Nurses are present at both the beginning and the end of life, and play a key role in caring for dying patients. It clearly indicates that role of nurses can never be ignored when we are talking of end of life care or palliative care. Palliative care is defined by literature as care that improves the quality of living in individuals who are facing life threatening problems and illness to prevent and treat them through early identification of pain and other physical and psychosocial problems. The main purpose of this study was, to assess palliative care knowledge and attitude among nurses of Mayo Hospital Lahore. A cross sectional descriptive survey was performed to assess the knowledge and attitude level. A simple random sample of n=150 was used. A structured questionnaire with demographic data, knowledge and attitude of palliative care was applied. The data was analyzed on SPSS version 21. 36% of the study participants had poor knowledge, 49.33% of the study participants had average knowledge and very less number of participants that is only 14.7% of the study participants had good knowledge of palliative care. Findings reveals that 33.33% of the study participants had negative attitude towards care of end of life among terminally ill patients, while 66.7% had positive attitude towards end of life care. Knowledge was poor among majority of the participants but attitude was found positive among them

Abstract: The study aims to compare between serum non-HDL Cholesterol, CRP and Uric Acid Levels in Metabolic Syndrome. Fifty subjects of metabolic syndrome (MetS) (30 women, 20 men) who confirmed by the ATP III diagnosis criteria and have no any medical treatment were included in the study. Twenty healthy subjects constituted as the control group (13 women, 7 men). Blood samples were obtained after overnight fasting by using standard sampling procedure and measured fasting blood sugar, lipid profile, serum uric acid and CRP levels. Non–HDL-C was calculated by a formula (Non HDL-C = TC - HDL-C), C-reactive protein was measured using a commercially available ELISA Kit (Ray Biotech, Inc.) Uric acid level was determined using enzymatic (urease) method. Blood sugar and lipid profile were measured by using standard colorimetric commercial kit. Mean, Standard deviation and unpaired t- test (p value) were applied. A p value < 0.05 was considered as statistically significant. Anthropometric variables (blood pressure, BMI and WC) highly significantly (p<0.0001) increased except age (p=0.37 NS) in MetS (n=50) patients than control (n=30) groups. Lipid profile including TC, TG, LDL-C and VLDL-C showed statistically significantly raised (p<0.0001) whereas HDL-C observed decreased (p<0.0001) in same manners. In case N-HDL-C, CRP and serum uric acid levels were found statistical significantly elevated (p<0.0001) in MetS on comparison with control group. Non-HDL-C may be an independent risk factor for cardiovascular events in MetS. Monitoring HDL-C concentrations may reduce the cardiovascular risk. Therefore, non-HDL-C and CRP might be useful markers for predicting cardiovascular events in both high-risk and healthy individuals. Serum Uric Acid levels were significantly higher with MetS samples. Uric acid and non HDL cholesterol can be considered as a component of MetS.

Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. The prevalence and impact of musculoskeletal conditions increase with aging. Aim of this study assesses lifestyle elderly women Suffering from knee osteoarthritis pain. A descriptive research design used in this study. Was conducted at out patient orthopedic and rheumatology clinics at Nasr City Hospital and the Nile Hospital, affiliated to the National Health Insurance Organization Cairo Egypt. A purposive sample of 120 elderly women with OA. Tools the investigator will use four tools for collection of the data, namely an interview questionnaire, Lawton scale for the Activities of Daily Life Arthropometne measurement, Measure Body mass index, and a pain. Revealed 85% of study subjects from urban areas, suffered from OA since many years, and 68% Unsatisfactory knowledge and Adequate practices 71.7% and 80% was obese, and 73% suffered from Moderate pain. The results of the study show the lifestyle practices older women are higher than women's knowledge and higher in cases of moderate obesity and moderate pain in most elderly women. Health education about lifestyle modification, practice exercise should be provided to all female with OA attended to orthopedic and rheumatology clinic.

