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Pati Aji Achdiat,1 Dini Atiyah,1 Fitri Yulianti,1 Endang Sutedja,1 Srie Prihianti Gondokaryono,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Tel/Fax +62222032426 Ext. 3449, Email pati.aji.achdiat@unpad.ac.idIntroduction: Anogenital warts (AGW) are sexually transmitted infections (STIs) caused by the human papillomavirus (HPV), particularly types 6 and 11. The highest incidence of AGW occurs in the age group of 15– 24 years. However, as life expectancy increases, there is a significant rise in the geriatric population worldwide. This demographic shift is directly proportional to the increasing number of STIs cases within the geriatric group.Cases: A case of AGW was reported in a 75-year-old man who had a history of erectile dysfunction medication use and recent sexual contact. During the physical examination, a hyperpigmented plaque with a verrucous surface was observed at the base of the penis. The results of the histopathological examination were consistent with the characteristics of AGW. In addition, HPV genotyping, through polymerase chain reaction (PCR) showed the presence of HPV type 6.Discussion: The aging process leads to a decline in immune function among geriatric individuals, which causes susceptibility to infections, including STIs. Moreover, the geriatric population has a different level of susceptibility to STIs compared to younger individuals. Factors such as physiological changes, decreased sexual function, low awareness of STIs, and having multiple sexual partners further increase the risk of STIs in this age group.Conclusion: Sexual intercourse is an important component of the human life. However, the natural decline in sexual function due to the aging process often occurs with advancing age. As a result, many geriatrics seek various solutions in order to maintain sexual function and activity in old age. Since STIs can occur at any age, early detection and education are essential, particularly for the geriatric population.Keywords: anogenital warts, geriatric, HPV, immunosenescence, sexually transmitted disease

Laila Tsaqilah,1 Hedwika Advina Nastiti,1 Hermin Aminah Usman,2 Erda Avriyanti,1 Hartati Purbo Dharmadji,1 Risa Miliawati Nurul Hidayah1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Laila Tsaqilah, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Tel/Fax +62 822 8447 4849, Email laila.tsaqilah@gmail.comAbstract: Familial Reactive Perforating Collagenosis (FRPC) is a very rare form of benign dermatosis frequently presented during early childhood and not associated with systemic diseases. Less than 50 FRPC patients have been reported in the literature. Due to the limited number of cases, the pathophysiology of this unique entity remains elusive; moreover, no standard treatment has been agreed upon. Here, we report a case of FRPC in a 20-year-old male who was presented with generalized multiple discrete papules covered with central keratotic plugs in all regions of his body, particularly in the facial area, neck, abdominal, and extensor region of the extremities for more than 7 years. Similar symptoms were acknowledged in the patient’s family members. Histopathological analyses identified the crateriform shape invagination in the epidermis filled with inflammatory lymphocytes and basophilic debris and perforated by basophilic collagen bundles from the underlying dermis. Based on the clinical and histopathological findings, the patient was diagnosed with FRPC. He was treated with topical desoximetasone 0.25% cream applied 2– 3 times daily. A follow-up evaluation after 4 weeks revealed a near-complete resolution of skin papules. To our knowledge, this is the first report of FRPC case from Indonesia. Unlike the majority of FRPC patients who had their disease onsets during infancy or early childhood, FRPC skin manifestations in our patient started during the adolescence period. The resolution of skin manifestations after daily application of topical desoximetasone suggests that topical corticosteroids are a potential treatment option for FRPC patients.Keywords: familial reactive perforating collagenosis, benign dermatosis, central keratotic plug, crateriform shape invagination, topical desoximetasone

Pati Aji Achdiat,1 Rita Septharina,1 Rasmia Rowawi,1 Hartati Purbo Dharmadji,1 Diah Puspitosari,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 2Department of Anatomy Pathology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281322750101, Email pati.aji.achdiat@unpad.ac.idAbstract: Extragenital warts caused by HPV types 6 and 11 are rarely reported. However, major risk factors for anogenital warts (AGW) include men who have sex with men (MSM) and Human Immunodeficiency Virus (HIV) infection. The incidence of extragenital warts among these populations has not been reported. This study presented a case report of a 33-year-old male with high-risk sexual behavior who showed symptoms of flesh-colored and hyperpigmentation papules. Furthermore, verrucous surfaces were observed at genital and extragenital. The patient had a history of using the same razor for pubic and armpit hair, bathing with a mesh scrub, and scratching the anal area. The histopathological result showed koilocytes, while polymerase chain reaction (PCR) examination for both genital and extragenital lesions confirmed HPV type 6 and 11. This represented the first reported case describing the incidence of extragenital and AGW caused by HPV types 6 and 11. The transmission of extragenital warts was facilitated through fomites autoinoculation, particularly in the immunocompromised condition induced by HIV, which was common among MSM. Extragenital warty-like lesions were considered as warts caused by HPV type 6/11, in HIV-infected persons, specifically MSM.Keywords: anogenital warts, extragenital warts, human papillomavirus type 6, human papillomavirus type 11, human immunodeficiency virus

