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Objective High body mass index is a well-established modifiable comorbidity that is known to increase postoperative complications in all types of surgery, including spine surgery. Obesity is increasing in prevalence amongst the general population. As this growing population of obese patients ages, understanding how they faire undergoing cervical disc arthroplasty (CDA) is important for providing safe and effective evidence-based care for cervical degenerative pathology. Methods Our study used the Healthcare Cost and Utilization Project’s National Inpatient Sample to assess patients undergoing CDA comparing patient characteristics and outcomes in nonobese patients to obese patients from 2004 to 2014. Results Our study found a significant increase in the overall utilization of CDA as a treatment modality (p = 0.012) and a statistically significant increase in obese patients undergoing CDA (p < 0.0001) from 2004 to 2014. Obesity was identified as an independent risk factor associated with increased rates of inpatient neurologic complications (odds ratio [OR], 6.99; p = 0.03), pulmonary embolus (OR, 5.41; p = 0.05), and wound infection (OR, 6.97; p < 0.001) in patients undergoing CDA from 2004 to 2014. Conclusion In patients undergoing CDA, from 2004 to 2014, obesity was identified as an independent risk factor with significantly increased rates of inpatient neurologic complications, pulmonary embolus and wound infection. Large prospective trials are needed to validate these findings.

El personal de salud a través del tiempo ha demostrado ser fundamental para la preservación del bienestar del ser humano; sin embargo, la formación que debe llevar para lograrlo no es la fórmula para alcanzar su salud propia. El presente trabajo pretende analizar las principales adversidades que experimentan los estudiantes de medicina durante su proceso de formación profesional, con el fin de motivar las reformas de los campos formativos. Es una investigación documental con información basada en la evidencia científica. Se encuentra que en México y América Latina son muchos los médicos que ingresan a la licenciatura en medicina, pero a la vez existe un porcentaje elevado que desertan, lo cual está relacionado con padecimientos que atentan directamente contra su integridad, como ansiedad, depresión, burnout, ideación suicida, adicciones y otras condicionantes económicas, familiares y sociales. Se encontraron índices de deserción hasta del 25%, que se sostienen o incluso se elevan con el paso del tiempo, por lo que se requiere atender esta problemática, sensibilizar a los diferentes sectores de la sociedad, pues el personal médico pese al cansancio o la sobrecarga, aun así, otorga la atención requerida por los usuarios y usuarias, muchas veces a costa de su bienestar propio.

Cocoa (Theobroma cacao L.) is a beverage crop with high economic value. Provision of natural PGR, namely red unions, which will be extracted. This study aimed to determine the effect of red onionxtract (Allium cepa L.) as a growth regulator on cocoa seeds. The research was conducted at a screen house at the Polytechnic of Agricultural Development Manokwari (Politeknik Pembangunan Pertanian Manokwari). The study method used was a completely randomized design (CRD), using five treatments and 20 replications, so the number of samples was 100 seeds. The treatments tested on cocoa plant seeds P0 (control), P1 (25% concentration of red onion extract), P2 (50% concentration of red onion extract), P3 (75% concentration of red onion extract), and P4 (100% concentration of red onion extract). The measurement variables included germination percentage, plant height, stem diameter, number of leaves, and seedling growth percentage. Differences in the concentration of growth regulators of red onion extract had a significantly different effect on seedling percentage and seed growth percentage and had a significant effect on plant height, stem diameter, and number of leaves of cocoa seedlings. Soaked cocoa seeds in red union extract with a concentration of 25% give optimum results.

Background: Nerve injury following arthroscopic shoulder procedures is a rare complication. Most patients will have gradual resolution of symptoms. Operative management may be required in the setting of complete nerve injury. Purpose: We present a case detailing our experience managing a patient with a complete median nerve transection following shoulder arthroscopy for a rotator cuff injury. Case Description: A thirty-nine-year-old female was referred to our office five months after undergoing a shoulder arthroscopy for a rotator cuff repair. Upon waking up from her initial surgery, she reported pain, numbness, and weakness in her right arm and hand, including the inability to make a fist or fully flex her first or second fingers. She was found to have right thenar eminence atrophy. Motor exam revealed profound weakness in flexors of the thumb and index finger. Because of the high likelihood of median nerve injury given the patient’s clinical presentation and surgical history along with an unremarkable brachial plexus MRI, surgery was recommended. Upon surgical exposure, the median nerve was found to be completely transected with a large neuroma. The neuroma was removed, and the nerve ends were trimmed with a sural nerve graft used to complete the repair. At her one and a half year follow up, she continued to demonstrate improvement although still complained of numbness in her first three fingers and weakness in her right hand. However, unlike preoperatively, her pain was well-controlled. Conclusion: Although distal neuropathies are a common preoperative complaint of patients with rotator cuff injuries, new onset nerve injuries as a complication from surgical repair should not be overlooked. Prevention of nerve injury is critical through adequate exposure and positioning during surgery. If a nerve injury does occur, examination during follow up visits are critical for monitoring the progression of symptoms and need for additional interventions.

