A Study on Endoscopic Palliation of Malignant Biliary Obstruction by Plastic Stents

INTRODUCTION: Malignant biliary obstruction comprises of malignancies causing proximal malignant obstruction like Gallbladder carcinoma, hilar cholangiocarcinoma, node causing obstruction and malignancies causing distal malignant biliary obstruction including pancreatic malignancy, ampullary adenocarcinoma, distal cholangiocarcinoma and duodenal adenocarcinoma. AIM OF THE STUDY: 1. To Study the causes of Malignant Biliary obstruction 2. To Study the success rate of endoscopic stenting in patients with malignant biliary obstruction. 3. To Study the reason for failure in endoscopic stenting. 4. To Study the morbidity and mortality of endocopic Biliary stenting. 5. To Study the effectiveness of 7F and 10F in endoscopic palliation of jaundice. 6. To Study the difference in patency rates of 7F and 10F plastic stent. 7. To Study the complication rate between 7F and 10F endocopic stenting. MATERIALS AND METHODS: The Study was conducted in Department of Digestive Health and Disease (DDHD) a super speciality department with rich heritage located in Government peripheral hospital, Anna Nagar, Chennai, attached to Government Kilpauk Medical College, Chennai. The study was conducted in DDHD inpatients and patients referred from Government Kilpauk Medical College (Surgical Gastroenterology, General Surgery), Government Royapettah Hospital (Surgical Gastroenterology, General Surgery), Government General Hospital (Surgical Gastroenterology, General Surgery).The study period was from December 2007 to December 2009. Patients with Malignant Biliary obstruction were divided in to two groups 1. Proximal Biliary Obstruction, 2. Distal Biliary Obstruction. After ERCP stenting patients with 7F plastic stent were compared with patients with 10F plastic stents. INCLUSION AND EXCLUSION CRITERIA: 1. All patients with Malignant biliary obstruction with informed consent were included. 2. Candidates not willing were excluded. 3. Candidates not fit for ERCP procedure were excluded. 4. Patients in whom benign cause was suspected were excluded. We used Duodenoscope of length 156cm working channel diameter of 4.2mm, field of view 1100 (Model No.ED341C Batch No.A120052) with a PENTAX video processor EPK 150C input 100-240V-50/60HZ ranging 300 VA max. We used ERBE endocut (Model ICC 200 EA INT) for Biliary sphincterotomy with cutting current 120 effect 3 without coagulation. CONCLUSION: 1. Most common cause of malignant biliary obstruction in this study was ampullary adenocarcinoma followed by distal cholangiocarcinoma, hilar cholangiocarcinoma, head of pancreas malignancy, Gall Bladder carcinoma and lymph node causing hilar obstruction. 2. Over all success rate of all patients with Malignant Biliary Obstruction was 68.6% with success rate of 78% for patients with distal Malignant Biliary Obstruction and 60% for patients with proximal Malignant Biliary Obstruction cases. 3. Most common reason for failure of endoscopic stenting in patients with malignant biliary obstruction was repeated entry of guidewire into pancreatic duct followed by tight stricture, nonvisualization of ampulla, anatomical difficulties and periampullary diverticulum. 4. Immediate complication rate was 10% with no mortality. Cholangitis being the commonest complication followed by pancreatitis, perforation, stent migration in one patient each. 5. Both 7F and 10F were equally effective in reducing jaundice in the short term. 6. Mean number of days of stent patency after 10F stent was 217 days and 61 days after 7F which was statistically significant. 7. Complication rate between patients treated with 7F Plastic stent and 10F plastic stent were similar

