Background: Breast diseases are showing a rising trend. The present study was conducted with aim of Clinicopathologic analysis of Breast Lumps. Materials & Methods: The present study was conducted on 130 breast specimens obtained from surgery department. The method of biopsy used was either open (excision and incision) or tru-cut needle biopsies depending on size and clinical parameters at presentation. Results: Maximum patients were seen in age group 40-60 years (70) followed by 20-40 years (40) and >60 years (20). Histological diagnosis was fibroadenoma in 49, fibrocystic disease in 20, benign phyllodes in 11, duct ectasia in 6, chronic mastitis in 15, granular cell tumour in 10, neurofibromas in 2, lactating adenomas in 4, lipomas in 6 and invasive lobular carcinomas in 22. Maximum masses were seen in upper inner quadrants (30%) followed by lower outer quadrants (24%), upper outer quadrants (12%), entire breast (11%), lower inner quadrants (10%), central (8%) and middle quadrants (5%). The difference was significant (P< 0.05). Conclusion: Most common breast mass was fibroadenoma followed by invasive lobular carcinomas. Most common site was upper inner quadrant.

The existence of the media and ideology is akin to two sides of a coin. This existence is characterized by interrelatedness and mutual influence. During the Presidential Election of 2019, partisanship became a prominent issue. The media was regarded as being partisan and supportive of the incumbent. Similar case was observed during the Presidential Election of 2014 where the author identified the partisanship of the daily the Jakarta Post toward one of the presidential candidates. This stance is reflected on the editorial of the Jakarta Post entitled Endorsing Jokowi. Through this editorial, the Jakarta Post established itself as the only daily that openly threw its support for one particular presidential candidate. The analysis of this research is based on the Critical Discourse Analysis developed primarily by Teun Van Dijk in order to identify the reasons and means employed by the Jakarta Post to demonstrate its partisanship. The choice of theme, outline, diction, vocabulary and sentences used in this editorial reflects the attempt to marginalize, trivialize and accost the other candidate. In addition, the editorial contributed in providing insight on the candidate and the unfolding event. The research also identified the ideology espoused by the Jakarta Post which included pluralism, human rights, civil society and Reformasi which influenced their stance toward partisanship in this daily. Two events that took place during the campaign, which include the bestowal of the title Islamic Commander in Chief and the proliferation of the use of memes as the form of people’s political expression are observed as the social context that spurred the publication of such editorial.

Background: Blood transfusion services play a vital role in the modern healthcare scenario, and blood and its components requirements widely outstrip the supplies therefore a stringent guidelines for transfusion, blood donations and utilization should be laid down and adhered. This study analyses the causes for discard of blood and its components. Materials and Methods: This was a retrospective study of various causes of discard of blood and blood components carried out in blood bank unit of a tertiary care hospital from the data collected from the blood donations by the voluntary donors from January 2014 to May 2017. Results: A total of 3442 blood bags were collected of which 3378 (98.14%) were from male donors and 64 (1.85%) were female donors. majority of the donors were in the age group of 21-30 years (55.37%). a total of 5453 blood /blood components were prepared of which 393 units of blood /blood components were discarded with an overall discard rate of 7.22%. discard rate for WB, PRC, FFP and platelets were 9.22%,4.12%,7.9% and 28% respectively. Conclusion: To prevent wastage of blood a proper coordination should be present between the clinicians and blood bank personnel. An updated software and automation, proper training of staff and a properly implemented blood transfusion policies would go a long way in reducing wastage of this vital body resource