Pati Aji Achdiat,1 Muhamad Radyn Haryadi Widjaya,1 Rasmia Rowawi,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62222032426 ext 3449, Fax +62222032426, Email pati.aji.achdiat@unpad.ac.idAbstract: Vulvar intraepithelial neoplasia (VIN), the precursor lesion of vulvar squamous cell carcinoma (VSCC), may present as pruritic or asymptomatic lichenified plaques surrounded by single or multiple discrete or confluent macules or papules. VIN is divided into high-grade squamous intraepithelial lesion (HSIL), which is human papillomavirus (HPV)-driven, and differentiated VIN (DVIN), which develops independently of HPV. Histopathological examination and HPV genotyping polymerase chain reaction (PCR) tests should be performed to distinguish between HSIL and DVIN. Lichenified plaques surrounded by multiple papules are found not only in VIN but also in vulvar lichen simplex chronicus (LSC). This chronic inflammatory skin disease mostly appears in labia majora and is triggered by sweating, rubbing, and mental stress. IHC staining of p16 and p53 are recommended as the most commonly used biomarkers for VIN in diagnostically challenging cases. IHC staining is also beneficial to confirm the accuracy of the HPV detection technique, as p16-negative staining may also represent a false-positive result. We report a case of the importance of p16 and p53 IHC staining in diagnosing vulvar LSC mimicking VIN with false-positive HPV-66. The patient was previously diagnosed with VIN based on clinical examination. HPV-66 was detected by PCR from a vulvar biopsy sample. Histopathological examination revealed stromal lymphocytic infiltration with non-specific chronic dermatitis; neither atypia nor koilocyte was observed. Both p16 and p53 IHC staining were negative. The patient was diagnosed and treated as vulvar LSC with 10 mg cetirizine tablet, emollient, and 0.1% mometasone furoate cream. Clinical improvement was observed as the lesions became asymptomatic hyperpigmented macules in the 4 weeks of follow-up, without recurrence after 3 years of follow-up. Both p16 and p53 IHC staining might help distinguish HSIL and DVIN mutually and from other vulvar mimics in diagnostically challenging cases.Keywords: immunohistochemical staining, p16, p53, vulvar intraepithelial neoplasia, vulvar lichen simplex chronicus

Abstract Background Live donor kidney transplantation is the preferred kidney replacement therapy for eligible patients but requires thorough donor evaluation to minimise risks. Contemporary guidelines recommend split kidney function measurement in living donors only when there is a significant kidney size discrepancy, yet the evidence for this is poor, and practice varies nationally. This study evaluates the efficacy of CT-derived kidney metrics in detecting significant functional asymmetry. Methods We conducted a retrospective cohort analysis of 123 prospective living kidney donors at a regional transplant centre from June 2011 to October 2014, utilising CT to determine kidney and cortical volumes and lengths. Asymmetric kidney function (AKF), defined by > 10% function difference on DMSA scans, was correlated with CT measurements to calculate the diagnostic accuracy of current guidelines. Results Among the prospective donors, the median age was 42 years, and 59.3% were female. The median split kidney function difference was 4%, with 25 individuals exhibiting > 10% AKF. Kidney length discrepancy proved to be a poor indicator of AKF (sensitivity: 28%, specificity: 84%). While negative predictive values for cortical and kidney volumes were high (96% and 93%, respectively), sensitivity was low, and specificity and positive predictive value did not meet satisfactory thresholds. Conclusions CT-derived metrics of kidney length, cortical, and total volume show limited sensitivity and specificity in identifying significant AKF. These findings provide evidence to support revised guideline development in the assessment of living kidney donors.

Abstract Introduction Despite the widespread use of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) transmission, scant information on HIV drug resistance mutations (DRMs) has been gathered over the past decade. This review aimed to estimate the pooled prevalence of pre-exposure prophylaxis and its two-way impact on DRM. Methods We systematically reviewed studies on DRM in pre-exposure prophylaxis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. PubMed, Cochrane, and SAGE databases were searched for English-language primary studies published between January 2001 and December 2023. The initial search was conducted on 9 August 2021 and was updated through 31 December 2023 to ensure the inclusion of the most recent findings. The registration number for this protocol review was CRD42022356061. Results A total of 26,367 participants and 562 seroconversion cases across 12 studies were included in this review. The pooled prevalence estimate for all mutations was 6.47% (95% Confidence Interval-CI 3.65–9.93), while Tenofovir Disoproxil Fumarate/Emtricitabine-associated drug resistance mutation prevalence was 1.52% (95% CI 0.23–3.60) in the pre-exposure prophylaxis arm after enrolment. A subgroup analysis, based on the study population, showed the prevalence in the heterosexual and men who have sex with men (MSM) groups was 5.53% (95% CI 2.55–9.40) and 7.47% (95% CI 3.80–12.11), respectively. Notably, there was no significant difference in the incidence of DRM between the pre-exposure prophylaxis and placebo groups (log-OR = 0.99, 95% CI −0.20 to 2.18, I2 = 0%; p = 0.10). Discussion Given the constrained prevalence of DRM, the World Health Organization (WHO) advocates the extensive adoption of pre-exposure prophylaxis. Our study demonstrated no increased risk of DRM with pre-exposure prophylaxis (p > 0.05), which is consistent with these settings. These findings align with the previous meta-analysis, which reported a 3.14-fold higher risk in the pre-exposure prophylaxis group than the placebo group, although the observed difference did not reach statistical significance (p = 0.21). Conclusions Despite the low prevalence of DRM, pre-exposure prophylaxis did not significantly increase the risk of DRM compared to placebo. However, long-term observation is required to determine further disadvantages of extensive pre-exposure prophylaxis use. PROSPERO Number: CRD42022356061.

