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Introduction: Diarrhea is a global problem that commonly occurs in cases of gastrointestinal infection. The prevalence of diarrhea in Indonesia was 6.8% according to Riskesdas 2018 data. The conventional diagnosis in cases of gastrointestinal infection is limited in sensitivity and time. This may be overcome by gastrointestinal syndromic testing that can detect a number of pathogens simultaneously in one assay. The aim of this study was to determine the role of the gastrointestinal syndromic testing panel in patients with gastrointestinal infection., Methodology: This retrospective study of stool specimens performed syndromic testing and microbiological cultures at a private hospital in Central Jakarta., Results: Of the 119 specimens with negative culture test results, syndromic gastrointestinal testing found pathogens in 46 specimens (38.7%), of which 32 specimens contained a single pathogen and 14 specimens had > 1 pathogen. The most frequently found pathogens were enteropathogenic E. coli, enteroaggregative E. coli, and C. difficile A/B toxins., Conclusions: Syndromic testing can increase the etiologic diagnosis of gastrointestinal infections in a shorter time period than the conventional methods., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2023 Saverio Bellizzi, Giuseppe Pichierri, Catello M Panu Napodano, Osama Ali Maher.)

Breast cancer ranks as the second leading cause of death among women, but early screening and self-awareness can help prevent it. Hormone therapy drugs that target estrogen levels offer potential treatments. However, conventional drug discovery entails extensive, costly processes. This study presents a framework for analyzing the quantitative structure-activity relationship (QSAR) of estrogen receptor alpha inhibitors. Our approach utilizes supervised learning, integrating self-attention Transformer and molecular graph information, to predict estrogen receptor alpha inhibitors. We established five classification models for predicting these inhibitors in breast cancer. Among these models, our proposed MATH model achieved remarkable precision, recall, F1 score, and specificity, with values of 0.952, 0.972, 0.960, and 0.922, respectively, alongside an ROC AUC of 0.977. MATH exhibited robust performance, suggesting its potential to assist pharmaceutical and health researchers in identifying candidate compounds for estrogen alpha inhibitors and guiding drug discovery pathways.

Background: Indonesia had the second-highest number of COVID-19 cases and deaths in South-East Asia. We aimed to determine the factors associated with this mortality and the effect of the recommended COVID-19 treatment regimen during the first 10 months of the epidemic., Methods: This was a retrospective cohort study using secondary data from medical records. In total, 689 adult COVID-19 inpatients hospitalized between March and December 2020 were enrolled. Clinical characteristics, laboratory parameters, and treatments were analyzed by survival outcome. Kaplan-Meier statistics were used to estimate survival., Findings: Of the 689 patients enrolled, 103 (14.9%) died. Disease severity was highly associated with mortality (hazard ratio [HR]: 7.69, p  < 0.001). Other clinical factors associated with mortality were older age and comorbidities. Based on laboratory parameters, higher procalcitonin and C-reactive protein contents and a neutrophil-to-lymphocyte ratio >3.53 were also linked to mortality. Favipiravir was associated with lower mortality, with adjusted HRs of 0.24 (0.11-0.54) and 0.40 (0.17-0.98) among the mild/moderate and severe cases, respectively. Among patients with severe disease, steroids showed some beneficial effects in the early days of hospitalization., Interpretation: Older age and comorbidities were associated with disease severity and, consequently, higher mortality. Higher mortality after the second week of hospitalization may be related to secondary bacterial infection. Favipiravir showed significant benefit for COVID-19 survival, while steroids showed benefit only in the early days of admission among patients with severe disease., Funding: This research did not receive a specific grant from any funding agency in the public, commercial, or not-for-profit sectors., Competing Interests: We declare that we have no competing interests., (© 2023 The Author(s).)

