F- kuber प्रणालीने वेतन करणेसाठी कर्मचा-यांचे खाते तपासणी केल्याबाबत
मुख्याध्यापकांचे प्रमाणपत्र
प्रमाणित करण्यात येते की मी (मुख्याध्यापकाचे नाव)
शालार्थ DDO कोड -
(शाळेचे नाव)
अंतर्गत वेतन घेत असलेल्या सर्व कर्मचारी
स्वत: तपासले असून ते SHALARTH
खात्री केलेली आहे. तसेच अधिनस्थ सर्व
यांचे वेतनाचे खाते क्रमांक व IFSC Code
प्रणालीमध्ये अद्ययावत असलेबाबत मी स्वतः
शिक्षकांना/शिक्षकेत्तर कर्मचारी यांचेकडून SHALARTH प्रणालीमधील Bank Statement
यावरील वेतनाचे खाते क्रमांक व IFSC Code बरोबर असलेबाबत खात्री करून त्यावर
स्वाक्षरी घेतलेली आहे. त्यासंबंधी सर्वांचे Bank Passbook / Cancelled Cheque
शाळेच्या दप्तरी ठेवण्यात आलेले आहे. यामध्ये काही तफावत आढळल्यास मी व्यक्तीश:
जबाबदार राहील. तसेच यानंतर जिल्हा कार्यालयाचे पुर्व परवानगी शिवाय एकाही कर्मचाऱ्यांनी
वेतनाचे खातेक्रमांक व IFSC Code यामध्ये बदल करू नये याबाबत सर्वांना सुचना देण्यात
आलेल्या आहेत.
यासोबत SHALARTH' प्रणालीमधील Bank Statement यावरील वेतनाचे
खाते क्रमांक व IFSC Code बरोबर असलेबाबत खात्री केलेबाबतची शिक्षकांची स्वाक्षरीची
प्रत सोबत जोडण्यात येत आहे.
उपस्थिती प्रमाणपत्र
प्रमाणित करण्यात येते की, माहे
/ उच्च प्राथमिक शाळा
सिंदखेड राजा अंतर्गत एकूण कार्यरत शिक्षक
जि.प. प्राथमिक
--पंचायत समिती
...असून त्यापैकी
रजेवर / अर्जित रजेवर आहेत. त्यांचे रजा कालावधीचे वेतन सदर वेतनात काढण्यात आले नाही.
करीता प्रमाणपत्र देण्यात येत आहे.
अ.क्र.
एकूण
शिक्षक संख्या
कार्यरत उपस्थित असलेले रजेवर
शिक्षक संख्या
असलेले शेरा
शिक्षक संख्या
नियमीत वेतन देयकासोबत जोडावयाचे मुख्याध्यापकांचे प्रमाणपत्र
प्रमाणित करण्यात येते की, जि. प. प्राथमिक/उच्च प्राथमिक शाळा
या शाळेचे माहे...
नियमित वेतन हे कर्मचारी उपस्थित व
नियमानुसार शालार्थ प्रणाली अंतर्गत जनरेट करण्यात आलेले आहे. तसेच Bank Statement
मध्ये प्रत्येक कर्मचारी यांचे वेतनाचे खाते बरोबर असल्याची खात्री केलेली आहे. यामध्ये
कर्मच्यऱ्यास अतिप्रदान झालेले नाही. सदर देयकामध्ये कोणतीही आर्थिक अनियमितता झालेली
असल्यास त्याची वसुली करण्यात येईल. याबाबत लेखी हमी घेण्यात येत आहे.
Incidence and Outcomes of Perforated Peptic Ulcers in Children: Analysis of the Kid's Inpatient Database and Report of Two Cases Treated by Laparoscopic Omental Patch Repair
Armando Salim Munoz Abraham et al. J Laparoendosc Adv Surg Tech A. 2019 Feb.
Abstract
Introduction: Peptic ulcer disease (PUD) is a rare condition in children. Perforated peptic ulcer (PPU), a complication of PUD has an estimated mortality between 1.3% and 20%. We evaluate incidence and outcomes of PPU in children using an administrative database, perform a review of the literature, and report our technique for laparoscopic omental patch repair for PPU in two pediatric patients.
Materials and methods: Kids' inpatient database (KID's) was analyzed for demographics, incidence, and outcomes. Incidence for each year was calculated based on the reported pediatric population in the United States for 2000, 2003, 2006, 2009, and 2012 by the U.S. Census Bureau. Additionally, we present two PPU cases, accompanied by a comprehensive review of the literature.
