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Effects of xylose on xylanase production by a thermophilic Bacillus sp showed diverse patterns on corn cob (CC) and wheat bran (WB) as sole carbon sources in solid- state fermentation (SSF) and submerged fermentation (SmF). Supplementation of these media with either mineral salt solution (MSS) or yeast extract peptone (YEP) also exerted variable effects. While under SSF, xylose stimulated xylanase synthesis by 44.01%, on wheat bran supplemented with MSS, it decreased the enzyme activity by 12.89% with YEP supplementation. In SmF, however the enzyme synthesis was stimulated by xylose on supplementation with both MSS and YEP by 41.38% and 27.47%, respectively. On corn cob under SSF, xylose repression was significant both with MSS (26.92%) and YEP (23.90%) supplementation. Repression by xylose also took place on corn cob and YEP (19.69%) under SmF, while significant stimulation (28.55%) was observed by MSS supplementation. The possible role of media composition and fermentation conditions in the regulation of xylanase synthesis by xylose is discussed.

Abstract Continuous surveillance and risk assessment of inactivated Coronavirus Disease 2019 (COVID-19)) vaccines provide an understanding of their safety profiles, guide vaccination strategy and public health policy. This study aims to analyze the characteristics and prevalence of officially reported serious adverse events following immunization (AEFIs) with inactivated COVID-19 vaccines by System Organ Class (SOC), age, and sex.To achieve this aim, a retrospective observational study was conducted between February 14th, 2021, and June 30th, 2022. Reported AEFIs were evaluated for data completeness. Causality assessment adhered to the World Health Organization guidelines. Findings revealed that the AEFIs occurrence did not significantly differ between vaccines used (ChAdOx1 vs. BNT162b2), sex, or SOC. The most prevalent AEFIs were vascular disorders (37%), followed by cardiac (25%) and nervous system disorders (14%). The adverse events were predominantly reported post-vaccination with the BNT162b2 vaccine, mainly after the first dose. The mean age was highest for miscellaneous disorders (70 ± 21.7 years) and the lowest for nervous system (46 ± 22 years) and immune system disorders (45 ± 19 years). Age differences were statistically different for vascular disorders (p = 0.003) and immune system disorders (p = 0.012). In conclusion, ongoing surveillance and risk assessment of the vaccine’s safety profile is crucial for detecting potential safety signals. Active surveillance of the reported serious AEFIs is highly needed to support evidence-based vaccination strategies and maintain public confidence in immunization programs,

A hybrid adhesive system composed of phenol-formaldehyde (PF) resin and polymeric methylene diphenyl diisocyanate (pMDI), modified with two types of alkaline catalysts, namely NaOH and CaCO3 at 20% (w/v), was used for manufacturing the oriented strand board (OSB) from sengon (Paraserianthes falcataria L. Nielsen) wood. The catalyst was added at a concentration of 1% of the solids content of PF adhesive, and pMDI was added at 2.5% and 5.0% of the PF adhesive solids content. Adding catalysts and cross-linking agents increased the solids content and viscosity of the adhesive and accelerated the gelation time. The water absorption of OSB increased with the addition of catalysts and crosslinking agents compared to the control PF. Still, the CaCO3 catalyst worked optimally in reducing the thickness swelling of OSB. The mechanical properties of the laboratory-fabricated OSB panels increased with the addition of catalyst and cross-linker, except for the modulus of elasticity parallel to the grain. The optimal performance of OSB was obtained by adding 1% CaCO3 and 2.5% pMDI based on the PF’s solids content.

BackgroundA national Oral Cholera Vaccine (OCV) Euvichol-Plus® campaign was launched in Lebanon, in response to the first outbreak in three decades, recorded in October 2022. The OCV vaccination campaign was carried out between November 2022 and February 2023. This study aims to cover adverse events reports, received at the Lebanese National Pharmacovigilance Program’s (LNPVP) passive surveillance system.MethodsCase reports were extracted from the LNPVP’s database. SPSS software was used to perform statistical analysis, with categorical variables compared using Pearson’s χ2 test. A descriptive analysis was performed based on age, gender, vaccine administered, and adverse event(s) associated with the administered vaccine.ResultsA total of 115 Adverse Events Following Immunization (AEFIs) were reported, which corresponded to 46 case reports. The top three reported AEFIs were fever (39.13%), diarrhea (30.43%), and vomiting (30.43%). Reported cases were non-serious (82.6%). The highest proportion of Individual Case Safety Reports (ICSRs) received is attributed to females (56.5%), and the age category of 2 and 11 years old (41.3%). Reporters’ age range was 1–74 years old.ConclusionMonitoring AEFIs through the cholera outbreak’s emergency campaign favors the safety profile of OCV.

The objective of this research was to investigate and evaluate the possibility of increasing the thermo-mechanical properties of ramie (Boehmeria nivea L.) fibers by impregnating them with a tannin-based non-isocyanate polyurethane (Bio-NIPU) resin. The resin was created by reacting tannin of Acacia mangium with dimethyl carbonate (DMC) and hexamethylenediamine (HMDA). The optimal time of impregnation was discovered to be 90 min, as demonstrated by its thermal stability, with a residual of 25% remaining after being treated to a temperature of 750 °C. When ramie fibers were impregnated with the newly developed tannin-based Bio-NIPU resin, their thermal and mechanical qualities significantly enhanced. In terms of mechanical properties, the impregnated ramie fibers had a tensile strength of 325 MPa and an elasticity modulus of 10.82 GPa. Py-GCMS was used to confirm the production of urethane groups as a result of the reaction between the tannin-based Bio-NIPU resin and ramie fibers. The use of FE-SEM in conjunction with EDS allowed the detection of nitrogen from urethane groups in Bio-NIPU. The characterization analysis also demonstrated that incorporating tannin-based Bio-NIPU resin into ramie fibers had a substantial impact on their thermal and mechanical properties, increasing their potential for wider use across varied industrial sectors.