As more ambitious protected area (PA) targets for the post-2020 global biodiversity framework are set beyond Aichi Target 11, renew thinking into spatial prioritisation is required to enable PA expansion that maximises environmental values. Our study focuses on the biodiverse and forest-rich Indonesian island of Sulawesi, which has a terrestrial PA network that covers 10% of the island. We used Marxan to investigate trade-offs in the design of an expanded PA network that prioritised different conservation features (biodiversity, forest cover, carbon stock, karst and valuable metal-rich areas) under varying island-wide coverage targets (17%, 30%, and 50%). Our first scenario, which required existing PAs to be selected, required larger areas to meet these coverage targets, in contrast to our second scenario, which allowed for any part of the island to be chosen, irrespective of PA status. The vast Mekongga and Bangkiriang Landscapes, and Gorontalo corridor were consistently identified as a high priority for protection under all scenarios. To meet our conservation targets through expanding current PAs, creating new PAs, and creating corridors that connect existing PAs, we used a spatially explicit three-phase approach. Our findings identified 26,508 km 2 of priority areas to be included in the current PA network, potentially assisting Indonesia in meeting its post-2020 GBF target, if our approach is replicated across Indonesia as a national or sub-national analysis. We discuss various land management options through other effective area-based conservation measures (OECMs) and the costs to deliver this strategy., (© 2023. The Author(s).)

Introduction: Spinocerebellar ataxia type-3 (SCA3) is an adult-onset autosomal dominant neurodegenerative disease. It is caused by expanding of CAG repeat in ATXN3 gene that later on would affect brain structures. This brain changes could be evaluated using brain MRI volumetric. However, findings across published brain volumetric studies have been inconsistent. Here, we report MRI brain volumetric analysis in a family of SCA 3 patients, which included pre-symptomatic and symptomatic patients., Methodology: The study included affected and unaffected members from a large six-generation family of SCA 3, genetically confirmed using PolyQ/CAG repeat expansion analysis, Sanger sequencing, and PCR. Clinical evaluation was performed using Scale for the Assessment and Rating of Ataxia (SARA). Subjects' brains were scanned using 3.0-T MRI with a 3D T1 BRAVO sequence. Evaluations were performed by 2 independent neuroradiologists. An automated volumetric analysis was performed using FreeSurfer and CERES (for the cerebellum)., Result: We evaluated 7 subjects from this SCA3 family, including 3 subjects with SCA3 and 4 unaffected subjects. The volumetric evaluation revealed smaller brain volumes ( p < 0.05) in the corpus callosum, cerebellar volume of lobules I-II, lobule IV, lobule VIIB and lobule IX; and in cerebellar gray matter volume of lobule IV, and VIIIA; in the pathologic/expanded CAG repeat group (SCA3)., Conclusion: Brain MRI volumetry of SCA3 subjects showed smaller brain volumes in multiple brain regions including the corpus callosum and gray matter volumes of several cerebellar lobules., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sobana, Huda, Hermawan, Sribudiani, Koan, Dian, Ong, Dahlan, Utami, Pusparini, Gamayani, Mohamed Ibrahim and Achmad.)

Spinocerebellar ataxia (SCA) is an autosomal dominant hereditary disease with progressive course, and no causal therapy. Diagnostics are still challenging, due to facility and protocols, and so as in Indonesia. As a national referral center, Dr. Hasan Sadikin Central General Hospital has received a lot of patients from all over Indonesia, particularly from Western Java. Study related to SCA (including clinical and genetic profile) is still limited in Indonesia. We identified index patients from three families with ataxia, hence intend to determine their clinical and genetic pattern. The hereditary pattern is autosomal dominant. Scale for the assessment and rating of ataxia (SARA) shows mild and moderate ataxia. Inventory of non-ataxia signs (INAS) scores of the patients were 3, 5 and 6. Montreal cognitive assessment-Indonesian version (MOCA-INA) shows only one patient has mild cognitive impairment, despite young age. Barthel index shows 1 subject has moderate dependency. Mutation in Ataxin3 polyQ repeats shows pathologically long CAG repeats, 72,10; 72,10; and 72,23 respectively in mutant and wild type allele. We diagnosed the index patients with spinocerebellar ataxia type 3. This study is the first case series study in Indonesia. The hereditary pattern is clearly shown as an autosomal dominant ataxia. The clinical and genetic profile was varied, and the symptom is progressive and deteriorates overtime, including wide based gait, speech problem, motor and sensor complaint, and cognitive decline complaint. Despite the same polyQ stretch length, the onset and clinical characteristics of patients are diverse., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

