Objectives: The objective of this study was to develop machine learning models to predict health insurance claim costs among older adults in Indonesia. Methods: This study utilized secondary data from the Indonesian National Health Insurance program (Jaminan Kesehatan Nasional [JKN]) spanning 2017 to 2023. Three modeling techniques—linear regression, random forest, and XGBoost—were employed to predict individual claim costs. Model performance was assessed using the root mean square error (RMSE), coefficient of determination (R2), and mean absolute error (MAE). Additionally, variable importance analysis was conducted to identify key predictors. Results: XGBoost with 500 boosting rounds yielded the best performance, with an RMSE of 11 360 283, an R2 of 0.81, and an MAE of 4 485 917, outperforming both linear regression (RMSE, 13 710 035; R2=0.72) and random forest (RMSE, 12 434 238; R2=0.78). Notably, outpatient care was identified as the most consistent predictor across all models. Other significant predictors included length of stay (LOS), diagnosis type (International Classification of Diseases, 10th revision chapter), facility type, facility classification, and severity of illness, particularly for moderate cases. Although LOS and diagnosis type were important predictors, these findings should be interpreted in the context of Indonesia’s fixed Indonesian Case-Based Groups payment system. Conclusions XGBoost provides reliable predictions of claim costs among older adults, capturing clinical, utilization, and structural drivers. These findings can inform targeted interventions, improve chronic disease management, optimize the referral system, and support integration of predictive tools into JKN to enhance responsiveness and promote sustainable, equitable financing.

Extracranial carotid artery aneurysms (ECAAs) are rare, and the optimal therapeutic modality for these lesions remains controversial. Surgical resection and covered stents may be limited to selected cases. While the concept of using flow diversion is appealing for large aneurysms, the application of flow diverters in extracranial carotid lesions may face restrictions due to off-label use, reimbursement challenges, and factors related to the devices themselves. We report our experience with multiple overlapping Low-profile Visualized Intraluminal Support (LVIS) stents as a reconstructive option for selected ECAAs. Five patients with large ECAAs were treated with multiple overlapping LVIS stents. The primary goal was parent-artery reconstruction and reduction of intra-aneurysmal flow reduction by increasing local metal coverage across the neck of the aneurysm. Double overlapping LVIS stents were used in 3 cases, whereas triple or more extensive overlapping constructs were used in 2 cases. During a mean radiologic follow-up of 24 months, complete occlusion in 2 cases, partial occlusion in 3 cases, and adjunctive procedures in 3 cases were required, and no major thromboembolic or hemorrhagic complications were documented. Adjunctive or staged treatment was required in 3 cases, including balloon angioplasty, additional LVIS stenting, flow-diverter placement, stent-graft placement, or coil embolization. Multiple overlapping LVIS stenting is a feasible and relatively safe reconstructive option for selected large or clinically significant ECAAs, particularly when primary flow-diverter treatment is constrained by off-label indication or reimbursement issues. However, they have limited standalone efficacy, particularly in large or complex aneurysms, often requiring adjunctive or staged treatment.

Objectives: Autism spectrum disorder (ASD) is a major neurodevelopmental disorder characterized by persistent deficits in social communication along with restricted, repetitive patterns of behaviour and interests. FMR1 gene, which causes Fragile X syndrome (FXS), is the most common single-gene contributor to ASD. Variations in CGG repeat length within the 5' untranslated region of FMR1 are central to the etiology of FXS. Given the established connection between FXS and ASD, this study investigated whether the trinucleotide repeat region of FMR1 is associated with ASD in Bangladeshi children. Methods: Seventy-one children participated in the study, including 39 with ASD and 32 age-matched controls. The FMR1 region was amplified using polymerase chain reaction and subsequently sequenced. Results: There was no statistically significant difference in the number of CGG repeats between patients with ASD and controls (p>0.01), with the most common repeat number being 27 in both groups. Interspersion of the two AGG trinucleotides among the CGG repeats was the most common pattern found in the study participants, with frequencies of 56.67% and 50.00% in the ASD and the control groups, respectively. Conclusion This study provides preliminary evidence that CGG repeat expansion in the FMR1 gene is unlikely to represent a major genetic contributor to ASD in Bangladeshi children. However, given the limited sample size, further investigations with a larger cohort are required to confirm these findings.