Malaria is still one of the most highly pathogenic diseases, which remains a significant problem for public health. Natural compounds are alternative ways as an antimalarial compound that are applied for the artemisinin combination. The aim of this study was to determine the effect of a combination of S. ligustrina extract and DHP on the differential leukocytes percentages. This study used 100 mice which were divided into five groups. Group A and B were used for the healthy mice and infected-untreated groups, respectively. Group C used as a controlled drug, received 222 mg/kg BW of DHP. Group D received 300 mg/kg BW of aqueous extract of S. ligustrina. Group E received a combination between 111 mg/kg BW of DHP and 200 mg/kg BW of aqueous extract S. ligustrina. The findings demonstrated that DHP and S. ligustrina extract had an impact on neutrophils, lymphocytes, inhibition, and percentages of parasitemia. The findings revealed that treatment groups C, D, and E reduced the percentage of parasitemia. The percentage of neutrophils in treated groups was significantly higher than in group A (P

Abstract Introduction The COVID-19 pandemic is a serious threat to everyone’s health. Numerous studies have demonstrated that vaccines are very effective in preventing COVID-19-related severe illness, hospitalization, and death. Children’s vaccination exerts its protecting effect by preventing the spread of the virus. The purpose of this study was to analyze the rate of COVID-19 immunization among Lebanese children aged 1 to 11 years and assess parental factors that affect immunization rates. Methods An online cross-sectional study was conducted between January and March 2023. The online survey was distributed across all social media channels, including the Ministry of Public Health website. Results A total of 390 parents filled the survey (mean age = 37.48 ± 8.39 years; 50.5% mothers; 70% with a university level of education). Mothers compared to fathers, having a history of bad reaction to a vaccine vs. not, and higher vaccine hesitancy were significantly associated with less willingness to administer the vaccine to the child. Trusting pharmaceutical companies was significantly associated with more willingness to administer the vaccine to the child. Conclusion The results of this study show that the factors associated with parents’ decisions to vaccinate their children may vary. Our findings conclude that vaccine acceptance is being highly associated with parental concerns, trust, and information regarding the vaccine safety and efficacy.

Acacia auriculiformis showed good potential to be developed as a raw material for bioactive compounds. The heartwood of A. auriculiformis is still rarely explored. The purpose of this study was to identify the bioactive components of the heartwood. Six compounds were identified from the heartwood through nuclear magnetic resonance and mass spectroscopy, namely the C-3,4',7,8 hydroxyl substituted flavonoids and chalcone. Two methylated teracacidins and chalcone-like teracacidin were identified for the first time in the A. auriculiformis heartwood, along with three known compounds. These compounds showed good radical scavenging and reduction activity, compared to crude extract and ascorbic acid, using three different antioxidant assays. The molecular structure-dependent activity was observed to affect the trend of the different antioxidant activities. This finding shows good potential for further development of plant parts of A. auriculiformis from Indonesia as new raw materials for medicines. Keywords: Acacia auriculiformis, antioxidant, chalcone, flavonoid, heartwood

The aqueous wood extract of bidara laut (Strychnos ligustrina) from maceration demonstrated the greatest antimalarial activity against Plasmodium falciparum strain 3D7. However, this method has several limitations, including a lengthy extraction time, which allows for microorganism contamination. The aim of this study was to quantify the yield, evaluate the antimalarial effectiveness of the P. falciparum growth in-vitro, and analyze the aqueous bidara laut heartwood extracts phytochemical composition from the two different extraction methods, namely the method of maceration extraction for 24 hours and the ultrasound-assisted extraction (UAE) for 30 (UAE30), 45 (UAE45), and 60 (UAE60) minutes. The bidara laut heartwood extract from the UAE60 method had relatively similar yield and antimalarial activity with the bidara laut heartwood extract from the UAE45 method. However, these extracts had higher yield and antimalarial activity than the extracts from the maceration and the UAE30 methods. The results of LC-MS/MS analysis revealed that the main compounds in the UAE45 and UAE60 extracts were strychnine, quinaprilat, and 3,4-bis-cyclobut-3-ene-1,2-dione, which has potent antimalarial properties. Keywords: antimalarial activity, Plasmodium falciparum, quinaprilat, strychnine, Strychnos ligustrina

An organism's biological processes are adapted to and driven by rhythmicity in the natural environment and periodicity of light is one of the most influential factors. In a developing organism, the onset of circadian rhythmicity might indicate the time point of functional necessity for aligning processes to the environment. Here, the circadian clock mechanism has been studied in the developing brain of Atlantic salmon (Salmo salar), by comparing the endogenous feeding alevin, independent on the environment for nutritional supply, to the exogenous feeding fry, dependent on the light period for detecting and catching prey. The results showed that while only a few clock genes were cyclic in the yolk sac alevins, many of the clock genes and genes of the circadian rhythm pathway cycled significantly in the feeding fry. Few genes were differentially expressed between time points in the circadian sampling series during the yolk sac stage, but several hundred genes were found differentially expressed in the first feeding stage. Genes important for cell cycle progression were cyclic or differentially expressed between time points after exogenous feeding, indicating a clock-controlled cell cycle at this stage. The expression of important genes in the melatonin synthesis were also cyclic in the feeding fry with an acrophase in the transition between light and dark or in darkness. Analyzing the impact of exogenous feeding on the developing brain supported a shift from utilization of proteins and lipids in the yolk to utilization and allocation of dietary energy and nutrients. Taken together, the life history transition related to onset of exogenous feeding is linked to the establishment of a persistent circadian rhythmicity in the salmon brain, which needs to be synchronized to light-dark cycles to enable the fry to search and capture feed.

Background: Several research capacity strengthening (RCS) initiatives have been established in Africa over the past decade. One such initiative is the Consortium for Advanced Research Training in Africa (CARTA) that has gained traction over the years and has been proven as an effective multidisciplinary approach to strengthen research capacity to address public and population health in Africa. Objectives: In this article, we document the experiences and management-related interventions that cushioned the CARTA programme and enabled it to remain resilient during the COVID pandemic. We further make recommendations on the enablers of resilience and optimal performance of such RCS initiatives during crises and beyond. Methods: We used routine information gathered by the CARTA secretariat from consortium correspondence, meeting minutes, reports and other related documents produced in the year 2020 in order to consolidate the experiences and interventions taken by the programme at programmatic, institutional and fellowship levels. Results: We identified a series of management-related cyclic phases that CARTA went through during the pandemic period, which included immobilisation, reflection, brainstorming, decision-making, intervening and recovery. We further identified strategic management-related interventions that contributed to the resilience of the programme during the pandemic including assessment and monitoring, communication management, policy and resource management, making investments and execution. Moreover, we observed that the strength of the leadership and management of CARTA, coupled with the consortium´s culture of collaboration, mutual trust, respect, openness, transparency, equitability, ownership, commitment and accountability, all contributed to its success during the pandemic period. Conclusion: We conclude that RCS initiatives undergo a series of phases during crises and that they need to promptly adopt and adapt appropriate management-related strategic interventions in order to remain resilient during such periods. This can be significantly realised if RCS initiatives build a culture of trust, commitment and joint ownership, and if they invest in strong management capacity.