Knowledge, attitude and practice study regarding anemia in antenatal women

Background: To study the knowledge, attitude and practices of antenatal women regarding nutrition and drug compliance in Maternal and Child Health Center, Mangalore.Methods: The study was carried out on 200 primigravida visiting the hospital over a period of 4 months from January 2014 to April 2014. Women attending the antenatal OPD were asked to fill a questionnaire regarding anemia so as to test their knowledge, attitudes and practices pertaining to anemia and role of their diet. Inclusion criteria: Primigravida, age > 19years.Results: 108 mothers out of 200 were aware of the correct sources of iron in food, however only 60 women actually implemented this in their diet practice. About 50 mothers were aware of a few maternal complications of anemia in pregnancy and 62 of them knew about fetal complications like low birth weight. The study reflects the ignorance, poverty and illiteracy among majority of the child bearing women coming to the Hospital.Conclusions: Assessments of knowledge and practice and health education are essential step towards prevention of anaemia in pregnancy. Educating antenatal women about the importance of diet and implementing this into practice will help in the prevention of anemia. 

An evaluation of potential adoption of web based marketing in hotel industry : A case study of Arugambay based hotels

The main aim of the study is to evaluate the potential adoption of web based marketing by the hotels in the Arugambay, South Eastern Sri Lanka. In order to achieve this, 83 hotels were selected from Arugambay region. The data were collected through questionnaires. The methodology adopted for this study is case study research approach for which the data gathered were qualitative as well as quantitative. Findings show that there are three factors positively affect the nature of adoption namely; individual factors, firm resources, innovation attributes. This indicates that when it comes to make decision of whether to adopt the web-based marketing, perceived innovation attributes come into play and exerts an influence. The research results show that these factors are relevant to sophisticated levels of adoption of webbased marketing. Therefore it can be concluded that there is a potential for web-based marketing adoption in hotel industry in Arugambay, South Eastern Sri Lank

Dynamics of market share in the microfinance industry in Bangladesh

We discuss evidence that the microcredit industry in Bangladesh has seen emergence of large variations in the size of the microfinance institutions operating in the market-- on the one hand, there are large national-level MFIs, while on the other hand, small localized MFIs operating only within the confines of a small area. Data from a recent survey of Pathrail union in Tangail district, a seasoned place for microcredit, reveals that within the local market competition is becoming more and more intense over time between established national-level MFIs and newly emerging local-level MFIs for market shares in terms of loan amount as well as borrowed members. Data reveals that there is market segmentation where some borrowers and MFIs opt for a package of low interest rates tied with low amount of loan disbursed and some other borrowers and MFIs settle for a package of high interest rates tied with high amount of loan disbursed. A Tobit regression estimation of member market shares in village micro credit market shows that size of the MFI, years of operation in the village, average loan size, deposit interest rates, loan amount disbursed for unique loan purposes (i.e., housing loan) are key determinants in determining MFI shares of a village microcredit market.Microcredit; Market Share; Product and Provider Characteristics of Microcredit

Nutritional parameters predicting postoperative infections

Thirteen nutritional parameters viz body mass index (BMI), mid arm circumference (MAC), mid calf circumference (MCC), triceps skin fold thickness (TST), abdominal skin fold thickness (ASFT), abdominal girth at umbilicus (AG U), haemoglobin (Hb), total leucocytes count (WBC), absolute lymphocyte count (ALC), serum proteins (Prot.), serum albumin (AIb), serum total iron binding capacity (TIBC) and serum iron (Fe) were estimated in 52 (36 male and 16 female) consecutive patients admitted to a surgical service at the Abbasi Shaheed Hospital, Karachi. Nine males and one female developed surgical infections whilst the wounds of 27 males and 15 females healed by primary intent. There was a significant difference in the values of BMI, MCC, ASFT, Prot., and AIb between the patients with infected and clean wounds. Whilst MCC was significantly dif­ferent, MAC was not as good a differentiator. Whilst Prot. and AIb were lower in the infected group, BMI, MCC, TST, ASFT were higher in the patients whose wounds healed by primary inten

