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Bersepeda sudah menjadi olahraga yang cukup populer di Indonesia, bahkan sudah menjadi hobi sebagian orang di Jabodetabek. Beberapa pertimbangan sebelum bersepeda antara lain jarak tujuan, target, waktu, tempat istirahat. Oleh karena itu, penelitian ini merancang sistem untuk menentukan jalur bersepeda menggunakan metode Simple Additive Weighting (SAW), kelebihan metode ini adalah sudah support dan banyak diimplementasikan dalam GIS dan mampu menampilkan hasil dari pembobotan dan perhitungan berdasarkan kriteria dengan sangat mudah dan efisien. Kriteria yang digunakan yaitu berdasarkan penelitian sebelumnya dan pembobotan yang dilakukan berdasarkan asumsi dari peneliti yang sama. Hasil dari implementasi metode SAW untuk menentukan rute bersepeda berupa rancangan sistem yang terdiri dari database, arsitektur sistem, dan desain antar muka pengguna. Kata Kunci : Rute, Sepeda, Simple Additive Weighting

During the COVID-19 pandemic, surface disinfection using prevailing chemical disinfection methods had several limitations. Due to cost-inefficiency and the inability to disinfect shaded places, static UVC lamps cannot address these limitations properly. Moreover, the average market price of the prevailing UVC robots is huge, approximately 55,165 USD. In this research firstly, a requirement elicitation study was conducted using a semi-structured interview approach to reveal the requirements to develop a cost-effective UVC robot. Secondly, a semi-autonomous robot named UVC-PURGE was developed based on the revealed requirements. Thirdly, a two-phased evaluation study was undertaken to validate the effectiveness of UVC-PURGE to inactivate the SARS-CoV-2 virus and the capability of semi-autonomous navigation in the first phase and to evaluate the usability of the system through a hybrid approach of SUPR-Q forms and subjective evaluation of the user feedback in the second phase. Pre-treatment swab testing revealed the presence of both Gram-positive and Gram-Negative bacteria at 17 out of 20 test surfaces in the conducted tests. After the UVC irradiation of the robot, the microbial load was detected in only 2 (1D and 1H) out of 17 test surfaces with significant reductions (95.33% in 1D and 90.9% in 1H) of microbial load. Moreover, the usability evaluation yields an above-average SUPR-Q score of 81.91% with significant scores in all the criteria (usability, trust, loyalty, and appearance) and the number of positive themes from the subjective evaluation using thematic analysis is twice the number of negative themes. Additionally, compared with the prevailing UVC disinfection robots in the market, UVC-PURGE is cost-effective with a price of less than 800 USD. Moreover, small form factor along with the real time camera feedback in the developed system helps the user to navigate in congested places easily. The developed robot can be used in any indoor environment in this prevailing pandemic situation and it can also provide cost-effective disinfection in medical facilities against the long-term residual effect of COVID-19 in the post-pandemic era.

Case Report: A six-year-old child who had undergone cardiac surgery five years ago presented to us with severe mitral valve regurgitation. During her current surgery, the coronary artery was injured during the attempt to release extensive epicardial adhesion, resulting in very poor contractility that prompted a delay in the intended valve repair. The injured coronary vessels were successfully repaired, yet low cardiac output syndrome persisted during perioperative care, necessitating further investigation of the coronary problem. It was later discovered that the patient had anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome., Discussion: The presence of severe mitral regurgitation, pulmonary hypertension, and anatomical factors may have contributed to the delayed presentation and diagnosis in this case. The severity of mitral regurgitation and the most likely underlying mechanism indicates a low possibility of recovery following coronary repair alone, warranting the need for concomitant mitral surgery. Coronary and mitral repair were performed in this patient, resulting in a favorable outcome., Conclusions: The management of ALCAPA presents unique challenges, especially in cases with delayed diagnosis. Proper diagnosis and tailored surgical approaches are crucial for achieving favorable outcomes in patients with ALCAPA., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Aim: N -acetyl- p -benzoquinoneimine (NAPQI), a toxic byproduct of paracetamol (Acetaminophen, APAP), can accumulate and cause liver damage by depleting glutathione and forming protein adducts in the mitochondria. These adducts disrupt the respiratory chain, increasing superoxide production and reducing ATP. The goal of this study was to provide computational proof that succinate dehydrogenase (SDH), a subunit of complex II in the mitochondrial respiratory chain, is a favorable binding partner for NAPQI in this regard., Method: Molecular docking, molecular dynamics simulation, protein-protein interaction networks (PPI), and KEGG metabolic pathway analysis were employed to identify binding characteristics, interaction partners, and their associations with metabolic pathways. A lipid membrane was added to the experimental apparatus to mimic the natural cellular environment of SDH. This modification made it possible to develop a context for investigating the role and interactions of SDH within a cellular ecosystem that was more realistic and biologically relevant., Result: The molecular binding affinity score for APAP and NAPQI with SDH was predicted -6.5 and -6.7 kcal/mol, respectively. Furthermore, RMSD, RMSF, and Rog from the molecular dynamics simulations study revealed that NAPQI has slightly higher stability and compactness compared to APAP at 100 ns timeframe with mitochondrial SDH., Conclusion: This study serves to predict the mechanistic process of paracetamol toxicity by using different computational approaches. In addition, this study will provide information about the drug target against APAP hepatotoxicity., Competing Interests: The authors declare that they have no known competing interest and they have taken all necessary precautions to preserve the intellectual property connected to this work and there are no barriers to publication that are related to intellectual property, including when to publish., (© 2024 The Authors.)

