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Let S be a ring with involution having a nontrivial symmetric idempotent element e . If Ω is any appropriate multiplicative generalized reverse ∗ CE-derivation of S with involution ∗ , then under some suitable restrictions on S , Ω is centrally-extended additive.

Background Bladder cancer (BC) is recorded as the fifth most common cancer worldwide with high morbidity and mortality. The most urgent problem in BCs is the high recurrence rate as two-thirds of non-muscle-invasive bladder cancer (NMIBC) will develop into muscle-invasive bladder cancer (MIBC), which retains a feature of rapid progress and metastasis. In addition, only a limited number of biomarkers are available for diagnosing BC compared to other cancers. Hence, finding sensitive and specific biomarkers for predicting the diagnosis and prognosis of patients with BC is critically needed. Therefore, this study aimed to determine the expression and clinical significance of urinary lncRNA BLACAT1 as a non-invasively diagnostic and prognostic biomarker to detect and differentiate BCs stages. Methods and results The expression levels of urinary BLACAT1 were detected by qRT-PCR assay in seventy (70) BC patients with different TNM grades (T0-T3) and twelve (12) healthy subjects as control. BLACAT1 was downregulated in superficial stages (T0 = 0.09 ± 0.02 and T1 = 0.5 ± 0.1) compared to healthy control. Furthermore, in the invasive stages, its levels started to elevate in the T2 stage (1.2 ± 0. 2), and higher levels were detected in the T3 stage with a mean value of (5.2 ± 0.6). This elevation was positively correlated with disease progression. Therefore, BLACAT1 can differentiate between metastatic and non-metastatic stages of BCs. Furthermore, its predictive values are not like to be influenced by schistosomal infection. Conclusions Upregulation of BLACAT1 in invasive stages predicted an unfavorable prognosis for patients with BCs, as it contributes to the migration and metastasis of BCs. Therefore, we can conclude that urinary BLACAT1 may be considered a non-invasive promising metastatic biomarker for BCs.

Background and Hypothesis While literature indicates that culture modulates phenomenological characteristics of hallucinations in schizophrenia-spectrum disorders, little is known about the extent culture modulates these characteristics in nonclinical samples. Study Design We compared lifetime prevalence, age of onset, and phenomenology of hallucinations as assessed with the Questionnaire for Psychotic Experiences between samples of nonclinical participants used from the Netherlands (N = 2999) and Qatar (N = 2999). While participant recruitment differed between the 2 countries, the samples were relatively equal in terms of demographic factors. Study Results Our findings indicate that the lifetime prevalence of tactile and olfactory hallucinations are the same across countries. However, the prevalence of auditory hallucinations (AH) and visual hallucinations (VH) were twice as high in the Dutch sample. The reported age of onset for auditory and tactile hallucinations was younger for the Dutch sample. Findings from the measurement invariance supported cross-cultural comparisons with exception for duration, distress, and insight. Qatar’s and Dutch participants reported similar valence and extent of interaction with AH and VH. However, compared to those in the Netherlands, participants from Qatar reported significantly more impact on daily functioning and a higher prevalence of receiving commands from hallucinations in the past week. Conclusions While AH and VH were more often reported in the Dutch sample, participants in Qatar generally had higher mean factor scores for past week AH and VH than in the Netherlands. The phenomenology of hallucinations in the Qatar sample was of greater clinical relevance, with potentially important implications for early screening and prevention.

The presented work shows the design and evaluation of the NIS 1 kN·m primary torque standard machine. The machine covers the range up to 1000 N·m with a very wide range of torque steps thanking different 4 mass stacks. The machine has a double-side lever arm with half-moon ends to provide calibration in the clockwise and anticlockwise directions. An air bearing was used as a fulcrum to provide a low friction coefficient. FEA was used in the design and optimization process of the lever arm. The relative expanded uncertainty of the machine is 0.03% which is proved by recalibration of two reference torque transducers of 200 N·m and 1000 N·m capacity. All En values are less than unity, which reveals the competence of the developed machine.