Abstract Recently, the CMS and ATLAS collaborations have announced the results for H → Z[→ ℓ + ℓ − ]γ with ℓ = e or μ [1, 2], where H → Zγ is a sub-process of H → ℓ + ℓ − γ. This semi-leptonic Higgs decay gets both resonant and non-resonant contributions from the loop-induced H → Z[→ ℓ + ℓ − ]γ. To probe further features coming from these contributions to H → ℓ + ℓ − γ, we argue that the polarization of the final state leptons is also an important parameter. We show that the interference of resonant and non-resonant contributions, which is negligible in the case of unpolarized leptons, plays a significant role when considering the polarization of the final state lepton. For this purpose, we have calculated the polarized decay rates and the longitudinal (P L ), normal (P N ), and transverse (P T ) polarization asymmetries. We find that these asymmetries purely come from the loop contributions and are helpful to further investigate the resonant and non-resonant nature of H → Z[→ ℓ + ℓ − ]γ decay. We observe that for ℓ = e, μ, the longitudinal decay rate is highly suppressed around m ℓℓ ≈ 60 GeV when the final lepton spin is − 1 2 $$ -\frac{1}{2} $$ , dramatically increasing the corresponding lepton polarization asymmetries. Furthermore, we analyze another observable, the ratio of decay rates R i ± ll ′ $$ {R}_{i\pm}^{{\mathcal{ll}}^{\prime }} $$ , where ℓ and ℓ ′ refer to different final state lepton generations. Precise measurements of these observables at the HL-LHC and the planned e + e − collider can provide fertile ground to test not only the SM but also to examine the signatures of possible NP beyond the SM.

Usman Hamid is the Chairperson of the Public Virtue Institute and Director of Amnesty International Indonesia. He is also a lecturer at the Indonesia Jentera School of Law, a human rights lawyer, and a member of the expert council at the Indonesian Bar Association (PERADI-RBA). In 1998, as a student activist at Trisakti University, he became involved in protests that contributed to the fall of the Suharto regime. He subsequently became the coordinator of KontraS, the Commission for Missing Persons and Victims of Violence. In 2004, he was appointed to the Presidential Fact-Finding Team that investigated the murder of prominent human rights defender Munir Said Thalib. In 2011, he was appointed to the Presidential Unit for the Supervision of Development, where he reviewed Indonesia’s National Human Rights Action Plan for 2011–2014. This commentary reflects on the unmet expectations of human rights improvements during President Jokowi's two terms in Indonesia. Written from his perspective of a long-time human rights activist, Usman Hamid critiques Jokowi's failure to address key human rights issues, including past violations, minority protections, and civil liberties, despite Jokowis early promises. The author combines personal experiences with an analysis of Jokowi's political compromises and their impact on Indonesia's declining human rights landscape.

BackgroundAccurate diagnosis of enteric fever is challenging, particularly in low- and middle-income countries, due to the overlap of clinical and laboratory features with other pathogens. To better understand the difficulties in enteric fever diagnosis, we evaluated the characteristics of patients clinically diagnosed with enteric fever and the real-world performance of TUBEX TF, one of the most used tests in Indonesia.Methodology/principal findingsPatients were recruited through the AFIRE (Etiology of Acute Febrile Illness Requiring Hospitalization) study at eight Indonesian hospitals. Blood culture was performed for all patients, and TUBEX TF was performed for suspected enteric cases. Salmonella PCR and ELISA tests were performed at a reference lab. Sensitivity and specificity of TUBEX TF and IgM and IgG anti-S. Typhi ELISA were determined. Of 301 patients clinically diagnosed with enteric fever, 50 (16.6%) were confirmed by blood culture and/or PCR. Confirmed cases were mostly school-aged children presenting with fever, anorexia, dizziness and/or abdominal pain with normal leukocyte count or leukopenia. TUBEX TF demonstrated a sensitivity of 97.6% to 70.7% and specificity of 38.3% to 67.2% at cutoffs of 4 and 6, respectively. Acute IgG demonstrated the best sensitivity and specificity, at 90.7% and 82.7%, respectively, and the best ROC characteristics.Conclusions/significanceA substantial proportion of enteric fever was misdiagnosed at all study hospitals, likely due to the overlap of clinical characteristics and lab parameters with those of other common pathogens. The TUBEX TF rapid serological assay demonstrated suboptimal performance in our setting and tended to over-diagnose enteric fever. The role of IgG from acute specimens for identification of enteric fever cases merits additional consideration.

