Unmasking Risk in the Elderly: Predictors of Emergency Department Outcomes and the Role of Early Warning Score

Introduction: The growing proportion of older adults worldwide has led to increasing utilization of Emergency Department (ED) services. In Indonesia, where the elderly population continues to expand rapidly, contemporary data on geriatric character­ istics and outcomes in the ED remain limited. Aim: This study primarily aimed to identify determinants of prolonged ED length of stay (EDLOS ≥ 4 h), 90-­day unplanned ED re-­admission and mortality. Secondary objective was to evaluate the diagnostic performance of various severity scoring systems in ED. Method: A retrospective review was conducted using medical records of patients aged ≥ 60 years who presented to the ED of a secondary hospital between January and June 2025. Data collected included demographic s, comorbidities, functional status, frailty, polypharmacy, nutritional status, triage category, clinical presentation, scoring assessments (REMS, HOTEL, NEWS2, APACHE-­II). Logistic regression analyses were used to identify predictors and ROC analyses assessed scoring system performance. Results: A total of 1433 geriatric patients were analyzed. Prolonged EDLOS occurred in 53.24% of patients, with independent predictors including specialist consultation, atypical clinical condition, delirium, malnutrition, frailty, and functional decline. The 90-­day mortality rate was 11.58%, and the 90-­day re-­admission rate was 14%. Delirium, frailty, comorbidity burden (CCI ≥ 2), functional decline, and ICU admission were cons

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Comparative characterization of silver nanoparticles synthesized by spore extract of Bacillus subtilis and Geobacillus stearothermophilus

Objective(s): Silver nanostructures have gathered remarkable attention due to their applications in diverse fields. Researchers have recently demonstrated that bacterial spores are capable of reducing silver ions to elemental silver leading to formation of nanoparticles. Materials and Methods: In this study, spores of Bacillus subtilis and Geobacillus stearothermophilus were employed to produce silver nanoparticles (SNPs) from silver nitrate (AgNO3) through a green synthesis method. The production of SNPs by spores, heat inactivated spores (microcapsule) and spore extracts was monitored and compared at wavelengths between 300 to 700 nm. The biosynthesized SNPs by spore extracts were characterized and confirmed by XRD and TEM analyses. Results: UV-Visible spectro scopy showed that the spore extracts were able to synthesize more SNPs than the other forms. The XRD pattern also revealed that the silver nanometals have crystalline structure with various topologies. The TEM micrographs showed polydispersed nanocrystal with dimensions ranging from 30 to 90 nm and 15 to 50 nm produced by spore extracts of B. subtilis and G. stearothermophilus, respectively. Moreover, these biologically synthesized nanoparticles exhibited antimicrobial activity against different opportunistic pathogens. Conclusion: This study suggests the bacterial spore extract as a safe, efficient, cost effective and eco-friendly material for biosynthesis of SNPs. Key words: Bacillus subtilis, Geobacil

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Triglyceride Metabolism in the Liver

Triglyceride molecules represent the major form of storage and transport of fatty acids within cells and in the plasma. The liver is the central organ for fatty acid metabolism. Fatty acids accrue in liver by hepatocellular uptake from the plasma and by de novo biosynthesis. Fatty acids are eliminated by oxidation within the cell or by secretion into the plasma within triglyceride-rich very low-density lipoproteins. Notwithstanding high fluxes through these pathways, under normal circumstances the liver stores only small amounts of fatty acids as triglycerides. In the setting of overnutrition and obesity, hepatic fatty acid metabolism is altered, commonly leading to the accumulation of triglycerides within hepatocytes, and to a clinical condition known as nonalcoholic fatty liver disease (NAFLD). In this review, we describe t he current understanding of fatty acid and triglyceride metabolism in the liver and its regulation in health and disease, identifying potential directions for future research. Advances in understanding the molecular mechanisms underlying the hepatic fat accumulation are critical to the development of targeted therapies for NAFLD. © 2018 American Physiological Society. Compr Physiol 8:1-22, 2018. Didactic Synopsis Major teaching points r A variety of endogenous and exogenous sources provide fatty acids that can be assembled into triglycerides within the liver in health and disease; r Multiple hepatocellular mechanisms regulate fatty acid uptake, synthesi

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Disclosure of key audit matters (KAMs) in financial reporting: evidence from an emerging economy

