal healthy subjects, 30 obese without diabetes type 2 and 30 obese with diabetes type 2. The qualitative estimation of PPAR-γ in human serum was done by ELISA method using ELISA kit from E lab science Biotechnology Co.Ltd. In our study we found a significant change in the level of PPAR- γ between the obese with DM-2 and control subject and also between obese without DM-2 and control subject but we did not find any significant difference between obese with DM-2 and obese without DM-2. In our present study we found the Increased Levels of PPAR- γ in the Obese without Diabetes Mellitus and Obese with Diabetes Mellitus. The levels were 8.03ng/ml ±11.16 and 8.04ng/ml±10.94 respectively. Finally, we observed that the level of PPAR- γ is increased with both the groups, i.e. obese without DM-2 and obese with DM-2 in comparison to normal subjects.

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Data from the National Center for Injury Prevention and Control in the United States show that approximately 2 million fires are reported each year which result in 1.2 million people with burn injuries. The present study, “Bacteriological profile of burn wound infections” was carried out in Department of Microbiology, in a tertiary care hospital, over a period of one year from Jan 2016 – Dec 2016. A total of 50 patients of all age groups and both sexes admitted in our Burn Care Unit were selected for this study. In the present study, Majority of patients were in the age group 31-40years. Out of 50 patients studied, 28 patients were male and 22 patients were females. A total of 128 organisms were isolated and Pseudomonas aeruginosa (44 cases) was the most common isolate followed by Staphylococcus aureus (37 cases) and coagulase negative staphylococci (29 cases). The other isolates included Klebsiella pneumonia, Escherichia coli, Proteus mirabilis, Citrobacter freundii and Enterococcus species. Modern infection control practice has been effective in reducing or eliminating endemic pathogenic and/or antibiotic-resistant organisms, preventing the establishment of newly introduced pathogenic and/or antibiotic-resistant organisms as the predominant nosocomial flora of the burn unit, and preventing reseeding of such strains back into the burn unit from patients housed in the adjacent convalescent ward.

In Cameroon, due to the weaknesses of institutions and inadequate laws, many agro industrial plantations which are in most parts of the country extensively apply fertilizers, pesticides and discharge their untreated waste into nature. These attitudes are consistent for industries, hospitals and individuals. Consequently chemicals are found in ground water. Artisan mining of gold in the South eastern and Eastern parts of Cameroon release substantial quantities of arsenic in to ground water. All these leads to ground water pollution .The ramification of this pollution of ground water is water borne diseases (such as typhoid, cholera and amoebic dysentery which are recurrent in most of the urban cities in Cameroon). This paper investigates why the laws regulating ground water are not enforced and the lacunae of these laws. The paper does so through a reading of records mainly from documentary and internet search. The data thus collected constitutes the sources from which the law is drawn, stated and analyzed in the light of the stated aim of the paper. The results inter alia show that the law that regulate ground water pollution are not well enforced. The said results also highlight the limitation of the available laws regulating ground water pollution in Cameroon. The results are significant as they expose gaps in the current laws regulating ground water pollution and conclude with suggestions on where the law should go.

This study aims to analyze several decesive determinants such as; direct compensation, indirect compensation, and employee status toward employee performance at PT. XYZ engaged in telecommunications infrastructure. The population of this study is all the employees in the business unit of PT. XYZ who are 56 employees, due to the total population is not greater than 100 respondents, the research sample is 100% of the population in the business unit of PT. XYZ. Data collection techniques used in this study was using questionnaire instruments which distributed to respondents in the business unit of PT. XYZ was held in November 2017 until March 2018. The data analysis technique used multiple regression analysis by using SPSS 24.0 to test the hypotheses, classic assumption test, reliability, instruments validity or measuring instruments which used. The finding in this study indicates that direct compensation, indirect compensation, and employee status have a significant and partial effect toward employee performance of PT. XYZ. This research certainly also has a number of managerial implications which are the practitioners must pay more attention to employee performance appraisal programs, providing compensation related to mandatory allowance, non-compulsory allowance, and program benefit which also defining a career path that is evident for the contract employees must be translated in employee career planning, so that all the employee are motivated to achieve their career goals in accordance with the target and the implementation of compensation online dashboard which must be performed by PT. XYZ, so that employees can access their right and obligation transparently or openly

