Primary sclerosing cholangitis (PSC) is a chronic inflammation of the bile ducts that leads to progressive narrowing, ultimately resulting in liver cirrhosis. A 10-year-old boy presented with jaundice, abdominal pain, nausea, weight loss, and yellow papules and nodules on the eyelids, elbows, and axillae. A physical examination revealed jaundice, pallor, and hepatosplenomegaly. The laboratory results revealed anemia, cholestasis, and elevated liver enzymes, along with hypoalbuminemia. The tests for viral hepatitis and autoimmune markers were negative. Abdominal ultrasonography revealed increased hepatic parenchymal echogenicity, dilatation of the extrahepatic bile ducts, ascites, splenomegaly, and proximal common bile duct enlargement with a contracted gallbladder. Magnetic resonance cholangiopancreatography showed the features consistent with PSC and early cirrhosis. Endoscopy revealed grade 3 esophageal varices. A liver biopsy showed cholestatic obstructive disease with portal and periportal fibrosis. The final diagnosis was PSC with xanthomatosis, complicated by hepatic cirrhosis and portal hypertension. Supportive therapy remains essential, particularly in regions with limited access to liver transplantation. An early diagnosis of PSC in children continues to be a major challenge.

PurposeAimed to investigate the potential of N-acetylcysteine (NAC) as an adjunctive immunomodulatory therapy to support the host immune response against Mycobacterium tuberculosis by enhancing interleukin-2 (IL-2) production.Patients and MethodsA quasi-experimental study was conducted on the effect of NAC administration on IL-2 levels in patients newly diagnosed with pulmonary tuberculosis at Universitas Airlangga Teaching Hospital, Indonesia. Participants who met the inclusion criteria were subsequently divided into two groups: treatment group (received 600 mg every 12 hours of NAC therapy, n = 15) and control group (did not receive NAC therapy, n = 15). Enzyme-linked immunosorbent assay (ELISA) was used to analyze IL-2 levels in both groups, which were subsequently compared using statistical analysis.ResultsAnalysis of IL-2 levels before treatment with NAC revealed no significant difference between the treatment and control groups. The treatment group exhibited a significant increase in IL-2 levels after NAC administration (p=0.023). The median IL-2 level in the treatment group increased from 243.7 to 386.62 ng/L after two weeks of NAC administration, whereas in the control group, it decreased from 303.6 to 285.89 ng/L. The comparison test analysis of delta IL-2 levels also showed a significant difference between the treatment and control group (p = 0.025), with the median value of delta IL-2 levels in the treatment group being 147.0 ng/L and −24.7 ng/L in the control group.ConclusionThis preliminary study demonstrated that IL-2 levels significantly increased with NAC supplementation, suggesting an enhanced immune response and its potential as an adjunct to standard tuberculosis therapy.

Drug-induced anaphylaxis is a severe, potentially fatal hypersensitivity reaction triggered by various pharmacologic agents, including antibiotics, nonsteroidal anti-inflammatory drugs, and biologics. It involves a spectrum of immunologic and nonimmunologic mechanisms, ranging from classical IgE-mediated pathways to complement activation and direct mast cell stimulation via receptors such as Mas-related G-protein-coupled receptor member X2 (MRGPRX2). The clinical heterogeneity of anaphylaxis presents significant diagnostic challenges, often requiring a combination of clinical evaluation, laboratory biomarkers (eg, serum tryptase and histamine), in vitro tests (eg, basophil activation test and specific IgE test), skin testing, and in some cases, a gold-standard drug provocation test, to establish a definitive diagnosis. Emerging insights into phenotypes and endotypes—such as cytokine-release reactions and bradykinin-mediated responses—enable a more complex understanding of pathophysiological mechanisms, facilitating precision diagnostics and targeted interventions. Accurate risk stratification considers both drug-related and patient-related factors, including genetic polymorphisms and comorbidities. Management hinges on the prompt administration of intramuscular epinephrine, with supportive therapies tailored to the underlying mechanism. In select patients, desensitization and delabeling strategies may allow continued treatment with essential medications. This review provides a comprehensive synthesis of the current knowledge on the pathogenesis, clinical features, diagnostic approaches, and management strategies for drug-induced anaphylaxis and highlights areas for future research aimed at improving patient safety and therapeutic outcomes.