Introduction: Acute appendicitis is the surgical emergency that occurs most often in pregnant women with a prevalence of 0.05 to 0.1%. It is a clinical entity that gives in to diagnostic problems. The treatment of appendicitis in pregnant women is surgical. The use of the laparoscopic route depends mainly on the age of pregnancy, the location of the appendix and the presence of complications. The prognosis is maternal and fetal and the mortality varies from 0.5 to 1.5%. Material and Methods: This is a retrospective study of 15 cases treated in the general surgery department B of the Rabta hospital from 2011 to 2018. Results: This is a series of 15 patients whose average age was 27 years with extremes of 20 and 39 years. Among our patients, 2 had a caesarean section median, 2 had a right subcostal for cholecystectomy, and one patient had a umbilical hernia plate replacement. The age of pregnancy was in the 2nd trimester in 8 patients. The duration of evolution of the symptomatology was on average 2 days. Pain in the right iliac fossa was present in 8 patients. A fever was observed in 2 patients. Vomiting was noted in 6 patients. A biological inflammatory syndrome was present in 7 patients. Abdominal ultrasonography, performed in 10 patients, made it possible to retain the diagnosis in 6 patients. Tocolysis was performed in all cases. The appendectomy was performed laparoscopically in 9 patients. Seven of them had a term less than 20 SA. The least advanced pregnancy was 8 SA and the most advanced 24 SA. The Mac Burney pathway was performed in 5 patients and one patient was operated on by median laparotomy. The appendix was inflammatory in 2 patients, phlegmonous in 5 patients, gangrenous in 4 patients and perforated in 4 patients including an appendiceal abscess in 3 cases and peritonitis in one case. Drainage was performed in 4 patients. The postoperative courses were marked by a wall abscess in 3 patients, Premature delivery for one and a spontaneous abortion for one. Conclusion: Acute appendicitis in pregnant women is a diagnostic problem mainly in the 2nd and 3rd trimesters of pregnancy. The laparoscopic approach has been described at any age of pregnancy, but it is far from being considered a gold standard for appendicitis in pregnant women; studies are underway to assess the long-term course of children whose mothers have had laparoscopic appendectomy.

Gastrointestinal lesions are the major group of specimens received in the surgical pathology department. This includes endoscopic biopsies from gastric and duodenal mucosa, appendicectomies, cholecystectomies and colonoscopy biopsies. This study was a retrospective analysis done between January 2015 and December 2017 which included 838 biopsies, both mucosal and resected specimens. These biopsies were fixed in 10% buffered formalin, routinely processed and paraffin embedded sections were taken and stained with Hematoxylin and Eosin. The stains were interpreted and statistical analysis of the data obtained was done. The most common specimen received was appendix which accounted for 49%, followed by cholecystectomies accounting to 38%, 5.5% biopsies from rectum and anal canal, 3%gastric mucosal biopsies, 3% biopsies from colon, 1% mucosal biopsies from small intestine, 0.5% mucosal biopsies from esophagus. In this study it was observed that appendix was the most common specimen received, followed by gall bladder. The most common tumor of esophagus was squamous cell carcinoma. The most common tumor of stomach was adenocarcinoma. Inflammatory lesions were more common in small intestine. Histopathological analysis of gastrointestinal lesions helps the clinicians for proper follow up and specific treatment. This study gives an overview of the various histopathological specimens received in the pathology department.

This study aims to comparative analyze performance ratio of PT. Permata Bank Tbk. The method used in this study is paired t test. The result are Performance of PT Bank Permata Tbk are had 8 data increasing are Minimum Capital Requirement (KPMM), Problematic productive assets and non-productive assets of total productive assets and non-earning, Problematic productive assets against total earning assets, Non-Performing Loan (NPL) net, Return on Assets (ROA), Net Interest Margin (NIM), Return on Equity (ROE) and Loan to Deposit Ratio (LDR ). Ratio Performance of bank are had 3 data decreasing are Reserve for impairment losses (CKPN) of financial assets to earning assets, Non-Performing Loan (NPL) gross and Operational Expenses on Operating Income and (BOPO) but there are not difference significant between Performance Ratio of Bank Permata in 2018 and Performance Ratio of Bank Permata in 2017.

Desmoplastic fibroma (DF) is considered as an extremely rare locally aggressive bone tumor with the clinical presentation of pain and swelling in the affected site most likely the metaphysic of long bones. Most of the times, a clinical confusion may occur due to the histological and biological similarity with extra abdominal desmoids tumor of soft tissue. In this case report, we define the clinico-pathological and radiographic features of DF of the mandible in a 15- year-old male, who presented to the Outpatient Department with swelling and pain over right wrist. Thus, we present a classic case of DF exhibiting characteristic features along with a review of the literature.

This paper is premised on the findings of a study that sought to find out the challenges faced by Kenyan Interior Designers in relation to their Interior Design Diploma Programmes’ training. The thesis for this paper is that challenges are a reflection of relevant knowledge and skills resulting from having the relevant curriculum and training facilities. As such, acquisition of relevant knowledge and skills by the Kenyan Interior Designers, coupled with the right training facilities and curriculum, leads to minimized challenges thus competences of IDDGs. Consequently, the relevance of the Kenya Interior Design Diploma Programmes to the manpower needs of the industry is therefore enhanced. The study employed a descriptive survey research design and was conducted in Nairobi County, Kenya. 120 Kenyan Interior Design Diploma Graduates formed the study sample. Data was collected using questionnaires, interviews, and observation; analyzed using Statistical Packages for Social Sciences (SPSS version 25) and presented using frequencies. From the study, it was established that KIDDGs face challenges creating detailed drawings from the initial sketches, using CAD, using computer Software applications for 2D & 3D, less team work in construction projects in Kenya between architect and interior designers. Due to inadequate training, majority of KIDDGs cannot deliver given tasks effectively until after retraining. It was also noted that the KIDDGs were looked down upon by architects and other design practitioners during practice making it a challenge to negotiate their salaries. This paper thus calls on the government and the public technical institutions to work towards expanding their contribution of interior design to society through the exchange and development of knowledge and experience in education and practice.

