Indonesia implements a self-assessment system so that taxpayers are trusted to calculate, pay, and report their own taxes in accordance with applicable tax provisions. Companies as taxpayers do tax avoidance by taking the advantage of loopholes in tax regulations without violating applicable regulations in order to pay taxes in the minimum amount. Therefore, this research is conducted to test the effect of profitability, leverage, and financial distress on tax avoidance with independent commissioners as a moderating variable. The population used in this research is all manufacturing companies which are listed in Indonesia Stock Exchange period 2019-2021. The 243 samples are taken by purposive sampling after outliers. The data used are secondary where annual reports and financial statements are obtained from the company’s official websites. This research uses SPSS and the analytical techniques are multiple linear regression and moderated regression analysis. The results of this research prove that profitability has a negative significant effect on tax avoidance, leverage has a positive significant effect on tax avoidance, financial distress does not have a significant effect on tax avoidance, and independent commissioners is unable to moderate the effects of profitability, leverage, and financial distress on tax avoidance.

The New ligand 5-methyl-2-(2-thienyl)-1,3-oxazole-4-carbaldehyde thiosemicarbazone (HL)(1) was synthesized. This ligand reacted with Co(II) and Ni(II) chloride in ratio 1:2 metal:ligand afforded two complexes, [Co(LH)]Cl2 (2) and [Ni(HL)2]Cl2 (3). The ligand and its metal (II) complexes have been characterized by spectroscopic techniques. The X-ray structural studies revealed that the free ligand exist in thione form and remain as neutral tridentate with NNS donor atoms in the tow complexes beside presence of uncoordinated chloride ions in the cavities of the crystal lattice of the complexes. One of these chlorides in complex (2) is hydrogen bonded to a proton of the amine of the ligand. While in complex (3) the chloride bonded to proton of imine (-N2H) of the ligand and the coordination environment has a distorted octahedral. The oxazole N and S atoms in the two complexes are cis to each other whereas the azomethine N atoms are trans coordinated. The ligand and its metal complexes were tested for their in vitro biological activity against six standard microorganisms: two Gram positive namely Bacillus subtilis and Micrococcus luteus, and one Gram negative bacteria Escherichia coli and three fungi: Saccharomyces cerevisiae (Baker’s yeast), Mucor spec., and Aspergillus niger, at a concentration 100µg/ml.

Introduction: Fibrothecal group tumours are part of the gonadal stromal and sex cord tumours (GSST) and represent 1-4.7% of all organic ovarian tumours and are usually benign. We felt it important to report a case in order to share our experience in the management of fibrothecal tumours of the ovary. Observation: This was a 51-year-old postmenopausal patient who was referred to the hospital for abdominal pain in the context of an abdominal mass. A clinical examination and abdominal ultrasound concluded that the left ovarian tumour was benign. A left annecxectomy was performed and the histological examination concluded that the tumour was benign. No tumour marker was measured and no CT scan was performed. The postoperative course was simple and the patient was followed for 3 months.

Background: Stomal site incisional hernia is a common complication following ostomy closure. Prophylactic mesh reinforcement of the fascial defect is typically not considered due to the contaminated nature of the case. The effectiveness of prophylactic mesh placement at the time of stoma closure is unknown because of fear of mesh infection and subsequent wound complications. Purpose: To compare the results obtained by placing synthetic mesh in the stoma site during closure with conventional technique without mesh to prevent incisional. Patients and Methods: Prospective interventional study had been designed to compare the outcome of permanent synthetic mesh placement at the time of ostomy closure. Total 45 patients were selected purposively who were candidates for ostomy closure and presented at the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2019 to September 2020 and divided into two groups (no mesh and mesh). In the mesh group, permanent synthetic mesh (ProleneTM – Polypropylene) was placed. Primary outcome, incisional stomal hernia was assessed at regular follow-up for one year along with associated morbidities. Results: The primary outcome of this study i.e. incisional hernia (stomal site) was observed among 1 (4.8%) patients at 4th week, 3 (14.3%) at 3rd month, 7 (33.3%) at 6th month and 8 (38.1%) at 12th month follow-up in no mesh group. And, only 1 patient at 6th month and 12th month follow-up had hernia in the mesh group (Figure 3). There was no difference statistically between no mesh and mesh groups at 4th week and 3rd month but significant difference found at 6th and 12th month follow-up (p=0.280, p=0.344, p=0.033 and p=0.017, respectively). Conclusion: Prophylactic placement of permanent polypropylene mesh during ostomy closure placement significantly reduced the rate of incisional hernia without any additional morbidity. Placement of mesh was found to be both safe and effective.

