Background: There is no standard protocol for treating oral lichen planus. We need to develop potent alternative immunosuppressive agent to benefit the patients. Aim: To investigate the efficacy of 0.1% tacrolimus with Colgate Oraguard-B paste for the treatment of patients with oral lichen planus. Methods: One hundred patients with clinical evidence of the lesion of oral lichen planus followed by histopathological confirmation seeking care at outpatient department were included in the study. Patients were provided with 0.1% tacrolimus ointment with Colgate Oraguard-B paste as the study medication. Reassessment was done from 3 months to 4 months, with follow-up of 2 years and 6 months. Results: Mean values of pre and post VAS (Visual Analogue Scale) for erosive and atrophic forms of oral lichen planus were 9.35±1.02, 2.96±0.24 and 7.82±0.56, 1.71±0.22 respectively. Similarly mean pre and post VAS scores for reticular and mixed forms of oral lichen planus were 4.16±0.44, 1.32±0.34 and 7.36±0.59, 3.33±0.48 respectively. Statistically significant results were obtained between pre and post treatment values on the Visual Analogue Scale among all forms of oral lichen planus. Conclusion: Topical tacrolimus ointment 0.1% with Oraguard-B paste showed us encouraging results for symptomatic Oral lichen planus. Clinical improvement was achieved in about a month’s treatment course.

Introduction: Incidence of shivering after spinal anaesthesia is common complaint in present anaesthesia practice. Several drugs available to manage shivering such as Pethidine, Tramadol, Dexmedetomidine etc. Among all Dexmedetomidine is effective. This study was designed to assess the efficacy of Dexmedetomidine, Tramadol and Pethidine in the management of shivering under spinal anaesthesia. Materials and Methods: A total 120 cases between age group 21 to 60 years, undergoing elective lower abdominal and lower limb surgeries under spinal anaesthesia method between ASA grade I&II were recruited. Based on drug administered study cases were randomly divided into 3 groups Group 1 with Inj. Tramadol 0.5mg/kg, Group 2 with Inj. Pethidine 0.5mg/kg and Group 3 with Inj. Dexmedetomidine 0.5μg/kg. Heart rate, BP, temperature, Shivering grades and seduction grades was noted for every 5 minutes interval till 15 min and then 15 min interval till 120 minutes. Results: Dexmedetomidine drug was showed better outcome than other drugs. Among the 40 cases, three cases who were given dexmedetomidine had shivering. In tramadol and Pethidine drug groups, 22 and 9 cases had shivering respectively at various time intervals. Dexmedetomidine had onset of sedation at 5 minutes with sedation score 3. In tramadol group, onset of sedation was seen at 15 minutes with sedation score 2. In Dexmedetomidine group, 5 cases had bradycardia and 3 cases had hypotension which was statistically not significant. None of the cases with above symptoms was found in tramadol and Pethidine group. Conclusion: Dexmedetomidine 0.5 μg/kg has been shown effective in reducing shivering than tramadol 0.5 mg/kg and Pethidine 0.5 mg/kg. Dexmedetomidine had higher degree of sedation rate than tramadol and Pethidine

Background: Menopause is an important transitional phase in women's life and needs active coping. Aim of study was to: Describe the coping patterns among menopausal women working at Zagazig University Hospitals. Subjects and methods: Research design: A descriptive study design was used. Setting: The study was conducted in the emergency departments of Zagazig University Hospitals (four hospitals). Sample: A purposive sample composed of 240 menopausal age fulltime employees at the setting. Tools of data collection: Two tools were used, Tool I: A self-administrated questionnaire composed of 3 parts. Part one: Covering respondents demographic. Part 2: This was for the details of women's obstetrical history, menopausal characteristics' and various menopausal symptoms .Part3: Intended to assess woman’ knowledge about menopause. Tool II: Various women coping strategies to deal with menopause. Results: The duration of menopause among the study sample was less than five years in 65.0% with a mean of 3.8 ± 2.7 and 62.1% had moderate/ severe menopausal symptoms, in additions to 79.6% of the study sample had total satisfactory knowledge. The cognitive coping strategy was the most commonly used 74.2% and only 15.4% &12.1% respectively of the study sample were using the re-interpretation and catastrophizing strategies. Conclusion: A high proportion of the menopausal women suffer moderate to severe menopausal symptoms, their knowledge about menopause was high, and they mostly use the cognitive coping strategy. Recommendations: The study recommended educational programs to improve women’ knowledge and coping regarding menopause.