Healthcare-associated infections (HCAI) are a major setback for any organization. The most important mechanism of spread of these HCAI is via the contaminated hands of the healthcare givers that is doctors, nurses, other staff or relatives/friends of the patients. Contaminated environmental surfaces are another important reservoir for the spread of these infections. However, they are often under recognized. HCA is one of the most important public health problems in most countries of the world. In any healthcare setup basic infection control, measures can reduce the rates of healthcare-associated infections, which help to reduce the length of stay, nosocomial infection and cost. It is important to implement the quality system which can be executed and monitored by using compliance measures in the routine process of the hospital in order to improve the standard of patient health care. The quality of hospital infection control program is a reflection of the overall standard care provided by the institution. The current study is aimed to help in assessing the pre-existing knowledge regarding infection control practices among doctors and nurses. In our study, both doctors and nurses had a fair knowledge about the spread of nosocomial infections, practised safe patient-care protocols, and had positive attitudes. Still, some gaps have been identified in their knowledge and practice of infection control. It is suggested that an effective training sessions should be organized at the time of hire and in-service periodically which might help to decrease the healthcare associated infections.

Early diagnosis of lung cancer plays a pivotal role in reducing death rate due to lung cancer. Bronchial washing, brushing and fine needle aspirations not only compliment tissue biopsies in diagnosis of lung cancer but also comparable. We aim to assess the diagnostic utility of bronchial wash and brush cytology and bronchial biopsy in diagnosing various pulmonary lesions and to compare the bronchial wash and brush cytology with bronchial biopsy in patients with lung cancer. All the patients who underwent fiberoptic bronchoscopy at Alluri Sitarama Raju Academy of Medical Sciences, Eluru during the period of August 2016 to June 2018 for suspected lung lesions on chest radiograph/ CT scan and came to cytology division of pathology department for bronchial wash & brush cytology were included in the study along with biopsy in available cases. Total 60 cases of bronchoscopically visible abnormal lesions underwent bronchial wash and/or brush cytology and/or bronchial biopsy. Of them, only 11.8% of cases of lung malignancy was detected by bronchial wash where as 28.9% of cases of lung malignancies were detected by bronchial brush and 58.8% of cases by bronchial biopsy. We conclude that endobronchial biopsies along with bronchial brush give better cellularity and yield when compared to bronchial wash. The probability of finding the histological subtypes is higher in Endobronchial biopsy when compared with brush and wash samples.

Nowadays the automotive industry in Indonesia is becoming increasingly competitive, causing an intense competition among the ATPM (Single Agent of Brand Holders), as well as competition between existing automotive manufacturers (sole agent) and newcomers. In the midst of the current business industry and its competitive environment, various strategies were implemented by the company in order to maintain its customers, and to win the competition by increasing its market share. Customer satisfaction has become one of important focus for many companies. This study aims to examine and analyze the effect of product quality and after-sales service on customer satisfaction at an authorized Mazda Serpong Dealer, Tangerang. The sample used in this study were 200 respondents from customers at Mazda Dealer Serpong, Tangerang. Sample size determination using Hair’s formula. Hypotheses of the study analized by using multiple linear regression performed with SPSS 2.4. The sampling technique uses purposive sampling. The results showed that the quality of the product significant and positive affect on customer satisfaction. And after-sales service is also significant and positive affect to customer satisfaction. Other results shows that the quality of products and after-sales service of significant and positive affects on customer satisfaction simultaneously

Fomite is an inanimate object or substance that could serve as a vehicle for transmission of infectious organisms amongst individuals. A large number of factors may affect the contamination rate of fomite such as moisture, consistent use and overall cleanliness. Fomites that are found in public places, restaurants, hotels, hospitals and restrooms may include among others handbags, mobile phones, money, door handles or knobs of showers, conveniences, faucets and toilet seats, chairs, lockers, sink and tables. Ladies handbags are multipurpose personal gadgets which may usually habour several kinds of microorganisms such as bacteria. The presence of viable pathogenic bacteria on inanimate entities had been reported by earlier investigators. In this study, a total of one hundred (100) handbags from female undergraduate Microbiology students of Gombe State University (GSU), were investigated for bacterial contaminants and their resistance or otherwise to some commercial antibiotics using standard Microbiology procedures. The results obtained revealed the presence of six (6) different bacterial species, namely Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella pneumoniae and Bacillus subtilis. The antibiotic sensitivity test showed that all the six (6) bacteria were sensitive to Pefloxacin while five isolates (S. aureus, E. coli, P. mirabilis, K. pneumoniae and Bacillus subtilis) , two isolates (B. subtilis and P. mirabilis) and another two isolates (K. pneumoniae and E. coli) were sensitive to chloramphenicol, amoxicillin and streptomycin, respectively. In conclusion, high level of bacterial contaminants were observed from the studied handbags and found some of the contaminants resistant to the tested antibiotics hence, appropriate use of effective disinfectants is highly encouraged to reduce the magnitude of bacterial contaminants and likelihood of transmitting drug recalcitrant organisms.