The objective of this study was to assess the properties of cross-laminated timber (CLT) fabricated from the combination of Sumatran pine (P) and coconut trunk (C) bonded with polyurethane adhesive. The basic properties of raw materials and adhesives were characterized. The CLT panels’ length, width, and thickness are 100 cm by 30 cm by 3.6 cm, respectively. Three-layer CLT was made with 4 combinations of face/core/back lamina, i.e., PPP, CCC, PCP, and CPC, which are arranged perpendicular to each other. The laminae were bonded using PU adhesive on 160 g.m-2 glue spread. The CLT’s delamination and wood failure percentages (WFP) were assessed following the JAS 3079 (2019) standard. The study’s results demonstrated that the PU adhesive employed in this investigation could curl ideally at 30°C for 200 min. Solid pine and coconut’s physical and chemical characteristics differed, but their wettability to polyurethane adhesives was identical. Hybrid pine CLT has greater attributes compared to single pine CLT. Single coconut CLT, on the other hand, offers better features than hybrid coconut CLT. All CLT samples failed to fulfil the JAS 3079 (2019) requirement for delamination (=< 10%) and WFP (>= 90%). Keywords: Coconut trunk, cross-laminated timber, layer combination, pine wood, polyurethane adhesive

The unique properties of metal-organic frameworks (MOFs) such as their large surface area and high porosity have attracted considerable attention in recent decades. The MOFs are a promising class of materials for developing highly efficient biosensors due to these same properties. This bibliometric analysis focused on the use of MOFs as enzyme-coupled materials in biosensor construction and aimed to provide a comprehensive overview of the research field by analyzing a collected database. The analysis included identifying the countries that have published the most, the most prominent applications, and trends for future directions in the field. The study used three databases with different numbers of documents, differentiated by research areas, with refinements made to the search as needed. The results suggest that MOF-derived biosensors are a growing field, with the Republic of China emerging as a significant contributor to research in this area. The study also used computational processing of trend analysis and geocoding to reveal these findings.

Abstract Background Since the deployment of Coronavirus Disease 2019 (COVID-19) vaccines, skepticism about the safety, incidence, and severity of Adverse Events Following Immunization (AEFI) was a concern. The study has two main objectives. First, to analyze AEFIs following COVID-19 vaccines (Pfizer-BioNTech, AstraZeneca, Sputnik, and Sinopharm) during the vaccination campaign in Lebanon and correlate them with age and gender. Second, to correlate Pfizer-BioNTech and AstraZeneca vaccines’ AEFI with the dose administered. Methods A retrospective study was carried out between February 14th, 2021, and February 14th, 2022. AEFI case reports received to the Lebanese Pharmacovigilance (PV) Program were cleaned, validated, and analyzed using SPSS software. Results A total of 6808 AEFI case reports were received to the Lebanese PV Program during the period of this study. Case reports were mostly received from females (60.7%) and from vaccine recipients aged 18–44 years. As for the vaccine type, AEFIs occurred more frequently with the AstraZeneca vaccine compared to the Pfizer-BioNTech vaccine. The latter had AEFIs mainly following dose 2, whereas AEFIs with the AstraZeneca vaccine were more frequently reported after dose 1, with general body pain being the most reported systemic AEFI with PZ (34.6%), while fatigue was the most reported AEFI with AZ vaccine (56.5%). Conclusions The AEFI reported with COVID-19 vaccines in Lebanon were aligned with those reported worldwide. The incidence of rare serious AEFIs should not discourage the public from getting vaccinated. Further studies are needed to evaluate their long-term potential risk.

This study aimed to evaluate the physical and mechanical properties of cross-laminated timber (CLT) characteristics from mangium (Acacia mangium) and puspa (Schima wallichii) woods and their combination using polyurethane (PU 1.2) adhesives. The manufacture of CLT began with basic adhesive characterization and thermo-mechanical analysis. Wood material’s physical and chemical properties were also tested with its response to the PU 1.2 wettability. The CLT (100 ´ 30 ´ 3.60) cm3 was manufactured with 160 g/m2 glue spread at a pressure of 0.80 MPa for 200 minutes. The CLT panels were characterized refers to the JAS 3079 standard. The results show that PU 1.2 had a gelatination time of 182.1 minutes at 25°C, was able to form urethane groups, and experienced an increase in storage modulus at 35°C. Mangium and puspa woods have different physical and chemical properties, but they interact similarly with PU 1.2 wettability. Puspa CLT panel has a higher density than mangium but lower dimensional stability. The bending mechanical properties of hybrid puspa-mangium-puspa CLT were able to match puspa CLT and have one sample of shear strength that met the JAS 3079 standard in both grain directions. Therefore, hybrid puspa-mangium-puspa CLT has the potential to be developed to improve its dimensional stability and mechanical properties. Keywords: Acacia mangium, cross-laminated timber, layer combination, polyurethane adhesive, Schima wallichii

The purpose of this study was to evaluate the characteristic of cross-laminated timber (CLT) made from puspa (Schima wallichii) wood, coconut (Cocos nucifera) trunk, and their combination using a polyurethane (PU) adhesive. The manufacturing of CLT begins with the characterization of the adhesive and wood materials used in this study. The CLT panels are made with dimensions of 100 cm × 30 cm × 3.6 cm. The laminate was organized into three layers with the face/core/back, namely puspa wood (PPP), coconut trunk (CCC), and their combination (PCP and CPC), perpendicular to each other using polyurethane adhesive with a glue spread of 160 g.m-2. The physical and mechanical properties of the CLT were assessed according to the JAS 3079 (2019) standard. The results showed that the polyurethane adhesive used in this study could cure optimally at a temperature of 30°C for 200 minutes. Puspa wood and coconut trunk had different physical and chemical properties but had similar wettability to polyurethane adhesives. The physical and mechanical characteristics of coconut CLT were better than puspa CLT. Based on the overall test results, the puspa hybrid CLT is better than the single wood species of the CLT. In contrast to coconut hybrid CLT, the single CLT of CCC was better than its hybrid CLT. Keywords: Coconut trunk, cross-laminated timber, layer combination, polyurethane adhesive, puspa wood