Resistant bacteria are emerging worldwide as a threat to the favorable outcome of common infection in community & hospital settings. Beta-lactams remain a cornerstone for antimicrobial chemotherapy of a large number of bacterial infections. The most common cause of bacterial resistance to β- lactam antibiotics is the production of β- lactamases, followed by ESBL’s and then the emergence of MBL activity which is one of the most feared resistance mechanism, because of its ability to hydrolyze virtually all β- lactams, including cabapenems. However MBL’s are unable to hydrolyze monobactams & are not inactivated by β- lactamase inhibitors like clavulinic acid, sulbactam and Tazobactam. In any nosocomial settings, carbapenems are used as the last resort for treatment of MDR gram negative bacterial infections. MBL producing gram negative bacteria often exhibit resistance to additional classes of drugs and behave as multidrug resistant bacteria. Hence the present study was undertaken for detection of MBL producing gram negative bacilli and to help treating physicians to select appropriate antibiotic in our hospital. It was a prospective study conducted from April 2018 to July 2018 after IEC clearance. The Gram Negative isolates were first screened for MBL production with ceftazidime disc, & were further tested by Combined Disc Test Method (CDT) and Modified Hodge Test (MHT). Total 300 gram negative isolates were studied. In these, the MBL producers were 43.6%, majority of the isolates were from pus (19.3%), followed by urine (14.3%). Amongst these, E. coli was the most common organism isolated (16.3%), followed by Klebsiella pneumoniae(11%) and Pseudomonas aeruginosa (6.6%).By combined disc test a total of 131 MBL producing strains were isolated and 126 strains were detected by MHT. The exposure of bacterial strains to a multitude of β- lactams has induced mutation of β- lactamase in many bacteria, expanding their activity even against carbapenems, by the production of MBL resulting into fewer therapeutic alternatives. Hence detection of MBL is very important in respect to the treatment plan and sparing use of antibiotics to avoid their spread in the hospitals.

Objective: To study the role of IgM enriched IVIg in reducing mortality in neonatal sepsis. Method: It is a prospective randomized study conducted in Special Newborn Care Unit(SNCU) of CNMCH, Kolkata over a period of two years (June 2016 – May 2018).Two groups of 248 newborn each (matched for gestational age, sex, weight and other variables) were randomly allocated to receive either antibiotics alone (control group) and antibiotics plus IgM enriched IVIg intravenously (5ml/kg/day) for 4 days(Immunotherapy Group). Result: Mortality from sepsis in control group was 88/248 (35.5%) of which death from culture proven sepsis was 70/182 (38.5%) and culture negative sepsis was 18/66 (27.3%).In immunotherapy group overall mortality was 40/248(16.1%) of which death from culture proven sepsis was 32/192 (16.7 %) and culture negative sepsis was 8/56(14.2%).Conclusion: We conclude that IgM enriched IVIg therapy in conjuction with antibiotic significantly reduces mortality in neontal sepsis,particularly in culture positive cases.

Programmed cell death 1 (PD-1), and its ligand programmed cell death-ligand 1 (PD-L1), is important for tumor-immune escape. Expression PD-L1 was observed in various solid tumors, including breast cancer (BC). The aim of this study is to examine the expression of PD-1 in tumor infiltrating lymphocytes (TILs) and PD-L1 in tumor cells (TC) in BC cases, to analyze the association between PD-1 and PD-L1 expression and clinicopathological features, as well as to correlate their expression with overall survival (OS). This is a retrospective study that was conducted on 110 cases of BC. Immunohistochemistry was performed to evaluate PD-1 and PD-L1 expression in TILs and TC respectively. There was no significant association between PD-1expression in TILs and clinicopathological variables. The presence of PD-1+ TIL was positively associated with PDL-1 expression in tumor cells; however, this association was not statistically significant (p = 0.062). On the other hand, PD-L1 expression in TC was significantly associated with lymph node involvement (P <0.0001), advanced stage (P = 0.035), high grade (P <0.0001), high TIL (P = 0.009), and negative ER (P = 0.01). BC cases with PD-L1 expression had a significantly worse OS (HR = 0.201; 95% CI [0.048 - 0.112], p <0.000). PD-L1 expression was an independent prognostic factor in multivariate analysis (HR = 0.195; 95% CI [0.058 - 0.655], p =0.008). In conclusion, PD-L1 expression is associated with advanced tumor stage, aggressive subtypes of BC, lymphatic infiltration, and poor OS in BC.