Background: Vinflunine is the only cytotoxic agent that had been tested as a second line therapy in platinum refractory urothelial carcinoma patients in a phase III clinical trial. The aim of our study was to evaluate the efficacy and safety of vinflunine as a second line after failure of platinum containing regimen. Patients and methods: We prospectively included 27 patients of locally advanced or metastatic urothelial cancer who presented to the National Cancer Institute (NCI) of Egypt. The primary objective was to assess the disease control rate. However, the secondary objectives were to assess the progression free survival (PFS) and overall survival (OS). Results: A total of 27 patients were treated at the NCI of Egypt. Median age was 64.1 years (42.3-76.8). Male to female ratio was 26:1. Eastern Cooperative Oncology Group performance status was zero in 2 patients, one in 23 patients while the ECOG PS 2 was in only 2 patients. The vast majority of the patients received 2 cycles (12 patients), one patient received 3 cycles, 5 patients received 4 cycles, and 8 patients received 6 cycles while one patient received 8 cycles. A complete response was observed in one patient, partial response in 9 patients and stable disease in 12 patients and progressive disease in 5 patients with a disease control rate of 81.4%. Median progression free survival (PFS) and overall survival for the entire population were 3.45 months and 3.22 months respectively. Median OS for the responders was 7.24 months. Toxicity was mild, and grade 3-4 adverse events were anemia (11.1%), neutropenic fever (4%), fatigue (14.8%) and constipation (7.4%). Conclusion: Vinflunine is an efficient and tolerable second line treatment in advanced urothelial carcinoma.

The shear strength of soil is one of the most important soil properties that should be identified before any foundation design. The presence of gypseous soil exacerbates foundation problems. In this research, an approach to forecasting shear strength parameters of gypseous soils based on basic soil properties was created using Artificial Neural Networks. Two models were built to forecast the cohesion and the angle of internal friction. Nine basic soil properties were used as inputs to both models for they were considered to have the most significant impact on soil shear strength, namely: depth, gypsum content, passing sieve no.200, liquid limit, plastic limit, plasticity index, water content, dry unit weight, and initial voids ratio. Multi-layer perceptron training by the backpropagation algorithm was used in creating the network. It was found that both models can predict shear strength parameters for gypseous soils with good reliability. Sensitivity analysis of the first model indicated that dry unit weight and plasticity index have the most significant effect on the predicted cohesion. While in the second model, the results indicated that the gypsum content and plasticity index have the most significant effect on the predicted angle of internal friction.

In this paper, the effect of footing shape resting on dry sand when subjected to machine dynamic loading is experimentally investigated. A laboratory set-up was prepared to simulate the case at different operating frequencies. Nine models were tested to examine the effects of the combinations of two parameters, including different frequencies of (0.5, 1, and 2 Hz) and different footing shapes (circular, square and rectangular). The tests were conducted under a load amplitude of (0.25 ton) using sand with medium and dense relative densities corresponding to (R.D. = 50% and 80%) having unit weights of (17.04 and 17.96 kN/m3) respectively. A shaft encoder and a vibration meter were used to measure the strain and amplitude displacement, while the stress in the soil at different depths was measured using flexible pressure sensors. It was found that the shape of footing has a considerable influence on the bearing capacity of the supporting soil under dynamic loading. For instance, the strain of dry sand under a circular footing was nearly (41%) higher, the amplitude displacement was nearly (17%) higher, and stress was nearly (12%) higher than square and rectangular footings, under the same conditions.

Red Sea represents one of the most remarkable marine ecosystems. However, it is also one of the world's least explored areas of marine biodiversity. The aims of this investigation were therefore, to isolate marine microorganisms from the seashore sediments and water in shallow region from west Yemen coast, to assess their antimicrobial potential, to identify the highly active isolate, and to purify and identify the bioactive compounds from it. In this regard, twenty-five bacterial strains have been isolated from twenty samples and tested for their antimicrobial ability against some pathogenic bacteria and yeast by using the agar disk diffusion and agar well diffusion assay. Out of the total 25 marine actinomycetes isolates only 13 exhibited interesting antimicrobial activity. The morphological, biochemical, and phylogenetic characteristics of the potential isolate 1S1 were compatible with their classification in the genus Streptomyces. The 16S rRNA gene sequences have shown that the isolate 1S1 clustered with Streptomyces longisporoflavus. The strain Streptomyces sp. 1S1 was cultivated and extracted with ethyl acetate. The GC–MS study of the extract indicated the presence of certain fatty acyl compounds e.g., tetradecanoic acid, 9-octadecenoic acid, hexadecanoic acid, and 9,12,15-octadecatrienoic acid. Using chromatographic techniques, three compounds were isolated and by spectroscopic methods e.g., IR, MS and NMR structurally elucidated. The three compounds were identified as a triacylglyceride, 9-octadecenoic acid, and hexadecanoic acid. The study reinforces the evidence of the potential of Streptomyces sp and the ability to produce several antimicrobial compounds.

