ABSTRACT
Sleep is one of the basic human physiological needs that can restore the body to its physiological functions after daily activities. Lack of sleep quality can significantly impact the body, one of the effects of which is related to chronic low-level inflammation and changes in the competence of the immune system. This research aims to knowing the relationship between sleep quality levels and Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in medical students of Universitas Nusa Cendana. It is an observational analytical study using the cross-sectional method. The number of research samples was determined using a hypothesis test formula against relative risk, with a total sample of 54 people. The population of this study is the class of 2019, 2020, and 2021 using the proportionate stratified random sampling technique, which divides populations into sub-populations in a propositional and random manner. The relationship test used is the ETA test. Based on the results of relationship testing using the ETA test, sleep quality with Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio shows that sleep quality has no significant relationship with Neutrophil Lymphocyte Ratio (p-value = 0,324); however, it has a significant relationship with the Platelet Lymphocyte Ratio (p-value = 0,042). Sleep quality does not have a significant relationship with the Neutrophil Lymphocyte Ratio but has a significant relationship with the Platelet Lymphocyte Ratio. 228 kata.

ABSTRACT
Metformin treatment for polycystic ovarian syndrome (PCOS) is gaining popularity and acceptance, although clinical practice still outpaces research in this area. Although non-randomized trials with metformin have shown a broad variety of improvements in metabolic, reproductive, and clinical variables, a detailed examination of the findings from the studies with appropriate controls reveals that the benefits are limited. With a focus on the few randomized controlled trials, our goal in this descriptive review is to increase physicians' awareness of the published clinical data available, not to create practise recommendations. We also draw attention to additional concerns that need to be addressed before definitive therapeutic metformin may be prescribed for PCOS in order to treat different conditions. It also emphasises the possibility for larger gains from improvements in lifestyle alone. We anticipate that the evaluation will encourage more prudent use of metformin in PCOS patients.

ABSTRACT
Community-Integrated Management of Childhood Illnesses (C-IMCI) is a multipronged strategy developed by the World Health Organization aimed at reducing childhood mortality and morbidity through the integration of enhanced health care services, improved case management skills and healthier community practices. Community resource persons (CORPs) play an important role in the knowledge transfer of this strategy to mothers of U-5 children within their communities. This study explored the knowledge of C-IMCI among CORPs and other primary healthcare workers, as well as accessibility to training, and recommendations for the promotion of C-IMCI. Qualitative data were obtained from a larger cross-sectional study conducted in Ibadan North East and Akinyele Local Government Areas of Oyo State, Nigeria. Data were collected through Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) among community resource persons, community health workers and selected key health officers in two local government areas (LGAs) in Oyo State, Nigeria. Data were transcribed and analyzed thematically. There was poor knowledge of C-IMCI among the participants, the majority of respondents received C-IMCI-related information from nurses and LGA staff. Regarding training, a few respondents who received the initial training on C-IMCI had been transferred from their LGAs, monitoring was infrequent and implementation of C-IMCI was not effective in the sampled areas. Community Resource Persons and Primary Health Care workers in this study did not receive regular trainings on C-IMCI; hence their knowledge was limited in this regard. Increased access to trainings on community practices would help in bridging the existing knowledge gaps in this field.

ABSTRACT
Background: Ventriculoperitoneal shunting is the main technique for extra-thecal cerebrospinal fluid (CSF) diversion. Even though VP shunts are the standard of care for many types of hydrocephalus, they tragically have many problems that require surgery more frequently than initial shunt insertions. The objective of this study was to analyze the hydrocephalic children who had undergone Ventriculo peritoneal shunt surgeries with regard to the etiology, clinical profile and complication. Methods: This is a prospective observational study that was conducted at department of Pediatric Neuro Surgery, Bangladesh Shishu Hospital & Institute (BSH&I) for a period of 5 years from January 2017 to January 2022. This study included 92 patients out of 240 patients of hydrocephalus (HCP) who underwent VP shunt placement and had complications. Results: A total of 92 patients (38.3%) out of 240 patients who presented with various patterns of complications over the period of the study were examined. The average age was 15.5±8.1 months, with 62 (67.4%) male and 30 (32.6%) female and mortality rate was 4.2%. 75 (81.5%) of the 92 patients experienced single complication, while the remaining 17(18.5%) had multiple complications. Forty-five (48.9%) patients had ventricular end malfunction and 26 (28.3%) patients had peritoneal end malfunction, 21(22.8%) patients had both ventricular and peritoneal end malfunction. Patient of early infective complications were 24(26.1%) and late infective complications were 6(6.5%). Moreover, numbers of early and late mechanical complication were 25(27.2%) and 37(40.2%) respectively. Conclusion: Pediatric patients frequently experience difficulties from VP shunts despite the best efforts of neurosurgeons worldwide to reduce these issues. A great care should be taken during insertion of the shunt system starting from scrubbing to avoid complications. Despite complications, the VP shunt remains the main surgical procedure used for hydrocephalus management.