Acacia auriculiformis and A. crassicarpa can be used as non-timber forest products to produce therapeutic agents. To achieve this, it is essential to identify the metabolite profile and biological activity of these raw materials. In this study, a liquid chromatography high resolution mass spectrometry platform was used to identify metabolites in the leaf, bark, and heartwood extracts that were positively related to antioxidant and antiproliferative activity using in vitro and in silico studies. A. crassicarpa heartwood extract showed significantly higher antioxidant activity compared to the other extracts. Moreover, the leaf and heartwood extracts from A. auriculiformis, as well as the heartwood extracts from A. crassicarpa, showed significantly high antiproliferative activity. Multivariate analysis using an orthogonal partial least squares model identified several metabolites as significant marker and differentiator compounds between the two Acacia species, with a positive correlation to biological activity. The molecular docking technique predicted various positions of hydroxyl substitution on the flavonoids from A. crassicarpa and A. auriculiformis that alter their binding energy to target receptors, which are related to oxidative stress and cancer treatment targets. Moreover, the methylated flavonoid molecules provide less binding energy. These flavonoids and their derivatives were predominantly found in the heartwood extracts, which demonstrates their potential for further exploration using this part of A. crassicarpa and A. auriculiformis.

Child participation is advocated for in many contexts related to children, such as in education and health services, but also in everyday life settings. To facilitate children’s real opportunities for participation, it is proposed that children need to be adequately empowered to liberate the child’s autonomous voice and activate their powers of action. This involves an understanding of children as opinion-forming and social individuals, who play an active part in social relationships. This article aims at a theoretical exploration of empowerment in the organization of ethically justifiable participation situations with children. With a semantic view of theory, an eclectic research design has been used to search for a theoretical framework based on basic human needs to be an active agent in one’s own life. The purpose is to define key factors that promote the sense of empowerment as a prerequisite for being an active participant in interaction with adults. This conceptualization aims to raise clearer guidelines for the implementation of child participation and presents an empowerment model with four dimensions for the active inclusion of children in participatory processes with adults. These dimensions are information, autonomy, recognition, and alliance.

Abstract Background Drug non-adherence is assumed to play an important role in development of hypertensive urgency, which is a common health problem resulting in frequent emergency department admissions and thus increased healthcare spending wastage. The objective of this study is to assess the rate of non-adherence to antihypertensives and to evaluate influencing factors predicting this behavior in Lebanese hypertensive adults. In addition, this study aim to estimate the cost of hospitalization for hypertensive urgency covered by the Ministry of Public Health in patients’ non-adherent to their antihypertensives. Methods A multi-methods approach is used comprising a cross-sectional study, additionally to an observational, retrospective, cost of illness study. A cross-sectional questionnaire based study is conducted from May to Dec, 2019 to address the study objective. Using the Ministry of Public Health hospitalization data during 2019, the cost of hospitalization for hypertensive urgency is assessed. Multivariable analysis is performed to calculate the adjusted odd ratios by fitting a logistic regression model. Results The cross-sectional study includes 494 participants and shows that 43.0% of patients hospitalized and covered by the Ministry of Public Health are non-adherent. The univariate regression model shows that adherence to antihypertensive medications is significantly associated with age (p-value = 0.005) and follow-up visits (p-value = 0.046). The odds of adherence for participants earning more than USD 2000 was 3.27 times that for those who earn less than USD 1000 (p = 0.026). The estimated cost of hospitalization for non-adherent patients is USD 452,353 in 2019. Conclusion Non-adherence associated hospitalization costs represents a financial burden to Lebanese health system.

Several researchers around the world have been investigating the use of supercritical fluids incorporated into the process to create a method known as hydrothermal gasification (HTG). Thus, the present study aims to evaluate what has been produced regarding biofuels produced from HTG. A bibliometric analysis of the Web of Science (WoS) database was performed for articles published between 2006 and 2022. In the first analysis, 331 articles were identified, and refined analyses for 320 and 311 publications of the Web of Science Core Collection database (2006- 2022) were performed using VOSviewer, CiteSpace, and Microsoft Excel. The year 2022 had the highest number of articles, with 54 publications, followed by 2021 and 2015 with 45 and 31 publications, respectively. The three journals with the most significant impact were Bioresource Technology, Algal Research: Biomass Biofuels And Bioproducts, and Biomass & Bioenergy, with TPs of 26, 18, and 17, respectively. China, the USA, and Canada represented 11.48%, 10.89%, and 7.52% of the total publications. Investments in research on supercritical fluids and carbonization should be more significant in countries that publish more. Much research still needs to be done for the advancement of the area, as evidenced by the low number of publications. Future studies should focus on related technologies such as liquefaction and pyrolysis

Pregnancy intention refers to a women's thinking at the time she became aware that she was pregnant. It can be categorized as intended and unintended. Identifying pregnancy intentions during prenatal periods help to employ careful monitoring of pregnancy that is at high risk for mother and children's health outcomes. Unintended pregnancy is a contributing factor for maternal and infant mortality, which is still high in Nepal. Reproductive and family planning program should incorporate pregnancy intention domains in health education and counseling with priority to design program to address and reduce unintended pregnancy. This brief research examines the pregnancy intentions and its associated factors among married women so that it could identify the intentions of pregnancy and factors influencing unintended pregnancy and could be useful to improve and maintain the health and well-being of women, family, community, and nation.

This study aimed to develop bio-based polyurethane (PU) resin derived from tannin for the impregnation process of ramie fibers (Boehmeria nivea L.) and to investigate the mechanical and thermal properties of impregnated fibers. Tannin was extracted from Acacia mangium bark using hot-water extraction. The polymeric diphenylmethane diisocyanate (pMDI) was added into tannin extract to prepare tannin-based PU (TPU) resin. Degummed ramie fibers were impregnated by TPU resins for 1, 2, and 3 h at a temperature of 25 °C under a pressure of 50 kPa in a vacuum chamber. The weight gain of fibers after impregnation increased by 73.26%. After the impregnation process, the formation of urethane linkages on fibers was detected by fourier-transform infrared spectroscopy (FTIR) and micro confocal Raman spectroscopy. Field emission scanning electron miscroscopy (FE-SEM) coupled with energy dispersive x-ray (EDX) detected the TPU on the surface of ramie fibers, indicating by increasing of Nitrogen content on ramie fibers which derived from TPU. Using thermogravimetric analysis (TGA), the thermal stability of fibers increased from 14.2% to 32.6% of weight residue after heating at 750 °C. In addition, x-ray diffractogram (XRD) analysis showed that impregnation process increased the crystallinity of ramie fibers, resulting in increased of modulus of elastictiy by maximum of 29.5% and tensile strength by 4.7%, respectively, after 1 h of impregnation time. This study demonstrated the positive effect of impregnating ramie fibers by TPU resin on their thermal and mechanical properties, enhancing their more comprehensive industrial application as a value-added functional material.

