Background: IAC Yokohama system has 5 categories that may be stratified by their risk of malignancy (ROM) and supply guidance within a management algorithm for every category. The main objectives were to categorize the Breast FNAC samples according to new system of reporting and to assess the Risk of malignancy (ROM), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy for all categories. Material and Methods: A total of 174 cases were prospectively studied over a period of one year from 1st November 2019 to 31st October 2020 in GMC, Jammu. All the FNAC received was reported routinely according to the newly proposed Yokohama system of reporting breast cytology. The ROM, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of Breast FNAC were calculated. Results: ROM is 0% for category 1, 2.27% for category 2, 50% for category 3, 50% for category 4 and 100% for category 5. Sensitivity, specificity, and diagnostic accuracy were, respectively, 100%, 100% and 99.11% for category A (only C5 category cases considered positive test results), 88.2%, 93.6%, and 93.6% for category B, (both C4 and C5 categories considered positive test results), and 94.1%, 91.48%, and 92.1% for category C (C3, C4, and C5 category cases grouped as positive test results). PPV and NPV were also calculated. Conclusion: Categorization of the Breast FNAB cytology according to IAC Yokohama system of reporting helps pathologist in the diagnostic clarity and guides clinician in the appropriate patient management.

Circumcision is the act of cutting to remove the entire foreskin from the penis. The frenulum of the penis can also be cut simultaneously in a procedure called a frenectomy. The word circumcision comes from the Latin circum meaning to twist and caedere meaning to cut (A Firmansyah et al,). The formulation of the problem in this study is to find out how the relationship between the influence of snakehead fish consumption on wound healing after circumcision. The research method used in this scientific paper is the grounded method, through a qualitative approach. The relationship between snakehead fish consumption and circumcision wound healing is because snakehead fish itself has a high protein content, namely albumin in snakehead fish (Nugroho, 2015). The conclusion of this study through direct observation on the sixth day is that the protein content in snakehead fish is higher than in other types of fish, the albumin content of snakehead fish reaches 6.22%.

Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Substance use disorders (SUD) are mental health conditions that arise from chronic drug use. There is an increased recognition of this problem in Saudi Arabia. Drugs of abuse testing is the detection of one or more illegal and/or prescribed substances in the urine, blood, saliva, hair, or sweat. Testing detects substances not normally found in the body. Drug abuse testing usually involves an initial screening test followed by a second test that identifies and/or confirms the presence of a drug or drugs. Initial screening is done by urine tests and confirmation is done by blood tests. Major drug class screened are Amphetamines, Barbiturates, Benzodiazapines, Cannibinoids, Cocaine, methadone and opiates. In this article we reviewed lab diagnosis of drug of abuse.

This research examines the influence of Narcissism, Board of Directors Bonus Scheme, Age, Gender and Term of Service with the moderating variable of Financial Reporting Quality on the tendency to commit fraud. Research respondents are CEOs of banks listed on the Indonesia Stock Exchange in 2015-2018 and the sampling technique uses the Purposive Sampling method. This study uses statistical regression analysis to see the effect of the independent variable on the dependent variable or the response to the moderating variable. The regression parameter test consists of the F test, to find out whether the independent variable has a simultaneous effect on the response variable or not. Then the t test, to test the effect of the independent variables one by one on the response variable. By using panel data regression modeling using an unweighted Fixed Effect Model and a weighted Fixed Effect Model, also using partial testing on the unweighted Fixed Effect model and the weighted Fixed Effect model. The results showed that panel data regression modeling using the unweighted Fixed Effect Model resulted in a significant simultaneous test, meaning that the variables of narcissism, directors' bonus scheme, age, gender and tenure affect the tendency to commit fraud simultaneously. Partial testing on the unweighted Fixed Effect model shows that individually only the tenure of service variable affects the tendency to commit fraud. The Fixed Effect Model with weights produces significant simultaneous tests, meaning that simultaneously the variables of narcissism, directors' bonus scheme, age, gender and years of service affect the tendency to commit fraud. And a partial test on the Fixed Effect model with weights shows that individually there are no independent variables that affect the tendency to commit fraud.

Background: The cytotoxic chemotherapy is the mainstay treatment of cancer and it is usually complicated with infections. Appropriate antibiotics and other supportive medications must be started immediately as bacterial infections may progress with the absence of granulocytes. Improved outcomes can be seen with empirical administration of broad-spectrum antibiotics and they remain as the standard of care. Patients with intermediate-risk for Febrile Nuetropenia (FN) (10%-20%) need to be evaluated for additional patient risk factors, after assessment, patients who present with at least one of the risk factors for FN is recommended for treatment with a G-CSF. Methodology: Our study was a retrospective cohort single centered observational study carried out randomly in 104 patients in the oncology department of Lourdes hospital, Cochin Data of the patients were collected from Mediware system, medical records and Statistical software SPSS were used for analysis of the data. Results: In our study febrile neutropenia was managed using antimicrobials, of which antibiotics and antifungals prescribed were 12.09% and 1.97% respectively and with granulocyte-colony stimulating factors (G-CSFs) (6.15%). Principally used empirical monotherapy was meropenem sulbactum / meropenem (n = 48) which was followed by piperacillin tazobactum (n=18) and cefoperazone sulbactum (n=15) This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The compliance with National Comprehensive Cancer Network (NCCN) guidelines were analyzed in that we can see 84.6% patients had partial compliance and 14.4% patients had full compliance. Conclusion: A total of 66 patients received both antibiotics and G-CSF treatment however 13 patients and 25 patients were managed only with G-CSF and antibiotic therapy respectively. This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. These regimens were used mainly in breast cancer patients. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The NCCN guidelines, majority of patients showed partial compliance(86.6%) and about (14.4%) showed full compliance.

