Bay College

Gastric Adenocarcinoma with enteroblastic differentiation (GAED) is a rare subtype of alpha fetoprotein-producing gastric cancers characterized by a tubulo-papillary pattern resembling fetal gastrointestinal epithelium. It expresses at least one of the following enteroblastic markers (EMs): glypican-3 (GPC3), spalt-like transcription factor 4 (SALL4), and α-fetoprotein (AFP). A 78-year-old man with a history of chronic dry cough was found to have multiple lung nodules on Chest X-ray and CT, suspicious for a malignancy. Therefore, percutaneous biopsy of the lung nodule was performed which showed CDX-2 positivity on immunohistochemistry (IHC). Next Generation Sequencing (NGS) and Caris GPSai were inconclusive. Therefore, a search for the primary site was initiated. Endoscopy revealed a fungating mass at the gastroesophageal junction while colonoscopy was unrevealing. Histology revealed well-differentiated adenocarcinoma with mucinous features. IHC was positive for SALL-4 and GPC3. HER2 expression returned a 3+ score. Alpha-fetoprotein (AFP) level was elevated. The patient was started on capecitabine and oxaliplatin in addition to trastuzumab with subsequent clinical and radiological improvement. Lung malignancy, primary or metastatic, can present as chronic cough. It is imperative for patients to undergo a thorough workup for a timely diagnosis. IHC plays a vital role in delineating the origin of the malignant cells. GPC3 expression is the most sensitive marker for GAED. High serum AFP levels directly correlate with the strength of immunostaining and are associated with a poor prognosis. High HER2 expression and PDL-1 immunostaining is commonly seen in GAED cases with the most common mutation being p53. Currently, there are no set guidelines for management of GAED. Unresectable, metastatic HER2 positive conventional adenocarcinoma is being managed using platinum-fluoropyrimidine doublet therapy with anti-HER2 monoclonal antibody trastuzumab. This case report calls for aggressive IHC staining for prompt diagnosis where necessary as well as proper guidelines for management.

Purpose: Using yearly data from 1980 to 2020, this study investigates the macroeconomic factors influencing Sierra Leone's balance of payments (BoP). The purpose is to determine the main macroeconomic determinants affecting Sierra Leone's external sector performance in order to address the paucity of empirical data on BoP dynamics in post-conflict nations. Methodology: Both short- and long-term relationships between BoP and its determinants—real GDP, foreign direct investment (FDI), real interest rate, official effective exchange rate (OEEXR), and the external balance on goods and services (EBGS)—are estimated using the Autoregressive Distributed Lag (ARDL) bounds-testing approach. Findings: The results show that while FDI has a negative impact on the BoP because of its link to import-intensive businesses and profit repatriation, real interest rates and exchange rate fluctuations have a considerable short- and long-term impact on the BoP. Unique Contribution to Theory, Practice and Policy: While EBGS is statistically insignificant, real GDP exhibits a favorable long-term effect. In order to guarantee a sustainable external balance, the study recommends preserving currency rate stability, encouraging export diversification, and creating FDI policies that improve domestic ties and lessen reliance on imports.

Background: ARDS affects 200,000 patients annually with 35-60% mortality. Cardiac dysfunction occurs in 60-78% of patients, yet systematic monitoring exists in <30% of ICUs despite point-of-care echo availability in 85% of facilities. This represents a critical quality gap with immediate improvement opportunity using existing technologies. Objective: Systematically evaluate cardiac monitoring evidence in ARDS and develop practical implementation framework for immediate deployment across diverse ICU settings using currently available technologies. Methods: Systematic search of MEDLINE, EMBASE, Cochrane through November 2024 for studies evaluating cardiac monitoring in ARDS using standard ICU equipment. Included RCTs and observational studies (≥20 patients) assessing cardiovascular effects of ventilation strategies. Evidence quality assessed using GRADE methodology. Surveyed technology availability and developed tiered protocols based on resource capabilities. Results: Seven studies (892 patients, low-moderate evidence quality) demonstrated cardiac dysfunction associated with increased mortality (OR 2.3, 95% CI: 1.6-3.2) but significant implementation gaps. Point-of-care echo available in 85% of ICUs, cardiac biomarkers in 98% of hospitals, yet protocols exist in <30%. Developed three-tier framework: Tier 1 (basic assessment, >95% ICUs, 6-12 months, <$50,000), Tier 2 (enhanced monitoring, 60-70% ICUs), Tier 3 (advanced centers). Barriers were organizational rather than technological. Conclusions: Despite limited evidence, immediate systematic cardiac monitoring implementation is feasible using existing technologies. Three-tier framework addresses resource limitations through scalable protocols. Pilot implementation in motivated centers could demonstrate feasibility while generating real-world evidence, transforming evidence limitations into quality improvement opportunities. Impact: Could improve recognition in 140,000 ARDS patients annually, potentially reducing mortality and ICU length of stay while establishing infrastructure for future research.

