Analysis of Cash Expenditure Accounting Information Systems to Improve Internal Control Activities at Medan Plus Rehabilitation Center Foundation

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This study aims to analyze the accounting information system for cash disbursements in enhancing the effectiveness of internal control activities at the Medan Plus Rehabilitation Foundation. Financial management, particularly in cash disbursement, is a crucial aspect in ensuring accountability and operational efficiency within the organization. The current financial recording system, which relies on Microsoft Excel, has several limitations such as a high risk of input errors, absence of audit trails, weak access controls, and delays in financial reporting. This research uses a qualitative approach with descriptive analysis methods. Data collection was conducted through interviews and documentation involving four key respondents in the foundation’s finance department. The results indicate that the current accounting information system for cash disbursement does not fully support optimal internal control activities. Authorization, segregation of duties, supervision, accounting records, access control, and independent verification still require improvement. An integrated and automated accounting information system is needed to enhance transparency, accuracy, and reliability of financial information, as well as to strengthen the overall internal control system.

Pulmonary Tuberculosis Revealed by A Fusiform Coronary Aneurysm in A Patient with Acute Myocardial Infarction

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Background: Coronary artery aneurysms (CAA) are rare (0.3 – 4.9 % of angiograms) and most often due to atherosclerosis. Granulomatous infections such as tuberculosis (TB) are an exceptional cause.

Case summary: A 53-year-old Mexican man presented with an extensive anterior ST-segment-elevation myocardial infarction. Coronary angiography revealed an 8-mm fusiform aneurysm in the proximal left-anterior-descending artery with preserved TIMI III flow and no obstructive lesions. Targeted history uncovered a two-year chronic cough and weight loss. Serial sputum smears were negative, but GeneXpert MTB/RIF was positive, confirming pulmonary TB. First-line antituberculous therapy was initiated; the patient remained hemodynamically stable without recurrent ischemia.

Discussion: In TB-endemic regions, Mycobacterium tuberculosis should be considered when a CAA lacks an atherosclerotic explanation. Advanced imaging plus microbiologic testing allows accurate diagnosis and may avert unnecessary coronary intervention, as antituberculous therapy alone can lead to aneurysm regression.

Learning points: Non-atherosclerotic CAAs mandate a broad etiologic work-up, including infections. Pulmonary TB may present solely with cardiovascular complications. GeneXpert MTB/RIF is a rapid, sensitive tool in acute settings. Multidisciplinary management (cardiology + infectious diseases) could optimize outcomes.

An Audit to Compare the Availability and Distribution of Human Resources for Eye Care in Orlu and Owerri Metropolis in South-Eastern Nigeria Using Vision 2020 Standards as Benchmarks and Literature Review

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AIM: The purpose of this study was to compare the availability and distribution of the various cadres of eye care workforce in Orlu, a sub-urban setting and Owerri metropolis, an urban setting in Imo State, in South Eastern Nigeria, using Vision 2020 standards as benchmarks with Literature review.

Methodology: Two areas in Imo State, namely Orlu and Owerri metropolis were used in this study. This was both a quantitative and qualitative cross-sectional survey. The quantitative data was assessed by distributing interviewer-administered questionnaires to the different categories of eye care workers (ECWs) in the various public health care facilities used in the study. The questionnaires contained sub-sections on the subjects’ sex, age, religion, marital status, level of education, years in service, location of residence, and training in eye care. The qualitative research covered training in eye careappropriateness to job postings as well as sponsorship to updates and workshops/refresher courses  by the various cadres  of eye care workers in the health care facilities under study, using focus group discussions (FGDs) and in-depth interviews (IDIs) .The qualitative interviews of the participants covered the state of study, the study area, type of health facility, sex, type of interview and the category of eye care worker (ECW) and the serial number of the interviewed participant.

Results: The results of the study showed that the eye care workers (n=271) working in 28 public health care Institutions included 45(16.6%) males and 226(83.4%) females with age range of 20-65years, and modal age range of 30-39years, with a mean age of 42.23±11.0 S.D. years. A large proportion 216(79.7%) of ECWs were married and most 206(76.0%) of the workers had tertiary education. A large proportion 170(62.7%) of the ECWs live in Owerri and the same number(62.7%) also work in Owerri, and 102(37.6%)were integrated eye care workers(IECWs). The qualitative survey also showed that some of the workers were not appropriately posted to their areas of specialization, not trained in eye care and were not sponsored to updates, workshops/ refresher courses and seminars.