The extant literature lavishes its focus on understanding Russia’s motivation for starting a war against Ukraine and on the broader question of the role of technology in determining the outcome of war. This article, however, undertakes a comprehensive examination of the relatively ignored yet important aspect of adapting military strategy during the war through Russian experience. It demonstrates that the Russian strategists have shown adequate appreciation for the principle of adaptation in formulating military strategy. To this effect, it identifies and explains three distinct sequential adaptations in the Russian military strategy during the ongoing Ukrainian war. The analysis, conducted with thoroughness and rigor, demonstrates that the Russian armed forces made a relatively quicker transition from the show of force to offense to defense. It also delves into the factors that drove these adaptations. This research has implications for both theory and policy. On the theoretical side, it reinforces the organic relationship between strategy and war. On the policy side, it highlights the importance of adapting military strategy to contain and limit the scope of war.

The complex linguistic characteristics and limited resources present sentiment analysis in Roman Urdu as a unique challenge, necessitating the development of accurate NLP models. In this study, we investigate the performance of prominent ensemble methods on two diverse datasets of UCL and IMDB movie reviews with Roman Urdu and English dialects, respectively. We perform a comparative examination to assess the effectiveness of ensemble techniques including stacking, bagging, random subspace, and boosting, optimized through grid search. The ensemble techniques employ four base learners (Support Vector Machine, Random Forest, Logistic Regression, and Naive Bayes) for sentiment classification. The experiment analysis focuses on different N-gram feature sets (unigrams, bigrams, and trigrams), Chi-square feature selection, and text representation schemes (Bag of Words and TF-IDF). Our empirical findings underscore the superiority of stacking across both datasets, achieving high accuracies and F1-scores: 80.30% and 81.76% on the UCL dataset, and 90.92% and 91.12% on the IMDB datasets, respectively. The proposed approach has significant performance compared to baseline approaches on the relevant tasks and improves the accuracy up to 7% on the UCL dataset.

Recent advances in Generative Adversarial Networks (GANs) have produced synthetic images with high visual fidelity, making them nearly indistinguishable from human-created images. These synthetic images referred to as deepfakes, have become a major source of misinformation due to social media. Technology is advancing rapidly, so reliable methods for distinguishing real from fake images are needed. The current detection mechanisms require image forensics tools such as error level analysis (ELA), and clone detection to detect manipulated images. These approaches are limited because they require forensics expertise to use, are manual in application nature, and are unscalable, creating a need for a framework for a scalable tool that experts and non-experts can use to combat the spread of manipulated images and preserve digital visual information authenticity. We approach this problem with a multi-model ensemble framework using the transfer learning method to effectively detect fake images. The proposed approach named Multi-Model GAN Guard (MMGANGuard)integrates four models into an ensemble framework to identify GAN-generated image characteristics to improve deepfake detection. The Gram-Net architecture, ResNet50V2, and DenseNet201 models are used with co-occurrence matrices using transfer learning for MMGANGuard. Through comprehensive experiments, the proposed model demonstrates promising results in detecting the deepfake with high accuracy on the StyleGAN dataset. For automated detection of deepfake-generated images, the proposed model exceeded 97% accuracy, 98.5% TPR, 98.4% TPR, and 95.6% TPR in these evaluations, eliminating the need for manual assessment which is promising for future research in this domain.

Recommender systems are crucial in today’s digital world, by enhancing user engagement experience in digital ecosystems. Internet of things (IoT) have huge potential to generate dynamic and real time data. The data generated through IoT are being utilized to extract dynamic context of the user. Integrating recommender systems with context-aware (IoT data) and cross-domain (Knowledge Transfer) capabilities have the capacity to further enhance the accuracy and relevance of recommendation systems. However, recommender systems struggle with the cold start problem, where non-availability of data hinders to make effective recommendations for new users. Therefore, IoT-enabled Context-Aware Cross-Domain Recommender Systems may employ latent user profiling to provide personalized and exceedingly relevant recommendations across domains. The proposed system, named Knowledge Transfer Cross-Domain User Latent Factors (KT-CDULF), creates a user profile that spans multiple data domains, capturing a wide range of user behavior on all domains. The KT-CDULF captures the combined knowledge across domains to make recommendations even with limited user data, i.e. cold start problem. Domain-independent factors, and context can be used across domains to make relevant recommendations. The effectiveness of a recommender system depends on the density of the ratings in the data. To address this, KT-CDULF used two benchmark datasets to create user profiles and an item-rating matrix with additional context extracted from IoT generated dataset. KT-CDULF is evaluated and compared it with state-of-the-art models for recommender systems and achieves an accuracy of 98%, demonstrating the benefits of transferring knowledge containing context across data domains in recommender systems.

Computer-aided decision support systems (DSSs) are becoming popular in a variety of professions. Notably, medical DSSs assist healthcare professionals (decision makers) choose the optimal course of action (decisions) while treating patients. Such systems help decision-makers in situations when there is uncertainty in manual decisions due to lack of information or expertise. Choosing a suitable learning algorithm in a DSS is essential and affects its performance. Among machine learning (ML) algorithms, artificial neural networks (ANNs) are considered the most suitable framework for many classification tasks. In healthcare, an ML-based prediction system/DSS employs data (genetic profile or clinical characteristics) and learning algorithms to forecast target values, which may give promising results. However, improving prediction accuracy is a crucial step in making informed decisions. One can apply various preprocessing methods (cross validation, feature selection, bagging, boosting, etc.) to achieve this. For complex classification tasks like cancer, decision-makers can utilize the hybridization of classifiers to increase prediction accuracy. The presented study investigates the possibilities of improvements in the design of hybridized systems for DSSs to assist healthcare professionals in robust decision-making before, during, and after cancer diagnosis. Since the network weights and the activation functions are the two crucial elements in the learning process of an ANN, this study is organized to investigates the improvement in the hybrid system by selecting suitable features from gene expression microarray data and using these features to compute the more realistic initial weights instead of using random guesses as initial weights for ANN. The use of the proposed framework gives promising results (upto 6.67% gain in accuracy when compared to previous study (Table-5) while 10.43% increase in accuracy when compared to conventional ML classifiers (Table-4).