The COVID-19 issue forced necessary changes in medical education that have been demanding and adjusting for different medical colleges, but they also provide a great opportunity for the betterment and possible challenging and useful transformation of medical education. This chapter examined the responses of medical organizations to this pandemic, its merits, and its challenges. It analyzed the potential effects of new strategies’ recognition and application on medical education in the post-COVID-19 period. The status of medical education before COVID-19 and the challenges of adopting competencies have been reviewed. The teaching and assessment strategies innovated in the COVID-19 era and reflections from faculty and students were discussed. Over the previous years, the pandemic has questioned concepts about how medical education should be delivered. The COVID-19 pandemic offers the medical education community a unique chance to reorient itself away from outdated standards and practices and toward more societally responsible and accountable standards and practices. All involved in medical education should all work together to prevent situations from “snapping back” to how they have always been because they were accepted practices and would be lost if the pandemic had the potential to disrupt growth and reform.

Rare earth metal cerium-doped titania nanoparticles (titanium dioxide [TiO2]) were produced utilizing a low-cost and straightforward sol–gel technique, and its enhanced photodynamic anticancer activity was tested on Y79 retinoblastoma cancer cells. The structural, optical, morphological, anticancer activity, and cytotoxicity of pure and cerium-doped TiO2 (Ce-doped TiO2) were investigated. In X-ray diffraction (XRD) measurements, apparent doping of cerium in TiO2 was detected, with reported anatase patterns shifting toward a lower angle in the anatase structure. Raman spectra verify the presence of cerium doping in TiO2 by revealing greater wave number shifting. The scanning electron microscope (SEM) and transmission electron microscope (TEM) analysis showed that the synthesized TiO2 and Ce-doped TiO2 nearly spherical. TiO2 and Ce-doped TiO2 were studied for their photodynamic anticancer activities, and the results suggest that cerium doping in TiO2 improves anticancer activity.

In this article we use one-dimensional, monoenergetic diffusion kinetic equation with one delayed neutron precursor concentration in Cartesian geometry to reconstruct the neutron flux of a reactor from the nuclear parameters, boundary, and initial conditions. The mathematical model is governed by a system of linear partial differential equations with prescribed boundary and initial conditions. As a matter of fact, the exact solution for any physical problem, if available, is of great importance which inevitably leads to a better understanding of the behavior of the involved physical phenomena. The present work represents an attempt for doing so, where the flux and precursor equations are solved by the help of Laplace transform in both spatial and time variables and consequently the exact expressions for the flux and concentration in space and time are established. We report numerical simulations as well study of numerical convergence of the obtained results.

Individual survival would be impossible without anxiety, which is a natural and important emotion. Anxiety is considered a disease that requires treatment when it occurs in the absence of a threat, or in a disproportionate proportion to a threat, as well as when it prevents the affected individual from leading a normal life. Generalized Anxiety Disorder (GAD) is a widespread mental disorder characterized by excessive and difficult-to-control anxiety and concerns. as well as a variety of psychological and physical symptoms. Patients with GAD frequently visit primary care, and it is widely acknowledged that the majority of patients should be treated in this environment. Clinical practice guidelines advocate pharmacological (e.g., SSRIs and venlafaxine) or cognitive behavior therapy as first-line therapies for GAD. There are several proposed etiological explanations for GAD, including Freud's psychoanalytic theory, Stack's interpersonal theory, and the Stress Diathesis Model. The exact pathophysiological process of the disease is not fully understood. Patients with GAD frequently visit primary care, and it is widely acknowledged that the majority of patients should be treated in this environment. Clinical practice guidelines advocate pharmacological (e.g., SSRIs and venlafaxine) or cognitive behavior therapy as first-line therapies for GAD. In this article, we’ll be discussing GAD epidemiology, etiology, evaluation, and treatment.

