Lung cancer is the most commonly diagnosed cancer in both men and women and has the highest incidence and mortality rate among all cancers in the world. In recent years immunotherapy has become a game-changer in the treatment of cancer. Here, we present a patient with metastatic Non-Small Cell right lung carcinoma who was treated with pembrolizumab and achieved a very good response. This case highlights the efficacy of neoadjuvant pembrolizumab on metastatic lung carcinoma which provides a clinically meaningful therapeutic option for the future.

This study aims to determine the effect of economic growth, population, industrialization, energy consumption and fossil fuel consumption of CO2 emissions in G-20 countries. Panel data is used as a data analysis technique in this study. The variables used are based on the concept of the Environmental Kuznets Curve. The Kuznets hypothesis explains that an increase in economic growth reduces inequality and poverty in a certain period of time (or referred to as the turning point limit). This study focuses on the G-20 countries in the 2013-2018 period. Based on the regression results of the CO2 emission variables (CO2), gross domestic product (GDP), energy consumption (KE), population (JP), industrialization (IND) and fossil fuel consumption (BBF) it was found that all independent variables simultaneously (GDP, KE, JP, IND and BBF) have a significant effect on the dependent variable (CO2). Furthermore, partially significant variables that affect CO2 emissions are GDP, JP, IND and BBF, while the variables that have no significant effect on CO2 emissions are only KE. Support and commitment to policies both nationally and regionally are needed to reduce environmental degradation through inclusive economic growth in G-20 countries.

The aim of investigation: to study the effect of early administration high doses of atorvastatin in the acute period of STEMI on the indicators of low dose dobutamine stress-echocardiography and parameters of left ventricular remodeling. Material and Methods: The study included 164 patients with STEMI All patients underwent myocardial revascularization (TLT or PCI) within the first 6 hours. The 1st group included 82 patients who received basic therapy (atorvastatin 20 mg), the 2nd group included 82 patients who took a loading dose of atorvastatin (at a dose of 80 mg per day). Low dose dobutamine stress-echocardiography was performed to detect myocardial stunning after stabilization of the patients condition on 4–6 days of the disease. In addition to general clinical and conventional laboratory research methods, on the 1st day and on the 10th day of treatment, the level of CPK MB, ESR, the number of blood leukocytes, and the level of fibrinogen (FN) were determined. Results: On the 10th day of therapy in patients of both groups, there was a significant increase in ESR (in the 1st group by 2.1 times, in the 2nd - by 1.6 times) and a decrease in the level of CRP (by 3 and 2.65 times, respectively) compared to the first day. The dynamics of these indicators reflects the regular processes of the course of AMI. A more significant change in these parameters was recorded in patients of the 2nd group who took atorvastatin at a dose of 80 mg. At the same time, on the 10th day of AMI, the number of peripheral blood leukocytes significantly decreased in them (p<0.05 when compared between groups). The number of dobutamine-responsive segments (segments with reversible dysfunction) in the group of patients treated with atorvastatin at a dose of 80 mg during myocardial reperfusion was significantly higher than in the control group (p<0.05). Conclusion: It was revealed that conducting of myocardium reperfusion in infarct-related coronary artery with simultaneous use of atorvastatin’s high doses promoted the limitation of myocardial necrosis development, reducing ischemic and reperfusion injuries of myocardium and influenced on the formation of myocardial stunning zones which is a reversible disfunction. The use of atorvastatin in the dose of 80 mg/per day in the first hours after acute myocardial infarction development promotes the improvement of LV systolic indices, prevents the progressing of LV cavity postinfarction dilatation.

