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Background: Temporal lobe epilepsy (TLE) has the highest probability of becoming resistant. One of the causes was Polymorphism in multidrug resistant-1 (MDR1) C3435T. In Dr. Cipto Mangunkusumo Hospital, potential drug-resistant epilepsy prevalence was 84.51%; 66.6% of them used carbamazepine (CBZ) as antiseizure medication. This comparative cross-sectional study aimed to investigate MDR1 C3435T polymorphism and CBZ plasma level (plCBZ) in Indonesian TLE patients. Methods: TLE patient was selected consecutively; divided into drug-responsive (DRV) and drugresistant (DRE) groups. Healthy subjects were included as a control for the gene polymorphism comparison. MDR1 was identified using the restriction fragment length polymorphism PCR technique; C allele at 159 and 57bp while T allele at 216bp. High-performance liquid chromatography was used to determine plCBZ. Results: There were 86 subjects; 61 in the study group and 25 controls. The genotype distribution between them was 0.58 vs 0.42, x2=0.54, p=0.000. In the study group, CBZ within therapeutic doses (dCBZ) had outreached the therapeutic plCBZ and found similar in all genotypes. DRE criteria were found in 37 subjects. Distribution of C and T in DRV was 0.63 vs 0.37, x2=10.4; and DRE 0.55 vs 0.45 x2=6.17 (p=0.019). In Tukey’s multiple comparison post hoc test, CT in DRV had significantly lower dCBZ (330,36 ± 174,91 mg) and plCBZ (7.15 ± 2.64 mcg/mL) compared to all genotypes in DRE. Whereas mean dCBZ was around 800mg and plCBZ outreached the toxic level; TT was the highest. Conclusion: The genotype MDR1 distribution was similar in the normal population and DRE. Therapeutic plCBZ was achieved using the low dose. CT genotype responds to lower dCBZ, while TT genotype outreached the highest toxic plCBZ.

Funding Acknowledgements Type of funding sources: None. Introduction Optimal secondary prevention remains key in improving cardiovascular outcomes post myocardial infarction. Barriers to achieving timely and individualized medical optimization include unavailability of close follow up’s, compliance to secondary prevention, and more recently, the impact of COVID pandemic on outpatient face to face clinic appointments. With the recent emphasis from the European Society of Cardiology on secondary prevention in addition to optimizing lipid therapy, a dedicated service for post MI patients to address individualized risks can provide a timely opportunity to improve holistic cardiovascular care. Purpose To assess established secondary prevention practices, we initially audited 52 patients who presented with ACS between Jan 2020 and July 2020. These patients were assessed for post MI care optimization at 6 weeks post discharge. Utilizing ESC guidelines as audit targets, in our 6-week post discharge audit, we identified that there was scope of ACE-inhibitor up titration in 55.8% of the patients, beta-blocker optimization in 9.6%, Lipid lowering agents in 15.4%, mineralocorticoid receptor antagonist addition in patients with impaired LV systolic function in 5.8% of the patients. 5% of patients with new diagnosis of diabetes required referral to specialist teams for diabetic medication initiation or optimization. These results provided an opportunity to introduce a structured post MI clinic that will allow individualized risk assessment on an outpatient basis. Method We proposed a one stop hybrid clinic where all patients discharged following a myocardial infarction received a consultation 6 – 8 weeks following a discharge. These patients were sent blood forms 2-3 weeks prior to their appointment for full blood count levels, renal functions, liver profile, HBa1c levels and lipid profile. Focus of this consultation was to assess and educate the patient on risk factors (smoking, diabetes, cardiac rehab program), assess and address compliance to secondary prevention medications and finally titrate medications to maximum tolerated doses whilst achieving ESC defined targets for secondary prevention (post MI target systolic BP Results To understand the Impact made by the clinic we obtained patient list through local electronic records to filter those discharged with a primary diagnosis of myocardial infarction in 2022. An audit tool was created and data collection was performed including baseline characteristics as per table 1 and interventions made Table 2. Conclusion(s) By establishing the post MI clinic we were able to demonstrate efficient individualized assessment and optimization of secondary prevention risk factors and pharmacotherapy.

