Objectives: Current tuberculosis (TB) control strategies face limitations, such as low antibiotic treatment compliance and a rise in multidrug resistance. Furthermore, the lack of a safeand effective vaccine compounds these challenges. The limited efficacy of existing vaccines against TB underscores the urgency for innovative strategies, such as immunoinformatics.Consequently, this study aimed to design a targeted multi-epitope vaccine against TB infectionutilizing an immunoinformatics approach. Methods: The multi-epitope vaccine targeted Ag85A, Ag85B, ESAT-6, and CFP-10 proteins. The design adopted various immunoinformatics tools for cytotoxic T lymphocyte (CTL), helper T lymphocyte (HTL), and linear B lymphocyte (LBL) epitope prediction, the assessment of vaccine characteristics, structure modeling, population coverage analysis, disulfide engineering, solubility prediction, molecular docking/dynamics with toll-like receptors (TLRs), codon optimization/cloning, and immune simulation. Results: The multi-epitope vaccine, which was assembled using 12 CTL, 25 HTL, and 21 LBL epitopesassociated with CpG adjuvants, showed promising characteristics. The immunoinformaticsanalysis confirmed the antigenicity, immunogenicity, and lack of allergenicity. Physicochemical evaluations indicated that the proteins were stable, thermostable, hydrophilic, and highly soluble. Docking simulations suggested high-affinity binding to TLRs, including TLR2, TLR4, and TLR9. In silico immune simulation predicted strong T cell (cytokine release) and B cell(immunoglobulin release) responses. Conclusion This immunoinformatics-designed multi-epitope vaccine targeting Ag85A, Ag85B, ESAT-6, and CFP-10 proteins showed promising characteristics in terms of stability, immunogenicity, antigenicity, solubility, and predicted induction of humoral and adaptive immune responses. This suggests its potential as a prophylactic and therapeutic vaccineagainst TB.

Background: The prevalence of confirmed cases of COVID-19 is high and tends to continue to increase in Indonesia. Based on data, the Province of South Kalimantan, Indonesia in early mid-2021 experienced a high spike in cases, resulting in a large number of deaths, especially in Banjar Regency. Active COVID-19 cases in South Kalimantan in July 2021 were recorded at 5,279 (12.41%) out of 42,527 positive cases. Data compiled from the COVID-19 Task Force (Satgas) showed that Banjar Regency was the third highest area of the cumulative number of deaths, with as many as 47 people dying in one day. The results of many research on risk factors for COVID-19 cases vary widely. People with comorbidities are a very vulnerable group. Objective: This study aims to identify the relationship between comorbid conditions and death based on data from COVID-19 admission in the Wetland Environment community in Banjar Regency, South Kalimantan, Indonesia in the years 2020-2021. Methods: This is a retrospective analytical observational study which used purposive sampling. The data were collected from the case form report (CFR). The dependent variable in this study was inpatients at Ratu Zaleha Hospital who died and were diagnosed as positive for COVID-19, while the independent variables were age (productive/non-productive), tuberculosis, hypertension, diabetes mellitus, asthma, pneumonia, heart disease, COPD (lung disease), HIV/AIDS, chronic kidney disease (CKD), and stroke (CVA). Data were analyzed by univariate, bivariate, and multivariate analyses with logistic regression method to obtain adjusted OR. Results: Out of 700 patients with confirmed COVID-19 infection, 273 (39%) had no comorbidity while 427 (61%) had at least one comorbid condition. There were 330 (47.1%) male patients and 370 (52.9%) female patients. There were 565 (80.7%) patients who belong in the productive age and 135 (19.35%) in the nonproductive age. Results showed that age (p=0.002), asthma (p=0.026), chronic kidney disease (p=0.000), and heart disease (p=0.002) are significant risk factors of COVID-19 death in Banjar Regency. Conclusion Based on our analysis of COVID-19-related deaths in Banjar Regency in Ratu Zaleha Hospital on the year 2020-2021, diabetes, pneumonia, kidney failure, and COPD were associated with increased mortality.
COVID-19 ; Comorbidity ; Mortality

Introduction: Dust is one of the chemical substances that cause occupational disease, especially among stone crafters. Its deposition for a long period can lead to various health problems, hence, there is a need for early detection. Therefore, this study aims to assess the occurrence of lung function disorder in headstone and stone mortar crafters. Methods: A cross-sectional design was used and the sample population consists of all headstone and stone mortar crafters in Allakuang Village, Sidrap Regency, Indonesia. They were selected using a purposive sampling method, and 33 out of 148 people met the criteria. Subsequently, their lung function was measured once using spirometry as well as FVC and FEV1 parameters. The data obtained were then analyzed using Chi-Square. Results: 18 of 33 respondents with lung function disorders. They had a long tenure, a normal working time, bad exercise habits, as well as a normal and overweight nutritional status based on their BMI category. The statistical test results showed that tenure, working time, and exercise habits had an effect on the disease condition with p=0.000. Meanwhile, other factors, such as age and nutritional status had no effect with p-values of 0.981 and 0.14, respectively. Conclusion: Based on the results, the majority of headstone and stone mortar crafters have lung function disorders, and the influential factors include tenure, working time, and exercise habits.

Caudal Duplication Syndrome is a rare case, congenital anomalies, involved the alimentary tract duplications and urogenital tracts duplication. The incidence is 1:100.000 births. We present a case of two months old female baby with abnormal genitalia and imperforate anus related to caudal duplication syndrome. On physical assessment we found duplication of vagina with single uterus and urethra with anorectal malformation (anovestibular and rectovaginal type). Intraoperative findings showed double-duplication of ascending colon, transverse, descending and half of sigmoid with duplication of the rest of sigmoid and rectum; left-sided rectum was adjacent to left vestibule and right-sided rectum adjacent to the right vagina; duplication of bladder and urethral duplication. On fourth, the reconstruction surgery was performed to correct digestive abnormality with Posterior Sagittal Anorectoplasy (PSARP) and separating duplication segment using stapler. Stapler was enough to separate duplication. Further reconstructive surgery were needed to achieve better gastrointestinal and genitourinary function outcome.