ABSTRACT
Introduction: Metabolic Syndrome (MetS) is a group of conditions that together raise your risk of cardiovascular disease, diabetes mellitus, dyslipidemia and hypertension. The diagnosis of MetS was established according to the revised criteria of the NCEP/ATP III (MS-NCEP/ ATP III). Although BMI is the most common screening measures to identify people who are at relatively high risk of MetS, this tool is not particularly the most effective tool. Thus, we seek to find single parameter with the strongest diagnostic accuracy for MetS in a sample of healthy, unrelated adults. Materials & Methods: The study was conducted on 200 apparently healthy male and female students of university of Maiduguri. Random sampling techniques were used to recruit the subjects aged 18–41 years with mean age of 25.65±5.56 years for males and 24.11±4.60 years for females. Examination of subjects consisted of physical examination with measurement of anthropometric and clinical parameters, filling out a questionnaire, and evaluation of serum lipid levels. Result: The result shows the mean±SD for the components of MetS includes BP (SBP=105.67±9.82; DBP=70.43±6.16); TG=1.69±0.72; HDL=1.10±0.37; FBG=3.88±0.72; WC=87.76±8.41 for males and BP (SBP=104.69±9.93; DBP=69.93±6.44), TG=1.82±0.69; HDL=1.13±0.39; FBG=3.64±0.79; WC=86.93±9.89 for females. The result shows prevalence of MetS in males was 8.1% and 21.5% in females. The result also shows that LAP has the highest diagnostic accuracy among the study population (AUC=0.856) than VAI (AUC=0.820) and BMI (AUC=0.523). LAP was also found to have highest diagnostic accuracy in males (AUC=0.908) than VAI (AUC=0.850) and BMI (AUC=0.498) while in females VAI was found to have highest diagnostic accuracy with AUC (0.865) than LAP (AUC=0.721) and BMI (AUC=0.436). Conclusion: This study therefore shows LAP has the highest diagnostic accuracy and particularly the most effective tool in identifying males who are at the risk of MetS. While VAI has ...........

ABSTRACT
Introduction: Mitral valve disease is a common heart condition that may require mitral valve replacement (MVR) surgery. One of the potential complications after MVR is the development of atrial fibrillation (AF). Left atrial volume index (LAVI) is a measure of left atrial size that has been linked to the development of AF in patients with mitral valve disease. The present study aimed to observe the post-operative support needed by patients after MVR surgery, particularly those with elevated LAVI and the incidence of post-operative AF. Methods: This prospective observational study was conducted at the Department of Cardiac Surgery, National institute of cardiovascular diseases (NICVD), Sher-e-Bangla Nagar, Dhaka, Bangladesh. The study duration was 1 year, from Mar, 2018 to Feb, 2019. During this period, a total of 60 patients who underwent Mitral Valve Replacement (MVR) for mitral valve diseases at the study hospital were included in the study following the inclusion and exclusion criteria through a purposive sampling method. The 60 patients were divided in two equal groups, Group A, consisting of 30 Patients who had Left Atrial Volume Index of ≥ 39 ml/m2 after operation, while group B had been comprised of 30 patients who had Left Atrial Volume Index of < 39 ml/m2 after operation. Result: Around 23.33% of participants in both groups were aged 21-30, while 40% of Group A and 36.66% of Group B were aged 31-40. In terms of BMI, 53.33% of Group A and 46.66% of Group B had a normal BMI, while 40% and 43.33% were overweight, and 6.66% and 10% were obese, respectively. Specifically, 23.33% of participants in Group A developed post-operative AF, while only 6.66% of participants in Group B developed it. The p-value for this comparison was 0.015. The results demonstrate that Group B had significantly smaller LA diameter, LA volume, LAVI, LVIDS, and LV ejection fraction compared to Group A at all three measurements post-operation (p<0.05). However, there was no significant ...