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Background: The peri-hilar branching pattern of renal arteries and variations such as accessory renal artery and early branching of the renal artery are important factors to be evaluated preoperatively to minimize potential complications during renal transplantation and renal surgeries. The present was done to study the perihilar branching pattern of the renal artery and variations of the renal artery in kidney donors. Materials and methods: 198 kidneys from 99 donors were analyzed using pre-operative CT renal angiograms prospectively, over 1 year 2 months. Results : Based on the branching pattern of primary and secondary branches of renal arteries, we identified 8 cardinal and 10 minor peri-hilar branching patterns. Type I (duplicated fork) peri- hilar branching pattern was the most found (70.2%) among 198 kidneys, followed by type II (triplicated fork) (19.2%) and type III (ladder) (10.6%). Duplicated fork pattern was common in both the right renal artery (75.7%) and left renal artery (64.6%) respectively. The prevalence of accessory renal artery was 39.4% with hilar artery at 21.2% and polar artery at 18.2%, and the prevalence of early division of renal artery was 20.2%. No statistical significance was associated between gender and laterality in the prevalence of both early division and accessory renal arteries (P > 0.05). Early division of renal artery was more frequent in females (28%) whilst accessory renal arteries were more common in males (40.7%). Conclusions: The present study showed a consistent peri-hilar branching pattern with high individual variability among Indian renal donors. The knowledge about the peri-hilar branching pattern as well as renal artery variations conferred by this study would greatly compliment urological surgeons during renal transplant surgeries.

Introduction: India is currently facing problems with pre-fix of ‘P’. They are “population explosion”, poverty, and pollution. Population explosion is directly perpetuating the other two problems. Family planning is the only safest and cost effective strategies to have impact on health of women. In many studies it was found that though people were aware of contraceptives but its usage was limited. To know the various factors influencing usage of family planning methods this study was conducted. The study was conducted to assess knowledge, attitude and practice of various family planning methods. Methodology: Cross–sectional study conducted by face to face interview of selected women using a questionnaire. Results: Total of 80% of women were aware that family planning is about limitation of births but, 208 (64.8%) women had ever used contraceptive. And 22 (10.58%) of them have faced minor complications, which has either self-resolved or on medication. The most common reason for not using contraceptive was being uncomfortable (81.42%) to use them. Conclusions: Women had good knowledge regarding contraceptives, but most of the women followed methods suggested by their elders. Advertisement regarding newer methods has to be strengthened.