The purpose of this study was to analyze effect of linear growth and psychosocial aspects of caregiving on cognitive development of toddlers. Methods: Longitudinal studies were carried out from pregnancy to three years old children in Bogor. The collected data included body height, nutritional status based on height by age index, morbidity, aspects of caregiving, and cognitive development of three years old children. Linear growth data is obtained from anthropometric measurements of height at birth, age six months, and twelve months measured using a length measuring instrument body with a precision level of 0.10 cm. Caregiving of psychosocial aspect divided by some characteristics, such as learning stimulation, language stimulation, academic stimulation, modelling, warmth and acceptance, caregiving variation, punishment & acceptance and physical environment. Cognitive development measurement was divided into two categories, namely delay and appropriate to age. Multiple logistic regression was applied to analyze the effects. Toddlers who were born stunted and continued to be stunted until they were three years old had lower cognitive development than stunted newborns that were able to achieve normal height at three years old. In addition, children who experience caregiving with poor psychosocial aspects had lower cognitive development than those with good caregiving. This study highlighted the importance efforts to improve nutritional status of children as well as providing good care for them.

Poor nutritional status or stunting still becomes a public health problem in Indonesia, with prevalence of 37.2% in 2013. Some research results show that stunted children have lower cognitive development than normal children. This study aims to assess whether there is an effect of giving multiple-nutrient biscuits and psychosocial parenting education on height and development of children under the age of three (toddlers). This study used quasi experimental design. The treatment was given for 2 mo to 28 stunted children who were divided into 3 groups, namely: (1) multiple-nutrient biscuits (2) psychosocial parenting education (3) multiple-nutrient biscuits and psychosocial parenting education. Multiple-nutrients biscuit was given 12 pieces a day for 2 mo. Meanwhile, psychosocial parenting education was given direcly by psychologist in the form of lectures, brainstorming and role play. In order to identify the effect of treatment on children's height and development, the data obtained was analyzed using paired t-test, while the analysis of differences between treatment groups was carried out using analysis of variance (ANOVA). The results showed that giving psychosocial parenting education significantly increased height, children's nutritional status based on height by age index, and improved cognitive development among toddlers. Giving multiple-nutrient biscuits and psychosocial parenting education significantly increased height and cognitive development among toddlers. In order to overcome children's growth and development problem, nutrition interventions need to be carried out along with the provision of education about maternal parenting to children.

Objective: The prevalence of Escherichia coli including from ice cubes in Indonesia is quite high. Unfortunately, little is known about the genetic diversity of E. coli from ice cube production site. Genotypic variation in E. coli populations is a major barrier to control public health risk associated with foodborne pathogen. The aims of this study were to analyze the genotypic diversity of E. coli strains isolated from various samples in order to determine the genetic relationship between those strains. This study is also important to understand the occurrence, prevalence and profile picture of different pathogenic E. coli in various sources which potentially cause disease., Results: Enterobacterial repetitive intergenic consensus (ERIC) and repetitive extragenic palindromic polymerase chain reaction (REP-PCR) dendrogram showed high genetic diversity of 120 E. coli isolates in majority of sampling sites. DNA fingerprint patterns showed 26 and 21 clusters with 11 and 3 fingerprints individual lineages for ERIC and REP-PCR respectively. There was no correlation observed between phylogenetic relationship and virulence genes. The result indicated a variation of E. coli isolates in ice cube manufacturers. ERIC-PCR method is more discriminative compared with REP-PCR to analyze the genetic diversity of E. coli from ice cubes production sites.