The classification of large-scale textual dataset is associated with a huge number of instances and millions of features which must be discriminated between large numbers of categories. The task requires the utilization of a defined hierarchy structure and tools that automatically classify instances within the hierarchy known as Large Scale Hierarchical Text Classification (LSHTC). Predicting the labels of instances by the employed classifiers is challenging due to the high number of features. Furthermore, the existing Dimensional Reduction (DR) approaches in cooperation with the LSHTC framework are still quite inefficient. In such a problem, an effective Hierarchical Dimensional Reduction approach can be advantageous in improving the performance of the LSHTC. Therefore, in this paper, we enhance the performance of LSHTC by proposing a Multi-stage Hierarchical Dimensional Reduction (MHDR) approach based on Modified Feature Hashing (MFH) and Hierarchical Bi-Filtering (HBF) method. In addition to alleviating bad collision and result discrepancy, experimental results show that the proposed approach has achieve the best performance in terms of micro-f1 and macro-f1 by recording average scores of 58.47% and 54.77% using TD-SVM, and average scores of 51.14% and 48.70% using TD-LR, respectively. The method also achieved 11% speed-up than the approaches compared.

Sarcasm has a significant role in human communication especially on social media platforms where users express their sentiments through humor, satire, and criticism. The identification of sarcasm is crucial in comprehending the sentiment and the communication context on platforms like Twitter. This ambiguous nature of the expression of content presents the detection of sarcasm as a considerable challenge in natural language processing (NLP). The importance and challenges increase further, especially in languages like Urdu where resources for NLP are limited. The traditional rule-based approaches lack the desired performance because of the subtle and context-based nature of sarcasm. However, the recent advancements in NLP, particularly the transformer architecture-based large language models (LLMs) like BERT offer promising solutions. In this research, we have utilized a newly created Urdu sarcasm dataset comprising 12,910 tweets manually re-annotated into sarcastic and non-sarcastic classes. These tweets were derived from the public Urdu tweet dataset consisting of 19,995 tweets. We have established baseline results using deep learning classifiers comprising CNN, LSTM, GRU, BiLSTM, and CNN-LSTM. To comprehensively capture the contextual information, we propose a novel hybrid model architecture that integrates multilingual BERT (mBERT) embeddings with BiLSTM and multi-head attention (MHA) for Urdu sarcasm. The proposed mBERT-BiLSTM-MHA model demonstrates superior performance by achieving an accuracy of 79.51% and an F1 score of 80.04%, outperforming deep learning classifiers trained with fastText word embeddings.

Industrial Internet of Things (IIoT) applications consist of resource constrained interconnected devices that make them vulnerable to data leak and integrity violation challenges. The mobility, dynamism, and complex structure of the network further make this issue more challenging. To control the information flow in such environments, access control is critical to make collaboration and communication safe. To deal with these challenges, recent studies employ attribute-based access control on top of blockchain technology. However, the attribute-based access control frameworks suffer due to high computational overhead. In this paper, we propose an improved role-based access control framework using hyperledger blockchain to deal with IIoT requirements with less computational overhead making the information control process more efficient and real-time. The proposed framework leverages a layered architecture of chaincodes to implement the improved access control framework that handles the permission delegation and conflict management to deal with the dynamism of the IIoT network. The system uses a Policy Contract, Device Contract, and Access Contract to manage the workflow of the whole access control process. Each chaincode in the proposed framework is isolated in terms of its responsibilities to make the design low coupled. The integration of improved access control with blockchain enables the proposed framework to provide a highly scalable solution, tamper-proof, and flexible to manage conflicting scenarios. The proposed system outperforms the recent studies significantly in computational overhead in extensive simulation results. To verify the scalability and efficiency, the proposed is evaluated against a large number of concurrent virtual clients in simulation and statistical analysis proves that the proposed system is promising for further research in this domain.