Introdução: A hemorragia peri-intraventricular grave tem sido associada a maior mortalidade e sequelas do neurodesenvolvimento.Mantém-se controverso o impacto da hemorragia peri-intraventricular isolada, sem lesão da substância branca. O objetivo deste trabalho foi avaliar a influência da hemorragia peri-intraventricular grave, associada ou não a leucomalácia peri-ventricular quística, na mortalidade e no neurodesenvolvimento aos 24 meses.Material e Métodos: Estudo de coorte retrospetiva que incluiu os recém-nascidos com hemorragia peri-intraventricular grave, internados numa maternidade de apoio perinatal diferenciado, entre 2006 e 2015, e dois controlos com a mesma idade gestacional, internados logo a seguir ao caso, sem hemorragia peri-intraventricular. A avaliação do neurodesenvolvimento, aos 24 meses, foi realizada em 99 crianças, com recurso à escala The Schedule of Growing Skills Scale II em 52 e à escala de desenvolvimento mental de Ruth Griffiths em 47 crianças. Considerou-se défice grave do neurodesenvolvimento: paralisia cerebral, atraso do desenvolvimento psicomotor, surdez com necessidade de prótese auditiva ou cegueira.Resultados: Foram incluídos 41 recém-nascidos com hemorragia peri-intraventricular grave e 82 controlos. Ocorreram 23 óbitos, 16 (39,0%) nas hemorragias peri-intraventricular graves e sete (8,5%) nos controlos (OR 7,6; IC 95% 2,6 - 20,4; p < 0,001). Verificou-se défice grave do neurodesenvolvimento em sete (30,4%) no grupo de hemorragia peri-intraventricular graves e um (1,3%) no grupo de controlos (OR 32; IC 95% 3,7 - 281; p < 0,001). Na análise individualizada, a mortalidade foi superior quer nas hemorragia peri-intraventricular grau III com leucomalácia peri-ventricular quística associada (OR 4,4 IC 95% 1,3 - 14,2; p = 0,015), quer na hemorragia peri-intraventricular grau IV (OR 12; IC 95% 3,5 - 41,2; p < 0,001), em relação aos controlos. Verificaram-se também diferenças no défice grave do neurodesenvolvimento em relação aos controlos (1,3%) na hemorragia peri-intraventricular grau III com leucomalácia peri-ventricular quística associada (75,0%, p < 0,001) e na hemorragia peri-intraventricular grau IV (50,0%, p < 0,001).Discussão: Este estudo evidenciou maior taxa de mortalidade e de alterações graves do neurodesenvolvimento nos prematuros com hemorragia peri-intraventricular grave. A análise dos grupos estratificados por idade gestacional e a abordagem separada dos vários tipos de hemorragia peri-intraventricular, permitiu evidenciar as complicações associadas à hemorragia peri-intraventriculargrau IV e grau III, associada ou não a leucomalácia peri-ventricular quística.Conclusão: Os recém-nascidos com hemorragia peri-intraventricular de grau IV ou grau III com leucomalácia peri-ventricular quística associaram-se a maior mortalidade e sequelas graves do neurodesenvolvimento.

PURPOSE To evaluate the effect of overdenture (OD) attachment type and the number of implants supporting mandibular ODs on peri-implant health. STUDY SELECTION From inception to October 2020, electronic databases (Medline/PubMed, Embase, Cochrane Library, and Scopus) were systematically searched. The outcomes of interest were marginal bone loss (MBL), pocket probing depth (PPD), plaque index, bleeding index, and implant survival rate. Bayesian network meta-analysis was performed using the GeMTC package supported by R. The weighted mean difference and 95% credible interval were estimated. RESULTS Twenty-eight studies with a total of 1166 participants who received 2666 dental implants were included. Except for 4 bar and 4 telescopic, which showed a statistically lower MBL than the 2 locator, all other interventions showed insignificant differences in MBL (P > 0.05). The difference in periodontal probing depth was not statistically significant when comparing the different groups. The pooled implant survival rates of the different interventions ranged from 88.9% to 100%. The rank probability test showed that 4 bar and 4 telescopic had the lowest MBL, 2 magnet and 2 bar had the highest PI, whereas 4 locator showed the least PPD. CONCLUSIONS Except for 4 implants+bar, or telescopic, and 4 locator that, respectively, showed less MBL and PPD compared to some interventions, it seemed that different attachment types and number of implants supporting mandibular ODs have no clear superiority over the other in terms of peri-implant health outcomes.

BACKGROUND Keratinized gingival insufficiency is a disease attributed to long-term tooth loss, can severely jeopardizes the long-term health of implants. A simple and effective augmentation surgery method should be urgently developed. CASE SUMMARY A healthy female patient, 45-year-old, requested implant restoration of the her left mandibular first molar and second molar. Before considering a stage II, as suggested from the probing depth measurements, the widths of the mesial, medial, and distal buccal keratinized gingiva of second molar (tooth #37) were measured and found to be 0.5 mm, 0.5 mm, and 0 mm, respectively. This suggested that the gingiva was insufficient to resist damage from bacterial and mechanical stimulation. Accordingly, modified apically repositioned flap (ARF) surgery combined with xenogeneic collagen matrix (XCM) and platelet-rich fibrin (PRF) was employed to increase the width of gingival tissue. After 1 mo of healing, the widths of mesial, medial, and distal buccal keratinized gingiva reached 4 mm, 4 mm, and 3 mm, respectively, and the thickness of the augmented mucosa was 4.5 mm. Subsequently, through the second-stage operation, the patient obtained an ideal soft tissue shape around the implant. CONCLUSION For cases with keratinized gingiva widths around implants less than 2mm，the soft tissue width and thickness could be increased by modified ARF surgery combined with XCM and PRF. Moreover, this surgery significantly alleviated patients’ pain and ameliorated oral functional comfort.