This study aims to determine the effectiveness of cognitive behaviour therapy with mindfulness techniques through group counselling to increase the confidence of high school students who experience a broken home, through experimental research with a single group pretest post-test design. The sample selection in the study was the purposive sampling technique, which obtained 8 samples from 12 populations that became the research sample. Data analysis used the Wilcoxon test to determine the increase in self-confidence before and after the intervention and the Mann Withney U Test to determine the differences between the intervention groups. The results of experiments that have been carried out show an increase in the self-confidence of students who experience a broken home after being given group counselling on cognitive behaviour therapy with mindfulness techniques.

Natural preservatives have been widely considered as non-synthetic materials that can prevent the biodegradation of wood due to subterranean termite attacks, namely Coptotermes curvignathus. Melia azedarach is a fast-growing species that has been widely studied for its antifeedant compounds and shows good potential to be developed as a biopesticide, especially as an anti-termite. This study aimed to identify the termicide and antifeedant properties of the wood, leaves, and bark extracts of Melia azedarach against subterranean termites and identify their bioactive compounds. The acetone extract from the three parts of the tree was fractionated. The most active fractions were selected from each part based on the percentage of termite mortality and antifeedant activity and analyzed for its bioactive compounds by pyrolysis GCMS. The ethyl acetate fraction of Melia azedarach bark exhibited strong toxic properties compared to other fractions. In the leaf section, the diethyl ether fraction showed the best termite repellent (antifeedant) properties. The anti-termite properties influenced phenolic compounds and organic acid that dominated the bark ethyl acetate fraction and leaf diethyl ether fraction. These findings show the great potential of bioactive compounds from biomaterials to be developed as a promising biopesticide. Keywords: anti-termite, bioactive compound, Melia azedarach, natural preservative

Light cues vary along the axis of periodicity, intensity and spectrum and perception of light is dependent on the photoreceptive capacity encoded within the genome and the opsins expressed. A global approach was taken to analyze the photoreceptive capacity and the effect of differing light conditions on a developing teleost prior to first feeding. The transcriptomes of embryos and alevins of Atlantic salmon (Salmo salar) exposed to different light conditions were analyzed, including a developmental series and a circadian profile. The results showed that genes mediating nonvisual photoreception are present prior to hatching when the retina is poorly differentiated. The clock genes were expressed early, but the circadian profile showed that only two clock genes were significantly cycling before first feeding. Few genes were differentially expressed between day and night within a light condition; however, many genes were significantly different between light conditions, indicating that light environment has an impact on the transcriptome during early development. Comparing the transcriptome data from constant conditions to periodicity of white light or different colors revealed overrepresentation of genes related to photoreception, eye development, muscle contraction, degradation of metabolites and cell cycle among others, and in constant light, several clock genes were upregulated. In constant white light and periodicity of green light, genes associated with DNA replication, chromatin remodeling, cell division and DNA repair were downregulated. The study implies a direct influence of light conditions on the transcriptome profile at early developmental stages, by a complex photoreceptive system where few clock genes are cycling.

Background Upon the authorization of COVID-19 vaccines worldwide, national and international standards were developed to help integrate mass COVID-19 immunization campaigns into the healthcare network. The primary objective is to evaluate the overall COVID-19 vaccination process through on-site visits to vaccination centers all over Lebanon to assess whether these are abiding by the national and international requirements for both Pfizer-BioNTech and AstraZeneca vaccines. The secondary objective is to explore whether the type of the facility, private versus governmental, and educational versus non-education, affects the vaccination process in these centers. Methods A convenient sample of 33 vaccination centers was selected from a list of all COVID-19 vaccination centers operating in Lebanon. Data were collected using a structured checklist developed following an extensive literature review of the national and international standards for Pfizer-BioNTech and AstraZeneca COVID-19 vaccines. A scoring system for the overall vaccination process was developed. Results Quality deficiencies were identified in several steps of the immunization process; however, the international standards were followed in most vaccination centers visited despite their limited resources. It was noticed that there were no significant differences between private and governmental, between educational and non-educational, and between Pfizer and AstraZeneca vaccination centers; the 33 vaccination centers visited have scored above 75 on the entire process immunization against COVID-19 with P-values above 0.05 in all steps evaluated. Conclusion An optimization of the immunization process should be performed to ensure that the practice is within international standards. This can be done by conducting periodic vaccination center visits, implementing clear guidelines, training staff involved in the vaccination process, and ensuring continuous support of the Lebanese Ministry of Public Health.

Salmonids are ideal models as many species follow a distinct developmental program from demersal eggs and a large yolk sac to hatching at an advanced developmental stage. Further, these economically important teleosts inhabit both marine- and freshwaters and experience diverse light environments during their life histories. At a genome level, salmonids have undergone a salmonid-specific fourth whole genome duplication event (Ss4R) compared to other teleosts that are already more genetically diverse compared to many non-teleost vertebrates. Thus, salmonids display phenotypically plastic visual systems that appear to be closely related to their anadromous migration patterns. This is most likely due to a complex interplay between their larger, more gene-rich genomes and broad spectrally enriched habitats; however, the molecular basis and functional consequences for such diversity is not fully understood. This study used advances in genome sequencing to identify the repertoire and genome organization of visual opsin genes (those primarily expressed in retinal photoreceptors) from six different salmonids [Atlantic salmon (Salmo salar), brown trout (Salmo trutta), Chinook salmon (Oncorhynchus tshawytcha), coho salmon (Oncorhynchus kisutch), rainbow trout (Oncorhynchus mykiss), and sockeye salmon (Oncorhynchus nerka)] compared to the northern pike (Esox lucius), a closely related non-salmonid species. Results identified multiple orthologues for all five visual opsin classes, except for presence of a single short-wavelength-sensitive-2 opsin gene. Several visual opsin genes were not retained after the Ss4R duplication event, which is consistent with the concept of salmonid rediploidization. Developmentally, transcriptomic analyzes of Atlantic salmon revealed differential expression within each opsin class, with two of the long-wavelength-sensitive opsins not being expressed before first feeding. Also, early opsin expression in the retina was located centrally, expanding dorsally and ventrally as eye development progressed, with rod opsin being the dominant visual opsin post-hatching. Modeling by spectral tuning analysis and atomistic molecular simulation, predicted the greatest variation in the spectral peak of absorbance to be within the Rh2 class, with a ∼40 nm difference in λmax values between the four medium-wavelength-sensitive photopigments. Overall, it appears that opsin duplication and expression, and their respective spectral tuning profiles, evolved to maximize specialist color vision throughout an anadromous lifecycle, with some visual opsin genes being lost to tailor marine-based vision.