In histopathological image analysis, the feature extraction task for classification proves to be demanding. This difficulty arises from the assortment of histological features appropriate for individual problems and the intricate presence of diverse geometric structures. The method proposed in this study leverages dictionary learning and sparse coding techniques to create priors tailored to specific targets, which is essential for classification purposes. Our approach introduces Penalized Sequential Discriminative Dictionary Learning (PSDDL), designed to integrate histopathological image features by acquiring structured, class-specific dictionaries. Initially, PSDDL constructs a dictionary from the input data, incorporating label information for each class. Subsequently, the proposed algorithm introduces a penalty and regularization term to amplify the efficacy of the acquired dictionary. Furthermore, the proposed method also tackles the class imbalance in the dataset by leveraging dictionary learning. Mainly, under-sampling is performed on the dataset, and the number of samples of fewer classes is kept for all categories and passed to the dictionary learning algorithm. Extensive experimental results highlight a notable enhancement in classification performance. The proposed structured discriminative dictionary learning technique consistently produces improved accuracies compared to other contemporary methods for classifying the BreakHis breast cancer dataset. Integrating class-specific information into the process of dictionary learning paves the way for enriching the interpretive capabilities of machine learning models while delving deeper into our comprehension of the complex and intricate structures inherent in biological tissues.

Background: Despite the availability of various effective antiretroviral (ARV) drugs, human immunodeficiency virus (HIV) infection has come with HIV drug resistance (HIVDR), which compromises its effectiveness in reducing HIV-related morbidity, mortality, and transmission. The emergence of transmitted (TDR) and acquired HIVDR (ADR) among antiretroviral therapy (ART)-naïve and experienced individuals have been reported in several Indonesian regions. Therefore, continuous HIVDR surveillance is needed in Indonesia, especially in Surabaya, which is identified as having the highest prevalence of HIV infection in East Java; thus, this study aimed to identify the emergence of TDR and ADR among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLWHA). Methods: Fifty-eight PLWHA infected with HIV type 1 (HIV-1), comprising 21 and 37 ART-naïve and experienced individuals were enrolled in this study, respectively. Blood samples collected from study participants were subjected to genotypic analysis, mainly towards the pol gene encoding protease (PR gene) and reverse transcriptase (RT gene) of HIV-1. Results: Seventeen PR and 21 RT genes were successfully amplified and sequenced from 29 samples. HIV-1 subtyping revealed CRF01_AE as the most dominant subtype (24/29; 82.76%), followed by subtype B (3/29; 10.34%). Uncommon subtypes, including subtype D and a recombinant containing subtypes B and G genomic fragments, were also identified. TDR for PR inhibitors was not detected; however, TDR and ADR for RT inhibitors were identified in 11.11% and 41.67% of samples, respectively. Two amino acid insertions at position 69 of the RT gene (69ins), a previously never-reported mutation in Indonesia, were identified in this study. Conclusion: Both TDR and ADR have emerged among PLWHA residing in Surabaya, East Java, Indonesia. Uncommon drug-resistance mutations and subtypes were identified in this study. These situations might hamper ART efficacy and treatment success. Continuous surveillance of HIVDR is necessary to monitor both TDR and ADR in Indonesia.

Objective: To understand how the acute exacerbations of chronic obstructive pulmonary disease (COPD) can lead to coagulation dysfunctions causing hemostatic abnormalities (prolonged prothrombin time, slightly longer activated partial thromboplastin time, higher fibrinogen levels, higher D-dimer levels, and slightly lower platelet counts). Study Design: Comparative cross-sectional. Place and Duration of Study: The study was conducted at the Department of Internal Medicine Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan during the period of July 2023 to December 2023. Methods: The current study utilized patients with a confirmed diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who were hospitalized in the respiratory care unit and were above 50 years of age. A total of 200 patients were accessed including their demographic characteristics (age, gender, residence, and job), clinical parameters (spirometry results (Forced expiratory volume in one second/Functional vital capacity ratio), complete blood counts, fibrinogen, prothrombin, activated partial thromboplastin time, D-dimers and arterial blood gas analysis. The intricate relationship between coagulation dysfunction and acute exacerbations of chronic obstructive pulmonary disease was analyzed using SPSS 26. Results: The results obtained that; patients with acute exacerbation of chronic obstructive pulmonary disease had prolonged prothrombin time (13.5 ± 1.2 seconds, P < 0.001) slightly longer aPTT (32.1 ± 2.5 seconds, P = 0.014), along with higher fibrinogen levels (350.2 ± 45.8 mg/dL, P < 0.001) and D-dimer levels (550.4 ± 120.3 ng/mL, P = 0.002), as compared to patients with stable chronic obstructive pulmonary disease. The platelet counts of Acute exacerbation of chronic obstructive pulmonary disease patients obtained were slightly lower (260.3 ± 45.4x10^3/μL, P = 0.009) compared to stable chronic obstructive pulmonary disease patients. Furthermore, results provided that coagulation dysfunction was significantly associated with infection, hypercapnia, and acute exacerbation of chronic obstructive pulmonary disease. The prevalence of coagulation dysfunction markers was higher among patients with acute exacerbation of chronic obstructive pulmonary disease. Conclusion: Coagulation dysfunction and its associated risk factors are higher in patients with acute exacerbation of chronic obstructive pulmonary disease and are elevated with increased exposure to air pollution.

Syphilis, an infectious disease caused by the spirochete Treponema pallidum, represents a pervasive global epidemic. Secondary syphilis is typically marked by the emergence of highly contagious mucocutaneous manifestations, including non-pruritic rashes on the palms and soles of the feet, alopecia, mucous patches, and condyloma lata. Here, we report a rare case of a 30-year-old male with newly discovered type 2 diabetes mellitus who presented with severe odynophagia due to secondary syphilis, confirmed by both nontreponemal VDRL/RPR and treponemal TPHA tests. Following the administration of a single-dose intramuscular injection of benzathine penicillin G 2.4 million units, the symptoms gradually decreased, allowing the patient to regain his health.