The electroencephalographic derived indices have been developed for adult patients, however these monitors have not been validated for infants.Frontal EEGs were recorded in 115 infants aged 1 year [0-3-months (N = 27), 4-6-months (N = 30), 7-9-months (N = 29) and 10-12-months (N = 29)] who received general anaesthesia with sevoflurane. Total power (µVNewborns show a mean relative δ-power at 80% in intraoperative EEG compared to infants (10-12 months) showing 47.5%. Relative β-power and α-power are low in newborns (mean 3.2% and 4.6%; respectively), with a marked increase in the older infants (4-6 months) (mean 10.9% and 14.4%; respectively). EEG dynamic in newborns from baseline (relative δ-power of 88%) to the intraoperative situation (80.5%) are discrete. In contrast infants 6-months have a strong reduction of relative δ-power from baseline to the intraoperative situation, which corresponds to an increase of faster frequencies.Age dependent perioperative EEG signatures can be demonstrated in infants younger than one year.We demonstrate significant differences in EEG readouts between newborns and infants which questions our monitoring systems in paediatric anaesthesia.

Objective: The aim was to describe the anthropometry, bone mineral content (BMC), bone mineral density (BMD), dietary calcium intake and 25(OH)D3 levels in 11- and 12-year-old children in a peri-urban area. Design: A cross-sectional, descriptive study in the quantitative domain was undertaken. Setting: Bronkhorstspruit, Gauteng, South Africa. Subjects: Children, conveniently selected, were assessed in two groups. The first group comprised 70 children. From the 70 children, 20 children were conveniently selected to form a sub-sample (n = 20). Outcome measures: Anthropometric data (weight, height) and dietary data (three quantified /multi-pass 24-hour recalls). Children in the sub-sample additionally underwent body composition assessment (dual-energy X-ray absorptiometry; DXA scan) and a finger prick for 25(OH)D3. Results: BMI and body composition data (body fat mass and lean fat mass) showed that the girls exceeded the boys in all measurements. The girls had a non-significantly higher BMD and BMC than the boys. The mean and median values for 25(OH)D3 were lower than the reference range values. Dietary intake results showed that the children had a sufficient macronutrient intake, but a deficient intake of calcium, phosphate and vitamin D. The sub-sample had a mean vitamin D intake of 3.2 mcg. Conclusion: The girls exceeded the boys in all the anthropometric and body composition measurements. The calcium and vitamin D intake of the children were of concern. There were no significant differences or relationships in the bone measurements and vitamin D status between the boys and girls.

OBJECTIVE: To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women. METHODS: We analyzed baseline data from 293 women who were eligible for a 3×2 factorial trial of exercise or yoga vs. routine activity, and omega-3 fish oil vs. placebo for vasomotor symptoms. Women self-collected salivary cortisol using swabs at four time points over two consecutive days and reported distress from heart racing or pounding during the past two weeks using a single item. Sample description and covariate data included demographics, clinical data, vasomotor symptom frequency from daily diaries, medication use, and validated questionnaires on depression, stress, and insomnia (Patient Health Questionnaire-8, Perceived Stress Scale, and Insomnia Severity index). Data were analyzed using descriptive statistics, chi-square and t-tests, and repeated measure linear regression models. RESULTS: Participants were on average 54.6 (SD=3.6) years old, most were white (67%),, most were postmenopausal (84%), and 26% reported distress related to palpitations. In adjusted models, the morning (wake plus 30-minute) geometric mean daily salivary cortisol concentrations were significantly more blunted in those with distress from palpitations compared to those without distress (p≤0.03). When all covariates were controlled, distress from palpitations was the sole significant predictor of wake plus 30-minute cortisol (−0.25 [−0.45 to −0.04], p=0.02). CONCLUSIONS: Palpitations among midlife women may be associated with blunted morning cortisol, and this relationship is not explained by demographics, clinical variables, vasomotor symptoms, medications, depression, stress, or insomnia.