As a form of Higher Education's Tridharma, community service through Focus Group Discussion (FGD) is needed to explore responses from students, namely Real Work Lecture participants to the economic phenomenon that is currently being rolled out by the government, namely Village-Owned Enterprises (BUM Desa). The purpose of this activity is to formulate a BUM Desa financial literacy model according to the perspective of students (participants of the Real Work Lecture) which at the same time implements the realm of knowledge received in college with real conditions in the field, namely the village. Considerations for choosing FGDs are: planned discussions, directed by trained moderators to explore participants' understanding and opinions regarding the topics discussed, namely financial literacy. The results of the FGD explained that the model applied in BUM Desa financial literacy is by integrating aspects of knowledge, skills and attitudes. Knowledge of finance is the basis for managers in managing achievements. Management skills or skills must also be owned by managers. Meanwhile, honesty is an important aspect and is inherent in financial managers.

Background: Over the years, aligner therapy has undergone a great evolution. The use of aligners is now an alternative to braces for aesthetic reasons. Their effectiveness and impact have yet to be evaluated. Objective: The objective of this study was to compare the effectiveness of dental movements with aligners versus the use of conventional appliances, as well as the effectiveness and impact on periodontal health and root resorption. Materials and Methods: A systematic search of PubMed, Ebsco Host and Scopus was performed using a well-designed formula. Articles published in the last 10 years in English and French were included after filtering the titles, abstracts then full texts. Results: Twenty-six records were deemed suitable for the objectives of our systematic review. All records focused on the comparison of treatment with aligners and fixed appliances. The difference in treatment and time efficiency was assessed in 17 papers, 6 papers evaluated the impact of orthodontic appliances on periodontal health, and the remaining 3 records focused on the occurrence of root resorption. Conclusion: Clear aligners produce clinically acceptable outcomes that could be comparable to fixed appliance therapy. Aligners facilitate oral hygiene practices which results in better periodontal health. However, it appears that Invisalign may not be as effective as fixed appliances in achieving certain tooth movements like vertical, radicular and rotational movements.

Ketamine, an N-methyl –D-aspartate (NMDA) antagonist, has been abused as a recreational drug due to its euphoric, dissociative, and hallucinogenic characteristics. Series of studies have been carried out on the effect of ketamine on cognition and memory. However, there is dearth literature on the activities of ketamine as a recreational drug of abuse; its effect on motor response in association with cognitive behaviours in Wistar rat models. Hence, this study is necessary to investigate the effects of chronic administration of sub-anesthetic doses of ketamine on perceptual, cognitive, and motor responses in Wistar rats. 25 Wistar rats (160-180 kg) were randomly selected into five groups and treated for three weeks thus: Group 1 (control), Group 2 (0.2 mL Ketamin-i.p), Group 3 (0.4 mL Ketamin-i.p), Group 4 (0.6 mL Ketamin-i.p) Group 5 (0.5 mL Cerebrex-orally). Neurobehavioral (Barnes, rotarod, and handgrip) activities exhibited by the various groups were recorded and analyzed using ANOVA. In the Barnes maze test, there was a significant increase (p<0.05) in escape time from weeks 1, 2 and 3 in groups 2, 3 and 4 when compared to control. In week 2 and 3 of the handgrip test, animals in group 4 had a significant improvement (p<0.05) in grip strength when compared to control. In weeks 1 and 2 of the rotarod test, groups 2 and 4 animals respectively, showed a significant increase (p<0.05) in balance compared to control. Sub-anesthetic doses of ketamine inhibited cognitive function but not motor responses in Wistar rats.