Experimental model was done for pile model of L / D = 25 installed into a laminar shear box contains different saturation soil densities (loose and dense sand) to evaluate the variation of pore water pressure before and after apply seismic loading. Two pore water pressure transducers placed at position near the middle and bottom of pile model to evaluate the pore water pressure during pullout tests. Seismic loading applied by uniaxial shaking table device, while the pullout tests were conducted through pullout device. The results of changing pore water pressure showed that the variation of pore water pressure near the bottom of pile is more than variation near the middle of pile in all tests. The variation of pore water pressure after apply seismic loading is more than the variation before apply seismic loading near the middle of pile and near the bottom of pile and in loose and dense sand. Variation of pore water pressure after apply seismic loading and uplift force is less than the variation after apply seismic loading in loose sand at middle and bottom of pile.

Background: The upgrowth and rapid prevalence of pandrug-resistant Acinetobacter baumannii strains that have a pathogenic activity to cause several infections are of considerable influence on the health of communities worldwide. No infections by these bacterial strains were recorded before 1998, and currently, the numbers are on the rise. Methods: The A. baumannii strains were isolated from male and female patients in Medical Microbiology Department, King Fahd Medical City (KFMC) in Riyadh, Saudi Arabia between 1/1/2020 to 29/12/2020. The statistical analysis was performed base on sex, age, source of samples, and response to commercially available antibiotics. The A. baumannii strains that resisted all the antibiotics including colistin and imipenem were selected for the synergic test. Results: The data showed that 62.28%, 77.07% of 342 A. baumannii strains were isolated from males and patients over 35 years of age. A. baumannii strains (pandrug-A. baumannii) that can resist all tested antibiotics were 8.19%. The major source of the A. baumannii isolates was the respiratory system (>50%). Among all isolates (N = 342), azidothymidine-resistant A. baumannii strains were more than 85%. There is a statistically significant difference (P < 0.05) in the number of colistin-resistant A. baumannii strains isolated from males comparing with the female. The combinations of colistin and silver nanoparticles or imipenem and silver nanoparticles resulted in synergistic action led to reduction of MICs of colistin, imipenem, and silver nanoparticles (more than four-fold reduction). Also, the combinations of colistin and imipenem had high synergistic action. Conclusion: The pandrug-resistant A. baumannii strains may represent a current and future threat that must be fought, and the synergy action of antibiotics and nanoparticles may be one of the available, rapid, and easy strategies to confront this global problem.

Religiosity is a multidimensional construct known to influence the occurrence of hallucinations. However, it remains unknown how different religiosity types affect clinically relevant phenomenological features of hallucinations. Therefore, we wished to explore associations between intrinsic and extrinsic (non-organizational and organizational) religiosity and hallucinations severity, distress or impact on daily function in a non-clinical Muslim population. We recruited a representative sample of full-time students at Qatar's only national university via systematic random sampling and administered the Questionnaire of Psychotic Experiences online. The study design was cross-sectional. Using structural equation modeling, we estimated effects of the religiosity types on hallucinations severity, distress or impact on daily function in the past week while accounting for sociodemographic variables, anxiety, depressive symptoms, and, delusions. Extrinsic non-organizational religiosity (ENORG) was associated with experiencing reduced distress or impact on daily function from hallucinations both directly and indirectly through intrinsic religiosity. In contrast, extrinsic non-organizational religiosity (EORG) was associated with increased hallucinations distress or impact albeit only through higher intrinsic religiosity. We found no association between any religiosity types and hallucinations severity. Younger and married participants from lower socio-economic class had comparatively more severe hallucinations and more distress from them. Qatari nationality was positively associated EORG and negatively associated with hallucinations distress or impact. Evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and distress or impact from past week's hallucinations supports the importance of alignment between religious, mental health, and well-being education.