OBJECTIVES This study aimed to identify the characteristics of menopausal symptoms among Japanese and Chinese women and to determine the correlation between menopausal symptoms and self-efficacy. METHODS We surveyed 40- to 59-year-old women, 329 of whom were from an urban area in Northwest China (Xi'an) and 310 were from an urban area in Western Japan (Ehime), using a menopausal symptoms inventory and a self-efficacy scale. Comparison analysis was conducted among pre-, peri-, and postmenopausal status, within and between the two cultural groups. Following a two-way ANOVA, multiple comparisons were performed using the Tukey-Kramer test. The correlation between severity of menopause symptoms and self-efficacy scores was evaluated using canonical correlation analysis. RESULTS The most frequently reported symptoms were fatigue (93.6%) among Japanese women and memory loss (76.6%) among Chinese women. Japanese women showed significantly higher severity scores across all factors than Chinese, sexual function: 19.58 (SE = 0.73) versus 15.04 (SE = 0.67); mental health condition: 35.44 (SE = 1.15) versus 27.12 (SE = 0.95); interpersonal anxiety: 27.45 (SE = 0.95) versus 21.92 (SE = 0.86); autonomic balance: 42.76 (SE = 1.27) versus 35.75 (SE = 1.17); other subjective symptoms: 39.68 (SE = 1.20) versus 33.07 (SE = 1.12) in the premenopausal group (P

Purpose To evaluate the rates of Herpes Simplex Virus types 1 (HSV-1) and 2 (HSV-2) in ocular specimens. Methods Retrospective case series of all patients with a positive laboratory evaluation for ocular HSV performed at the Auckland District Health Board, Auckland, New Zealand between 1 January 2006 and 31 December 2017 were included in the study. Results A total of 423 specimens were positive for HSV-1 (99.3%, n = 419) or HSV-2 (0.7%; n = 4). The majority of positive tests were identified through DNA amplification (n = 352; 83%) testing while the remainder were obtained by viral culture (n = 71; 17%). Ocular disease caused by HSV-2 in this study included acute retinal necrosis (n = 2), keratitis (n = 1), and blepharitis (n = 1). Conclusions HSV type 2 is a rare cause of ocular and peri-ocular infection but may cause severe, vision threatening disease.

This paper explores the effects of gamification (a game-based student response system) on student learning in the United Arab Emirates (UAE). The data, collected through a series of semi-structured in-depth interviews with 32 learners, were analyzed using qualitative thematic analysis (i.e., template analysis). Based on an in-depth analysis of the data using NVIVO 10, the authors propose and apply the “PERI” model to develop multi-focal insights into gamification and its influences on student learning. The model proposed is original and comprehensive, encompassing (1) Preferabilities (P), (2) Experiences (E), (3) Recommendations (R), and (4) Impressions (I). Although most of the findings were positive with regard to application and receptivity across all dimensions of the PERI model for the gamification tool—a game-based student response system (GSRS) used for delivering education—they also reveal areas in need of development for the successful embedding of gamifying technology–enhanced learning provisions and their efficacy in teaching and learning pedagogy. The conclusions of this study outline implications for educators, students, education leaders, and gamification product developers.