Results: The annual number of primary discharge diagnosis of PPU in the KID was 178 cases for 2000, 252 for 2003, 255 for 2006, 299 for 2009, and 266 for 2012. An increase trend over time was noted between 2000 and 2009; however, it was not statistically significant (0.05). PPU appears to be more common in Caucasian teenage boys. The mean length of stay was 8.02 days and with a statistically significant increase in healthcare charges ($33,187 versus $78,142, P = .002) when comparing year 2000-2012.
Outcomes of omental patch repair in large or giant perforated peptic ulcer are comparable to gastrectomy
Kai Siang Chan et al. Eur J Trauma Emerg Surg. 2021 Dec.
Abstract
Purpose: Perforated peptic ulcer (PPU) complicates 2 to 10% of patients with peptic ulcer disease and has mortality risk of up to 20%. Omental patch repair is the mainstay of surgical management and gastric resectional procedures are advocated for a large/giant ulcer or suspected malignancy. Emergency gastrectomy is associated with increased morbidity and mortality. The aim of this study is to compare the outcomes of omental patch repair with gastrectomy in patients with large PPU (≥ 20 mm).
Methods: A retrospective review of all PPU patients who underwent surgery from January 2008 to December 2014 was done. Patients with PPU < 20 mm were excluded. Patient demographics and perioperative data were recorded. Length of hospital stay, post-operative complications, need for intensive care unit admission and all-cause mortality are reported.
Results: 110 patients with a median age of 69.1 (range 28-90) years had PPU ≥ 20 mm. 42 (38.2%) patients presented within 24 h from the onset of abdominal pain. The median American Society of Anaesthesiology score was 3 (range 1-4). 52 patients had omental patch repair and 58 patients had gastrectomy. The overall incidence of intra-abdominal collection, post-operative leakage, re-operation and all-cause mortality was 16.4%, 11.8%, 6.4% and 19.1%, respectively. No difference in post-operative outcomes between the two groups was detected: intra-abdominal collection (p = 0.793), post-operative leakage (p = 0.813), re-operation (p = 0.809) and all-cause mortality (p = 0.736).
Conclusion: Omental patch repair confers similar perioperative outcomes as compared to gastrectomy in patients with large PPU.
Role of Empiric Anti-Fungal Therapy in the Treatment of Perforated Peptic Ulcer Disease: Review of the Evidence and Future Directions
Jared M Huston et al. Surg Infect (Larchmt). 2019 Dec.
Abstract
Background: Peptic ulcer disease (PUD) affects four million people worldwide. Perforated peptic ulcer (PPU) occurs in less than 15% of cases but is associated with significant morbidity and mortality rates. Administration of antibiotics is standard treatment for gastrointestinal perforations, including PPU. Although fungal growth is common in peritoneal fluid cultures from patients with PPU, current data suggest empiric anti-fungal therapy fails to improve outcomes. To examine the role of anti-fungal agents in the treatment of PPU, the Surgical Infection Society hosted an Update Symposium at its 37th Annual Meeting. Here, we provide a synopsis of the symposium's findings and a brief review of prospective and retrospective reports on the subject. Methods: A search of Pubmed/MEDLINE, EMBASE, and the Cochrane Library was performed between January 1, 2000, and November 1, 2018, comparing outcomes of PPU following empiric anti-fungal treatment versus no anti-fungal therapy. We used the search terms "perforated peptic ulcer," "gastroduodenal ulcer," "anti-fungal," and "perforated" or "perforation." Results: There are no randomized clinical trials comparing outcomes specifically for patients with PPU treated with or without empiric anti-fungal therapy. We identified one randomized multi-center trial evaluating outcomes for patients with intra-abdominal perforations, including PPU, that were treated with or without empiric anti-fungal therapy. We identified one single-center prospective series and three additional retrospective studies comparing outcomes for patients with PPU treated with or without empiric anti-fungal therapy. Conclusion: The current evidence reviewed here does not demonstrate efficacy of anti-fungal agents in improving outcomes in patients with PPU. As such, we caution against the routine use of empiric anti-fungal agents in these patients. Further studies should help identify specific subpopulations of patients who might derive benefit from anti-fungal therapy and help define appropriate treatment regimens and durations that minimize the risk of resistance, adverse events, and cost
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