An earthquake is the result of a sudden release of stored energy n the Earth’s crust that creates seismic waves. In term of the earthquake, this study aimed to cluster which areas were the most affected by earthquake occured in Java Province in 2017. The algorithm used in this study was Self Organizing Maps algorithm (SOMs) with Cohonen as a type of Artificial Neural Networks (ANN) that is trained using unsupervised learning in decision making. In addition, the clustering results through its algoritm are functioned as a base of determining the eartquake pattern criteria and which areas often occurred in order to be able to mitigate earthquake that causes fatal impacts.

Primary lymphoma of breast is an uncommon tumour that constitutes 0.04% to 0.5% of malignant breast neoplasms [1]. Here, we present an interesting case of a 28 years old lady who presented with ascites alongwith past history of lumpectomy breast. Her ascitic fluid cytology showed monomorphic malignant tumour cells of poorly preserved morphology. Being suspicious of tumour type, we reviewed the clinical details and past histopathology records of the patient.

Background: Spleen is an essential organ due to its significant role in immunological and haematological functions of the body. Splenic notches on various borders establish the lobulation of the spleen in early life. Aim: To study the morphological and morphometric parameters of the spleen in aborted foetuses Materials and Methods: 30 foetal spleen specimens (Male-14; Female-16) of both sexes from 12-40 weeks of gestational age were obtained from the Department of Anatomy, Santhiram Medical College, Nandyal. The morphometric parameters like length, width, thickness and weight of the foetal spleen were measured and recorded Results: The incidence of wedge shape was 23 (76.66%), the pyramidal shape was 6(20%), and leaf-shaped was 1(3.33%). The incidence of the single notch was observed in 19 (63.33%), two notches in 9(30%), and three notches in 2(6.66%) specimens were found in the present study. The parameters like length, width, thickness, and weight of the fetal spleen were increased in relation to the gestational age in the present study. Conclusion: The present study acknowledges the anatomical and morphological basis of the spleen may be helpful for the surgeons while doing partial splenectomy in the removal of the affected segment by ligating the segmental branch of the splenic artery.

Introduction: Bronchoscopy is a valuable diagnostic tool and has a significant clinical impact on the management of pneumonia, especially ventilator-associated pneumonia in ICU patients who fail to respond to standard, guideline-based therapy. The investigation of bronchial alveolar lavage (BAL) specimens involves an extensive laboratory work. Currently, there are very few published studies evaluating the diagnostic benefit of collecting multiple BAL specimens during bronchoscopy. These redundant specimens result in a significant workload increase for the diagnostic microbiology laboratory. Objective: To investigate the optimal number of specimens for bacteriology, virology, mycology, Pneumocystis jirovecii (PJP) and Legionella penumophila specimens in order to optimize the utility of BAL specimens with the aim of minimizing harm to the patient and optimizing resource utilization for the laboratory. Method: BAL specimens collected at an academic institution in Southern Ontario were reviewed retrospectively over a 15 month period for bacteriology, 16 months for virology, one year for mycology, and three years for L. pneumophila and P. jirovecii. Results: One thousand sixty-three BAL specimens were ordered for bacterial culture, yielding positive results in 45.5%. Among them, a concordance rate of 97.1% was found between two or more specimens acquired from different lung lobes. The concordance rate of multiple virology samples was 98.6% among patients in whom 2 specimens were collected per procedure, and 100% among those with 3 specimens per procedure. To study whether one specimen is sufficient for the detection of filamentous fungi, we reviewed 43 BAL samples which grew Aspergillus fumigatus between. A concordance rate of only 60% was found between two specimens obtained from different lung lobes. A concordance rate of 100% was found among multiple specimens ordered for L. pneumophila and P. jirovecii with positivity rates of 0.14% and 0.92% respectively. Conclusion: We recommend a single specimen per BAL be sent from the most purulent lung segment for bacteriology and viral PCR. Single specimens may also be appropriate for L. pneumophila and P. jirovecii, however further study is needed. Multiple specimens should be submitted for mycology investigations. By eliminating duplicate specimens laboratory utilization can be optimized and patient morbidity may be decreased.