Purpose – The new audit regulation for disclosure of key audit matters (KAMs) in financial reporting has been introduced in both developed and developing countries. This study investigates the influence of three distinctive sets of variables, namely industry features, firm characteristics and auditor attributes, on the extent, pattern and level of disclosure of KAMs by companies listed in Bangladesh, an emerging economy. Design/methodology/approach – The study uses qualitative and quantitative research approaches to investigate the pattern of disclosure of KAMs and their determinants. With a sample of 447 firm-year observations from companies listed on the Dhaka Stock Exchange over 2018–2020, the study reveals industrylevel, firm-level and auditor-specific characte ristics that affect KAMs’ communication in the new audit reporting model. Findings – The findings suggest that significant differences exist between firms in the number and types of KAMs reported and the extent of their disclosure. The study findings also observed variations both within and across different industry sectors. Highly regulated firms disclose a greater number of KAMs, while environmentally sensitive firms are found to provide a greater detail of the issues presented as KAMs. Further, both firm size and age positively impact the number of KAMs disclosed and the extent of the disclosure provided. Big-4-affiliated auditors do not issue a significantly higher number of KAMs but deliver extensive details to their KAMs description, compared to non-Big-4 auditors. In addition, while auditors, in general, tend to issue boilerplate KAMs, Big-4 associates are found to disclose more new KAMs. However, audit fees and auditor rotation do not influence KAMs disclosure. Research limitations/implications – This study is based on two years of publicly available data. However, future studies could consider in-depth interviews to explore the motivation behind KAMs’ disclosure in Bangladesh and other developing countries with similar cultural and contextual values. Practical implications – These findings have substantial policy considerations for improving firms’ audit quality and, thus, their financial reporting quality, with implications for national and international standardsetters, regulators and other stakeholders. Originality/value – This study is one of the earliest endeavours to investigate KAMs in a context of an emerging country, such as Bangladesh, which adopted KAMs’ disclosure in 2018.

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Evaluation of the antimicrobial activities and mechanisms of synthetic antimicrobial peptide against food-borne pathogens

(Abstract not found)

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Ketogenic diet enhances cognitive- behavioral function and hippocampal neurogenesis while attenuating amyloid pathology in Tg-SwDI mice

Background: The ketogenic diet (KD), characterized by high-fat, low-carbohydrate, and moderate protein intake, has gained attention for its therapeutic potential in patients with neurodegenerative diseases, including Alzheimer’s disease (AD). Studies in AD rodent models report that KD and/or ketogenic supplements attenuate cognitive-behavioral impairments, neuroinflammation, amyloid-β (Aβ) plaques, and tau pathology. However, it is unknown whether KD can similarly benefit individuals with cerebral amyloid angiopathy (CAA), a prevalent condition in which Aβ accumulates in cerebral vessels. CAA is highly comorbid with AD and, on its own, increases the risk of stroke, cognitive impairment, and dementia, yet no effective treatments currently exist. Objective: To determine whether KD can improve cognitive-behavioral and neuropathological outcomes in a mouse model with CAA. Methods: Male Tg-SwDI mice were fed either a standard chow or KD from 3.5 to 7.5 months of age. Following ∼3 months of dietary intervention, glucose and ketone body levels were assessed, then mice underwent a battery of behavioral tests to evaluate locomotor activity, anxiety-related behaviors, and cognition. Immunohistochemistry was performed to assess amyloid pathology, vascular density, neuroinflammation, white matter integrity, and hippocampal neurogenesis. Results: In addition to KD inducing nutritional ketosis and achieving metabolic benefits, mice on KD exhibited increased activity, enhanced spatial le

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Chapter 4 The Plastics Ecosystem

(Abstract not found)

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Immunostimulatory Effect of Moringa oleifera Extracts on Cyclophosphamide-induced Immunosuppressed Mice

In this study, the effect of Moringa oleifera extracts were inves­ tigated on an immunosuppressed model of cyclophosphamideinduced Swiss mice. M. oleifera seed and root extracts (2.0 g kg−1 body wt) were administered orally for 7 consecutive days; cyclo­ phosphamide (CP) (200 mg kg−1 i.p.) was administered by IV on the 4th day. Results indicated that the extracts of the M. oleifera seeds and roots ameliorated the immunosuppressive effects of CP on delayed type hypersensitivity (DTH) response, leukocyte counts, relative organ weight, IgM concentration, serum TNF-α assay and micro-histological images. This study demonstrated in vivo the therapeutic effect of M. oleifera on the immune response in clinical application. ARTICLE HISTORY Received 3 May 2020 KEYW ORDS Bioactivity; immunostimulatory activity; immunosuppression; Swiss mice Introduction There is a growing interest in using natural products to improve the immune response since many natural products have shown immunomodulatory effects and influence on the immune system of the human body.[1] Immunosuppression is a state where the body responds inadequately to pathogens and external organism, individuals who are immunocompromised are at higher risk of infec­ tion and cancer.[2] Immunosuppression can be due to the patient’s genetics disposition or due to external source such as radiation, drug or chemotherapy. Most of the synthetic prescription immunostimulants (e.g. Lonquex, Mepact) possess side effe

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