The margin is one of the components of the cast restoration most susceptible to failure, both biologically and mechanically. Obtaining a good marginal seal is one of the most important factor in determining the long term success of cast restorations. The purpose of the study was to comparative evaluate the casting accuracy by axial coverage of the die spacer 1.00 mm short from the finish line and complete axial coverage of the die spacer. Irrespective of the method of the die spacer application, all the castings showed deficiency in the marginal fit. Efforts were made to select and utilize standard method. The enhancement of marginal fit with incomplete axial die spacer coverage by providing an area of close adaptation near the marginal area, thereby improving the marginal seal and thus reducing the dissolution of cementing media is of great clinical significance. Increased casting accuracy with die spacer application short by 1.00 mm from finish line could be due to the reason that unpainted area will ensure an area of close adaptation at the margin. From this study, it is clear that the die spacer application short by 1.00 mm from finish line gives better marginal adaptation to castings when compared to full length die spacer application

Percy Bysshe Shelley was one of the important English romantic lyric poets. He remains a central role in English Romanticism. The theme in his work includes religious fervor, nature, Ancient Greek aesthetics, and emotional response to beauty. These are components of Romanticism. His major works are considered as challenging beliefs of revolutionary philosophy, and his odes and shorter lyrics are widely known for their stylistic mastery.

Pericardial effusion is an extremely rare expression of hyperthyroidism. We report a case of a patient with Graves’ disease who developed a sanguineous pericardial effusion. Our patient had been hospitalized for retrosternal chest pain and dyspnea. She underwent pericardiocentesis resulting in 700 ml of blood. The pericardial fluid’s cytology and culture were negative. Besides, thyroid hormone markers were progressively normalized using antithyroid drugs .Thus the pericardial effusion resolved without recurrence.

Supervisory practice has evolved since its origins in colonial times, and its effectiveness as a means of improving instruction depends on the ability of educational leaders to remain responsive to the needs of teachers and students. An educational leader’s resolve to remain adaptable also depends on an appreciation of the changing and evolving nature of supervision, especially in the new millennium. An educational leader who understands the history of supervision and how current demands are influenced by that history will be better able to confront the technological, social, political, and moral issues of the day. Educational leaders also will have to develop the requisite knowledge, skills, and dispositions that are the foundation for effective supervisory practice. This chapter explicates how supervision has evolved to its current state, how you might respond to ever-increasing supervisory needs and demands, and how your beliefs and attitudes affect how you react to daily challenges.

Abstract: Infertility is more of a social problem rather than a medical problem. The term “subfertility” used to describe any form of reduced fertility that results in a prolonged duration of unwanted lack of conception. The difficulty to conceive or subfertility constitutes a major social and psychological burden amongst couples especially in lower-middle country like Bangladeshi women. Accurate and precise diagnosis is mandatory prior to management of case. Although there are many diagnostic tests available, the clinical presentation of each patient can usually be linked to specific and efficient testing strategies. Ultrasonography is an accurate and reliable test for evaluation of subfertilty. Ultrasonographic imaging is easy to use, safe, and readily available noninvasive means to evaluate fertility potential. The purpose of the study is to evaluate and correlate the clinical findings with ultrasonography finding of the subfertile female patient. A hospital based cross sectional study conducted Department of obstetrics & Gynecology (Infertility unit), Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. Sample was selected from the population by Purposive sampling. All subjects were subfertility in reproductive age group. Total 50 patients were enrolled for study after fulfilling inclusion and exclusion criteria Detail demographic data were collected from the patients and recorded in structured case report form. All collected questionnaire checked very carefully to identify the error in the data. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data. Maximum numbers of patients (62.0%) were between 20-30 years age group with mean age was 26.47 ± 11.57 years. Detailed history taking, examination suggested that, etiology for subfertility were (14%) for tubal factors and (26%) ovarian factors. Clinical and pathological factors for subfertilty were verified by pelvic ultrasonography in all the cases. In case of female infertility, uterine factors account for 32% of the cases. Among the uterine causes, fibroids or myomas in the uterus found (16%) cases, endometrial thickening (10%), endometrial polyp and endometriosis (6%) cases. Ovarian factors like polycystic ovary syndrome (PCOS) found (18%) cases. In 24% of women, USG tests were normal and there is no easily identifiable cause for infertility. Subfertility is not an uncommon problem in our country, major social, personal and economical burden. When pregnancy is considered such an important event in life, and considered a “socially unacceptable condition”, it can lead to a search for treatment appropriately and accurately. Aetiology of infertility are numerous and presentation also variable, sometimes confusion occurs regarding the actual diagnosis and thus delay the prompt management which may result in poorer clinical outcome. Therefore proper clinical evaluation with sonographic and other pathological findings correlation, interpretation helps to proper diagnosis, treatment and prevention as well.