Conclusion: The results of the study showed a skewed distribution of ophthalmic nurses, optometrists and ophthalmologists in favour of the urban, Owerri . However, the eye care personnel to population ratio could not be fully ascertained in this study due to non-contribution from privately-owned clinics which were not  included in this study. The obvious health care manpower mal-distribution gap could be urgently addressed through adequate provision of social amenities like safe water/electricity, recreational facilities, establishment of industrial estates in Orlu and other rural areas Imo State to generate employment opportunities to minimize the prevailing rural-urban drift of health care manpower. Training of eye health personnel (human resource development), one of the key goals of Vision 2020 was not met, but can be improved through re-training and in-service training with motivations and inducements in form of sponsorships to updates, workshops and refresher courses.  Additionally, the integration of primary eye care into the health care system of the state will go a long way in closing the existing health care gaps and by extension, the socio-economic gaps that exist between the more economically endowed Owerri and the rural population in Orlu, as it is popularly said that “health is wealth”.

Response to DOAC Treatment in A Patient with Biventricular Thrombus Secondary to Heart Failure with Reduced LVEF of Ischemic Etiology

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Current evidence regarding the use of direct oral anticoagulants (DOACs) in the presence of left ventricular thrombus is primarily derived from observational studies with positive results in different meta-analyses that suggest a possible role for treatment.

We present the case of a 54-year-old female with a history of arterial hypertension and diabetes mellitus recently diagnosed, who came for medical evaluation due to deterioration of functional class. Electrocardiogram in sinus rhythm with anterior bundle branch block.

Immunopathology and Laboratory Diagnosis of Rheumatoid Arthritis: A Review of Literature

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This review explores rheumatoid arthritis, an autoimmune disorder whose immunopathology involves a convergence of genetic susceptibility (notably HLA-DRB1 shared epitope alleles) and environmental exposures (smoking, infections) leading to an aberrant immune response. RA is a prevalent autoimmune disease globally, and though historically considered uncommon in Africa, emerging data show it is an important and likely under-recognized health issue in regions like Nigeria. Epidemiologically, ~0.5% of the world’s population is affected with millions suffering chronic pain and disability. In Africa and Southeastern Nigeria, true prevalence is uncertain due to diagnostic gaps, but RA cases are increasingly reported as awareness grows. Autoimmune processes – generation of RF and ACPA autoantibodies, activation of T cells and macrophages, and a cytokine-driven inflammation – result in synovial damage and systemic effects. Understanding these mechanisms explains why specific biomarkers (RF, ACPA) are useful in diagnosis and why therapies targeting cytokines (like TNF or IL-6 inhibitors) are effective. In laboratory diagnosis, we identified the core tools: RF and ACPA testing for confirming autoantibodies, ESR and CRP for gauging inflammation, and newer panels for disease activity. In resource-constrained settings, basic assays can be performed with relatively low-cost methods (e.g. ESR by Westergren, RF by latex agglutination), but introducing more specific tests like anti-CCP is vital for improving diagnostic specificity. We provided practical outlines for these assays, emphasizing adherence to SOPs and quality control to ensure accuracy of results.

Chronic Inflammatory Response Syndrome (CIRS): A Review of Diagnosis, Immunological Mechanisms and Treatment Challenges

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Chronic Inflammatory Response Syndrome (CIRS) is an emerging and controversial condition characterized by a multi-system, multi-symptom illness triggered primarily by biotoxin exposure, particularly from water-damaged buildings (WDB). First described by Dr. Ritchie Shoemaker, CIRS is thought to result from a genetically predisposed individual’s inability to eliminate biotoxins effectively, leading to chronic immune activation. Despite increasing patient reports and clinical attention, CIRS remains a contentious diagnosis due to its complex symptomatology, lack of standardized diagnostic criteria, and limited recognition in mainstream medicine. This review aims to explore the underlying immunological mechanisms, examine the diagnostic challenges and controversies, and highlight the significant treatment gaps that impede effective management. A growing body of evidence supports the biological plausibility of CIRS, particularly involving innate immune dysregulation, complement activation, and cytokine imbalances. However, further research, standardized guidelines, and consensus in the medical community are urgently needed to validate and manage this debilitating condition.