Background: Recently, implants have been widely considered as an option for replacing missing teeth. There are several biological conditions that must be considered for the success of an implant. Failure to satisfy any of these factors may result in complications, such as peri-implantitis or failure of the implant. Aim: The aim of this study was to evaluate the general dentist's attitude towards the management of peri-implant diseases in Saudi Arabia. Methods: A multicenter cross-sectional electronic-based questionnaire was formulated based on the validated questionnaire from a previous study. It was targeted towards the general dental practitioners in Saudi Arabia. The study sample consisted of 721 general dental practitioners. The questionnaire consisted of 17 questions divided into five sections. Pearson's chi-square test was used for inferential statistical analysis with Holm's correction, for adjusted p-value, the alpha at 95% confidence interval was 0.05, and all values below alpha were considered statistically significant. Results: The majority of participants had attended an implant training course (51.2%) while the rest had not (48.7%). The majority of the participants (67.3%) thought they need special instruments for the detection of peri-implantitis but only 29.5% thought they do not need any special instruments for the intended purpose. Most participants (79.3%) said they can identify and differentiate between normal and abnormal soft tissue around an implant, while 6.5% of the respondents could not. More than half of the participants (54.8%) could differentiate between peri-implant mucositis and peri-implantitis, and 19.4% had no idea about this. Amoxicillin & metronidazole was considered as the best and most effective antibiotic by the majority of respondents (76%), while only (5%) of dentists selected ciprofloxacin. Conclusion: This study concludes by suggesting that most of the participants have adequate knowledge about peri-implant soft tissue assessment, mechanism of periodontitis and peri-implantitis, its initiation and progression along with its management. Most of the participants found the training courses on peri-implantitis to be efficient. It is recommended to conduct more courses and studies that would aim at understanding the pathogenesis, etiology, diagnosis, and treatment of peri-implant diseases so as to increase awareness among general dentists.

A simplified peri-appendectomy antibiotic regimen was as effective with fewer nursing resources and treatment costs

Menstrual management (MM) facilities in schools are neglected in low- and middle-income countries. We examined the existing MM facilities, identified the deficient, and collected students' ideas in peri-urban schools of Nepal. The schools had basic MM facilities including water sanitation and hygiene (WASH) infrastructures, gender-segregated toilet facilities with taps, dustbins and running water, provision of emergency sanitary pads, etc. Out of 71 students who reported soiling of dresses with menstrual blood as a common problem, 27% went home and did not return in such situation instead of washing off at school. Forty-six per cent of students used washable absorbents, but washing and drying facilities were lacking, and students adapted by using disposable pads at school and washable at home. Out of 126 students, 106 took days off during menstruation in the past three months with an average of 2.6 days by one student. Sixty-one per cent gave the reason as pain and 39% tiredness for taking days off. Healthcare facilities were lacking in schools, hence, lack of these facilities in schools might be contributing to absenteeism. The traditionally advocated list of MM facilities for schools, largely involving WASH facilities, should be updated, including newly identified factors which were also suggested by students.

Urban development at city periphery as a unique process of urbanisation, manifests in distinctive spatial and socio-economic characteristics. The emergence of settlement types—an admixture of rural and urban characteristics—functionally transient between agrarian and non-agrarian economy with pervasive change in land uses and attendant livelihood sources, retreating mode of rural social norms and advancing urban way of life are remarkably obvious in peri-urban landscape of large Indian cities. The resultant socio-economic challenges for peri-urban inhabitants often create chasm between promised development agenda and their aspirations. Delving into the socio-economic transformations on account of land appropriation by the State government for urban and industrial development and ramifications of land negotiations in five peri-urban villages of Noida—this study reveals the discordant side of urbanisation benefitting urban at the cost of rural, and administrative processes which remain oblivious to the aspirations of those whose lands provided the grounds of this development agenda.

