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Tobacco leaf contains antibacterial secondary metabolite compounds, such as phenol, alkaloids, and essential oils. This study compares the potential antibacterial effects of Indonesian tobacco leaf extracted using the heat reflux method (producing an extract) and pyrolysis method (providing a bio-oil). The tobacco leaf extract was challenged against Staphylococcus aureus ATCC 25923, Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853. The bio-oil from the pyrolysis method showed inhibitory Kirby Bauer zones higher than those of the extract from heat reflux method, with the maximum results in the pyrolysis method indicating zones of 6.35 mm (S. aureus), 5.90 mm (E. faecalis), 3.97 mm (E. coli), and 5.025 mm (P. aeruginosa). Further study analyzed the effectiveness of the disc and well diffusion antibacterial test methods for measuring the antibacterial effect of bio-oils against Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. The bio-oil used in the well diffusion test method showed the most significant antibacterial effectiveness. It showed the biggest inhibition zone, with a maximum of 11.65 mm and 8.90 mm for E. coli and P. aeruginosa. Our results showed Nicotiana tabacum var. Virginia Bio Oil from Ponorogo (Indonesia) is a strong potential antimicrobial, especially using well diffusion test.

Abstract Introduction Early diagnosis of tuberculosis (TB) and universal access to drug-susceptibility testing (DST) are critical elements of the WHO End TB Strategy. Current rapid tests (e.g., Xpert® MTB/RIF and Ultra-assays) can detect rifampicin resistance-conferring mutations, but cannot detect resistance to Isoniazid and second-line anti-TB agents. Although Line Probe Assay is capable of detecting resistance to second-line anti-TB agents, it requires sophisticated laboratory infrastructure and advanced skills which are often not readily available in settings replete with TB. A rapid test capable of detecting Isoniazid and second-line anti-TB drug resistance is highly needed. Methods We conducted a diagnostic accuracy study to evaluate a new automated Xpert MTB/XDR 10-colour assay for rapid detection of Isoniazid and second-line drugs, including ethionamide, fluoroquinolones, and injectable drugs (Amikacin, Kanamycin, and Capreomycin). Positive Xpert MTB/RIF respiratory specimens were prospectively collected through routine diagnosis and surveillance of drug resistance at the Central TB Reference Laboratory in Tanzania. Specimens were tested by both Xpert XDR assay and LPA against culture-based phenotypic DST as the reference standard. Findings We analysed specimens from 151 TB patients with a mean age (SD) of 36.2 (12.7) years. The majority (n = 109, 72.2%) were males. The sensitivity for Xpert MTB/XDR was 93.5% (95% CI, 87.4–96.7); for Isoniazid, 96.6 (95% CI, 92.1–98.6); for Fluoroquinolone, 98.7% (95% Cl 94.8–99.7); for Amikacin, 96.6%; and (95% CI 92.1–98.6) for Ethionamide. Ethionamide had the lowest specificity of 50% and the highest was 100% for Fluoroquinolone. The diagnostic performance was generally comparable to that of LPA with slight variations between the two assays. The non-determinate rate (i.e., invalid M. tuberculosis complex detection) of Xpert MTB/XDR was 2·96%. Conclusion The Xpert MTB/XDR demonstrated high sensitivity and specificity for detecting resistance to Isoniazid, Fluoroquinolones, and injectable agents. This assay can be used in clinical settings to facilitate rapid diagnosis of mono-isoniazid and extensively drug-resistant TB.

Background: The Corona Virus Disease 2019 (COVID-19) pandemic is causing problems in public health. One of the prevention efforts is vaccination. Omicron, the new variant of COVID-19, is a variant that is spreading rapidly in Indonesia, including in Riau Province. Purpose: This study aims to describe the determinants of vaccination status in deaths of Omicron variant COVID-19 patients in Riau Province from February to April 2022. Methods: Cross-sectional research was conducted using secondary data. A total of 158 patients who died with confirmed COVID-19 and the Omicron variant via S-Gene Target Failure (SGTF) and sequencing test, and were treated at a referral hospital in Riau Province within two months (8 February – 4 April 2022) were included in the study. The distribution of patient deaths was analyzed univariately and bivariately. Results: Most of the death cases were unvaccinated (67.09%). As many as 48.73% of the 158 deaths were elderly ≥61 years, and the majority (70.13%) of cases were unvaccinated. It was found that 64.56% of the 158 patient deaths occurred in mainland Riau, and the majority (67.65%) were unvaccinated. Diabetes mellitus (35.86%) and cardiovascular disease (28.97%) were the highest comorbidities. Conclusion: In preventing deaths due to COVID-19, it is necessary to accelerate and increase vaccination coverage, especially for children and the elderly in land and coastal areas. Vaccination can optimize protection against COVID-19. Apart from that, efforts are needed to prevent the severity of comorbidities.