User involvement in research has gained increased attention in recent decades. However, there is a lack of studies involving children as co-researchers, and particularly uncertainty regarding how to facilitate this type of collaboration. In this study, we explore children’s experiences of being part of a co-creation process in research in light of self-determination theory. By participating in a collaborative research project focusing on empowerment in educational support services, four girls aged 13–14 were interviewed about their experience as co-researchers. Using thematic analysis, three overarching elements were identified as significant in the co-creation process: (1) a sense of freedom to explore (autonomy); (2) a sense of significant contribution (competence); and (3) a safe social context (relatedness). These findings illuminate factors that promote children’s active participation in collaborative processes with adults. Potential challenges are also discussed.

The anatomical properties of tension wood were investigated for number and diameter of vessel and its correlation with lignin composition. Reaction wood sample was taken from the leaning stem of mindi (Melia azedarach). The formation of tension wood reduced the number and size of vessel and, consequently, increased the proportion of fiber. Number and diameter of vessels positively correlated with lignin content. However, syringyl/guaiacyl ratio of lignin and erythro/threo ratio of β-O-4 structures were negatively correlated with number and diameter of vessels. It was confirmed that changes in the proportion of wood cell was an importance factor influencing the changes in chemical characteristic of tension wood lignin.

Biodiesel can be produced from vegetable oils, animal fats, frying oils, and from microorganism-synthesized oils. These sources render biodiesel an easily biodegradable fuel. The aim of this work was to perform an advanced bibliometric analysis of primary studies relating to biodiesel production worldwide by identifying the key countries and regions that have shown a strong engagement in this area, and by understanding the dynamics of their collaboration and research outputs. Additionally, an assessment of the main primary feedstocks employed in this research was carried out, along with an analysis of the current and future trends that are expected to define new paths and methodologies to be used in the manufacture of biodegradable and renewable fuels. A total of 4586 academic outputs were selected, including peer-reviewed research articles, conference papers, and literature reviews related to biodiesel production, in the time period spanning from 2010 to 2021. Articles that focused on feedstocks for the production of biodiesel were also included, with a search that returned 330 papers. Lastly, 60 articles relating to biodiesel production via sewage were specifically included to allow for an analysis of this source as a promising feedstock in the future of the biofuel market. Via the geocoding and the document analyses performed, we concluded that China, Malaysia, and India are the largest writers of articles in this area, revealing a great interest in biofuels in Asia. Additionally, it was noted that environmental concerns have caused authors to conduct research on feedstocks that can address the sustainability challenges in the production of biodiesel.

A combustão em meios porosos tem sido uma alternativa promissora para produção de energia térmica tornando o processo mais eficiente e menos poluente. A combustão de GLP (Gás Liquefeito de Petróleo) em um queimador poroso melhorado cataliticamente com perovskitas (LaFe0,6Co0,4O3 e LaCoO3) impregnadas em esferas de alumina (Al2O3) foi avaliada. A fase catalítica foi sintetizada pelo método Citrato. A combustão do GLP foi estudada e os parâmetros do processo analisados (velocidade de chama, eficiência total, razão de equivalência, emissões), os parâmetros foram avaliados em meio inerte e catalítico. Ao revestir o meio poroso Al2O3 com catalisadores de perovskitas foi observado a redução das emissões de CO (58%) e NO (87%) na diminuição da razão de equivalência (ɸ) 0,7. O queimador teve uma eficiência total máxima de 94,31% no leito catalítico. Temperaturas são alcançadas com maiores eficiências e menores emissões de poluentes no processo de combustão com o uso de perovskitas.

Purpose: This project aimed to acknowledge the entrepreneurship program in managing human resources in the pandemic era in Indonesia. The essay to understand the entrepreneurship activities in managing human resources in the pandemic era is assumed to have a close connection with acknowledging the entrepreneurship programs in the outbreak of coronavirus 2019 in Indonesia. Methodology: A serial of online information searching and literature review sessions was conducted. After data was gathered, the analysis processing using a qualitative phenomenological approach and profound interpretations were done to see if the research question's reliability and validity were met. Findings: The existing literature on understanding the entrepreneurship program in managing human resources in the pandemic and crisis era of the Covid-19 showed that there are five entrepreneurship activities that were shown relatively significant business program in managing human resources since outbreaks 2020. Finally, we successfully outlined the five related programs as follows: 1) Creating a business crisis plan, 2) More care and services, 3) be among the community, 4) Community relations, 5) Creative thinking endure, 6) Be adjustable. Originality: Direct insights into the entrepreneurship practices, policymaking, and academic business development are beneficial in creating the next entrepreneurship program plan, especially the strategy to manage human resources with an entrepreneurial role in the pandemic crisis. Research implication: Further project is needed to anticipate the next economic crisis and social-political changes that impacted economic development in Indonesia.

Background. Conflicting results are reported on the effect of Ramadan fasting on the cardiovascular health of patients with hypertension, a highly prevalent cardiovascular disease risk factor. This research aimed to evaluate the impact of fasting on cardiac health and heart rate variability (as a measure of cardiac stress) of hypertensive patients. Methods. Patients with controlled hypertension were followed in a prospective cohort during and after Ramadan. Lipid panel and blood glucose were measured at the end of each phase. Blood pressure and heart rate variability were monitored in the morning, afternoon, and evening of each follow-up day. Results. The study included 58 subjects (mean age: 54 ± 11.5 years, 52% male). Fasting did not affect body composition, lipid panel parameters, and blood pressure of hypertensive subjects; males only presented lower body weight and hip circumference during Ramadan. Blood glucose was significantly higher during Ramadan. Fasting significantly increased HRV during the afternoon period. Conclusions. Ramadan intermittent fasting reduces cardiac stress among hypertensive patients controlled by and adherent to hypertensive medication, without affecting their hypertensive state.