Objective: This study aims to describe histological manifestations and characterise the CDV strain in the tiger to determine its molecular epidemiology and postulate viral pathogenicity. Methods: Histopathology characterisation of the infected tissues were performed through haematoxylin and eosin and immunohistochemistry staining, respectively. We conducted virus isolation and titration in Chinese hamster ovarian expressing the dog signalling lymphocytic activation molecule (CHO-SLAM) cells. Reverse transcription polymerase chain reaction was performed to confirm the presence of CDV RNA, nucleotide and amino acid sequence analyses for comprehensive characterisation of the CDV strain. Results: Notable histopathological changes were observed primarily in the brain, lung, liver, kidney, spleen, and stomach, with viral antigens localised in the lung, liver, kidney, and stomach tissues. CDV-induced cell cytopathic effects yielding 4.27 × 10 6 TCID 50 /mL were observed at 48 h post-inoculation in CHO-SLAM cells. Phylogenetic analysis suggested that the virus originated from the Asia-1 clade. Notably, 549H and 519I mutations in the hemagglutinin protein were observed, indicating adaptation to a non-canid wildlife species. Conclusions and Relevance: Overall, this study enhances our understanding of the molecular characterisation and evolutionary dynamics of the CDV strain present in the Malayan tiger and serves as a benchmark for developing effective preventative measures to protect Malayan tigers and mitigate their risk of extinction.

Background: Vasovagal reactions (VVRs) are abnormal autonomic responses mediated by the vagus nerve. They can occur during or after interventional procedures and negatively impact patient care. The aim of this study was to evaluate the incidence of VVRs observed during nonoperative orthopedic interventions in outpatient clinics and to analyze the associated risk factors. Methods: The data of 1,208 patients who underwent nonoperative orthopedic interventions at a single-center outpatient clinic between December 2023 and December 2024 were retrospectively analyzed. Patients were categorized into 2 groups based on the occurrence of VVR. The clinical data of both groups were analyzed to identify factors associated with VVRs. Results: A total of 1,208 patients with a mean age of 54.7 years were included in the study. Among the 1,208 patients included, 51 cases of VVRs were reported (4.2%). The VVR group had a younger mean age (44.2 vs. 55.1 years, p < 0.001) and a higher proportion of females (74.5% vs. 59.2%, p = 0.029) compared to the non-VVR group. Mean visual analog scale (VAS) scores during intervention were higher in the VVR group (6.41 vs. 2.98, p < 0.001), and blood-injury-injection (BII) phobia was more common (39.2% vs. 1.8%, p < 0.001). Fasting time was longer in the VVR group (3.9 vs. 2.8 hours, p = 0.003). No significant differences were observed in hypertension, coronary artery disease, cerebrovascular disease, or asthma between groups (p > 0.05). Conclusions Younger age, female sex, higher VAS scores, BII phobia, and longer fasting times were the risk factors for VVRs associated with nonoperative orthopedic interventions.