Abstract Background Eliminating hepatitis B virus (HBV) is a significant worldwide challenge requiring innovative approaches for vaccination, screening, disease management, and the prevention of related conditions. Programs that support patients in accessing needed clinical services can help optimize access to preventive services and treatment resources for hepatitis B. Methods Here, we outline a coordinator-supported program (HBV Pathway) that connects patients infected with HBV to laboratory testing, imaging, and specialty care for treatment initiation and/or liver cancer surveillance (screening of high-risk patients for liver cancer). This study describes the HBV Pathway steps and reports sociodemographic factors of patients by initiation and completion. Results Results showed a 72.5% completion rate (defined as completing all Pathway steps including the final specialty visit) among patients who initiated the Pathway. Differences in completion were observed by age, race, ethnicity, and service area, with higher rates for younger ages, Asian race, non-Hispanic ethnicity, and lower rates for patients within one service area. Of those who completed the specialty visit, 59.5% were referred for hepatocellular carcinoma surveillance. Conclusions The HBV Pathway offers dual benefits– care coordination support for patients to promote Pathway completion and a standardized testing and referral program to reduce physician burden. This program provides an easy and reliable process for patients and physicians to obtain updated clinical information and initiate treatment and/or liver cancer screening if needed.

The objective of this study is to develop an improved shoe insole that enhances heat and moisture transmission (thermo-physiological comfort) qualities, as well as its mechanical characteristics, through the utilization of weft knitting spacer fabric. Two samples were prepared. One sample was comprised of Tri-Blend knitted fabric layers, while the other sample was made using cotton knitted fabrics in both layers. These layers, in both samples, were connected by spacer yarns of monofilament nylon. Tri-blend fabric was made from Bamboo (80%), flax (15%), and polypropylene (5%). Monofilament nylon was used in spacer layer. Thermo-physiological comfort testing i.e., air permeability, moisture management and thermal resistance test were performed for all the samples. The investigation also established the correlation between the mechanical properties, such as puncture resistance and tactile comfort, of footwear materials and their interaction with the human body. The prepared samples of shoe insole were also compared with the commercially available insoles made from synthetic materials. The outcome of the study suggests that the natural fiber spacer fabric can be used as an alternative to rubber. In conclusion, the results of this study offer valuable insights for product developers seeking sustainable alternatives that can meet consumer demands for both wearability and comfort.

Background. The COVID-19 pandemic has led to an increase in SARS-CoV-2–test positive potential organ donors. The benefits of life-saving liver transplantation (LT) must be balanced against the potential risk of donor-derived viral transmission. Although emerging evidence suggests that the use of COVID-19–positive donor organs may be safe, granular series thoroughly evaluating safety are still needed. Results of 29 consecutive LTs from COVID-19–positive donors at a single center are presented here. Methods. A retrospective cohort study of LT recipients between April 2020 and December 2022 was conducted. Differences between recipients of COVID-19–positive (n = 29 total; 25 index, 4 redo) and COVID-19–negative (n = 472 total; 454 index, 18 redo) deceased donor liver grafts were compared. Results. COVID-19–positive donors were significantly younger (P = 0.04) and had lower kidney donor profile indices (P = 0.04) than COVID-19–negative donors. Recipients of COVID-19–positive donor grafts were older (P = 0.04) but otherwise similar to recipients of negative donors. Donor SARS-CoV-2 infection status was not associated with a overall survival of recipients (hazard ratio, 1.11; 95% confidence interval, 0.24-5.04; P = 0.89). There were 3 deaths among recipients of liver grafts from COVID-19–positive donors. No death seemed virally mediated because there was no qualitative association with peri-LT antispike antibody titers, post-LT prophylaxis, or SARS-CoV-2 variants. Conclusions. The utilization of liver grafts from COVID-19–positive donors was not associated with a decreased overall survival of recipients. There was no suggestion of viral transmission from donor to recipient. The results from this large single-center study suggest that COVID-19–positive donors may be used safely to expand the deceased donor pool.