Middle level managers play a very vital role in employee talent development in institutions of higher learning since they man a large population of employees at this level. Talent development seems to be the key theme driving the educational institutions. The study sought to investigate the influence of leadership styles of middle level managers on employee talent development at Rongo University. Descriptive research design was used for the study because it allowed for the statistical analysis of data to describe the trends about responses to questions and to test research questions. The study targeted 10 senior management level staff, 8 Deans, 30 middle level managers of departments and sections, 80 middle level employees, 100 low level management employees. Simple random sampling was used on middle and low level employees from different sections and departments.10 senior management level staff, 8 Deans, 30 middle level managers of departments was sampled using purposive sampling method. Reliability was ensured through test-retest which yielded 0.78 Cronbach‟s alpha. To ensure content validity, the questionnaire is to be given to the experts and researchers of Rongo University who examined the items critically and pass on their comments to the researcher. Statistical techniques of averages and percentages with the aid of Computer Statistical Software for Social Sciences to yield descriptive results. The findings revealed that 63% of the respondents observed that stakeholders were involved in talent development in Rongo University while 37 % indicated that stakeholders were not involved. The study concluded that leadership styles of middle level managers influence employee talent development in Rongo University since effective leadership style is seen as a potent source of management development and sustained competitive advantage. The study recommended that the middle level managers in Rongo University should be trained on talent management and leadership style to apply in management of employees talents. The study adhered to ethical considerations.

Abstract: Obstetrics patients may require intensive care at any time unpredictably. The most common causes of morbidity and mortality in these patients are anaemia, hemorrhage, hypertension, pre eclampsia, eclampsia, septicemia and their complications. The aim of this study was to evaluate the incidence, occurrence, indications, course of ICU stay, interventions required and the outcome of those obstetric patients admitted in the ICU. It was a hospital based, retrospective study conducted in a tertiary care medical college in Haryana, in North India over a period of 2 years – from January 2015 to January 2017. Out of a total deliveries of 7150, 165 patients required ICU admission and care (2.30 %). Most admissions were in the post partum period – 95(57.57 %), followed by antepartum period – 70 (42.43 %). Most common indications for ICU admission were obstetric hemorrhage – 50 (%), eclampsia -17(%), pre eclampsia- 8 (%), septicemic shock – 23 (%), HELLP syndrome – 16 (%), DIC- 10 (%), cerebral malaria-10 (%), dengue-7 (%), hepatic encephalopathy-5(%). The most common interventions warranted were artificial ventilation-139 (84.24 %), transfusion of blood & blood products-140 (84.84 %), surgical exploratory laparotomy – 35 (21.21 %) and there were 15 maternal deaths (9.09 %).

If societies are indeed different, it is not unreasonable to reaffirm the argument advanced in that theories and principles of instructional supervision are not necessarily universal. In consequence, there is need to construct instructional supervisory strategies and educational goals that are appropriate to the nature and operation of educational organisations in developing countries. Supervision of instruction in developing countries exists in different contexts from developed countries. It is therefore incumbent to understand the various contexts that instructional supervisors carry out their tasks. This paper looks at some of the contextual realities of instructional supervision in prismatic societies.