Laurus nobilis is one of the most popular species belonging to the lauraceae family and it has been reported to possess many physiological properties such as antimicrobial, antifungal and wound healing effects. In this study, effects of ethanolic leaf extract of Laurus nobilis on some oxidative stress markers and liver function parameters of female Wistar rats were investigated. Five rats were randomly assigned into each of groups 1-4, of which group one (1) served as control and received distilled water. Groups 2-4 were treated with 100mg/kg bw, 200mg/kg bw and 400mg/kg bw of the ethanolic extract of the leaves of Laurus nobilis respectively, for a period of 14 days. The results obtained indicated that the superoxide dismutase and catalase enzyme activities as well as, gluthathione reductase and peroxidase activities were not significantly affected. The malondialdehyde level did not change significantly after two weeks of extract administration. The extract caused no significant (P<0.05) alteration in the enzyme activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), as well as serum concentrations of total protein (TP), albumin (ALB) and total bilirubin. This study have shown that extract of Laurus nobilis neither altered hepatic function parameters nor promoted toxic stress in the female Wistar rats.

Background: Breast cancer is a heterogeneous, phenotypically complex disease made up of various biologic subgroups with unique behaviors and therapeutic responses. Noted that despite lack of a cure for metastatic breast cancer (MBC), there have been appreciable advancements in survival that have occurred at the same time as newer systemic treatments. BRCA1 or BRCA2 mutations cause homologous recombination deficient (HRD) cells, which are vulnerable to PARPi agent treatment. Case Report: This case report presents a 40 years old single female, known case of multiple co-morbidities who was diagnosed with Bilateral breast cancer in June 2022. She has a Positive family history of malignancy; mother died from endometrial cancer and aunt from paternal side has breast cancer. She underwent needle core biopsy from her Right breast mass, which revealed Invasive high-grade ductal carcinoma with metaplastic features (foci of keratinizing squamous differentiation, and myxoid stromal change). DCIS, of intermediate and high grades and a solid pattern, was noted, focally suspicious for lymphovascular invasion, Triple negative (ER negative (<1%), PR negative (<1%) and her-2 (+2) FISH negative (Her-2 Low), KI 67= 70%. Left breast mass Biopsy done on 12/9/2022 showed Invasive Lobular carcinoma, grade 3, ER negative, PR negative, Her-2 +1, KI 67=70%, BRCA2 POSITIVE & PDL1 CPS score 10%. Staging positron emission tomography scan done on 10 October 2022. She had a Large hypermetabolic fungating right breast mass infiltrating the chest wall, consistent with biopsy-proven malignancy. Additional smaller FDG-avid lesions noted in the right breast. Moreover, she had FDG-avid right axillary and right internal mammary nodal metastases. Mildly FDG-avid left breast mass, consistent with biopsy-proven malignancy. FDG-avid liver and pleural metastases. She was started on PARP inhibitor (Olaparib) on 20/9/2022 after which she had amazing fast clinical response leading to falling off the large fungating mass. Conclusion: The chance of developing breast and ovarian cancer is extremely elevated if one possesses BRAC 1 or BRCA 2 mutation. In this situation, PARP inhibitors, mutation-targeted therapy, has better outcomes in reducing the morbidity and mortality associated with metastatic breast cancer (Olaparib).

The combination of gastric tumor and hiatal hernia is a rare event, that makes management delicate, and the prognosis pejorative given the risk of multidirectional lymphatic dissemination. Through this case report, we present a fully laparoscopic management, in an 80-year-old woman with a gastric tumor of the upper 1⁄3 of the stomach, associated with a huge hiatal hernia. This lady presented to the emergencies during the period of the Covid 19 pandemic, for dyspnea crisis of progressive worsening. thoraco-abdominopelvic CT showed a huge hiatal hernia explaining its symptomatology. Esogastroduodenal fibroscopy showed a cardia-gastric tumor. A total laparoscopy gastrectomy with lymph node dissection D1.5 associated with a cure of hiatal hernia were performed. The postoperative follow-up was simple and the patient declared outgoing on Day 5 postoperative.

The present study was undertaken to examine the direct effect of second line anti-tuberculosis drugs Ethionamide (ETH), Para amino salicylic acid (PAS), Aloe vera on Mycobacterium tuberculosis (MTB) strain H37Rv ATCC No- 27294. It is found that Aloe vera does not interfere with single or in the combination of both ETH and PAS showing the bioenhancer activity. In vitro study of Aloe vera observed that the extract inhibited the growth of H37Rv strains. The present results will pave new avenues to find a new medicine that possesses Aloe vera alone or in combination with drugs to combat H37Rv strains controlling tuberculosis.