Daemonorops (Indonesian: jernang) resin is one of Indonesia’s leading non-timber forest products and can be developed as a source of natural antioxidants and sun protection. This study aimed to select promising solvents for extracting a Daemonorops acehensis resin and phytosome formulation with high antioxidant capacities and sun protection factor (SPF) values. Jernang resin was extracted using a water–ethanol mixture in five different ratios. The promising extract was then mixed with soy lecithin in three different formulations. A promising extract and phytosome were then selected based on their antioxidant capacities and sun protection factor (SPF) values. A liquid chromatography mass spectrometry/mass spectrometry (LC–MS/MS) analysis was also performed on five extracts to identify the components in the extracts that might be responsible for the biological activity. The results showed that the ethanol solvent variation and phytosome formulation influenced the antioxidant capacity and SPF value. A hundred-percent ethanolic extract and F1 phytosome exhibited the highest antioxidant capacities and SPF values. A qualitative analysis revealed the various classes of compounds in the extract and phytosome. A flavylium chromophore, dracorhodin, dominated the resin extract and was presumed to be the marker compound responsible for their antioxidant capabilities and SPF values. These findings are important for manufacturing sunscreens containing active compounds of bioactive natural resins.

Samama (Anthocephalus macrophyllus) is one of a pioneer indigenous fast growing species in Indonesia which have been used as traditional medicine for various diseases. The objectives were to determine the yield extract, to analyze their antidiabetic activity by inhibition assay for α-glucosidase enzyme activity and chemical analysis with GCMS. Extraction of leaves, bark and wood samples were done by using ethanol 95%. Fractionation the most active ethanol extract was conducted by using n-hexane and ethyl acetate. The yield of ethanol extracts in leaves, bark and wood were 13.90%, 12.87%, and 2.18% respectively. Based on antidiabetic activity assay, the bark ethanol extract was the most active extract by the IC50 value of 5.86 μg mL-1. Phytochemical analysis on bark ethanol extracts showed that they contained flavonoid, quinon, triterpenoid, saponin and tannin which were assumed have high contribution in antidiabetic activities. The result of fractionation ethanol extract bark showed that the ethyl acetate fraction was the most active fraction (IC50 6.82 μg mL-1). GCMS analysis indicated the presence of dominant phenolic compounds such as pyrocatechol, antiarol, isopropyl myristate and phenol in which were suspected have antidiabetic activity. These results strongly suggested that ethyl acetate fraction of Samama bark was a potential natural source for antidiabetic agents.

Potato peel was found to be a superior substrate for solid state fermentation, compared to wheat bran, for the production of α-amylase by two thermophilic isolates of Bacillus licheniformis and Bacillus subtilis. Under optimal conditions, B. licheniformis produced 270 units/ml and 175 units/ml of α-amylase on potato peel and wheat bran, respectively, while the corresponding values for B. subtilis were 600 units/ml and 265 units/ml. The enzyme from B.␣licheniformis was optimally active at 90 °C and pH 9.0, while that from B. subtilis at 60 °C and pH 7.0. The nature of the experimental data permitted excellent polynomial fits, on the basis of which, two master equations, corresponding to the isolated strains, were derived for estimation of enzyme activity for any set of values of temperature, particle size, moisture, and incubation time within the indicated ranges. [ABSTRACT FROM AUTHOR]

Background: Job satisfaction influences the quality of health services in hospitals. However, low job satisfaction of nurses exists in the literature and influenced by various factors, including supervision. Thus, a reflective supervision model is considered effective in improving nurse job satisfaction. Objective: This study aims to analyze the effect of the reflective supervision model on nurse job satisfaction. Methods: This was a quasi-experimental study with control group design conducted between May-July 2017 in the Tugurejo Hospital and Dr. Moewardi hospital. There were sixty-eight nurses selected using purposive sampling, with 34 nurses assigned in the experiment and control group. Data were collected using questionnaires and then analyzed by paired t-test. Results: Paired t-test obtained p-value of 0.000, which indicated that the reflective supervision model has a significant influence to nurse work satisfaction. Conclusion: The reflective supervision model has a significant effect in increasing nurse job satisfaction. Therefore, this model could be applied by the head nurses to improve nurse outcome indicator, especially for nurse job satisfaction.

Similar with other construction materials, wood strength is decreasing when applied by long term loading. Wooden cooling tower structure at Star Energy Geothermal (Wayang Windu) Ltd was built in 1998 and it should be evaluated to avoid sudden structural failure. Evaluation conducted through several steps: wood species identification, the physical and mechanical properties testing, and estimation for remaining service-lifetime by generating mathematical models derived from creep test and reduction of cross sectional area of the wood. Identification result that the wood are redwood (Sequoia sempervirens) and Douglas fir (Pseudotsuga menziesii). The wood density value has degraded from the surface until 0.25 cm depth. Strength characteristics of the wood have considerably decreased, but the allowable stress for bending, tension parallel to grain, and shear were still higher than NDS2005 requirements. The allowable stress for compression parallel to grain was slightly lower than NDS, while compression perpendicular to grain was much lower. Average modulus of elasticity reduces become lower than the value stated by the code, but the minimum value of modulus of elasticity (Emin) of redwood was still higher than the code value, while Emin of Douglas fir is slightly lower. Then, in accordance with those findings, the construction would not failure yet but the deformation and vibration will occur in higher rate than design planning. This research develops mathematical models for estimating the remaining service-lifetime of the wooden cooling tower structure in geothermal power plant based on the wood performance in resisting long term loading and its deterioration rate. The deterioration rate of wood member of cooling tower structure at Star Energy Geothermal (Wayang Windu) Ltd is 0.0147 cm depth per year, so equation for the residual service life estimation is σlaterσtoday=bh2(b−0.0147T)(h−0.0147T)2, and σlater must be lower than allowable stress.