Pembalut wanita digunakan oleh wanita di saat menstruasi yang berfungsi untuk menyerap darah dari vagina. Pembalut dibagi menjadi 2 jenis yaitu pembalut sekali pakai yang biasanya terbuat dari kapas dan plastik, dan pembalut kain yang dapat digunakan kembali (reusable pads). Menurut Yayasan Lembaga Konsumen Indonesia (YLKI) pembalut menjadi salah satu pencemar tertinggi di Indonesia. Jumlah sampah pembalut dalam satu bulan bisa mencapai 1,4 miliar. Selain itu, ditemukannya zat klorin yang berbahaya bagi Kesehatan. Rata-rata setiap wanita menggunakan lebih dari 16.000 pembalut/tampon/pantyliners selama hidupnya. Itu artinya, terdapat lebih dari 45 juta produk wanita digunakan dan dibuang setiap tahun. Di Indonesia sendiri, sampah pembalut ternyata dapat mencapai 26 ton setiap hari. Fakultas Kesehatan Masyarakat Universitas Andalas menyadari bahwa permasalahan sampah terutama sampah dari pembalut merupakan hal yang sangat penting bagi keseimbangan ekosistem lingkungan. Sebagai langkah awal mengurangi sampah pembalut dengan memberikan edukasi dan sosialisasi pembuatan pembalut kain. Kegiatan diawali dengan sosialisasi dengan kepala sekolah dan guru, setelah itu diberikan kepada seluruh siswi SMA Al-Ishlah sebanyak 29 orang. Lalu dilakukan pre-test untuk mengetahui pengetahuan siswi terkait pembalut ramah lingkungan dan menstruasi dimana lebih dari separuh siswi (89%) memiliki pengetahuan yang baik mengenai kesehatan reproduksi. Setelah itu dilakukan penyuluhan mengenai dampak penggunaan pembalut sekali pakai terhadap lingkungan dan mengedukasi siswi untuk menggunakan pembalut kain dan menjelaskan cara pembuatan pembalut kain. Diharapkan dengan dilakukannya kegiatan ini, penggunaan pembalut sekali pakai/ pembalut plastik sedikit demi sedikit dapat dikurangi, sehingga sampah pembalut dapat berkurang jumlahnya dan menjadikan lingkungan lebih baik.

Many Gram-negative bacteria use CdiA effector proteins to inhibit the growth of neighboring competitors. CdiA transfers its toxic CdiA-CT region into the periplasm of target cells, where it is released through proteolytic cleavage. The N-terminal cytoplasm-entry domain of the CdiA-CT then mediates translocation across the inner membrane to deliver the C-terminal toxin domain into the cytosol. Here, we show that proteolysis not only liberates the CdiA-CT for delivery, but is also required to activate the entry domain for membrane translocation. Translocation function depends on precise cleavage after a conserved VENN peptide sequence, and the processed ∆VENN entry domain exhibits distinct biophysical and thermodynamic properties. By contrast, imprecisely processed CdiA-CT fragments do not undergo this transition and fail to translocate to the cytoplasm. These findings suggest that CdiA-CT processing induces a critical structural switch that converts the entry domain into a membrane-translocation competent conformation.

Specific language impairment (SLI) is a developmental disorder with substantial genetic contributions. A genome-wide linkage analysis and homozygosity mapping were performed in five consanguineous families from Pakistan. The highest LOD scores of 2.49 at 12p11.22-q11.21 in family PKSLI-31 and 1.92 at 6p in family PKSLI-20 were observed. Homozygosity mapping showed a loss of heterozygosity on 1q25.3-q32.2 and 2q36.3-q37.3 in PKSLI-20. A loss of heterozygosity mapped, in PKSLI-31 and PKSLI-34 flanks, NFXL1 and CNTNAP2, which are genes previously identified in SLI. Our findings report novel SLI loci and corroborate previously reported SLI loci, indicating the utility of a family-based approach.