Fruits are sweet fleshy products of a plants, that contain various nutrients and when consumed help the human in diverse ways. Some build up muscles, some burst immune system, some are anti-oxidant and amongst other functions. Because of the high commercial demand, naturally ripe fruits are scarce, thus; alternative (artificial) ways of making them ripe for consumption has become inevitable and uncontrollable. The aim of this study is to evaluate the effect of Calcium Carbide ripened fruit (Pawpaw) on the Haematological parameters of the Wistar rats. Mature unripe pawpaw’s were plucked off from the parent plant and were divide into two groups, one group was kept and allowed to rip at normal room temperature and the other group was induced with Calcium Carbide to ripe for 48 hours.10g of the CaC2 was placed in a bowl and 5ml of water was used to dissolved it in a closed metal bucket containing 1kg of the fruit [Pawpaw] rapped with black nylon and was allowed for two days [48 hours] for ripening. After ripening, sampled fruits were washed and juiced. 600g of both the naturally ripened and calcium carbide induced ripened fruits [Pawpaw] were peeled separately and blended in an electric blender with 350ml/1L of deionized water. The two sets of juice was filtered with a clean fine sieve and was poured into clean bottles labeled [CaC2 ripened and naturally ripened pawpaw juice]. A total of 21 adult Wister rats of both sexes weighing between 126.9g- 213.3g were used for this study. 9 Wistar rats were used for Sub Acute Test ( LD50). The rest 12 Wistar rats were divided into three groups (Control, Natural and CaC2). 5ml/kg of the naturally ripened and calcium carbide induced ripened fruits [Pawpaw] were administered orally to the rats based on the body weight. The rats were weighed weekly, then one rat was sacrificed in each group and blood samples were collected from the three groups for hematological analysis. The result showed reduction in mean Pack Cell Volume, Total White Blood Count, Hemoglobin, Red Blood Cells, Platelets, Neutrophil, Monocytes for both the Wistar rats fed with Naturally ripened and CaC2 ripened groups in comparison with the control group. There is evidence of increase in the mean Lymphocytes level for both the Wistar rats fed with Naturally ripened and CaC2 ripened groups in comparison with the control group, but the CaC2 treated group tend to be higher. Eosinophil levels is higher in the CaC2 treated group. In a nutshell, The consumption of fruits ripened with Calcium Carbide pose devastating effect on the bone marrow, deleterious effect on the circulating blood, heart and brain, that will evenly lead to myocardiac infarction, Eosinophilia, Anemia, thrombocythopenia, paralysis, stroke, seizure and mortality may eventually arise.

Objective: To determine the electro physical agents (EPA) commonly used by physiotherapist in the management of non-specific low back pain in Karachi, Pakistan. Methodology: A cross sectional study was conducted on physiotherapist practicing in different clinical settings in Karachi Pakistan between January to March 2016. Written informed consent were taken from each study participants. Data were collected from 90 physiotherapists who were selected through non probability purposive sampling. Structured questionnaire was used to collect data. Data was entered and analyzed by using SPSS version 21. Results: It was found that out of 90 physiotherapists, 27(30.0%) male and 63(70.0%) female had responded. With mean (S. D) Age was 28.8(4.32188). The EPA used mostly in patients with non-specific low back pain as TENS 18(20.0%), Thermotherapy 17(18.9%, Ultrasound therapy 12(13.3%) and Interferential therapy 9(10.0%). In combination TENS, ultrasound and thermotherapy is about 8(8.9%) and interferential and thermotherapy is about 7(7.8 %). Conclusion: Physiotherapists give preference to some EPA such as TENS, Thermotherapy, Interferential therapy (I.F.C) and Ultrasound (U.S) to manage nonspecific low back pain. However, there is a need to highlights the use of EPA according to Evidence based practice.