The three decades following the fall of the Union of Soviet Socialist Republics, USSR, were marked by the Russian policies of catching up with Western countries. First, at the beginning of the decade that followed this fall, the restructuring of the economy was left to market forces, next there was an implementation of the policy of modernization of certain industrial sectors and the development of new technologies from the following decade. These policies have allowed investments by Western multinationals to access the Russian market, which thus fits into the global just-in-time management approach because of the economic and geopolitical arguments it presents. The war between Ukraine and the Russian Federation produced the opposite effect. That of dismantling these same multinational companies in a short time. It is this paradox that multinational companies established in Russia must resolve in order to participate in the remodeling of socio-economic relations with the Russian Federation. The question is: How do they do it? What risks do they run to achieve this? This article has deciphered the mechanisms of remodeling of socio-economic relations against the background of the risks incurred by these multinational companies in the light of the war between the Russian Federation and the West by the agency of Ukraine.

His association of mediastinal germ-cell tumours (MGCTs) with haematologic neoplasms is a rare though well known circumstance, and few cases are found in the literature. Most of these are non-seminomatous tumours in young males. The diagnosis of the haematological condition is usually either synchronic or metachronic with that of the germ-cell tumour. The prognosis is poor and basically determined by the haematologic neoplasia. Less than 20 cases of PMGCT with evolution into acute megakaryocytic leukemia have been reported in worldwide literature. Hematologic neoplasias associated with extragonadal germ cell tumors represent one of the most intriguing and biologically distinctive aspects of male germ cell cancers. The case report we present is that of a young 33 year old male with an initial diagnosis of both conditions which were detected synchronously. Despite timely intervention he succumbed to multiorgan failure following chemotherapy and an autopsy was performed.

Climate change is a threat not only to the affected country but to the entire world. Over the last few decades, incidents of climatic change have increased drastically, and these incidents have both direct and indirect impacts on the economy. The United Nations Environment Programme (UNEP) Adaptation Gap Report 2016 warns of the increasing impacts of climatic risks and, as a result, an increase in global adaptation costs. The prediction is that international costs will increase by two to three times by 2030 and four to five times by 2050. This study investigates the short-run and long-term impacts of climate change on economic growth across low-income countries from 2005 to 2018. The study uses the Panel Autoregressive Distributed Lag (PARDL) approach. This model allows us to study both the short-run and long-term effects of climate change on economic growth and capture the possible links in the short run. For the study purposes, twenty-two low-income countries were chosen from almost all continents on the basis of their income levels. The data for the GDP, as a proxy of a country's economic growth, is taken from the World Development Indicators (WDI), and for climate change, we use the global climatic risk index (CRI) developed by German watch (CRI) is used as an explanatory variable in the model. The empirical results show that climatic change, especially weather-related events, negatively impacts the economic growth of low-income countries during the studied period in the long run. But in the short run, climatic change does not significantly affect the economic growth of countries. Moreover, climate change has been severely affecting low-income countries over the last few decades, as reported in the study. As climatic risk increases, the vulnerability in these countries also increases, and this study supports the need for a global mitigation approach.

This paper reviewed the role of entrepreneurship and vocational education in sustainable development. Graduate unemployment is one of the greatest challenges that bedevil Nigeria, a nation endowed with enormous wealth in terms of human, mineral and natural resources. This paper stresses the importance of entrepreneurship and vocational education curriculum in solving unemployment problems and achieving sustainable development. This papers argues that entrepreneurship and vocational education will provide students who are leaders of tomorrow with skills with which they can be self-reliant because human resource through knowledge based capacity are the cornerstone for effective management and utilization of natural resources. The paper concludes that entrepreneurship and vocational education when engendered leads to employment generation, growth of the economy and promotes sustainable development. The paper recommended that educational institutions at all levels must inculcate and intensify the integration of entrepreneurship and vocational education into its curriculum systems.

We report a case of a 25-year-old female, with a history of gastrojejunal anastomosis 6 years ago for pyloric stenosis due to intentional corrosive ingestion, who was admitted for jaundice related to the common bile duct stones diagnosed at MRI. The patient had undergone Endoscopic retrograde cholangiopancreatography (ERCP) and upper endoscopy that allowed the diagnosis of afferent loop syndrome related to pyloric stenosis and duodenal stenosis. The afferent loop syndrome was related to hyper pressure in this afferent loop and was managed surgically by performing a jejuno-duodenal anastomosis.

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.