Introduction: Ice can be contaminated by pathogenic bacteria. This study aimed to identify critical points in iced beverage production and distribution lines to examine the presence of pathogenic bacteria in a beverage and its processing environment, as well as when water and ice used as main ingredients., Methodology: The critical points were determined using the principles of Hazard Analytical Critical Control Point (HACCP) to analyze each processing and distribution step from the survey. Samples collected from the points of concern based on the critical points that were found were tested for pathogens by conventional method and molecular method using primers and polymerase chain reaction (PCR)., Results: Escherichia coli was found in 6.34% of samples, and 0.7% of them were confirmed as enterotoxigenic Escherichia coli (ETEC) by PCR. Vibrio cholerae was found in in 0.7% of water samples used to make iced beverages and in ice production, as well as in 2.12% of distribution and production tools. Salmonella Typhimurium was found in 1.4% of water samples used to make ice and ice products. Staphylococcus aureus was found in 2.02% of the surfaces of ice distribution and production tools and in 5.05% of production and distribution workers' hands. S. aureus counts ranged from 2.4×102 - 3.5×102 colonies/100 cm² surface area and 1.9×10¹ - 3.7×102 colonies/workers' hands., Conclusion: Control on many critical points in iced beverage processing and distribution is required so that the beverages are safe for consumption., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2017 Halim Nababan, Winiati Pudji Rahayu, Diana Elizabeth Waturangi, Suratmono Suratmono, Rina Puspitasari, Nugroho Indrotristanto, Eva Nikastri, Suci Yuliangsih, Novi Pusparini.)

In the 200 years since the Sumatran rhinoceros was first scientifically described (Fisher 1814), the range of the species has contracted from a broad region in Southeast Asia to three areas on the island of Sumatra and one in Kalimantan, Indonesia. Assessing population and spatial distribution of this very rare species is challenging because of their elusiveness and very low population number. Using an occupancy model with spatial dependency, we assessed the fraction of the total landscape occupied by Sumatran rhinos over a 30,345-km2 survey area and the effects of covariates in the areas where they are known to occur. In the Leuser Landscape (surveyed in 2007), the model averaging result of conditional occupancy estimate was ψ(SE[ψ]) = 0.151(0.109) or 2,371.47 km2, and the model averaging result of replicated level detection probability p(SE[p]) = 0.252(0.267); in Way Kambas National Park--2008: ψ(SE[ψ]) = 0.468(0.165) or 634.18 km2, and p(SE[p]) = 0.138(0.571); and in Bukit Barisan Selatan National Park--2010: ψ(SE[ψ]) = 0.322(0.049) or 819.67 km2, and p(SE[p]) = 0.365(0.42). In the Leuser Landscape, rhino occurrence was positively associated with primary dry land forest and rivers, and negatively associated with the presence of a road. In Way Kambas, occurrence was negatively associated with the presence of a road. In Bukit Barisan Selatan, occurrence was negatively associated with presence of primary dryland forest and rivers. Using the probabilities of site occupancy, we developed spatially explicit maps that can be used to outline intensive protection zones for in-situ conservation efforts, and provide a detailed assessment of conserving Sumatran rhinos in the wild. We summarize our core recommendation in four points: consolidate small population, strong protection, determine the percentage of breeding females, and recognize the cost of doing nothing. To reduce the probability of poaching, here we present only the randomized location of site level occupancy in our result while retaining the overall estimation of occupancy for a given area. ψ

Dietary isoflavones are considered to be cardioprotective because of their structural similarity to estrogen. Equol is a metabolite of daidzein that is more potent than daidzein itself. The effect of equol on endothelial function and oxidative stress remains unclear. The objective of this study was to determine the effect of 100 mg/day soy isoflavone supplementation on the following markers: vascular cell adhesion molecule-1 (VCAM-1) and nitric oxide (NO) as markers of vascular endothelial function, and malonyldialdehyde (MDA) as oxidative stress marker in equol-producing postmenopausal women. A stratified randomized double blind controlled trial was conducted among 190 postmenopausal Indonesian women aged 47 to 60 years. They were stratified into equol producers and equol nonproducers. The random allocation of intervention was carried out separately in each stratum. The intervention group received tablets consisting of 100 mg soy isoflavones and calcium carbonate 500 mg, and the control group received 500 mg calcium carbonate. The concentrations of VCAM-1, NO and MDA were measured at baseline and post-supplementation at 6 months. After 6 months of supplementation the MDA concentrations were significantly lower in the soy-isoflavone equol producers compared with equol nonproducers (p=0.021). Similar results were also found for VCAM-1 and NO concentrations, but these were statistically not significant (p = 0.413 and p= 0.724, respectively). This study demonstrates that isoflavone supplementation in postmenopausal women with equol-producer status had a more beneficial effect by decreasing the MDA concentration, but did not improve VCAM-1 and NO concentrations.