Incidentes en el muestreo de pequeños mamíferos relacionados con la presencia del jabalí (Sus scrofa) en zonas naturales perirubanas Desde hace poco tiempo, las poblaciones de jabalí (Sus scrofa) de muchos países han venido aumentando de forma constante, lo que ha dado lugar a conflictos con las actividades humanas, como su habituación a las personas y a las zonas urbanas. Los jabalíes pueden interferir en el muestreo de pequeños mamíferos, ya que reducen las capturas potenciales. En este estudio analizamos si los incidentes registrados en el muestreo realizado en el marco de un programa de seguimiento de pequeños mamíferos (SEMICE, www.semice.org) podrían estar relacionados con la densidad de jabalíes en una red de parques protegidos. Nuestros resultados sugirieron que la ubicación periurbana ejercía un efecto independiente de la densidad de jabalíes en los parques, que hacía aumentar el número de trampas dañadas (no disponibles para la captura) y que podría producir la subestimación del tamaño de las poblaciones de micromamíferos debido a la menor disponibilidad de trampas. Presumimos que esta alta tasa de ataques a las trampas en una zona pequeña y localizada podría estar relacionada con la posibilidad de que, en el caso del parque periurbano, los jabalíes puedan asociar la presencia humana con más oportunidades de obtener alimentos de origen antrópico.

Aim The aim of this prospective study was to determine the influence of vertical soft tissue thickness on bone level changes in platform-switched implants placed eqicrestally or subcrestally and restored with screw-retained or cement-retained restorations. Methods Platform-switched bone-level implants were placed in a single stage manner in the posterior mandibular region. Implant sites were divided into thick (control) and thin (test) vertical soft tissue groups. The implants in the control group were placed equicrestally. The implant sites from the control group were randomly allocated to receive equicrestally or subcrestally placed implants. Bone remodeling/loss was radiographically measured at baseline, three months postoperatively and six months after delivery of final prosthetic restoration. Results The mean crestal bone loss values three months postoperatively and six months post prosthetic restoration were higher in sites with thin versus sites with thick gingiva. In implant sites with thin gingiva, subcrestally placed implants presented less bone loss than eqicrestally placed implants. Conclusion Platform switched implants are prone to more bone loss when they are placed in sites with thin soft tissue, regardless of the type of final restoration (screw-retained or cement-retained). Subcrestal placement of platform-switched implants can prevent crestal bone loss in sites with vertical soft tissue thickness < 3 mm.

Staphylococcus may be evaluated to be a serious microorganism to colonizes and contaminate both the healthy and immuno-competent people in the community along with the hospitalized patients with decreased immunity. This bacterium has been commonly present on the skin and in the nasal cavity of the human body. In the particular sites the organisms may give rise to local diseases of the nose, urethra, vagina and gastrointestinal tract, skin however most of them are minor and not associated with any mortality. S. aureus as well as coagulase-negative staphylococcus which are gram-positive bacteria that lives on the upper respiratory, mouth and skin structure creation, are the possible element for nosocomial and opportunistic disease in humans as well as in animals. Major complications involved with staphylococcus involved SSI, bullous impetigo, skin & soft tissues infection, bacteremia, pulmonary infections etc. The situation is further complicated by methicillin resistance in staphylococcus. MRSA/MRCoNS are considered as the emerging cause of hospital-acquired infections. it is very necessary to quantify the load of infections in order to achieve good hospital infection control policies. Furthermore, the morbidity and mortality rate may also be reduced in the same manner.

Objective To evaluate the anaesthetist’s ability to predict abnormalities in preanaesthetic blood test results obtained from cats and dogs older than 8 years and to describe the impact of these preanaesthetic blood test results on the American Society Anesthesiologists (ASA) physical status classification, anaesthetic protocol and procedures. Study design Observational, prospective, clinical multi-centre study. Animals A total of 333 cats and dogs. Methods After a clinical examination and review of the animal´s clinical history the anaesthetist completed the first part of a set of questions including ASA status and anticipated abnormalities in blood tests. After this, blood results were presented, and the anaesthetist completed the second part of the set of questions, including changes in ASA status or anaesthetic protocol, and procedure delay or cancellation. Preanaesthetic blood tests included: haematocrit, total proteins, electrolytes, glucose, lactate, urea and creatinine. Examiners were classified as senior clinicians, clinicians, anaesthesia residents or nurses, and interns. For statistical analysis, the chi-square test was used. A p value Results The ASA status increased in three dogs and one cat (1.2%); in two of them abnormalities were not expected by the examiner. The anaesthetic protocol changed in seven animals (2.1%); the most common change related to fluid therapy. Anaesthesia was delayed in two dogs (0.6%) to administer intravenous fluid therapy. No cases were cancelled. Abnormalities were more commonly found [37 out of 58 assessments (approximately 64%)] when the anaesthetist predicted them compared to when they were unexpected [49 of 275 assessments (approximately 18%); p Conclusions and clinical relevance Routine non-targeted blood tests in cats and dogs older than 8 years led to few changes in the anaesthetic management, and anaesthetists correctly predicted blood test results in most cases.