Host-parasite interactions are impacted by climate, which may result in variation of parasitism across landscapes and time. Understanding how parasitism varies across these spatio-temporal scales is crucial to predicting how organisms will respond to and cope under a rapidly changing climate. Empirical work on how parasitism varies across climates is limited. Here, we examine the variation of parasitism across seasons and identify the likely climatic factors that explain this variation using Agriocnemis femina damselflies and Arrenurus water mite ectoparasites as a host-parasite study system. We assessed parasitism in a natural population in Sylhet, Bangladesh which is located in subtropical climate between 2021 and 2023. We calculated prevalence (proportion of infected individuals) and intensity (the number of parasites on an infected individual) of parasitism across different seasons. Parasite prevalence and intensity were greater during cooler seasons (autumn and winter) compared to hotter seasons (spring and summer). Mean temperature and precipitation were negatively correlated with parasite prevalence, whereas only mean precipitation was negatively correlated with parasite intensity. Tropical, subtropical and mediterranean regions are predicted to experience extreme climatic events (extreme temperature, less precipitation and frequent drought) as a consequence of anthropogenic climate change, and our finding suggests that this might alter patterns of parasitism in aquatic insects., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Indonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic., Methods: This is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes., Results: From 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered., Conclusions: The mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response., Competing Interests: The authors declare that they have no competing interests for the submitted work., (Copyright: © 2023 Burhan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries., Methods: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria., Results: A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10))., Conclusion: Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities., Competing Interests: Competing interests: None., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

This study evaluates the efficacy and safety of oral triiodothyronine on time to extubation for infants less than 5 months undergoing heart surgery in Indonesia, and primarily relates to patients in emerging programs with high malnutrition and mortality. In this randomized, double-blind, placebo-controlled trial, oral triiodothyronine (T3, Tetronine®) 1 μg/kg-body weight/dose or placebo (saccharum lactis) was administered via nasogastric tube every 6 h for 60 h to treatment group. A total of 120 patients were randomized into T3 (61 patients) and placebo (59 patients) groups. The majority of the patients had moderate to severe malnutrition (55.83%) with a high post-operative mortality rate of 23.3%. The T3 group showed significantly higher serum FT3 levels from 1 until 48 h post cross-clamp removal (p < 0.0001), lower incidence of low cardiac output syndrome at both 6 h (28 [45.9%] vs. 39 [66.1%] patients, p = 0.03, OR 2.3, 95% CI: 1.10-4.81) and 12 h after cross-clamp removal (25 [41.7%] vs. 36 [63.2%], p = 0.02, OR 2.40, 95% CI: 1.14-5.05). Although not statistically significant, the treatment group had shorter median (IQR) intubation time (2.59 [1.25-5.24] vs. 3.77 [1.28-6.64] days, p = 0.16, HR 1.36, 95% CI: 0.88-2.09)] and lower mortality (10 [16.4%] vs. 18 [30.5%], p = 0.07]. Patients with Aristotle score < 10.0 (low risk) receiving T3 had faster extubation than placebo patients (p = 0.021, HR of 1.90, 95% CI: 1.10-3.28) and were significantly less likely to require CPR or experience infection (p = 0.027, OR 8.56, 95% CI:0.99-73.9 and p = 0.022, OR 4.09 95% CI: 1.16-14.4, respectively). Oral T3 supplementation reduced overall incidence of low cardiac output syndrome and significantly reduced the time to extubation in low-risk patients. Therefore, prophylactic oral T3 administration may be beneficial in these patients.Trial Registration: ClinicalTrials.gov NCT02222532., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: This study evaluated thiamine levels in Indonesian children with congenital heart diseases before and after cardiopulmonary bypass and their relationship with clinical and surgical outcomes., Method: A prospective, single center cross-sectional study was conducted to evaluate thiamine levels in 25 children undergoing congenital heart diseases surgery with cardiopulmonary bypass procedure. Thiamine levels were quantified using a high-performance liquid chromatography method., Result: Preoperative thiamine deficiency was observed in one subject. Thiamine levels did not differ statistically between nutritional status and clinical outcomes categories. There were no significant changes in thiamine levels before and after cardiopulmonary bypass (median pre versus post (P 25-75 ): 50 ng/mL (59.00-116.00) and 83.00 ng/mL (70.00-101.00), p  = 0.84), although a significant reduction in thiamine levels were observed with longer cardiopulmonary bypass duration ( p  = 0.017, R = -0.472)., Conclusion: Thiamine levels were not significantly impacted by cardiac surgery except in patients undergoing extremely long cardiopulmonary bypass duration. However, clinical outcome was not affected by thiamine levels.

Objectives: Acute pulmonary hypertension and pulmonary hypertensive crisis may result in adverse clinical outcomes if unsuccessfully treated. Inhaled nitric oxide has long been considered as the standard pharmacotherapy for acute pulmonary hypertension, but lack of feasibility in some settings and evidences challenging its benefits lead to the use of alternative treatment, amongst which is nitroglycerin inhalation. The purpose of this review article is to discuss available data on the use of nitroglycerin inhalation for acute treatment of pulmonary hypertension in children with CHD and its potential benefit in post-operative setting., Data Sources: Literatures included in this review were acquired by searching in PubMed online database. Keywords used were "Pulmonary Hypertension", "Congenital heart defects", "Pediatrics", "Inhaled nitroglycerin", and its synonyms., Study Selection: Title and abstract were screened to select relevant literatures including the three paediatric clinical trials on nitroglycerin inhalation. Critical appraisal of the clinical trials was then done using the University of Oxford Centre of Evidence-Based Medicine Critical Appraisal Tools., Conclusions: Paediatric studies showed the benefit of nitroglycerin inhalation in uncorrected cases of CHD during catheterisation procedures. Until recently, there have been no studies conducted in paediatric post-operative CHD cases. Further study is required to provide evidence for inhaled nitroglycerin use in this setting including the appropriate dosing and potential side effects with repeated administration.