Cellulase is a very important enzyme for ethanol production from lignocellulose and others. Bagasse is very good to be chosen as lignocellulosic material for cellulase production because it is cheap and already available in a huge amount. Solid-state fermentation has advantages than submerged fermentation because of its higher yield and activity. Cellulase production using solid-state fermentation has been researched by many people, but for different substrate, different pretreatment and different fungi producer, it is likely to have a different condition. It is very important to perform specific study to optimize cellulase production with specific substrate and specific fungi which available in Indonesia. Because large amount of fungi strains available so it is wise full if they are screened using effective and efficient methods. This research is started by initial screening of three strain of Trichoderma reesei and five strain of Aspergillus niger using Congo red dye staining on CMC agar plate. It is shown that a strain of Trichoderma reesei and two strains of Aspergillus niger has better activity than the others. Further screening is performed by conducting solid-state fermentation using bagasse by three best strains for five days. The activity of the cellulase is measured every 24-hour using Ghose method by dinitrosalicylic acid as reagent. The highest activity is shown by A.niger ITBCC L74 on third day at 0.525 Unit/gram

Oleochemical wastewater discharge from the industry into water sources is one of the main causes of water pollution. A proper treatment is required before the effluent is discharged to the environment. Since the oleochemical wastewater contains nutrients and probiotics that are good for plants, it could be used as a nutrient provider for the plants instead. Therefore, the formulation of synbiotic plant nutrients from this effluent is an effective way of using the oleochemical effluent. This study aimed to formulate the plant nutrients by using industrial wastewater, which contains the synbiotic enhancement and validating the significance of the formulated plant nutrients into three types of plants; Abelmoschus esculentus (Okra), Solanum Melongena (Brinjal), and Capsicum annuum (Chilli peppers). Synbiotic is a combination of both prebiotics and probiotics that benefit the host by stimulating the growth of a limited number of health-promoting bacteria. To formulate the plant nutrient, the wastewater was filtered using a cotton cloth before the pre-biotics solution was added. Sample A (filtered wastewater was mixed with Sample B (prebiotics solution) by different percentages, namely F1 (100%:0%), F2 (75%:25%), F3 (50%:50%), F3 (25%:75%), 0%:100% (Sample A to Sample B respectively) and lastly, 50%:50% (Sample C (unfiltered wastewater) to Sample B respectively). The height of the plant and the number of leaves are measured weekly for four months. From the data, it can be seen that F3 gave significant results for the okra plant, in which it gains the highest height of plant compared to the other two plants. On the other hand, F6 give the best results for both the brinjal and the chilli plant where their leaves grow the highest from the second until the fourth month of plant growth. Hence, this research gives an added value to the wastewater, whereas the wastewater is used as the synbiotic plant nutrient enhancer and work best for the plants.

Motorcycle is a preferred private transportation mode (45%) among Malaysian due to its affordability and eases to move around especially in the hectic urban areas. These vulnerable road users are exposed to greater risk in road collisions due to sharing the roadway with other motor vehicles and unprotected. Worse still, the road was designed without concern for the motorcycle's characteristics. No doubt, segregating motorcycles exclusively from the roadway is an effective engineering measure to address motorcycle safety. But it may not be feasible to introduce in the well-built urban areas. Identification of the road and traffic variables that affecting safe motorcycling in the urban roadway is an initiative to create a safer riding environment. The initial study was carried out to identified traffic and roadway variables that affecting safe motorcycling. The seven pre-determined variables that were found to significantly influencing Malaysian motorcycle riders' safety perception are: pavement condition, paved shoulder width, posted speed limit, mixed traffic volume, type of roadway, lane width, and parking condition. These pre-determined variables were further investigated in the subsequent study, questionnaire with fourteen short video clips representing different traffic and roadway conditions was aired to 483 respondents to rate the motorcycling safety score (MSS) based on their safe riding perception. The response on MSS was further developed into Motorcycling Safety Index (MSI). Lastly, 114 combinations of different traffic and roadway conditions for seven pre-determined variables were formed to establish the Composite MSI boundary. The development of Composite MSI is to enable the road authorities and agencies and/or practitioners to assess the problematic road segments that required immediate remedial actions.