Background: Acute upper-limb ischemia (AULI) is not always as limb-threatening as those in the leg, so thrombo-embolectomy is not always as necessary for limb salvage. Objective: To evaluate “the outcomes of limb and life at the end of one month, in patients with AULI” and to analyze the following factors: presentation from the time of the acute event, evaluation of limb at the time of presentation regarding its viability, and compare the outcomes in early presentation vs late presentation. Methodology: This was a retrospective study; hence, clinical profiles of all patients during the past seven years were reviewed for those presenting with AULI. Data on anticoagulation were collected, imaging and operative procedures were extracted. All statistical analyses were performed using SPSS 11.0 for Windows. Results: In our study, 25 (42.4%) patients were included due to native arterial thrombosis, 11 (18.6%) due to embolic disease, and the same percentage due to exposure to a high-altitude area (HAA) (more than 9000 feet). 4 (6.8%) patients had thoracic outlet syndrome and cervical rib, and 5 (8.5%) had hypercoagulable disorder. Our study population was younger with a mean of 44.9 years with an SD of 13, and the majority were male (5 out of 59 were female). 16 were active smokers, and 2 were former smokers. The left upper limb incidence was 59% (n = 35), and the right upper limb was 41% (n = 24). In our study, the most common site was the brachial artery 53% (26 out of 49) and axillary artery 35% (17 out of 49) when iatrogenic, traumatic, and thoracic outlet syndromes are excluded. Out of the 59 patients, 39 patients had undergone color Doppler flow imaging of the affected limb and 30 patients had undergone CT angiography of the arch and the limb. Two patients presented with gangrene to the forearm, and 12 patients underwent Colour doppler flow imaging (CDFI) before they presented to our center. In our study, 37% of the patients presented within 48 hours of the onset of symptoms, out of which above-elbow amputation was done in only 1 patient, that is, 4.5%, and 24% of the patients presented within an 8–14-day period, among which one patient (11%) had undergone above-elbow amputation and 22% of the patients presented after 14 days, in which there were 2 above-elbow-amputation patients (15%) with a statistically non-significant P value of 0.5. A total of 45 patients were managed with anticoagulation. A detailed discussion on the treatment outcome of each case has been presented in the article. Conclusion: CT angiography, when available, is a well-accepted first-line investigation for AULI. When we compare AULI with lower-limb ischemia, collateral circulation conservative management is also an option, provided that it is not associated with tissue loss. AULI like lower-limb ischemia has better limb salvage when diagnosed and intervened early.

Abstract Background The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence. Methods This study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon. Results Forty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n = 38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study. Conclusions This first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon. Trial Registration ClinicalTrials.gov Identifier: NCT00725777

Abstract Background Paediatric drug formulations for artemisinin combination therapy (P-ACT) have been developed over the past few years and have been shown to improve the therapeutic management of young children with uncomplicated falciparum malaria. This process was however not equally paralleled by a timely adoption of P-ACT in national and international treatment recommendations. National malaria programmes in sub-Saharan Africa have not yet widely embraced this new therapeutic tool. To which extent P-ACT is used in the field in sub-Saharan Africa is not known to date. Methods This snapshot questionnaire survey aimed to provide an overview on the current routine practices for the availability and use of P-ACT as anti-malarial treatment for young children in sub-Saharan Africa. Health care personnel in seven countries in West-, Central, and East-Africa were invited to answer a structured questionnaire assessing use and availability of P-ACT. Results A total of 71 respondents including doctors, nurses and pharmacy personnel responsible for the anti-malarial treatment of young children were interviewed. P-ACT was used by 83% (95% confidence interval: 73-90%; n = 59) as first-line treatment for young children. Use of 15 different P-ACT products was reported among which only two have received WHO prequalification status and approval by a stringent registration authority. Use of a specific P-ACT product was not linked to consumer prices or availability of supporting clinical trial data, but may depend more on the marketing capacity of the manufacturer. Major differences in frequency and dosing of anti-malarial regimens with identical anti-malarial compounds and the marketing of loose combinations were recorded. Conclusion Paediatric ACT is widely used for the treatment of uncomplicated malaria in young children. However, the majority of P-ACT formulations in use do not meet highest international quality standards evoking concerns for patients' safety and the induction of drug resistance. Improving the quality of currently marketed P-ACT should constitute a public health priority besides their adoption into official treatment recommendations.

Objective: To know the pattern of skin disorders amongst patients reporting to the Dermatology outpatient of a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Dermatology OPD Combined Military Hospital, Bahawalpur Pakistan from May to Oct 2022. Methodology: Eight thousand sixty-eight patients attending the outpatient department (OPD) for skin problems were included in the study. Consultants with Postgraduate qualifications in Dermatology diagnosed all cases. Diagnosis of skin problems were noted for each patient. Diseases were categorized into various groups. Results: The mean age of patients was 29.04±15.941 years. 54.35% of patients (n=4385) were in the 20-40 years age range. Infections were the most commonly seen disease group (n=2152,26.7%), followed by dermatitis and eczematous disorders (n=1784,22.1%), parasitic diseases (n=1341,16.6%) and acquired pigmentary disorders (n=579,7.2%) in descending order of frequency. Together, these four groups of diseases accounted for 72.6% of total patients. Infections and infestations accounted for 43.3% of patients reporting to our outpatients during the study period. Scabies was the most common disease in 15.6% (n=1262) of our patients. Scabies and dermatophyte infections were the two most commonly encountered diseases. These two diseases comprised 26.5% (n=2141) of the total cases. Conclusion: Infections and infestations accounted for 43.3% of patients reporting to our outpatients during the study period. Scabies and dermatophyte infections were the two most commonly encountered diseases. Public health education regarding personal hygiene and dermatological care availability can help lessen the burden of skin diseases.