Introduction: Since March 11, 2020, the COVID-19 pandemic has disrupted social and business activities, resulting in many companies going out of business due to limited economic transactions. All health care sectors are required to performed COVID-19 screening before services are carried out and provide COVID-19 vaccination services. Aim: The purpose of this study was to describe the motivational experience and performance of Indonesian nurses working in Qatar during the pandemic COVID-19. Research Methods: This type of research is qualitative, using 15 Indonesian nurses as informants were working in Qatar. In Qatar there are 51 Indonesian nurses who are actively working as registered nurses. The research instruments used were interviews and recordings. Interviews with informants were conducted one by one. The data that has been entered into the Nvivo system, then a qualitative content analysis is carried out to find the matics related to work motivation and performance. Results: The results show that Indonesian nurses still want to work in Qatar until they retire for the following reasons: (1) getting a high salary, (2) being able to live as a family in Qatar, (3) there are opportunities for international standard school children in Qatar with free from the company, (4) get leave tickets for family members every year, and (5) get premium class health insurance for employees and their family members. The themes of work motivation found in Indonesian nurses who worked during the pandemic COVID-19 in Qatar were: (1) good financial support, (2) leadership support, (3) personal protective equipment support, (4) occupational health support, (5) work environment support, (6) family support, (7) work obligations, and (8) professional obligations. The performance of Indonesian nurses during the COVID-19 pandemic was demonstrated by: (1) working comfortably because personal protective equipment facilities were adequate and work facilities were quite comfortable even in the summer, (2) working by carrying out special work procedures in handling COVID-19, (3) work in accordance with working conditions, especially in the use of personal protective equipment, (4) work carefully when dealing with highly virulent infectious diseases, and (5) work professionally in accordance with nursing process standards. Conclusion: Indonesian nurses still want to work in Qatar due of getting a high salary and family living allowances in Qatar, being able to gather with family members and send their children to international school in Qatar. The themes of factors work motivation found in Indonesian nurses who work during the COVID-19 pandemic season in Qatar are: (1) financial support, (2) leadership support, (3) personal protective equipment support, (4) occupational health support, (5) work environment support, (6) family support, (7) work obligations, and (8) professional obligations. The performance of Indonesian nurses during the COVID-19 pandemic was shown by: (1) working in accordance with work procedures to carry out COVID-19 screening, (2) working wearing complete personal protective equipment, especially when dealing with patients with signs and symptoms of COVID-19, (3) work carefully in order to avoid exposure to infectious diseases from patients with COVID-19, (4) work in accordance with working conditions, this causes an additional burden and gets overtime pay if there is additional working hours and professional work in accordance with nursing professional standards.

Although COVID-19 vaccines are now widely available in Bayelsa State, adequate immunization of the population is hampered by vaccine hesitancy. This study aimed to identify factors associated with COVID-19 vaccine hesitancy. One thousand and a hundred (1,100) adults aged ≥ 18 years were selected from 300 randomly selected households in two semi-urban communities in Bayelsa State and were interviewed in this descriptive cross-sectional survey. Willingness to receive COVID- 19 vaccines and the associated factors were assessed using an interviewer-administered structured questionnaire. A slim majority of the 1,100 participants were women (51.1%) and single (72.6%). About half of the participants were university undergraduates (52.2%). Awareness of COVID-19 among the participants was 67.1%, and less than a third of respondents were unwilling to take the COVID-19 testing. However, the unwillingness to accept the COVID-19 vaccine was high in the population (45.5%). On bivariate analysis, willingness to take the COVID-19 vaccine was associated with having ever heard of the vaccine (p<.001), willingness to take COVID-19 testing (p<.001), and educational qualification (p<.001). On regression analysis, only willingness to take testing (p=0.000, CI=0.267, 0.446) and prior vaccine awareness (p= 0.049, CI = 0.592, 0.446) independently related to a willingness to take the vaccine. Common reasons for unwillingness to take COVID-19 vaccines included possible side effects, safety, and efficacy concerns. The willingness to receive the COVID-19 vaccine in this mostly educated and youthful populace was relatively poor. Public health education concerning the safety and efficacy of the vaccine should be intensified to improve the community’s willingness.

Introduction: Upper gastrointestinal bleeding (UGIB) is a frequent cause of medical care. They constitute medical and surgical emergencies that quickly involve the patient’s vital prognosis. The main objective of this work is to study the epidemiological profile of UGIB. Materials and Methods: Our work is a descriptive prospective study including all patients admitted for upper gastrointestinal bleeding from January to December 2020. All patients received specific emergency care as well as upper endoscopy. Results: 72 patients with UGIB were included, 31 men (43.1%) and 41 women (56.9%). The average age is 56.5 ± 6.8 years. UGIB was manifested as isolated melena (40.3%), hematemesis associated with melena (25%). On admission, hemoglobinemia was below 7 g/dl in 51.4% of cases. The history of the patients was dominated by portal hypertension (PHT) (13.7%), taking antiplatelet agents (13.7%) and anticoagulants (11%). The average time for completion of the upper endoscopy is 36.97h ± 8.9. The main diagnoses were ulcer bleeding (34.7%), PHT related bleeding (23.67%), and gastritis (16.6%). Bleeding recurrence and mortality were estimated at 25% and 5.6% of cases respectively. Conclusion: The majority of upper gastrointestinal bleeding occurred in patients over 60 years old. The most common etiologies are ulcer disease and bleeding related to portal hypertension. Gastroscopy is the key examination and constitutes the main stage for diagnostic, etiological, prognostic and therapeutic purposes.