Introduction Metabolic equivalents (METs) are measures of patient's functional capacity. It provides insight into patient's risk of perioperative complications. METs are usually obtained from estimation based on patient's history or by cardiopulmonary exercise testing (CPET). However, the validity of estimated METs has been questioned in multiple studies. In this study, we sought to compare the subjective METs from preoperative evaluation and objective METs derived from CPET, to investigate the reliability and validity of subjective METs. Methods A retrospective study was carried out for patients scheduled for aortic surgery from March 2017 to September 2018. Patients were classified into 3 subjective categories: Poor (< 4 METs), Moderate (4–10 METs) and Good (> 10 METs), whereas objective METs values were obtained from CPET. Comparative analysis between patient's objective METs and subjective METs was carried out to identify any variations. Results Subjective METs correlate with objective METs. Although subjective METs tends to overestimate patient's functional capacity, leading to 44.4% misclassified in the Moderate category. In contrast, Poor category only misclassified 5% by underestimation. In addition, the results confirmed significant differences between the Moderate and Poor categories as expected. Conclusion Although subjective METs categories correlate with objective METs, it tends to overestimate patient's METs. They are more accurate in identifying patients with Poor functional capacity (< 4 METs). Therefore, it is a convenient tool for clinician to effectively exclude patients with Poor METs. However, use of subjective METs should be considered carefully due to its limitation in estimating Moderate or Good METs. Take-home message Subjective metabolic equivalents correlate with objective metabolic equivalents.

In Malaysia, motorcycles represented 45% of all registered vehicles. Alarmingly, motorcyclists comprise 65% of total road deaths. One major reason being that these vulnerable road users get entangled with other mixed vehicles. It is appreciated that roadway design guidelines are based on the characteristics of drivers/automobiles and not riders/motorcycles. Thus, motorcyclists are expected to occupy the dynamically changing space that is available along the roadway. An effective engineering measure to tackle motorcycle safety problems in mixed traffic conditions would be to segregate the motorcycles exclusively. However, this measure is not appropriate for urban roads. One practical approach to address motorcycling safety along urban roads is to identify the traffic and road environment variables that affects safe motorcycling. This list of variables can be used to check the safe motorcycling status along segments of urban roads. The variables relating to bicyclist's perception on the roadway segments were adopted for the variables affecting motorcycling safety along urban roads. To corroborate the adopted variables factors with the actual perception of motorcyclist, the questionnaires related to the variables affecting safe motorcycling were responded by 137 motorcyclists. The variables were identified to be pavement condition, on-street parking, traffic volume, divided/undivided roadway, left-side kerb clearance, lane width, and travelling speed. To further understand these seven variables from the aspect of motorcyclist perceptions, 14 short clips were presented to 483 motorcyclists who rated each clip based on their perception of safe motorcycling. Results found that the odds of feeling unsafe riding on bad pavement is 61.5 times greater than the odds of riding on good pavement. The odds of unsafe motorcycling along roads with on-street parking is 43.2 times higher than without on- street parking. Overall, it infers that the maintenance of road pavement conditions must be of high priority to the local authorities followed by issues of on-street parking along urban links.

The current study conducted to investigate the anatomical and histological structure of the cornea in sparrow hawk accipiter nisus. By using an optical microscope and histological stains. Anatomical results showed that the cornea composed of two parts, the peripheral cornea and the central cornea, and there was variation in corneal thickness according to the anatomical region. Histologically, the cornea consists of five layers. The first layer of the central cornea consists of non- keratinized stratified squamous epithelial tissue composed of four rows of cells. Whereas, Bowman's membrane appeared clear and thicker on the dorsal side than on the ventral side. The corneal stroma consists of collagen fibers arranged in three secondary layers within the stroma. The corneal stroma also distinguished by the presence of fibroblast cells, which randomly distributed among the collagen fibers. The Descemet membrane appeared clear and equal in thickness between the dorsal and ventral sides. The endothelium tissue appears in the form simple squamous epithelia. The histological structure of the cornea root seemed similar to its formation in the central cornea. Still, it characterized by the presence of pigment cells spread in the stromal corneal root. Among the distinct results that appeared in this study is the presence of blood vessels spreading in the root of the cornea. The study concluded that the anatomical and histological structure of the cornea in this bird distinguished by some specialties that contribute to increasing the effectiveness of the function of the cornea in this bird.