Feasibility of Steam-Based IPAS Learning Module in Developing Critical Thinking Skills of Grade V Elementary School Students

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STEAM-based learning modules are a phenomenon as a medium for developing critical thinking skills in learning Science of Nature and Social Sciences (IPAS) in elementary schools (SD). The purpose of this study was to describe the feasibility of developing STEAM-based IPAS learning modules as a medium for developing critical thinking skills. The type of research is Research and Development (R&D). Data were collected through expert validation questionnaires and tests. The results showed that the validation scores for all experts were greater than 0.80, meaning that the IPAS learning module was valid for data collection; Student response questionnaire> 80%, meaning that the readability of the IPAS learning module has good criteria; Increased average learning outcomes of 33.41 and a decrease in standard deviation of 3.646; The results of hypothesis testing obtained data calculated significance value (0.000) <0.05 or absolute t count (23. The conclusion of the research is that the STEAM-based IPAS learning module can be interpreted as feasible to be used as learning media in developing critical thinking skills, because it has fulfilled the validity aspects, practicality aspects, and effectiveness aspects.

Acute and Sub acute Toxicity Studies of Euphorbia hirta on Mice and Wistar rats

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This study aimed at evaluating the acute and subacute toxicity of the aqueous leaf extract of Euphorbia hirta in experimental animals. For acute toxicity assessment, mice were orally administered single doses of 2000 and 3000 mg/kg  body weight (bw), with the administration volume set at 1 mL/100 g bw. A limit test was conducted to estimate the median lethal dose (LD₅₀). In the subacute toxicity study, rats received daily oral doses of 500, 1000, 2000 and 3000 mg/kg bw for 28 consecutive days. A control group received distilled water. Biochemical parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), Alanine phosphatase (ALP), Total protein, creatinine and Urea were analyzed in plasma samples. Hematological parameters such as red and white blood cell counts, hemoglobin, hematocrit and platelets were also evaluated. Histopathological examination of the liver and kidneys was performed to assess organ-specific toxicity. The results indicated that the LD₅₀ of the aqueous extract of Euphorbia hirta is greater than 3000 mg/kg, suggesting low acute toxicity. In the subacute study, histological examination of rat organs revealed no acute or chronic damage, although minor liver changes such as sinusoidal dialatation and mild portal inflammation were observed at high doses which is supported with elevated AST and ALT. In conclusion, the toxicological profile indicates that these extracts are safe at tested doses, although higher concentrations may warrant caution due to mild histological and biochemical changes.

The Effect of Substituting Concentrate with Different Levels of Gliricidia sepium Leaves in a Complete Feed on Nutrient Content, Crude Fiber Fractions, Digestibility, and In Vitro Fermentation Products

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The objective of this study was to evaluate the effect of substituting concentrate with different levels of Gliricidia (Gamal) leaves in a complete feed on nutrient content, fiber fractions, digestibility, and fermentation products through in vitro analysis, as well as to determine the optimal level of Gliricidia leaf inclusion for producing high-quality complete feed. The method used in this study was a field experimental method for feed preparation, employing a Completely Randomized Design (CRD) to analyze nutrient content, crude fiber fraction components, and in vitro observation variables with four treatments and four replications. The highest NDF and ADF contents were observed in the control diet (P0), at 41.49% and 25.21%, respectively, while the lowest values were found in the P3 treatment, at 26.08% and 21.60%. Based on the analysis of variance, the dry matter digestibility (DMD) and organic matter digestibility (OMD) showed significant differences (P<0.01), with the P3 treatment having the highest values of 66.34% and 71.43%, respectively. Gas production from the 2nd to the 48th hour showed significant differences (P<0.01). The treatment diets showed a significant effect (P<0.01) on DMD and OMD, with the highest values in P3 (75.88% and 82.79%). Ammonia (NH₃) concentration measurements also showed significant differences (P<0.01). The results of microbial protein synthesis measurement after 48 hours of incubation showed a P-value > 0.05, with the highest value observed in treatment P3 at 44.024 g N/kg OMTR.

Building an Entrepreneurship Tradition Among Youth in Bondowoso Regency, Indonesia

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This study investigates the development of an entrepreneurial tradition among youth in Bondowoso Regency, Indonesia, in 2024. Drawing upon a qualitative methodology with a phenomenological approach, the research aims to understand the meanings and experiences of young entrepreneurs in the region. The findings highlight the interplay between supportive structures (family, education, social networks, and policy) and individual agency (rationalization, motivation, and reflective monitoring) in fostering entrepreneurial spirit. This study emphasizes the need for a comprehensive approach that integrates both structural support and individual capacity building to cultivate a robust entrepreneurial ecosystem among the youth.