Purpose: The integration of video-based learning into surgical education highlights the need for high-quality instructional content, especially for complex procedures such as percutaneous nephrolithotomy (PCNL). This study aimed to systematically evaluate and compare the educational quality of YouTube videos demonstrating supine and prone PCNL techniques. Materials and Methods: A comprehensive YouTube search was conducted between January 6 and 19, 2025, using the keywords “supine PCNL,” “prone PCNL,” “supine percutaneous nephrolithotomy,” and “prone percutaneous nephrolithotomy.” Eligible videos were assessed using three validated scoring systems: Global Quality Score (GQS), the DISCERN instrument (a validated tool for assessing the quality of health information), and the JAMA (Journal of the American Medical Association) criteria, along with a novel tool, the PCNL-Edu Score (educational score). A total of 120 videos (60 supine, 60 prone) were included. Results: Supine PCNL videos demonstrated significantly higher DISCERN reliability scores (p=0.037), GQS scores (p=0.001), and PCNL-Edu Scores (p=0.018) compared to prone PCNL videos. Subgroup analyses showed no significant differences in educational quality based on video source (academic/individual) or video type (educational/surgical demonstration). In correlation analyses, video length positively correlated with PCNL-Edu Scores in both groups (prone: p=0.004, supine: p=0.001), whereas popularity metrics such as views (prone: p=0.069, supine: p=0.061) and likes (prone: p=0.183, supine: p=0.225) were not significantly associated with educational quality. Conclusions Supine PCNL videos currently offer superior instructional quality on YouTube. The PCNL-Edu Score provides a focused framework for evaluating surgical videos and underscores the need for standardized guidelines to improve video-based surgical education.

Nipah virus (NiV), a pathogen with pandemic potential, lacks approved treatments or vaccines, highlighting the urgent need for research on immune-targeted antigenic determinants. A significant gap persists in NiV research, as studies on the fusion (F) protein critical for viral entry as well as the B cells epitopes, have primarily focused on computational prediction rather than experimental validation of immunogenic epitopes obtained through immunoinformatics approach. This study focused on the conserved F protein across NiV human isolates and employed an immunoinformatics approach to predict linear B-cell epitopes capable of direct immune activation. Predicted epitopes were screened for antigenicity, toxicity, and allergenicity. Molecular docking analysis was performed to evaluate its binding affinity with B-cell receptors (BCRs). To validate its immunogenicity, the LF6 peptide was synthesized and used in an indirect ELISA to test sera from cohort previously infected with NiV as well as with negative cohort. Epitope LF6 (LISNIEIGFCL) was identified as a strong candidate based on its immunogenic properties. Molecular docking showed favorable binding of LF6 with BCR. ELISA results revealed that one sera from the survival cohort showed positive response which is an IgG antibody response 2-fold higher (0.343) than the cut-off value (0.0171). This study provides the first reported evidence linking computational predictions with functional immune reactivity for a B-cell epitope of NiV. The findings suggest that LF6 has the potential to elicit specific immune responses. However, given the small sample size, further validation in larger cohorts is essential to confirm LF6’s vaccine relevance.

Alagille syndrome (ALGS), also known as arteriohepatic dysplasia, is a rare multisystem vascular disorder affecting brain, liver, heart, ophthalmic and skeletal systems. Moyamoya syndrome is a rare arteriopathy due to an underlying cause that can lead to ischemic and hemorrhagic strokes. Here, we report a rare case of ALGS in a patient with congenital narrowing of bilateral internal carotid arteries (ICA) with superimposed intracranial arteriopathy and associated moyamoya syndrome. A 34-year-old female presented with progressively worsening intermittent right eye visual blurriness, associated headache, and dizziness. Digital subtraction angiogram findings were consistent with the bilateral intracranial steno-occlusive disease at the ICA terminus with moyamoya collaterals at the skull base; bilateral posterior communicating arteries supplied the bilateral middle cerebral arteries, and the left ophthalmic artery supplied the distal right anterior cerebral artery. Her right-sided vision abnormalities were highly concerning for branch retinal artery occlusion based on fundoscopic exam. She continued antiplatelet therapy and was scheduled for an ophthalmology follow-up as an outpatient. The patient was monitored in outpatient stroke clinic with surveillance scans. Due to patient preference and the absence of further strokes on preventive medications, the initial plan of external carotid artery to ICA bypass was deferred. Early identification of moyamoya syndrome and initiation of secondary stroke preventive therapy in symptomatic patients can reduce the incidence of ischemic strokes. This is an important consideration for patients transitioning from pediatric to adult neurologists, as the latter may not be as familiar with managing this condition.