Bacterial infections are very commonly acquired infections. Cephalosporins are broad-spectrum antibiotics used to manage a wide-variety of infections caused by gram-positive and gram-negative bacteria. The knowledge of the basic chemistry helps in understanding the pharmacokinetic, antimicrobial and toxicological profiles of cephalosporins. Cephalosporins are antibiotics with bactericidal activity which act by inhibiting the synthesis of cell wall in bacteria. The drugs of this class are classified into five generations in which the antimicrobial spectrum shifts from gram-positive bacteria to gram-negative bacteria with increasing generations of Cephalosporins. Antibiotic-producing bacteria contain a wide range of complex defense mechanisms to protect themselves from their own antibiotics and it results in the development of antibiotic resistance. The various mechanisms by which bacteria develop resistance are: production of β-lactamases, alteration of the porin channels, alteration of molecular structure of transpeptidase, and upregulation of cephalosporin efflux pumps. The new cephalosporins are the foundation for the real warning signs to open up new and interesting possibilities for serious infections in the future thereby ensuring rational selection of antibiotics for various infections.

Genotoxicity is described as the property of the agent to cause changes in the genetic material leading to damage in the genetic information, such agents are called as genotoxins. This property is much seen in drugs that are used in the treatment of cancer. Cyclophosphamide is an anticancer drug that lead to gene toxicity through formation of its metabolites and generation of reactive oxygen species and free radicals that damage the genetic material. The main objectives of this research is to evaluate the effect of Momordica cymbalaria (10mg/kg and 50mg/ kg) on cyclophosphamide induced genotoxicity and also to study the genotoxic effect of Momordica cymbalaria (50mg/kg) without Cyclophosphamide treatment. The dose selection was made based on previous acute toxicity report. Animals were treated with Momordica cymbalaria and bone marrow cells were been isolated to observe the effect of drugs on the chromosomes and cellular division through chromosomal aberration assay and micronuclei assay respectively. Effect of drugs on the anti-oxidant enzymes such as glutathione and cellular lipid peroxidation was studied using the liver homogenate. The test drug Momordica cymbalaria showed significant genoprotective effect in dose dependent manner against the chromosomal aberrations and micronuclei formation induced by Cyclophosphamide. And also there was significant inhibition of lipid peroxidation and rise in GSH levels indicating the anti-oxidant property of the test drugs. The drugs Momordica cymbalaria has significant gene protecting effect in cells from Cyclophosphamide induced genotoxicity

Noni juice is a globally popular health beverage originating in the tropics and used since long in traditional medicines in certain areas around the globe. A review published that noni juice may provide protection against tobacco smoke-induced DNA damage, blood lipid and homocysteine elevation as well as systemic inflammation. Morinda citrifolia contains phytochemicals that own antibacterial, antiviral, antifungal, antitumor, anthelminthic, analgesic, hypotensive, anti-inflammatory, immune enhancing effects, improve joint health, increase physical endurance, increase immune activity, inhibit glycation of proteins, aid weight management, help maintain bone health in women, help maintain normal blood pressure and improve gum health. It has comparatively more antioxidant property. It has very good interaction with the immune system. Fruits, seeds, barks, leaves and flowers have good therapeutical values; out of which fruits are more important therapeutically. Keywords: antioxidant, clinical trial, immune system, inflammation, Morinda citrifolia , noni juice Cite this Article Zeel K. Shah. Review on Morinda citrifolia L.—Noni Juice. Research & Reviews: A Journal of Pharmacognosy . 2020; 7(1): 55–60p.

New public management is a major paradigm in public administration, and its widespread adoption has been explained by institutional theory. However, most studies treat adoption as a discrete event and cannot explain why some organizations are moving away in the face of isomorphic pressure. We investigate three dimensions of isomorphism—convergence, compliance, and commitment—and test their separate effects on interorganizational similarity in adopting private service delivery, a primary form of outsourcing, among U.S. local governments. This study contributes to the literature by demonstrating the multiplicity of isomorphism and by showing how variation occurs in the isomorphic process.

Whether you are a new employee or seasoned professional you need easy access to the latest test methods, updated quality control procedures, and calculations at your fingertips. You need to perform analyses quickly and easily and troubleshoot problems as they arise. You need a resource that is not only informative, but also practical and easy to use. Drinking Water Chemistry: A Laboratory Manual fills this need.The book gives you a thorough overview of the most basic, and therefore important, laboratory topics such as:Laboratory Safety - dos and don'ts based on real experienceSampling - preservation techniques, online sampling, and record keepingLaboratory Instruments - practical use ranges, principles of operation, calibration, conditioning, useful life and replacement, common quality control issuesChemical Use - reagents, standards, indicators, purpose and use, chemical quality and properties, avoidance of contamination, molecular weight calculationsQuality Control - replicate analyses, spiked, split, and reference samples, percent recovery of standard, standard deviation, control charts, and everyday quality control measuresWeights and Concentrations - care and analytical balances, mathematical conversions among concentration units, dilutions and concentration changesThe remaining chapters cover test analysis including: reason for the test, type of sample taken, treatment plant control significance, expected range of results, appropriate quality control procedures, apparatus used, reagents, including function, concentration and instructions for preparation, procedural steps, calculations and notes on possible problems, and references. This is a working manual, meant to be kept by your side in the lab, not on the shelf in an office or library. You can bend it, you can lay it flat, you can take it anywhere you do your job. Useful and practical Drinking Water Chemistry: A Laboratory Manual provides the information you need to perform tests, understand the results, apply them to the determination of water quality before and after treatment, and troubleshoot any problems.