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.

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.

Analysis of The Relationship Between Compliance in Taking Pulmonary Tuberculosis Medication in East Kolaka District

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Tuberculosis is still a global health problem today. 5.8 million in 2020 and 6.4 million in 2021. The number of 2022 is a large number of people suffering from TB in the previous year. people diagnosed with TB in the world as many as 7.5 million people in 2022. This study is to analyze the relationship between adherence to taking pulmonary tuberculosis medication in East Kolaka Regency. This study was conducted in six working areas of the East Kolaka Regency Health Service, namely at the Tirawuta Health Center, Tinondo Health Center, Lalolae Health Center, Mowewe Health Center, Sanggona Health Center, and Ueesi Health Center in May – June 2024. This type of research is a study using a Cross Sectional Study approach with univariate, Bivariate, and Multivariate analysis. the population is 59 patients spread across six working areas of the East Kolaka Regency Health Service. Chi-Square Test Results of knowledge (P-Value 0.004<0.05), Family Support (P-Value 0.000<0.05), Role of Health Workers (P-Value 0.325), Stigma (P-Value 0.008<0.05), Access (P-Value-0.000<0.05), Income (P-Value-0.002<0.05), Medical Costs (P-Value0.003<0.05). The dominant variable is related to Access to Health Facilities with an OR value of 22.818. Access to health facilities is the main point in obtaining optimal health services. Compliance with taking tuberculosis medication is the basis for the success and completion of tuberculosis disease, it is expected that related parties will provide more emphasis on the consequences of non-compliance with taking tuberculosis medication.

The Development of Problem Based Learning Materials to Improve Students’ Logical Mathematical Intelligence on SPLTV

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The research was conducted with the aim of developing valid, practical, and effective PBL learning materials for SPLTV subjects. The development of learning materials aims to improve students’ logical mathematical intelligence. This research is a type of development research with the 4D Thiagarajan model with the stages of define, design, develop, and disseminate. The learning materials produced include teaching modules, students worksheet, learning videos, test packages, and instruction manuals for using learning materials. Data collection was carried out using observation, questionnaire, and test methods. The results of the study showed that the learning materials developed were valid, practical, and effective. The level of validity can be seen from the validity value of each tool as follows, teaching modules of 3,79, students worksheet of 3,82, test packages 3,86, and instruction manuals 3,75. The level of practicality can be seen from the results of observations of the implementation of learning materials with an average of 3,43. The level of effectiveness of the materials can be seen from the results of student learning completion with a classical completion percentage of 84,6%, the N-Gain category is high with a student percentage of 97,29%, students’ logical mathematical intelligence activities are in the good category with a percentage of 84,33%, and the percentage value of student responses is 92,05% with a positive response.

Biosynthesis of Ag-nanoparticles from North Central Nigerian Propolis Extract as Highly Efficient Anticorrosion Additive of Carbon Steel in Acidic Medium

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Metals in use begin to corrode as soon as they come in contact with a hostile environment. This drastically reduces the useful life of metallic materials, affecting home and industrial properties. In addition to the high cost of production, inorganic corrosion inhibitors are known to be harmful to the ecosystem, thus the need for low-cost, efficient, and environmentally friendly alternatives. Due to their high surface-to-volume ratio and capacity to create self-assembled films on metal surfaces, benign nanoparticles present a good alternative. In this study, North Central Nigerian propolis Extracts (NCNPE) were utilized to synthesize silver nanoparticles and were characterized spectroscopically. The North Central Nigerian propolis Extracts-Silver Nanoparticles composites (NCNPE -AgNPs) were then tested for corrosion-inhibitive potentials in HCl solution. The surface plasmon resonance (SPR) absorption bands were obtained at around 422 nm. The XRD results showed that the resultant crystalline NCNPE -AgNPs has FCC structure, with a mean nanoparticle size of 1.36128 ± 0.04962. The STEM image revealed several oval structures that were densely filled with AgNPs, which appeared as white spots, with patterns that appeared homogeneous. In the presence of 1000 ppm NCNPE -AgNPs, the results showed high inhibition efficiency of 86.49 and 96.44 % for EIS and gravimetric technique, respectively. Also, the thermodynamic and adsorption characteristics of NCNPE -AgNPs on CS in HCl solution were calculated. It was discovered that the NCNPE -AgNPs performed well as an inhibitor of CS corrosion in HCl.

The Addition of Lauric Acid from DPKFA (Distilled Palm Kernel Fatty Acid) as A Feed Additive on The Physiological Responses of Broiler

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The aim of the research is to examine the effect of adding additive products to feed on the physiological responses of broilers during 1 (one) rearing period including rectal temperature, shank temperature, comb temperature, respiratory frequency and heart rate frequency. The research was conducted from September 21 to October 26, 2024 in Mr. Soleh’s Farm. Kidal Village, Tumpang District, Malang Regency, East Java. The material used in this study was non-sexing DOC (Day Old Chick) strain Lohmann from PT Japfa Comfeed Tbk. A total of 300 broilers with a body weight diversity coefficient of less than 10% were reared for 35 days. This study used 6 treatment groups, each consisting of 5 replicates including T0 (Basal feed as control treatment), T1 (Basal feed + zinc bacitracin 0.1% as positive control treatment), T2 (Basal feed + 0.05% feed additive product), T3 (Basal feed + 0.10% feed additive product), T4 (Basal feed + 0.15% feed additive product) and T5 (Basal feed + 0.20% feed additive product). The data obtained were analyzed using analysis of variance (ANOVA) and continued with Duncan’s Multiple Range Test (DMRT) if there was a significant effect. The results showed that the addition of DPKFA-based feed additive products with high lauric acid content in the feed did not significantly affect the physiological response of broilers (P>0.05). The provision of additives with the highest concentration helps to optimize the physiological response of broilers so that this product can be recommended as a substitute for the role of AGP to support the performance of broiler production and health.