The most common human pathogen that colonizes in a third of healthy people around the world are Staphylococcus aureus, and one of the materials allegedly able to overcome the pathogen is resin. Resin has been used in folk medicine for thousands of years to treat diseases. The antimicrobial activity of natural resins can be associated with a variety of organic compounds contained in them such as diterpenoids and triterpenoids. This research aimed to explore the antibacterial and antioxidant activities of Pinus merkusii, P. oocarpa, P. insularis, Agathis loranthifolia resins and essential oil. Resin was separated by distillation process to get essential oil and the residue was extracted using n-hexane, ethyl acetate (EtOAc), and methanol (MeOH). Antioxidant activity was performed by DPPH (1,1diphenyl-2-picryl hydrazyl) radical scavenging method. The antibacterial activity of resins and essential oil of the samples determined using the disc diffusion method against Staphylococcus aureus and Escherichia coli. The results showed that the yield of resin extract was ranging from 8.44 % to 95.56%. All extracts and essential oil could not inhibit E coli growth but inhibit the S. aureus growth. This experiment concluded that resin n-hexane extract from P.oocarpa was the most potent as antibacterial activity against S. aureus. All of the samples used had less potential antioxidant activity compared to positive control ascorbic acid. Result of this study show that pine resin from Indonesia has potential as an antibacterial agent.

IntroductionImplementation of health technology assessment (HTA) is still in an early stage with some heterogeneity in the Middle East and North Africa (MENA). Our objective was to assess the current and future status of HTA implementation in the MENA region by focusing on regional commonalities.MethodsPreparatory discussions for the first ISPOR conference in the MENA region indicated some potentially generalizable trends of HTA roadmaps. To widen the perspective, a policy survey was conducted among conference participants by applying an HTA implementation scorecard. Discussion group members helped to validate key conclusions during and after the conference.ResultsHealth policy experts in MENA countries would like to facilitate HTA implementation and expect significant changes with some generalizable directions in 10 years compared to the current status according. HTA capacity building has to be strengthened by more graduate and postgraduate programs. Increased public budget and enhanced institutionalization are necessary success factors of HTA implementation. The scope of HTA has to be extended from pharmaceuticals to non-pharmaceutical technologies and to revision of previous policy decisions. Although cost-effectiveness with explicit threshold remains the most preferred HTA criterion, several other criteria have to be considered, maybe even by applying an explicit MCDA framework. The role of local evidence and data has to be strengthened in MENA countries, which translates to the extended use of local patient registries and payers' databases. Duplication of efforts can be reduced if international collaboration is integrated into national HTA implementation.DiscussionOur results should be viewed as an initial step in a multi-stakeholder dialogue on HTA implementation. Each MENA country should develop its context-specific HTA roadmap, as such roadmaps are not transferable without taking into account country size, economic status, public health priorities and adopted systems of health care financing.

Reactive oxygen species (ROS) are related to several degenerative diseases. In this study, Acacia, a genus with many fast-growing species, was investigated to explore the many phytochemical compounds that are biologically active in processes dealing with ROS-related diseases. This study aimed to select extracts of Acacia heartwood on the basis of their pharmacological and phytochemical profiles and identify their bioactive compounds. Five methanolic extracts from Acacia heartwood were evaluated for their antioxidant activity using three different in vitro assays: toxicity toward Artemia salina and phenolic and polyphenolic content. Multivariate analysis was conducted to select two promising extracts and then their bioactive compounds were identified using liquid chromatography coupled with mass spectrometry. Acacia crassicarpa extracts showed the highest antioxidant activity, as well as phenolic and hydrolyzable tannin contents, but low toxicity. The A. mangium extract exhibited high flavonoid and condensed tannin content, whereas A. decurrrens had the highest toxicity with low antioxidant activity. Pearson’s correlation analysis demonstrated no correlation between antioxidant activity and toxicity. Moreover, the phytochemical profile exhibited an association with pharmacological parameters. Principal component analysis followed by cluster analysis divided the extracts into three clusters. Two heartwood extracts of A. crassicarpa and A. auriculiformis were chosen as the best extracts. Identification showed that these extracts were dominated by phenolic compounds, as well as anthraquinone and xanthone.

Abstract Background Youth health risk behaviors, including substance use (psychoactive substances including alcohol and illicit drugs), have been the subject of relatively limited study to date in Middle Eastern countries. This study provides insights into the perceived prevalence and patterns of alcohol and drug use among Palestinian youth. Methods The study was based on ten focus groups and 17 individual interviews with youth aged 16–24 years (n = 83), collected as part of the formative phase of a cross-sectional, population representative study of risk taking behaviors among Palestinian youth in the West Bank in 2012. Qualitative analysis was used to code detailed notes of focus groups and interviews. Results Most participants reported that substance use exists, even in socially conservative communities. Almost all participants agreed that alcohol consumption is common and that alcohol is easily available. The top alcoholic drinks referred to by the study participants were vodka, whisky, beer, and wine. Most participants claimed that they drink alcohol to cope with stress, for fun, out of curiosity, to challenge society, and due to the influence of the media. Participants were familiar with illicit drugs and knew of youth who engaged in drug use: marijuana, cocaine, and heroin were mentioned most frequently. Study participants believed that youth use drugs as a result of stress, the Israeli occupation, inadequate parental control, lack of awareness, unhappiness, curiosity, and for entertainment. Many participants were unaware of any local institutions to support youth with substance use problems. Others expressed their distrust of any such institution as they assumed them to be inefficient, profit-driven, and posing the risk of potential breaches of confidentiality. Conclusions Although this study uses a purposive sample, the results suggest that substance use exists among Palestinian youth. Risk behaviors are a concern given inadequate youth-friendly counseling services and the strong cultural constraints on open discussion or education about the impact of high risk behaviors. These barriers to treatment and counseling can exacerbate the health and social consequences of alcohol abuse and illicit drug use.

Cryptococcal infection results from inhalation of fungal spores and usually is confined to the lungs, but may disseminate systemically. Radiologically, cryptococcal infection has multiple forms of presentation. The diagnosis is usually based on fungal isolation from cultured clinical specimens. Long term antifungal therapy is recommended, but surgical procedures may eventually be necessary when large thoracic symptomatic masses are present. We report a case of a 41-year-old male, immunocompetent, investigating a palpable mass in the left supraclavicular region associated with unintentional weight loss over the last three months. He also reported chest pain in this period. Chest X-ray, ultrasonography, and computed tomography were performed, which diagnosed a mediastinal and left supraclavicular mass, interpreted as lymph node conglomerates of unknown etiology. He also underwent a biopsy of the left supraclavicular mass for etiological determination by histopathology, which confirmed cryptococcosis infection. Although very infrequent, mediastinal cryptococcal infection (simulating masses) is a challenging but important differential diagnosis of benign and malignant lesions, since its treatment is usually clinical.