Primary plasma cell leukemia (pPCL) is a rare lymphoproliferative disease characterized by a malignant proliferation of plasma cells in the bone marrow and peripheral blood. It is either primary (in 60% of cases) or a secondary complication of multiple myeloma [1]. In this context, we report the case of a 37-year-old patient with respiratory distress, whose bone marrow smear showed the presence of 64% of dystrophic plasma cells. A serum protein electrophoresis with immunofixation was performed, revealing results in favor of pPCL. A cytogenetic study was not performed due to lack of resources. The patient was put on multidrug therapy with a favorable evolution.

Introduction: There are millions of people in the world but no two humans are exactly alike not even identical twins. Genetic variations in man are caused by several environmental factors acting alongside with selection, gene flow, genetic drift and migration. Studies have been done on morphogenetic traits such as the pattern of hand clasping in some parts of Africa and among some tribes in southern region of Nigeria but there is no available data on the pattern of hand clasping among the Idoma tribe of Benue State. Hence, this study aimed to determine the pattern of hand clasping among the Idoma people of Benue State, Nigeria. Materials and Methods: The study was community-based, descriptive, and cross-sectional with a sample size of 401. Data was collected using a closed-ended questionnaire that was administered by an interviewer following an examination of hand clasping pattern. Results and Discussion: The proportion of participants that expressed hand clasping with the left thumb on top was 16.7%, while right thumb on top was 83.3%. There were no significant socio-demographic characteristics among participants (p > 0.05). Conclusions: The study implies that hand clasping with the right thumb on top is a marked characteristic of the people of Idoma and, as such, can be used to identify them amongst other tribes where the identity of the tribes is not known ab initio.

Despite decades of research, the causes and biology of schizophrenia remain unknown. The condition is associated with metabolic symptoms such as hyperinsulinemia, dyslipidaemia, type 2 diabetes (T2DM), and obesity. These sensations are a prevalent side effect of the new antipsychotic medications. Nevertheless, metabolic dysfunction in schizophrenia has been studied before the antipsychotic phase, and it has also been documented in patients with first- onset schizophrenia prior to antipsychotic treatment. We investigate the evidence for metabolic abnormalities in schizophrenia patients, both in the central and peripheral nervous systems. Post-mortem brain tissue molecular analysis indicated alterations in glucose metabolism and insulin signalling pathways, whereas blood-based molecular profiling revealed hyperinsulinemia and abnormalities in insulin and co-released factor synthesis after the development of symptoms. Yet, such features are not seen in all patients with the disorder, and not all people with such defects have schizophrenia symptoms. One explanation of these facts is the presence of an underlying metabolic sensitivity in a subset of persons that interacts with environmental or hereditary factors to create the disorder's overt symptoms.

Therapeutic phlebotomy is the removal of red blood cells or serum iron from the blood. It is one of the preferred treatments for blood disorders. In ancient times this process was known as bloodletting. Generalized method included were venesection and arteriotomy and systemic methods included were cupping and by leeches. It stimulates bone marrow stem cells to generate new red blood cells (RBCs). Iron for hemoglobin synthesis is taken from the body thus reducing serum iron. Different indications of therapeutic phlebotomy include Polycythemia Vera, Hemochromatosis, Porphyria cutanea tarda, Sickle cell disease, Non-Alcoholic Fatty liver disease (NAFLD) with hyperferritinemia. Other methods available for reducing RBC and iron level include apheresis and administration of desferroxamine. Phlebotomy can cause rare adverse effects, such as thrombosis, mostly seen in patients with polycythemia Vera. Other adverse effects include Hematoma at phlebotomy site. Usually hematoma is mild but in severe cases can cause damage in nerves and surrounding tissue. Haemoconcentration, extravasation, Syncope and Fainting, petechiae, Excessive Bleeding, edema, arterial puncture, pain and anemia are some of the adverse effects caused by therapeutic phlebotomy. Unsafe phlebotomy can expose patients and health workers to various infections like Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV); syphilis and malaria. Different countries have approved allogenic use of blood units obtained from therapeutic phlebotomy. Mostly blood collected from patients with hemochromatosis is permitted. The article also discusses criteria for initiating therapeutic phlebotomy and various regimen followed in different diseases.