Background: Every year, more than half a million people in the world suffer from acute cerebrovascular events, including ischemic stroke, intracerebral and subarachnoid hemorrhage, giving a mortality of nearly 20%. Acute strokes, especially subarachnoid hemorrhage is frequently accompanied by a variety of electrocardiographic (ECG) abnormalities. Objective: To find out the cardiac function assessment by echocardiography in ischemic stroke/non hemorrhagic cerebral infarction. Material and Methods: An observational study was conducted in Department of Medicine and Cardiology, Sher-E-Bangla Medical College Hospital, Bangladesh from July to December-2019. 51 patients of ischemic stroke were taken and 2D transthoracic echocardiography was done to find potential cardioembolic abnormalities. Results: 74.5% of patients had echocardiographic abnormalities and 41.1% had potential cardioembolic abnormalities, out of which most common were ventricular wall hypokinesia, calcific aortic valve, rheumatic heart disease and dilated cardiomyopathy. The prevalence was almost similar in different age groups and both the sexes. Conclusion: Prevalence of potential cardioembolic abnormalities is high (41.1%) in ischemic stroke patients and 2D echocardiography is therefore recommended in the management and secondary prevention of cardioembolicstroke, which has a higher mortality and more chances of recurrence than atherothrombotic type of ischemicstroke.

Some infectious oral diseases are treated by medicinal plants in tropical areas, because they are abundant and cheap. The present work aimed to evaluate the antiseptic activity of the aqueous extract of Alchornea cordifolia leaves against three oral bacteria recognised as opportunistic pathogens, namely Streptococcus mitis, Staphylococcus epidermidis, and Micrococcus luteus. Fresh leaves of A. cordifolia were harvested, dried and pulverised. The extraction was performed by decocting in distilled water. The phytochemical screening was performed on the extract based on principles of colour change, and precipitation. Biological studies consisted in the in vitro antiseptic evaluation of the aqueous extract using the agar disc diffusion method, in comparison with a reference antiseptic mouthwash containing chlorhexidine. The extract had a 11.96% yield. The phytochemical screening revealed the presence of alkaloids, phenols, flavonoids, terpenes, tannins, glycosides, coumarins and saponins. The evaluation of the antiseptic activity revealed that the extract is active against S. mitis and S. epidermidis, and inactive against M. luteus. The diameters of inhibition zones were 16.9±1.1mm and 11.2±0.7mm at the concentration of 40mg/ml, and 7.7±0.3mm and 8.5±0.5mm at the concentration of 20mg/ml against S. mitis and S. epidermidis, respectively. Chlorhexidine did not inhibit S. mitis and showed diameters of inhibition of 13.0±1.0mm and 15.1±1.0mm against S. epidermidis and M. luteus, respectively. The minimal inhibitory concentration of the extract against the 2 sensitive bacteria was 20mg/ml.

In the present era of technology it has been simpler to deal with the disaster both natural and man made. Disaster Management activities rely upon substantial volumes of precise, applicable, on-time geo information that different organization systematically make and maintain. Information Technology is changing each part of human life. Disaster management desires forceful enhancements in its sources to decrease injury and save the lifetime of individuals. The advanced methods of information technology such as web, remote sensing, satellite communication, GIS, etc. can facilitate in coming up with and implementation of disaster management. Web provides a useful platform for disaster mitigation communications. On GIS is basic as effective preparedness, communication and training tool for disaster management on the other hand Remote Sensing as a tool can very effectively contribute towards identification of hazards areas. Communication satellite have become vital for providing emergency communication and timely help into natural disaster monitoring and mitigation mechanisms is critical for hazards reduction. There should be more emphasis on development of new technologies in disaster mitigation. The disaster preparedness and awareness is the only effective method of mitigating the impact of future disaster. In this paper an attempt has been made to highlight the role of information technology in management of natural disaster in Nepal.