Diffuse large B cell lymphoma (DLBCL) of the ethmoid sinus is very rare entity. The presenting symptoms are usually similar to those of benign inflammatory diseases. We report a case of a 50-year-old male patient who presented with acute onset progressive proptosis right periorbital swelling, redness and treated initially as periorbital cellulitis secondary to right maxillary and ethmoidal fungal sinusitis, but proven to have be a diffuse large B-cell lymphoma (DLBCL) of the ethmoid sinus. HIV serology was negative. The patient was referred to the department of oncology where chemotherapeutic treatment for the lymphoma. We emphasize the importance of considering primary lymphoma of the ethmoid sinus in the differential diagnosis of periorbital cellulitis and refractory rhinosinusitis, to help in early diagnosis, which can improve prognosis.

The study objective was to establish financial challenges of nongovernmental organisations’ in promotion of quality education in Musoma District, Tanzania. Despite the efforts put by non-governmental organizations in promoting quality education in the country, there are several challenges that are encountered by NGOs which hinder their support in promoting quality education. The study adopted a descriptive survey design. The target population was 19 NGO Leaders, 111 Head Teachers, the DEO, 111VEOs and DCSQAO, totalling to 243. The NGO officials, DEOs, DCSQAs, and were purposively selected because they were few. A 30 percent simple random sample was used to get33 Head Teachers and 33 VEOs .Data was collected through questionnaires and interview schedules.To ensure face and content validity of the research instruments, 2 experts in the department of Educational Administration Planning and Economics of Kisii University were requested to scrutinize the research instruments so as to validate them. Reliability of the instruments was addressed through piloting in 5 schools and reliability coefficients were obtained by subjecting the instruments to a Split-half Technique and Spearman ―Brown Prophesy formula‖. The co-efficient of reliability obtained was 0.721 which indicated that the instruments were reliable.Data was analysed qualitatively and SPSS programme was used. The findings of the study reveal that the majority (87) 88.6 percent of all respondents said that training on financial matters in the schools was done quarterly. It was recommended that the government to work closely with NGOs to provide quality education. Informed consent of the respondents were ensured and confidentiality adhered to.

Hydroquinone (HQ) and clobetasol 17-propionate (17PC) are two medicinal agents commonly incorporated because of their skin bleaching properties into lightening cosmetics sold out in some sub-Saharan regions (Senegal, Togo, South Africa, Cameroon…). The aim of this study was to quantify these agents in lightening creams and body lotions marketed in Douala, the economic capital city of Cameroon. A preliminary investigation was carried out at the main cosmetics sales outlets (pharmacies, perfumeries and supermarkets) of the city, in order to come out the overall proportion of lightening cosmetics and to inventory the mainly bleaching agents listed as ingredients in these products. About forty lightening creams and body lotions were purchased and then analyzed in other to come out their respective hydroquinone and 17PC concentrations. The results have revealed a compliance rate of 79%, with 47.5% of the samples containing hydroquinone at a higher concentration than the one allowed in cosmetics (≤ 2%). Clobetasol 17-propionate, forbidden in cosmetics, has been identified in all the samples with 77.5% having a dosage above the 0.05% accepted medicinal creams, what may lead to systemic repercussions when used chronically.

The purpose of this study was study was to examine teachers’ attitude towards open performance appraisal on pupils’ academic achievement. A quantitative and qualitative research survey design was adopted. The target population involved all primary school teachers, school quality assurers’, Human Resource Officer and District Education Officer, totaling to 1213. Random sampling technique was used to obtain 328 teachers and 33 head teachers, that is, 30% of the population, while the District Education Officer and Human Resource Officer and School Quality Assurance officers were purposively selected because they are few and the only existing ones. This study used semi structured interviews, questionnaires and documentary analysis for data collection. Qualitative data obtained was analyzed descriptively while SPSS software version 23 was used to analyze quantitative data. To ensure face and content validity of research instruments, two experts in the department of Education Administration Planning and Economics of Kisii University scrutinized the research instruments and validated them. A pilot study was conducted for reliability reasons. Anonymity, confidentiality, privacy and informed consent of the respondents were ensured. Findings of this study revealed that 65.52% of head teachers believed that teacher attitudes influences pupils’ academic success while 34.48% disagreed. It was concluded that positive attitude was key to pupils’ success. The study recommended that teachers and head teachers should be involved in setting goals and objectives of the performance appraisal process, The study adhered to the ethical consideration accordingly.