A 53-year-old man with a subcutaneous implantable cardioverter-defibrillator (S-ICD) presented with inappropriate shocks. He underwent device extraction, and the lead was freed using a rotating mechanical dilator sheath. As patients with S-ICDs get older, extractions will become more complicated and more common. We have described a novel method of S-ICD lead extraction. (Level of Difficulty: Advanced.), Central Illustration

Carcinoma of the breast is the most prevalent cancer among Egyptian women and constitutes 29% of National Cancer Institute cases. Median age at diagnosis is one decade younger than in countries of Europe and North America and most patients are premenopausal. Tumours are relatively advanced at presentation. The majority of tumours are invasive duct subtype and the profile of hormone receptors is positive for estrogen receptors and /or progesterone receptors in less than half of cases. This overview examines genetic changes, potential and established predictive and prognostic markers and end results of surgery, radiotherapy and systemic therapy for early, locally advanced and metastatic disease stages. Disease presentations common to the region and early detection strategies are presented

Background Statins are a cornerstone therapy for management of hypercholesterolaemia in primary and secondary prevention of cardiovascular disease, however there is individual variation regarding efficacy of therapy and adverse side-effects experienced. Purpose Polymorphisms of the SLCO1B1 gene have shown correlation with the risk of statin side-effects and efficacy of treatment, however in real-world clinical practice, their utility remains to be established. Methods We carried out retrospective multiple linear regression analysis using robust standard errors of 129 individuals undergoing genetic testing for the SLCO1B1 polymorphisms rs4149056 and rs2306283 to investigate for an association to statin side effects and efficacy respectively. In addition, logistic regressions which account for the binary nature of the outcomes were performed. The rs4149056 gene has 3 outcomes: T/T (considered least associated with statin intolerance), C/C (considered most associated with statin intolerance) and T/C (considered intermediately associated with statin intolerance). The rs2306283 gene has 3 outcomes: A/A (considered least associated with statin response), G/G (considered most associated with statin response) and A/G (considered intermediately associated with statin response). Results According to multiple regression and logistic regression analyses SLCO1B1 rs4149056 genotypes (C/C and T/C relative to the base type T/T) do not predict the incidence of myalgia, myopathy, creatine kinase rise, liver function derangement or gastrointestinal side effects at 5% significance. SLCO1B1 rs2306283 (G/G and A/G relative to the base type A/A) do not predict LDL response to statins (p-values 0.33 and 0.52 respectively). Conclusions The presence of rs4149056 C/C and T/C genotypes was not associated with an increased risk of statin side-effects. Similarly rs2306283 genotypes did not correlate with the efficacy of statin treatment. These genotype predictors were primarily based on Simvastatin – an earlier generation statin, whereas the majority of the patients in this cohort were treated with more contemporary and widely used statins such as Atorvastatin and Rosuvastatin. We therefore conclude that these genotypic markers may have limited application in modern day clinical practice and that substantial investment of limited resources towards them may not be justified. Funding Acknowledgement Type of funding sources: None.

Background and aimsPsychotic-like experiences (PLEs) are hallucinatory or delusional experiences that fall below the threshold of a diagnosable psychotic disorder. Although PLEs are common across the spectrum of psychiatric disorders, they also have been commonly reported in the general population. In this study, we aimed to describe the types of PLEs experienced by university students in Qatar. Furthermore, we aimed to examine how students frame, explain, and deal with these experiences as well as understand how culture and religion may shape the way students attribute and respond to these experiences.MethodThis study used a qualitative phenomenological approach. For collecting the data, we conducted semi-structured interviews using the Questionnaire for Psychotic Experiences (QPE). The QPE is a valid and reliable tool to assess the phenomenology of psychotic-like experiences. The questionnaire was translated into Arabic and tested and validated in Qatar (a fast-developing Muslim country in the Arabian Peninsula). We conducted interviews in Arabic with 12 undergraduate female students at Qatar University (the only national university in Qatar). The interviewees were of different Arab nationalities. Interviews were transcribed verbatim and two authors conducted the content-thematic analysis separately, as a strategy to validate the findings. The study was part of a larger nationally funded project that was approved by the Qatar University Institutional Review Board. The approvals were granted before any interview was conducted.ResultsThe PLEs were prevalent in our non-clinical sample. The content-thematic analysis revealed the following main themes about these experiences: type, impact on daily function, frequency, immediate reaction, attribution style, assumptions about the root cause of these experiences, other associations, and religious links to experiences. The results also highlighted that religion and culture play a role in shaping the types of hallucinations and some delusions.ConclusionOur findings support the importance of culture and religion in relation to the types and explanations that students provided when describing PLEs. Notably, it was common among those who reported having these experiences to normalize and link PLEs to real-life events. This may be a defense mechanism to protect the self against the stigma of mental illness and from being labeled as “abnormal”.