Background: A common cause of mortality is traumatic brain injury (TBI). One of the deadliest complications is cerebral bleeding. Unanimously, CT scans are considered as gold-standard diagnostic tools for traumatic brain damage. In-patient assessment is aided by the patient's general condition score (GCS). Patients with a high GCS are often overlooked, yet it is possible that they may have major difficulties in the future. However, it is debatable whether or not a CT scan should be performed in individuals with GCS between 13 and 15 or not. Objective: It is our goal to examine individuals who have suffered head trauma and have a high GCS 10-15 on a CT scan who may have been overlooked but are now experiencing symptoms. We discovered the prevalence of ICH in 70 individuals with GCS ranging from 10-15. Methods: The computed tomography scans of 70 individuals with head trauma were performed. All patients underwent a non-contrast computed brain CT scan of 5mm axial images and slice thicknesses from the foramen magnum up to the vertex from which the findings were obtained. The patient's name, age, gender, and GCS score were all entered into a Performa. Results: The results showed that 32 patients (45.71 percent) experienced cerebral bleeding out of 70 individuals. Conclusion: Patients with RTA are at greater risk of developing ICH, and this risk is greater in men than in women.

High-quality human resources play an important role in economic growth. In the current cause of national industrialization and modernization and international integration, developing high-quality human resources has been of greater and greater significance and in dire need to meet the requirements of the 4th Industrial Revolution and international integration. Therefore, amending and perfecting the policies of developing high-quality human resources is a regular and long-term task and an objective necessity. It demonstrates a profound understanding of the viewpoint: "Improving quality of human resources and local human resources” is one of the three breakthroughs in the socio-economic development strategy for the period of 2021 - 2022 with a vision to 2045.

The mode of locomotion of humans and primates leads to changes in their skeleton. Objective: Establish a link between the morphology of the tibia and the locomotive function from a comparative anatomical study between the tibias of bipeds, Homo Sapiens (HS) and Pan troglodytes verus (PTV), and of quadrupeds, Canis lupus familiaris (CLF) and Sus scrofadomesticus (SSD). Materials and methods: It concerned an analytical and comparative study by direct observation involving a sample of 52 tibias. We proceeded by direct observation, to a synthetic analysis of the morphological characteristics of the tibia that we compared in bipeds and in quadrupeds. Results: The tibial diaphyses of HS and PTV presented the same morphological conformation with an italic S aspect in HS and a varus aspect in PTV. With CLF and SSD, they are straighter and the different faces are distributed differently. The proximal epiphyses are voluminous and massive in both classes. In quadrupeds, they present upper tibial articular surfaces which are deformed backwards and a voluminous anterior tibial tuberosity. The distal epiphyses in quadrupeds are convex with more pronounced creases. Conclusion: This comparative study allowed us to demonstrate that the locomotive function has a significant impact on the morphology of the tibia.

The Balance of Payments in Nigeria was studied using annual data from 1981 to 2019 in this article. The paper's major goal was to examine the long-term factors that influence Nigeria's Balance of Payments. The Autoregressive Distributed Lag Model (ARDL) was used in the investigation. Long-term results from the ARDL regression showed that the exchange rate coefficient was negative, whereas short-term results showed a positive value. Also, the coefficients of FDI, GDP growth, interest rates, and crude oil prices were positive and significant. There is a strong case can be made for governmental intervention to improve economic productivity, as evidenced by this study. To help the economy thrive, capital investments and expenditures should be made. The government should make incentives to prospective foreign investors in order to attract FDI inflows into the country. Government should also enhance safety and security and build a sense of belonging in the Niger Delta in order to promote peace and ease of doing business in the petroleum industry there.