Background: Acral and mucosal melanomas, the most common sun-shielded site melanoma subtypes in Asia and Indonesia, often yield poor prognoses. The invasion depth reflects their progressivity, and the pathogenesis is influenced by vitamin D receptor (VDR) status and CD8+ T-Lymphocyte amount. This study aims to determine the association between the invasion depth of acral and mucosal melanomas with their VDR and CD8+ immunoexpression., Methods: A cross-sectional observational study was conducted on 60 formalin-fixed paraffin-embedded (FPPE) samples, with equal representation in acral and mucosal melanoma groups from 2017 to 2021. The samples were assessed for the invasion depth and immunoexpression of VDR and CD8+. A chi-square test with an alternative Exact-Fisher analysis was used to determine the association between the variables in both subtype groups., Results: An association between VDR and CD8+ immunoexpression and invasion depth in acral melanoma (p value = 0.0001 and 0.009, respectively) was observed, while only VDR immunoexpression was associated with the invasion depth in mucosal melanoma (p-value =0.004). Interestingly, no association was found between CD8+ immunoexpression and the invasion depth in mucosal melanoma (p = 0.640)., Conclusion: The role of VDR and CD8+ T-lymphocytes are inversely associated with melanoma depth in acral melanoma, while only VDR is associated with melanoma depth in mucosal melanoma., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Breastfeeding is crucial in providing infants with needed nutrition and immunity to foster their healthy growth and development; yet, optimal support from health workers is critical for it to be successful., Aim: To determine factors influencing tangible breastfeeding support among health workers in Nigeria., Methods: This cross-sectional study was conducted in Nigeria's six geopolitical zones between August 2022 and February 2023 among health workers ( N  = 2,922). Data were gathered through an interviewer-administered, validated questionnaire. Significant factors of tangible breastfeeding support were identified through multivariable logistic regression, and corresponding odds ratios with 95% confidence intervals were reported., Results: The mean age of the health workers was 28.6 ( SD  = 9.3) years. Just 45% (1,316) achieved optimal scores for tangible breastfeeding support. Only 31.4% (918) of lactation support providers/specialists practice tangible breastfeeding support and half (50.6%, 1,479) had a favorable attitude towards providing tangible breastfeeding support. About two-fifths (39.3%, 1,148) engaged caregivers in reviewing breast milk storage procedures, whereas, 54.6% (1,595) and 78.0% (2,279) of health workers assisted with breast pumps and breastfeeding attachment respectively. The odds of having optimal tangible breastfeeding support were higher for health workers aged 52 years or older compared to those aged under 20 years (aOR 1.88, 95% CI [1.13, 3.12]), a positive attitude (aOR 1.43, 95% CI [1.22, 1.69]), availability of a breastfeeding champion (aOR 1.47, 95% CI [1.21, 1.79]), 1.69]), provision of breast-pump videos (aOR; 2.33, 95% CI [1.85, 2.95]), and hand-expression videos (aOR; 1.41, 95% CI [1.02, 1.79]). (duplication)., Conclusion: Health workers' tangible breastfeeding support in Nigeria is suboptimal and is driven by age, service level, attitude, availability of breastfeeding champions, and appropriate practice aids. Targeted interventions to improve health workers' attitudes, technical skills, provision of aids, and task shifting to non-specialists are needed for optimal tangible breastfeeding support., Competing Interests: Disclosures and Conflicts of InterestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Langerhans cell histiocytosis (LCH) is a rare clonal disorder of the monocyte-macrophage system. There are 3 distinct types of LCH: multisystem type (MS), single-system multi-site (SS-m), and single-system single-site (SS-s). The disease is most common in young children, especially males. In this case, we report the rare case of a young Asian girl who initially complained of dyspnea, diarrhea, rash, and fever. Upon further examination, multiple systems were implicated, including the bone, skin, lung, liver, and spleen. Multisystem LCH with risk organ involvement give poor prognosis to the patients., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Aneurysmal bone cyst (ABC) is a benign and locally proliferative vascular disorder in the form of a non-neoplastic bone lesion commonly found in children and young adults. Several treatments and therapeutic options are available. Percutaneous sclerotherapy is an alternative treatment for ABC with less morbidity than other therapies. An 11-year-old girl presented with a lump in her left flank since 10 months ago with paresthesia, and leg weakness. The patient was unable to raise her legs and walk. The patient underwent posterior surgical and stabilization procedures with tumor extirpation. Three months postsurgery, the lump progressively increased and tenderness. MRI showed an expansile destructive lytic lesion, firm borders, regular margins, and multiple septa with clear transition zones, without periosteal reactions, forming a picture of a "soap bubble appearance" surrounding the lumbar paravertebral. The patient underwent sclerotherapy using 5 ml of absolute alcohol under visual fluoroscopy guidance. After the sclerotherapy, the patient showed clinical improvement and decreased lump size. No side effects or massive bleeding were experienced postsclerotherapy. Thoracolumbar x-ray post sclerotherapy showed a decreased mass size in the posterior lumbar area. This case demonstrates that sclerotherapy presents a secure alternative for pediatric patients in contrast to spinal ABC surgery. It offers minimal invasiveness and reduced morbidity. The percutaneous administration of absolute alcohol proves effective in treating spinal ABC. In this case, the patient experienced clinical improvement, leading to a decrease in lump size. There were no instances of significant bleeding around the lump postsclerotherapy., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Sub-Saharan Africa (SSA) is plagued by myriads of diseases, mostly infectious; but cancer disease burden is rising among non-communicable diseases. Nigeria has a high burden of cancer, however its remote underserved culturally-conserved populations have been understudied, a gap this study sought to fill., Methods: This was a cross-sectional multi-institutional descriptive study of histologically diagnosed cancers over a four-year period (January 2019-December 2022) archived in the Departments of Pathology and Cancer Registries of six tertiary hospitals in the northeast of Nigeria. Data obtained included age at diagnosis, gender, tumor site and available cancer care infrastructure. Population data of the study region and its demographics was obtained from the National Population Commission and used to calculate incident rates for the population studied., Results: A total of 4,681 incident cancer cases from 2,770 females and 1,911 males were identified. The median age at diagnosis for females was 45 years (range 1-95yrs), and 56 years (range 1-99yrs) for males. Observed age-specific incidence rates (ASR) increased steadily for both genders reaching peaks in the age group 80 years and above with the highest ASR seen among males (321/100,000 persons) compared to females (215.5/100,000 persons). Breast, cervical, prostatic, colorectal and skin cancers were the five most common incident cancers. In females, breast, cervical, skin, ovarian and colorectal cancers were the top five malignancies; while prostate, haematolymphoid, skin, colorectal and urinary bladder cancers predominated in men., Conclusion: Remote SSA communities are witnessing rising cancer disease burden. Proactive control programs inclusive of advocacy, vaccination, screening, and improved diagnostics are needed., 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. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Ezenkwa, Lawan, Garbati, Suleiman, Katagum, Kabir, Adamu, Modu, Olanrewaju, Dachi, Abdullahi, Alkali, Bojude, Usman, Omotoso, Schlumbrecht, George and Audu.)