Unfortunately, suppuration of a postoperative wound remains the most frequent complication of surgical intervention. If suppuration is located superficially, within the subcutaneous fat, it can be successfully managed with minimal functional losses. The clinical course is significantly complicated if the focus of infection is located under the skin, in the thickness of the muscles, in the fracture zone. In the case of suppuration in the area of osteosynthesis, the complication may become critical.Such a complication is a serious condition that requires multi-stage complex and sometimes multidisciplinary treatment.The conditions for a successful outcome in this pathology are the minimum period from the moment of suppuration, active surgical tactics, stability of the implant, and good vascularization of the surrounding soft tissues.Active surgical tactics involves the opening and sanitation of purulent foci, leaks, recesses. Staged necrectomies are inevitable companions of surgical treatment and can cause the formation of defects in the skin, subcutaneous tissue, and muscles.The resulting soft tissue defect leads to exposure of the bone and plate. Removal of the metal fixator becomes inevitable.Only the closure of the defect with a complex of tissues based on free vascularized composite grafts can radically solve the problem.The article presents two clinical observations of deep wound infection after bone osteosynthesis, where autotransplantation of a vascularized flap was used. The use of this technique made it possible to achieve suppression of infection, wound healing by primary intention, to create conditions for consolidation of the fracture, restoration of function and preservation of the limb as a whole.

Abnormal uterine bleeding (AUB) is defined as abnormal volume, duration, or frequency of menstrual period and is a common symptom in women of all ages (premenopausal, perimenopausal, and postmenopausal). The acronym PALM-COEIN, introduced by the International Federation of Gynecology and Obstetrics (FIGO), facilitates the evaluation and differential diagnosis of AUB, mostly in premenopausal women with AUB. Endometrial evaluation (including ultrasound or hysteroscopic imaging and tissue sampling) for subtle pathology is proposed in patients who are at high risk for endometrial cancer and in patients at low risk who present with AUB and who present poor correspondence in medical treatment. Many new diagnostic modalities are available in clinicians in order to help the assessment of women presenting with abnormalities in their menstrual pattern. The present study reviews the optimal management of women presenting with AUB, taking into consideration the actual need for invasive management in these women, who of them require it, and who can be diagnosed without histological verification. The importance of endometrial tissue sampling in women who present with AUB as well as the best timing for a clinician to conduct a biopsy are two axons analyzed below, according to the latest worldwide guidelines and major publications about this subject.

This work was carried out on the phenotypic characteristics of the Kababich sheep exploited in the peri-urban zone of N'Djamena (Chad). This phenotypic characterization of Kababich sheep should be continued on local breeds for genetic improvement and objective optimization of productivity. The objective of this study is the characterization of phenotypically Kababich sheep exploited in the peri-urban area of ​​N'Djamena-Chad. It was conducted in 39 farms and involved 1035 sheep aged less than one year old. Phenotypic traits were measured according to the guideline defined by FAO. A total of 12 variables were measured including five qualitative and seven quantitative. The results obtained show a positively significant correlation (p> 0.001) between the age of the sheep estimated by the breeder and the dentition (0.83). The ears are drooping and measure 17.90 ± 2.77 cm. The color of the brown dress (fawn) and the smooth and short coat are dominant. The females are matte and the rams of brown dress have horns in the forms of the vestiges. The Kababich is large with a height at the withers of 81.50 ± 9.40 cm, a rump height of 83.24 ± 9.42 cm and a chest circumference of 88.29 ± 9.22 cm. The body is 72.82 ± 9.63 cm long, has a basin width of 19.89 ± 2.53 cm and a chest depth of 40.68 ± 5.16 cm. These measurements show that Kababich is a meat breed by excellence. In addition, the sexual dimorphism very accentuated in this race orients towards a valorization of the young males in the fattening workshops.