A 12-month randomized double blind controlled trial was conducted among 182 Indonesian postmenopausal women aged 47 to 60 years to determine the effect of 100 mg/day soy isoflavone supplementation on vascular endothelial function such as vascular cell adhesion molecule-1 (VCAM-1), nitric oxide (NO) and malondialdehyde (MDA) as oxidative stress marker. The subjects were randomized to the intervention group receiving tablets consisting of 100 mg soy isoflavones and calcium carbonate 500 mg, and to the control group receiving 500 mg calcium carbonate. The concentrations of VCAM-1, NO and MDA were measured at baseline, and postsupplementation at 6 months and 12 months. After supplementation, the MDA concentrations were significantly lower in the soy isoflavone group compared with the control group (p=0.001). The concentrations of VCAM-1 and NO were not affected (p=0.992 and p=0.759, respectively). In all group the MDA concentration increased compared with baseline concentrations but the relative change of MDA concentrations was significantly lower in the soy isoflavone group compared with the control group. This study demonstrates that supplemental intake of soy isoflavones for 6 months and 12 months had an effect on oxidative stress by decreasing MDA concentration, but did not improve vascular endothelial function.

Large carnivores living in tropical rainforests are under immense pressure from the rapid conversion of their habitat. In response, millions of dollars are spent on conserving these species. However, the cost-effectiveness of such investments is poorly understood and this is largely because the requisite population estimates are difficult to achieve at appropriate spatial scales for these secretive species. Here, we apply a robust detection/non-detection sampling technique to produce the first reliable population metric (occupancy) for a critically endangered large carnivore; the Sumatran tiger (Panthera tigris sumatrae). From 2007-2009, seven landscapes were surveyed through 13,511 km of transects in 394 grid cells (17×17 km). Tiger sign was detected in 206 cells, producing a naive estimate of 0.52. However, after controlling for an unequal detection probability (where p = 0.13±0.017; ±S.E.), the estimated tiger occupancy was 0.72±0.048. Whilst the Sumatra-wide survey results gives cause for optimism, a significant negative correlation between occupancy and recent deforestation was found. For example, the Northern Riau landscape had an average deforestation rate of 9.8%/yr and by far the lowest occupancy (0.33±0.055). Our results highlight the key tiger areas in need of protection and have led to one area (Leuser-Ulu Masen) being upgraded as a 'global priority' for wild tiger conservation. However, Sumatra has one of the highest global deforestation rates and the two largest tiger landscapes identified in this study will become highly fragmented if their respective proposed roads networks are approved. Thus, it is vital that the Indonesian government tackles these threats, e.g. through improved land-use planning, if it is to succeed in meeting its ambitious National Tiger Recovery Plan targets of doubling the number of Sumatran tigers by 2022.

The majority of wild Sumatran tigers are believed to live in 12 Tiger Conservation Landscapes covering approximately 88,000 km(2) . However, the actual distribution of tigers across Sumatra has never been accurately mapped. Over the past 20 years, conservation efforts focused on the Sumatran tigers have increased, but the population continues to decline as a result of several key threats. To identify the status of the Sumatran tiger distribution across the island, an island-wide questionnaire survey comprised of 35 respondents from various backgrounds was conducted between May and June 2010. The survey found that Sumatran tigers are positively present in 27 habitat patches larger than 250 km(2) and possibly present in another 2. In addition, a review on major published studies on the Sumatran tiger was conducted to identify the current conservation status of the Sumatran tiger. Collectively, these studies have identified several key factors that have contributed to the decline of Sumatran tiger populations, including: forest habitat fragmentation and loss, direct killing of tigers and their prey, and the retaliatory killing of tigers due to conflict with villagers. The present paper provides management authorities and the international community with a recent assessment and a base map of the actual distribution of Sumatran tigers as well as a general overview on the current status and possible future conservation challenges of Sumatran tiger management., (© 2010 ISZS, Blackwell Publishing and IOZ/CAS.)