ESL WRITING VARIABILITY: WRITING TASKS, GENDER AND PROFICIENCY LEVEL

Research focusing on L1 (native speakers of English) writers has shown that students tend to perform differently on different writing tasks. L1 students perform better on narrative and descriptive writing tasks than argumentative.  In fact, some scholars have suggested that L1 students lack a schema for argumentative writing, which perhaps contribute to their poor performance on argumentative writing tasks. This tendency seems also applicable to L2 (non-native speakers of English) writers.  This paper reports the findings of a study on the impact of narrative and argumentative writing tasks, gender and proficiency level on the quality of Malaysian English as a second language (ESL) learners’ writing.  The findings of this study are discussed in the light of variability in ESL writing.  Their implications for writing assessment practices are also highlighted. Keywords:  ESL writing, task variability, gender, proficiencylevel

Esl Writing Variability: Writing Tasks, Gender And Proficiency Level

Research focusing on L1 (native speakers of English) writers has shown that students tend to perform differently on different writing tasks. L1 students perform better on narrative and descriptive writing tasks than argumentative. In fact, some scholars have suggested that L1 students lack a schema for argumentative writing, which perhaps contribute to their poor performance on argumentative writing tasks. This tendency seems also applicable to L2 (non-native speakers of English) writers. This paper reports the findings of a study on the impact of narrative and argumentative writing tasks, gender and proficiency level on the quality of Malaysian English as a second language (ESL) learners\u27 writing. The findings of this study are discussed in the light of variability in ESL writing. Their implications for writing assessment practices are also highlighted

Interior Atmosphere: Does It Really Have an Impact on Consumer Purchasing Behavior at Self- Serving Convenience Stores?

The main aim of this study was to investigate the impact of interior store atmosphere on consumer purchasing behavior at self-serving convenience stores in Ampara District, Sri Lanka.  Today, retail industry became highly competitive with the increasing number of convenience and other types of retail stores in the area. Hence, the retailers need to be more customer focused and have to differentiate from their competitors by making their interior atmosphere more attractive to consumers and to encourage them to spend more time, money, to purchase more merchandises and to stimulate their repeat purchase intention. A survey research was employed to collect primary information from 292 customers from convenience stores in Ampara District. Interior atmospheric factors such as, music, scent, light and color were used to identify the impact of interior atmosphere on consumer purchasing behavior. Convenience sampling was employed for data collection using a questionnaire with a five-point Likert scale. SPSS 20.0 was used to analyze the data. Significant interior atmospheric factors that influence consumer purchasing behavior included music, scent, light and it is found out that color has no any impact on consumer purchasing behavior. Keywords: Interior atmosphere, convenience stores, consumer behavio

The Role of Audio Visual Contents on the Development of Education in Bangladesh: A Systematic Review

Background: The act of communicating with another person is referred to as communication. Information is any written, audiovisual information that conveys knowledge about a new person, place, thing, situation, or environment. To execute this, one need a sender and a receiver as well as a medium, a message that makes sense, and discussion. Audio-visual digital materials are a vital part of the world's sustainable educational development in this era of technology. Objectives: The purpose of this research is to identify how audiovisual materials have impacted Bangladesh's educational advancement. Methods: The study's data came from Scopus and Google Scholar, PUBMED articles that were published between 2004 and 2019. To find further studies, the reference lists of all included studies and pertinent systematic reviews were examined. All searches were limited to just human research and the English language. This systematic review was conducted in accordance with PRISMA guidelines. Results: The results of 10 studies, selected at random, indicate that more widespread use of audio-visual information might improve technical knowledge, attitudes, and practices in educational advancement as well as reduce all forms of illiteracy in Bangladesh. Conclusion: After reading the articles, it was determined that audiovisual content plays a specific role in the educational development, increasing knowledge, attitude, and practice. In-depth research and projects are needed to understand the audio-visual concept's contribution to society. Keyword: Role, audio-visual contents, education, advancements, Bangladesh. DOI: 10.7176/JEP/14-18-04 Publication date:June 30th 202