BACKGROUND: Cluster of differentiation 274 (CD274) antigen has been investigated in tumors to evaluate its regulation and effect as a predictive of targeted therapy. Its expression and effect in lymphoma have raised interest recently. However, results were mixed and showed wide variations. AIM: This study aims to explore and compare CD274 antigen immunohistochemical expression in tumor and peri-tumor cells of classic Hodgkin lymphoma (HL) and diffuse large B cells non-HL (NHL) and its relation with clinicopathological criteria. METHODS: This work was carried out on 78 cases of lymph node excision biopsy (48 HL and 30 NHL). Prepared sections were applied for immunohistochemistry using CD274 monoclonal rabbit anti-human (programmed cell death protein 1 [PD-L1] ZR3-ASR, a Sigma Aldrich company). Assessment of CD274 antigen in tumor cells was considered positive if detected in >10% (membranous staining with cytoplasmic accentuation). Peri-tumor cells were scored as: 0, no positive cells/high-power field (HPF); 1, 30 positive cells/HPF. RESULTS: CD274 antigen was expressed in 53.8% of total lymphoma cases with significantly more expression of CD274 antigen in HL than NHL (66.7% vs. 33.3%). Classic HL showed significantly higher expression of CD274 antigen in tumor and peri-tumor cells and significant association with elevated erythrocyte sedimentation rate and lactate dehydrogenase and male gender. INTERPRETATION AND CONCLUSION: There is a more frequent and significant expression of CD274 antigen in classic HL than NHL cases in tumor and peri-tumor cells and a significant association with bad prognostic criteria in classic HL. High expression of CD274 antigen in classic HL proposes its potential use as a marker, especially for prognostic indication.

Background:Abnormal uterine bleeding is dened as bleeding from uterus that differs from that of usual normal menstrual bleeding, in frequency of occurrence or in amount or in alteration of ow. The advantages of hysteroscopy as an accurate diagnostic technique are that it not only allows direct visual observation of pathology but also provides a means to sample the site, most likely to yield positive results. The present study was conducted to study the role of Hysteroscopy in abnormal uterine bleeding in Peri and Post-menopausal women at a tertiary care hospital. Material And Methods: Present study was single-center, prospective, Cross sectional study, conducted in women age ≥40years with heavy menstrual bleeding, prolonged bleeding, frequent menstruation, intermenstrual bleeding and post coital bleeding, Post-menopausal bleeding. Hysteroscopy was performed preferably in post-menstrual phase or post bleeding phase with a standard 4mm hysteroscope(Stryker) with a 30 degree fore-oblique lens. Procedure was performed under IV sedation with normal saline as distention media. Results: In present study, majority of the subjects (n=28) i.e. 36.8% presented with heavy menstrual bleeding followed by prolonged bleeding (32.8%), post- menopausal bleeding (21%), frequent menstruation (7.89%) and inter-menstrual bleeding (1.3%). On hysteroscopy normal ndings were present in 32 subjects (42%) followed by hyperplasia (17.1%), atrophic endometrium (13.1%), submucous broid (14.4%), endometrial growth (2.96%) & broid polyp (1.36%). Histopathology examination noted Proliferative endometrium (31.5%), secretory (10.5%), disordered proliferative phase (1.3%), simple hyperplasia (18.4%), complex hyperplasia with atypia (1.3%), submucous broid (14.4%), endometrial polyp (34.2%), atrophy (13.1%), broid polyp (1.34%) and malignancy (3.96%). Sensitivity, Specicity, PPV, NPV values were 100 % except for sensitivity for endometrial growth (66.7 %). p Value was highly signicant for all parameters (p