Caecal diverticulitis is an uncommon condition in western countries and is often confused with the diagnosis of acute appendicitis. A distinction between the two entities is almost made intraoperatively. The management of solitary inflamed caecal diverticulae is still controversial; it ranges from a conservative approach with antibiotics to a right hemicolectomy. We present a case of 27 year old female which presented to the emergency department with symptoms similar to acute appendicitis. However, a CT scan showed signs of perforated caecal diverticulitis, thus an ileocaecal resection was realized. Across our case and a literature review, we try to highlight the difficulty of a preoperative diagnosis of this rare clinical condition and to discuss essentially its surgical management

This research was conducted to examine the effect of Good Corporate Governancen (GCG) and debt policy on dividend policy with profitability as an intervening variable. The proxy of GCG in this study is institutional ownership and the frequency of board meetings while the debt policy is proxied through leverage (debt equity ratio). The population in this study is that all companies indexed by compass 100 listed on the Indonesia Stock Exchange in 2016-2017 are 66 companies, with the sampling method using purposive sampling. The results obtained in this study are that institutional ownership has no influence on dividend policy either directly or indirectly through variable intervening ROE. While the frequency of board of directors meetings and debt policy (DER) has an influence on dividend policy both directly and indirectly through variable intervening ROE. The conclusion of the study is that profitability is able to become a variable intervening between GCG proxied through the frequency of board of directors meetings and debt policies that are proxied through DER on dividend policy. Companies that have large profitability tend to provide high dividends.

Background: Lack of medication adherence to anti-diabetic therapy causes suboptimal glycemic control and leads to treatment failure and increased mortality from diabetes complications. The study aimed to assess medication adherence among type 2 diabetes mellitus patients at outpatient setting and its correlation with glycemic control. Methods: A cross-sectional observational study was conducted between January 2019 and March 2019 at several outpatient clinics in Ibb city, Yemen. A total of 370 patients of type 2 diabetes mellitus who use oral hypoglycemic drug therapy for at least 3 months were enrolled in the study. Fasting and postprandial blood glucose as well as glycosylated hemoglobin were measured and details of drug therapy were noted. Morisky Medication Adherence Scale was used to assess medication adherence. Results: Only 1.1% of type 2 diabetes mellitus patients had high medication adherence to oral hypoglycemic drugs, while 61.9% had moderate and 37% had low medication adherence. Most common medication adherence issues identified in type 2 diabetes mellitus patients were forgetting to take their medication when traveling, stopping of medication once feeling better, and difficulty to adhere to medication plan. Only 12.1% were having optimally controlled glycemic levels, whereas 87.8% were having uncontrolled glycemic levels. Conclusions: Despite having a good overall medication adherence among type 2 diabetes mellitus patients, the glycemic control still low in most patients. The study shows urgent need for reviewing anti-diabetic pharmacotherapy, counseling, and health education of patients.

The aim of this study is to investigates the role of auditor Independence and materiality and risk on audit quality reduction, which is mediated by non audit service. In order to generate the goal of the study, we conduct a survey study at the public accounting firm. We test our 246 usable data from public accountant using Structural Equation Modelling analysis. The results indicate that eirther auditor ethics or materiality and risk had a negative effect on reduced audit quality Replacing and altering of audit process. Otherwise non audit services mediate the relationship between auditor auditor independence and materiality and risk to audit quality reduction.

Public waste disposal workers in Cross River State do not take precautionary measures and are exposed to waste that generates gases, dust and microorganisms. Spirometry and respiratory symptoms in public waste workers in Cross River state, Nigeria was studied with the aid of a spirometer and questionnaire respectively. Dust and gases (NO2, SO2, H2S and FL) emitted from the vicinity were also studied. Two hundred and forty (240) male subjects were used for the study comprising 120 test and 120 control subjects with similar anthropometric parameters. Results showed that the mean FVC (Liters) in the test subjects was significantly reduced (p<0.01) compared to the control. Mean FEV1 (liter) of the test group was significantly lower (p<0.001) than control. Result for FEV1% (Liters) and PEFR (L/min) in the test subjects was not significantly different compared to control. Percentage of oxygen saturation (SPO2%) in both control and test subjects were not significantly different. Dust levels (mg/m3) in the test sites was significantly higher (p<0.001) than in control sites. SO2, NO2 and H2S were significantly higher in test sites compared to control (p<0.05-p<0.01). There was a higher incidence of respiratory symptoms such as productive cough, sneezing etc in public waste workers. Public waste workers had a restrictive pattern of impairment caused likely by significantly high dust levels with SO2 level which exceeded the ambient levels as documented by the Federal Ministry of Environment in Nigeria