Speech acts which belongs to the field of pragmatics carrying a concept that when people say something, they perform an action. The study aims at investigating speech acts in a documentary film entittled the Tinder Swindler. There have been various research on speech acts in movies, but there is a lack of research on this topic which carries a documentary film as the center of attention. A qualitative research method is employed in the research using a document review as the data collection technique and descriptive and interpretative technique to analyze the data. The finding suggests that representative category dominates the utterances in the film taking 74% occurance. Hopefully, this study will fill the research gap and enrich the collection of studies on speech acts.

Background: Acute limb ischemia (ALI) can be defined as sudden deterioration in limb perfusion, often producing new or worsening symptomatology and usually threatening limb viability. The incidence of ALI is approximately 1.5 cases per 10,000 persons per year. Objective: The main objective of the study is to assess the spectrum of ALI and effective management options in a tertiary care center. Methodology: This was a retrospective and prospective observational study. All patients admitted in tertiary care center with ALI were included in this study. The medical records of patients admitted since last three years were collected retrospectively and the data of patients with ALI getting admitted during next one year was collected simultaneously. Patients who were included prospectively were followed for at least one month. Results: In the study period, we received 136 patients with 138 ALI (ALI presenting with 14 days = 95, ACLI = 17, ALI with delayed presentation = 26). Average age of patients was 47.4 years. 21 to 40 years age group made the largest cohort of 56 patients. 10.79% of the lower limb ischemia were female (15 out of 136). Among these categories, the outcomes depend upon the time of presentation (earlier presentation has the better outcomes in terms of limb salvage). The delayed presentation of ALI has poorer outcome of amputation whereas mortality rates are higher in ALI presenting early. Patency in ALI is better due to embolus. Outcome of ALI due to embolus are best followed by acute thromboembolic occlusion without pre-existing CLI. The worst outcomes in amputation are for ACLI when they present late. Etiology wise Cardio embolic group comprised as the commonest cause; High Altitude Thrombosis also is very significant in our setting. Class II B ischemia which is most surgically amenable, and the amputation rate is 20%. Conclusion: In our study, outcome of various modalities of management of ALI has been evaluated. Our study provided data which could be accessed to define the outcome and most amenable to any useful intervention affecting outcome in patients of limb ischemia. Revascularization in ALI is aimed not only to prevent amputation but also to limit the level of amputation which is a forgotten aspect of salvage procedure in lower extremity.

This paper presents a deep learning-based framework for automating the visual inspection of plastic bottles in an Industry 4.0 context, detecting surface defects to enhance product quality. Our contributions include the acceleration of model development through knowledge transfer learning, an inventive data generation strategy that combines physical samples with synthetic data augmentation techniques, an extensive evaluation of pre-trained deep convolutional neural networks, and a user-friendly interface for real-time quality inspection reporting and making the information easily accessible and actionable. In comparison to existing methods, our proposed method outperforms with a higher Accuracy to Size Ratio of 7.0. This characteristic underscores its capacity to efficiently and accurately classify and detect defects across multiple classes while maintaining a low area utilization. This feature not only demonstrates its exceptional performance but also positions it as a practical solution for real-world scenarios with resource constraints.

Background Runs of homozygosity (ROHs) analysis of controls provide a convenient resource to minimize the association of false positive results of disease-associated ROHs and genetic variants for simple and complex disorders in individuals from the same population. Evidence for the value of ROHs to speech or language-related traits is restricted due to the absence of population-matched behaviourally defined controls and limited family-based studies. Aim This study aims to identify common ROHs in the Pakistani population, focussing on the total length and frequency of ROHs of variable sizes, shared ROHs, and their genomic distribution. Subjects and methods We performed homozygosity analysis (in PLINK) of 86 individuals (39 males, 47 females) with no history of speech or language-related phenotypes (controls) who had been genotyped with the Illumina Infinium QC Array-24. Results ROHs of 1-

The association of self-reported BMI at age 20, at age 40, the highest BMI within the past 3 years, and current BMI with current mid-life cardiovascular risk factors and coronary artery calcium (CAC) was evaluated among 1148 South Asian American participants (mean age 57 years) in the MASALA study. A 1 kg/m2 higher BMI at age 20 was associated with higher odds of hypertension (aOR 1.07, 95% CI 1.03–1.12), pre-diabetes/diabetes (aOR 1.05 [1.01–1.09]), and prevalent CAC (aOR 1.06 [1.02–1.11]) in mid-life. Associations were similar for all BMI measures. Weight across young adulthood is associated with mid-life cardiovascular health in South Asian American adults.