Water plays the important roles for plants. Besides maintaining the cell turgidity, it also functions as a nutrients solvent for photosythesis process, which affects plant growth. This study aimed to determine the effects of the source and volume of irrigation water with drip irrigation system on the growth of pepper plants in polybags. This research was conducted at the green house of Polbangtan Manokwari, Anday, West Papua from June to October 2020. This research was arranged in a factorial Completely Randomized Design consisting of two treatment factors, namely irrigation water source (PDAM water and ground water) and volume (150 mL per plant, 200 mL per plant, and 250 mL per plant). The results showed that PDAM water showed a better effect than groundwater, while the volume of irrigation water applied to pepper plants had no significant effect on plant height, number of leaves, and stem diameter. This situation is thought to be due to genetic factors from the pepper cultivars grown. PDAM water has a better effect because of its high pH and higher content of Nitrite as N content. Also, it has lower temperature, lower TDS, and lower iron contents. Meanwhile, irrigation water volume of 250 mL per plant per day has a minimal risk of plant drought compared to other treatments.

Clinicians have managed and treated lower back pain since the earliest days of practice. Historically, lower back pain and its accompanying symptoms of radiating leg pain and muscle weakness have been recognized to be due to any of the various lumbar spine pathologies that lead to the compression of the lumbar nerves at the root, the most common of which is the radiculopathy known as sciatica. More recently, however, with the increased rise in chronic diseases, the importance of differentially diagnosing a similarly presenting pathology, known as lumbosacral plexopathy, cannot be understated. Given the similar clinical presentation of lumbar spine pathologies and lumbosacral plexopathies, it can be difficult to differentiate these two diagnoses in the clinical setting. Resultingly, the inappropriate diagnosis of either pathology can result in ineffective clinical management. Thus, this review aims to aid in the clinical differentiation between lumbar spine pathology and lumbosacral plexopathy. Specifically, this paper delves into spine and plexus anatomy, delineates the clinical assessment of both pathologies, and highlights powerful diagnostic tools in the hopes of bolstering appropriate diagnosis and treatment. Lastly, this review will describe emerging treatment options for both pathologies in the preclinical and clinical realms, with a special emphasis on regenerative nerve therapies.

Background: Haemophilus influenzae causes life-threatening invasive diseases such as septicaemia and meningitis. Reports on circulating H. influenzae causing invasive disease in lower-middle income settings, including Indonesia, are lacking. This study describes the serotype distributions and whole-genome sequence (WGS) data of H. influenzae isolated from hospitalized patients at Soetomo Hospital, Surabaya, Indonesia., Methods: H. influenzae isolates were isolated from blood and pleural fluid specimens and identified using culture-based and molecular methods, followed by serotyping and WGS using RT‒PCR and Illumina MiSeq, respectively. Sequencing reads were assembled, and further analyses were undertaken to determine the genomic content and reconstruct the phylogeny. A second dataset consisting of publicly available H. influenzae genomes was curated to conduct phylogenetic analyses of isolates in this study in the context of globally circulating isolates., Results: Ten H. influenzae isolates from hospitalized patients were collected, and septicaemia was the most common diagnosis (n=8). RT‒PCR and WGS were performed to determine whether all the isolates were nontypeable H. influenzae (NTHi). There were four newly identified STs distributed across the two main clusters. A total of 91 out of 126 virulence factor (VF)-related genes in Haemophilus sp. were detected in at least one isolate. Further evaluation incorporating a global collection of H. influenzae genomes confirmed the diverse population structure of NTHi in this study., Conclusion: This study showed that all H. influenzae recovered from invasive disease patients were nonvaccine-preventable NTHi isolates. The inclusion of WGS revealed four novel STs and the possession of key VF-associated genes., (© 2024. The Author(s).)