Oil palm is a strategic commodity in the Indonesian national economy. The condition of the oil palm seed industry in Indonesia has continued to change as a result of the increase of new domestic seed producers, thus affecting consumer behaviour and the direction of corporate strategy. PPKS itself as one of Indonesia's oil palm seed producers has been impacted by the changes occurring both from the instability of Crude Palm Oil prices, moratorium, regulation, increased competition and economic shifts. In the current era of distraction, PPKS must move quickly, precisely and responsibly to survive from the competition is increasingly competitive. At this moment, competitive conditions are too tight that PPKS management is aware of exploiting assets in the context of brands that are owned to maximize corporate performance. The most potential market for exploitation is the people's plantation market. Specifically, that directly touches the consumer mind generated based on the latest information on consumer behaviour. The research is conducted on the people's plantation segment as its population. The respondents' sampling of ninety-nine oil palm farmers. By applying the Partial Least Squares-Structural Equation Model (PLS-SEM) with the SmartPLS V3.2.8 tool, the conclusion of the research result is that there is a positive and insignificant influence between the brand associations of PPKS on the repurchase decision of oil palm seeds. There is a positive and significant influence between perceived quality of PPKS on repurchase decision of oil palm seeds, the customer satisfaction of PPKS on repurchase decision of oil palm seeds, brand association on customer satisfaction, and perceived quality towards customer satisfaction of PPKS. Also, demonstrating positive and significant influence between the brand association of PPKS and perceived quality of PPKS on repurchase decision of oil palm seed through customer satisfaction of PPKS

We report the case of an infective Candida albicans fungal endocarditis occurring in a 68-year-old male patient operated on for valvulopathy and with a pacemaker, with a delay of 06 years between his cardiovascular surgery and the onset of endocarditis. The diagnosis was confirmed by blood culture and echocardiography showing the presence of vegetations, the patient was then put under fluconazole with clinical and transient biological improvement before the worsening of the clinical picture and control echocardiography increase the size of his abscess of the mitral ring, which motivated the decision of a surgical treatment.

This research is an event study that aims to find empirical evidence of the impact of the quick count of the results of the presidential election on the Indonesian capital market. The population of this study are stocks that are consistently listed on the Indonesia Stock Exchange during the study period. The data used is secondary data in the form of a daily sectoral index two days before and two days after the event. Paired Samples t-test is used to test the hypotheses. The results of the Paired Samples t-test show that there are no significant abnormal returns in the period around the date of the event, and in the period between before and after the quick count event the results of the presidential election. The results of the study also prove that there is no abnormal trading frequency in the period around the date of the event, and in the period between before and after the quick count event the results of the presidential election. In general, it can be concluded that there is no impact from the quick count of the results of the presidential election on the Indonesian capital market

Hypertension is a major cause of morbidity and mortality worldwide. Patients’ beliefs and knowledge about hypertension have a strong influence on compliance to treatment and control of the disease. Up to date, there is no previous data on hypertension health beliefs in Bahrain. Therefore, this research was conducted to study patients’ beliefs and explore the association between patients’ characteristics and their beliefs. Aim: To understand Bahraini patients’ beliefs about hypertension in primary health care in Bahrain. Objectives: To explore patients’ beliefs about hypertension in primary health care in Bahrain; to study the association between personal characteristics (demographic, socioeconomic and medical) and patients’ beliefs. Study design: Cross-sectional study. Settings: Data was collected from two primary care health centers in each health region in Kingdom of Bahrain using validated questionnaire. Participants 454 hypertensive adult Bahraini patients ≥18 years, who were attending primary care within 10 days period in February 2018 (1st – 14th February), were recruited. Pregnant women, patients with psychotic disorder or cognitive impairment, and patients who are unable to communicate were excluded. Data was analyzed qualitatively for themes using SPSS version 23.0. Results: Patients’ mean age was 58.2 ± 11.697 years with females constituting 58.4%. Based on the Health Beliefs Model, participants have strong beliefs regarding their susceptibility to the effects of hypertension, seriousness of its complications and the benefits of a proper and healthy management plan. On the other hand, they have weak beliefs in the efficacy of the barriers (i.e. alternative medicine and medication side effects) toward hypertension management. The most variables having the largest influence on patients’ beliefs were duration of having hypertension and existence of other chronic medical problems. Conclusion: The findings suggest that participants were fairly knowledgeable about hypertension. We concluded that patients’ perceptions are an important factor in hypertension care and should be deeply explored