Computational chemistry, molecular docking, and drug design approaches, combined with the biochemical evaluation of the antitumor activity of selected derivatives of the thiouracil-based dihydroindeno pyrido pyrimidines against topoisomerase I and II. The IC50 of other cell lines including the normal human lung cell line W138, lung cancer cell line, A549, breast cancer cell line, MCF-7, cervical cancer, HeLa, and liver cancer cell line HepG2 was evaluated using biochemical methods. The global reactivity descriptors and physicochemical parameters were computed, showing good agreement with the Lipinski and Veber’s rules of the drug criteria. The molecular docking study of the ligands with the topoisomerase protein provides the binding sites, binding energies, and deactivation constant for the inhibition pocket. Various biochemical methods were used to evaluate the IC50 of the cell lines. The QSAR model was developed for colorectal cell line HCT as a case study. Four QSAR statistical models were predicted between the IC50 of the colorectal cell line HCT to correlate the anticancer activity and the computed physicochemical and quantum chemical global reactivity descriptors. The predictive power of the models indicates a good correlation between the observed and the predicted activity.

Background\ud \ud Prevalence trends from Arabic speaking countries on psychiatric symptoms before and after COVID-19 pandemic is lacking. We estimated the point prevalence and change in depression and anxiety symptoms scores in relation to sociodemographic variables following the resolution of the first wave in Qatar compared with before the pandemic.\ud \ud \ud \ud Methods\ud \ud We conducted a trend analysis using repeated nationally representative cross-sectional surveys spanning 2017, 2018, 2020/2021 and using the Physician Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to assess depressive and anxiety symptoms. Negative binomial regression modelled changes in these symptoms in relation sociodemographics and survey year.\ud \ud \ud \ud Results\ud \ud The two-week prevalence of depressive symptoms (≥10 on the PHQ-9) was 6.6% in 2017 and 6.5% in 2020/2021 (p = 0.986). The two-week prevalence of anxiety symptoms (≥10 or higher on the GAD-7) was 3.6% in 2018 and 5.1% in 2020/2021 (p = 0.062). The data for 2020/21 showed a 35.1% and 29.2% decrease in depression and anxiety symptoms scores compared to pre-pandemic years (2017/2018) after adjusting for sociodemographic factors.\ud \ud \ud \ud Limitations\ud \ud Screening tools rather than structured interviews were to assess depressive and anxiety symptoms.\ud \ud \ud \ud Conclusions\ud \ud Prevalence for depression and anxiety post the first COVID wave did not differ significantly to pre-pandemic estimates. The end of the first wave of the pandemic had a ‘levelling’ effect on these symptoms and their associations with traditional sociodemographic risk factors. The 2020/21 depression and anxiety symptoms scores remained high for Qataris and Arabs, suggesting that these cultural groups may benefit most from public mental health interventions.

Background: Status epilepticus (SE) is a serious neurological emergency that is associated with increased morbidity and mortality. There is emerging interest in understanding the clinical characteristics and identification of the prognosis of children with SE. Objective: To identify the clinical profile and prognosis of children presenting by status epilepticus. Methodology: This is a descriptive analytical study carried out on 31 children who presented by convulsive SE and were admitted to the pediatric intensive care unit. Clinical data, Complete blood count, C-reactive protein, erythrocyte sedimentation rate, serum glucose & electrolytes and cerebrospinal fluid analysis were estimated. Magnetic resonance imaging was done to all included children. Results: Most of the children who presented with SE were younger than 5 years of age (45.2% were