Background: Post-abortion care (PAC) is a crucial component of emergency obstetric care, and many of the primary health care centres (PHC) in the internally displaced person (IDP) camps and host communities in Maiduguri lack it. Improved access to high-quality PACs is essential for meeting the reproductive health needs of the IDPs and reducing the maternal morbidity and mortality that can result from miscarriages. OBJECTIVE: To determine the trend in managing miscarriages in the IDP camps and host communities in Maiduguri and the impact of the volunteer obstetrician scheme (VOS) on PAC., Methodology: We conducted a longitudinal study in selected PHCs serving IDP camps and host communities in Maiduguri. The study spanned five (5) years, and we compared the management of miscarriages and PAC services one year before the VOS project, two years during the project and two years after the project. During the two-year VOS project, staff manning the PHCs had supportive supervision with hands-on training on PAC. Chi-square for trend and odd ratio with a 95% confidence interval was used as appropriate to compare the trend in PAC services provided during the study period., Results: One thousand eight hundred and eight (1808) women presented with miscarriages, and 1562 (86.4%) required uterine evacuation. Medical evacuation with oral misoprostol was offered to 974 (62.4%), and manual vacuum aspiration (MVA) was used in 422 (27.0%) of the women who needed uterine evacuation. There was a statistically significant rise in the use of medical evacuation throughout the study period (52.2% before VOS, and 71.4% by the second year of VOS) with ꭓ2=41.64 and P<0.001. In comparison, the use of MVA fell from 38.6% in 2015 to 27.7% in 2019 (ꭓ2=34.74 and P<0.001). Similar rising trends were also observed in postabortion family planning acceptance (ꭓ2=22.27, P<0.001)., Conclusion: The Volunteer Obstetrician Scheme project appears to have improved PAC services, especially medical evacuation and family planning uptake in the PHCs in IDP camps and host communities in Maiduguri, Borno State, Nigeria. We recommend task shifting of PAC services and periodic supportive supervision to ensure the quality of care., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Individuals with human immunodeficiency virus (HIV) infection are prone to developing persistent and unremitting anogenital warts (AGWs). To address this health condition, immunotherapy using tuberculin purified protein derivative (PPD) has been proven to be a promising novel and safe treatment for AGWs in HIV patients. Therefore, this study involved a case of a 21-year-old man with stage I HIV infection, possessing CD4 counts 548 cells/uL and routinely receiving HIV antiretroviral. Patients presented with a condyloma acuminata type AGWs, supported by histopathological results, and tested positive for Human papillomavirus type 11. The treatment approach involved administering 15 tuberculin units of PPD weekly to the largest lesion for 5 weeks. The lesion started to respond two weeks following the first injection and showed a 50% decrease in size after five weeks. There was pain on the site of injection and sub-febrile for a short period. In conclusion, tuberculin PPD is safe and has the potential for the treatment of AGWs in HIV-positive patients for further development., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest., (Copyright © 2023, the Author(s).)