Bank Indonesia made changes to regulations regarding the assessment of bank soundness. The soundness of the bank was initially regulated in Bank Indonesia regulation number 6/10 / PBI / 2004 concerning the bank soundness rating system using the CAMELS method (Capital, Assets, Management, Earning, Liquidity, Sensitivity), then changed to Bank Indonesia regulation number 13/1 / PBI / 2011 concerning the bank soundness rating system using the RGEC method (Risk Profile, Good Corporate Governance, Earnings, and Capital), the regulation contains that banks are required to assess the soundness of banks using a Risk-based Bank Rating approach both individually or on a consolidated basis. This research is a type of evaluative research. Evaluative research is research whose activities collect data or information to be compared with criteria and then draw conclusions. The documents used in this study are the Financial Statements and Annual Reports of PT. Bank Mandiri (persero) Tbk 2014-2017 Period. Independent bank health assessment is based on a rating system for commercial banks, in accordance with Bank Indonesia Regulation No. 13/1 / PBI / 2011, and SE No. 13/24 DPNP on October 25, 2011, based on the bank's health assessment conducted by the RGEC method, it was concluded that the health level of PT. Bank Mandiri (Persero) Tbk from 2014-2017 is Very Healthy (SS)

The breast is the most frequent site of cancer among women in both developed and in developing countries [1]. Breast cancer is the most frequent cause of cancer death in women from less developed countries and second most frequent (after lung cancer) among women in developed countries [1]. It is increasing in incidence in the developing world due to increased life expectancy, increased urbanization and the adoption of western lifestyles [2]. According to the World Health Organization (WHO), “Early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control” [2]. Breast cancer staging also takes into account cancer's grade; the presence of tumor markers, such as receptors for estrogen, progesterone and HER2; and proliferation factors.Standard screening for new and recurrent breast cancer involves clinical breast exam and breast imaging. Given the recognized differences in breast cancer incidence, subtypes, and prognosis among women , it is important to evaluate potential biomarkers in the landscape of breast cancer subtypes ranging from DCIS to triple-negative breast cancer (TNBC) to determine if a simple blood test can enhance the diagnosis of this disease and knowing about stage of disease, and helping in proper treatment. In this review we tried to discuss role of genetic panels in breast cancer management

The revolving door policy has become a bottleneck for the Hotel Managers. Be it the lower level staff or the top management staff, they leave the organization once they are trained and groomed as per the hotel standards. This crisis leaves the hotel at catch 22 situations. They have no option other than to hire a new staff and train them. “The Bureau of Labor Statistics [1] estimates an annualized employee turnover rate of 73.8% in the hotel and motel industry. This figure is striking consider most HR experts agree a healthy turnover rate should actually be somewhere in the 10-15% range”. Considering the high rate of attrition, training a new staff as per the standard policies becomes a costlier challenge for Hotel Industry. There are various reasons behind turnover i.e. Job dissatisfaction, better career growth/opportunities etc. There are a variety of reasons why an employee would consider quitting his or her job within the hospitality industry. These have been identified and researched significantly in the past 60 years (Brown et al., 2015; Huselid, 1995; Kang et al., 2015; Mobley, 1982; Poulston, 2008; Smith and Watkins, 1978) [2]. Yet, organizations are continually trying to identify areas for improvement regarding turnover as turnover costs can be extremely expensive. In fact, they are sometimes considered the highest cost an organization has to endure (Tracey and Hinkin, 2008; Woods, 2002).