Based on the excellent nutrient level, the current study was focused on isolation and anti-bacterial activity of the actinomycetes from marine mangrove soil samples. As result, 10 different strains of actinomycetes strains were identified on actinomycetes isolation agar plates. The identified strains were shown with white, clear, uncontaminated well matured spore producing ability. Based on the initial observation, the isolated colonies were actinomycetes. The partially extracted crude compound shown excellent anti-bacterial activity against P. aeruginosa and K. pneumoniae with 15 mm and 13 mm zone of inhibitions were observed at 500 μL concentrations. The minimum inhibition concentration result was also confirmed the 500 μL concentration against both the tested concentration with high inhibition rate. Then, the intracellular damages, decreased cell growth of the crude actinomycetes extract treated bacterial strains were clearly observed by confocal laser scanning electron microscope. The extracellular damages of bacterial cell wall and shape of the both the pathogens were clearly shown by scanning electron microscope. Therefore, all the results were clearly supported to the partially extracted crude compound and it has excellent anti-bacterial activity against tested multi drug resistant bacteria.

Aceh Health Insurance (Jaminan Kesehatan Aceh—JKA) has been implemented since 2010 to increase the health equity by covering the health expenses and guaranteeing that all Acehnese are covered regardless of their economic, educational, and social statuses. However, since its implementation, there has been no study on its impact on health quality, particularly regarding the utilization of the main referral hospital (Dr Zainoel Abidin Hospital located in Banda Aceh) and the effects of the geographic accessibility and the number of specialist doctors in each regency/city on hospital utilization. This retrospective study assessed the equity factors during the Aceh Health Insurance implementation and during its integration to National Health Insurance (Jaminan Kesehatan Nasional—JKN) from 2013 to 2021 using data of travel time (time spent for travelling from the origin regency/city of referred patients to the main referral center) and healthcare resources (number of specialist doctors). The data were analyzed using Student’s t-tests, Kolmogorov-Smirnov or Mann-Whitney U test when appropriate. Williamson Index was calculated to determine the disparities of health equity between regencies. Our data indicated the noticeably increase of health facilities utilization since the implantation of Aceh Health Insurance. However, there was no equity in the use of main referral facility by the residents in Aceh - was dominated by residents who lived closer and from more populated regencies/cities. In conclusion, there are accessibility and financial hardship barriers in accessing the health care facilities during the implementation of Aceh Health Insurance that need to be addressed by the government to achieve the health equity for all Acehnese.

The xylanolytic and amylolytic yeasts were qualitatively determined by Cong red xylan agar and soluble starch agar plates, respectively. The most xylanase and α-amylase inducible strain (AUN-02) was selected and identified using PCR amplification of 26S rRNA gene and sequence analysis. The comparison of the alignment results and phylogenetic analysis of the sequences of the isolated yeast to published rRNA gene sequences in GenBank, confirmed the identification of the isolate as Pichia membranifaciens. Xylanase and α-amylase production by isolated P. membranifaciens were investigated at different pH values (4-8), temperature degrees (20-45°C), incubation time (1-7 days) and various substrates.A higher production of xylanase (38.8 U/mL) and a-amylase (28.7 U/mL) was obtained after 4 days of fermentation of P. membranifaciens. Higher activity of xylanase (36.83 U/mL) and a-amylase (27.7 U/mL) was obtained in the fermentation of P. membranifaciens in a culture medium adjusted to pH 7.0. The optimum temperature showed maximum xylanase and a-amylase activity (42.6 and 32.5 units/mL, respectively) was estimated at 35 °C. The xylanase and a-amylase activities of P. membranifaciens were estimated and compared for the different substrates tested. The strain revealed 100% relative activity of xylanase and a-amylase on beechwood and potato starch, respectively. The affinity of enzymes towards substrate was estimated using Km values. The Km values of xylanase and α-amylase increased in the order of pH’s 7.0, 6.0 and 4.5 (0.85, 1.6 and 3.4 mg xylan/mL and 0.22, 0.43 and 2.8 mg starch/mL, respectively). the yeast P. membranifaciensis is suitable for produce neutral xylanase and α-amylase enzymes. So, it could be used as a promising strain for production of these enzymes in industrial field.