Haemophilus influenzae is part of the human nasopharyngeal microbiota and a pathogen causing invasive disease. The extensive genetic diversity observed in H. influenzae necessitates discriminatory analytical approaches to evaluate its population structure. This study developed a core genome multilocus sequence typing (cgMLST) scheme for H. influenzae using pangenome analysis tools and validated the cgMLST scheme using datasets consisting of complete reference genomes ( N = 14) and high-quality draft H. influenzae genomes ( N = 2297). The draft genome dataset was divided into a development dataset ( N = 921) and a validation dataset ( N = 1376). The development dataset was used to identify potential core genes, and the validation dataset was used to refine the final core gene list to ensure the reliability of the proposed cgMLST scheme. Functional classifications were made for all the resulting core genes. Phylogenetic analyses were performed using both allelic profiles and nucleotide sequence alignments of the core genome to test congruence, as assessed by Spearman's correlation and ordinary least square linear regression tests. Preliminary analyses using the development dataset identified 1067 core genes, which were refined to 1037 with the validation dataset. More than 70% of core genes were predicted to encode proteins essential for metabolism or genetic information processing. Phylogenetic and statistical analyses indicated that the core genome allelic profile accurately represented phylogenetic relatedness among the isolates ( R 2 = 0.945). We used this cgMLST scheme to define a high-resolution population structure for H. influenzae , which enhances the genomic analysis of this clinically relevant human pathogen.

The Haemophilus influenzae serotype b (Hib) conjugate vaccine routine immunization programme has been implemented for almost a decade; however, there is limited surveillance of H. influenzae carriage rates in the Indonesian population. H. influenzae was isolated from nasopharyngeal (NP) swab specimens of healthy children on Lombok Island, West Nusa Tenggara Province, Indonesia from 2018 to 2019. Serotyping was performed using quantitative polymerase chain reaction. We identified H. influenzae in 40 of the 96 (41.6 %) NP swab specimens. We identified 39 non-typeable H. influenzae (NTHi) isolates and 1 Hib isolate., Competing Interests: The authors declare that there are no conflicts of interest., (© 2023 The Authors.)

Late-stage breast cancer usually presents with locally advanced disease, with or without metastasis. The primary tumor is typically large with skin infiltration which affects quality of life. Surgical resection will result in an extensive defect which potentially deteriorates patients' quality of life if not properly managed. Keystone perforator island flap (KPIF) is a local advancement flap based on multiple perforators which can be a reliable reconstructive method to close an extensive defect., Methods: This is a case series of 11 patients with symptomatic late-stage breast cancers indicated for neoadjuvant chemotherapy and subsequent mastectomy at Dharmais Cancer Hospital. The postmastectomy defect was closed with KPIF and clinical evaluation included flap success rate, percentage of flap necrotic area, and quality of life. There are modifications of the KPIF consisting of the more rounded shape and additional flap movement of the flap's distal lateral ends to the center resembling an "omega" conformation., Results: Mean percentage of flap necrosis area was 9.7% and none of the patients needed additional surgery. The patients' quality of life evaluated using Patient-reported Aesthetic European Organization for Research and Treatment of Cancer (EORTC) Quality of Life, Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life, Questionnaire-Breast Cancer-23-questions (QLQ-BR23) was fair, with sufficiently good scores for global health status and functional scale, and minimal symptomatology burden. The lowest score was for fatigue and financial difficulties parameters from QLQ-C30 and sexual functioning and future perspective from QLQ-BR23., Conclusion: This is a preliminary study to show that a KPIF could be considered as a method for defect-resurfacing reconstruction after mastectomy., (Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: With the rise in working-age population, there has been notable economic growth in Indonesia. Along with it, there is an increase in expenditure for non-food items such as health-care service, without exception to plastic surgery practice. Aesthetic plastic surgery practice has gained its popularity in several other developing countries such as Brazil, Russia, India and China. Epidemiology report of private plastic surgery practice in Jakarta, the capital of Indonesia, will provide the evidence of increasing need for aesthetic plastic surgery practices as the basis for further improvement., Methods: This is a single-centre descriptive cross-sectional study with a total sampling method which included all patients registered at a private plastic surgery clinic between January 2008 and December 2016., Results: There were 1457 medical procedures. The majority (93.4%) of patients were female. More than 80% were surgical procedures, the most common ones were breast implant and blepharoplasty with the latter being similarly popular in both gender. The majority of the patients fell into 20-45-year-old group. Patients <20-year-old had undergone a more minor surgical procedure such as skin tumour and nevus excision or scar treatment while patients >45-year-old had more procedures with rejuvenation purpose., Conclusion: The epidemiology of private plastic surgery practice in an urban area of developing country resembles those in either developed or developing countries with a similar socio-demographic profile. This data can be further utilised for a more focused private plastic surgery practice improvement. The limitation however is that, the study is based on a single centre data., Competing Interests: There are no conflicts of interest.