The CHA₂DS₂-VASc score was originally developed to assess stroke risk in patients with atrial fibrillation (AF). Recently, it has been explored as a potential tool for predicting adverse cardiovascular outcomes after percutaneous coronary intervention (PCI). However, its effectiveness in this context remains underexplored. This review aims to evaluate the ability of the CHA₂DS₂-VASc score to predict adverse cardiovascular outcomes in patients undergoing PCI. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Ten observational studies involving a total of 14,143 patients were included. The primary outcomes were ISR, AST, and MACE. Pooled odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Most included studies were observational with varying endpoints, follow-up periods, and stent technologies, limiting causal inference, subgroup analyses, and introducing potential bias. The pooled analysis showed that higher CHA₂DS₂-VASc scores were significantly associated with increased risks of ISR (OR: 2.21; 95% CI: 1.75-2.78), AST (OR: 1.99; 95% CI: 1.53-2.60), and MACE (HR: 1.44; 95% CI: 1.22-1.69). The CHA₂DS₂-VASc score shows strong predictive value for ISR, AST, and MACE after PCI. Its simplicity and ease of use make it a practical tool for bedside risk assessment in clinical settings. Future prospective, multicenter studies with patient-level data are needed to validate the CHA₂DS₂-VASc score in non-AF populations.

Chitosan, a natural polysaccharide with immunomodulatory and regenerative properties, has shown promise in enhancing tissue repair. While 5% minoxidil remains the standard treatment for androgenetic alopecia, interest in non-hormonal or adjunctive therapies such as chitosan is growing. To evaluate the clinical efficacy and safety of topical 2% chitosan applied after microneedling in comparison with 5% topical minoxidil and a no-treatment control group in patients with androgenetic alopecia or diffuse hair loss. A prospective, controlled study enrolled 30 patients (aged 22-58y), randomized equally into 3 groups (n=10 each): (1) microneedling followed by 4mL of 2% chitosan (Chitosan group), (2) twice-daily application of 5% topical minoxidil (Minoxidil group), and (3) untreated control (Control group). Treatments continued for 6 months. Primary outcomes included trichoscopic hair density and hair shaft diameter; secondary outcomes included patient satisfaction scores and adverse events. A representative scalp biopsy from the chitosan group was evaluated histologically. After 6 months, both the chitosan and minoxidil groups demonstrated significant increases in mean hair density compared with the control group (+30.5% and +22.3%, respectively; P=0.032 and P=0.048). Although the chitosan group showed a numerically greater improvement than the minoxidil group, this difference was not statistically significant (P=0.62). Hair shaft diameter and patient satisfaction scores improved in both treatment groups. No meaningful changes were observed in the control group. Mild, transient erythema occurred in 3 patients (1 in the chitosan group and 2 in the minoxidil group). Histologic analysis in a chitosan-treated subject showed increased follicular density and improved dermal matrix organization. In this small controlled study, microneedling followed by topical 2% chitosan resulted in significant improvements in hair growth parameters compared with no treatment, and outcomes were generally comparable to those observed with 5% minoxidil. While these results are promising, the small sample size limits definitive conclusions regarding comparative efficacy. Larger, adequately powered trials are warranted to confirm these preliminary findings and to better delineate the role of chitosan as a standalone or adjunctive therapy. Level II.

The rapid deployment of autonomous AI agents across critical domains has raised significant concerns regarding reliability, accountability, and safety. This chapter examines the role of human oversight and fail-safe mechanisms in ensuring responsible AI operations. It highlights the necessity of integrating monitoring systems, intervention protocols, and adaptive safety measures to mitigate unintended consequences arising from autonomous decision-making. Case studies and recent advancements in AI safety engineering are discussed to illustrate practical implementations of oversight frameworks. Furthermore, the chapter explores regulatory, ethical, and technical dimensions, emphasizing the importance of maintaining human-in-the-loop control to safeguard against catastrophic failures. Recommendations for designing robust fail-safe architectures and continuous oversight strategies are provided to guide researchers, developers, and policymakers in the deployment of secure and accountable AI agents.

The development of fire stations (Pos Damkar) in Gresik Regency represents a strategic step to strengthen fire disaster mitigation in a rapidly growing region. New stations in strategic districts such as Manyar, Kebomas, and Driyorejo aim to shorten response times and improve the effectiveness of fire handling. A transformation has also occurred in the role of firefighters, who are no longer merely reactive but also active as community mobilizers, facilitators, and educators. Through education programs, volunteer training, and regular evacuation drills, public awareness of fire prevention is significantly enhanced. Educational programs include the use of fire extinguishers, counseling on electrical short-circuit and gas leak hazards, as well as evacuation simulations in schools and industrial areas. Capacity building is further supported by cross-sector partnerships, involving schools, industries, and private stakeholders. The establishment of fire volunteers strengthens early detection and initial response, accelerating mitigation efforts and reducing losses. Technologies such as Geographic Information Systems (GIS) and integrated communication systems are being applied to improve efficiency and effectiveness. Despite challenges such as limited funding, strategic land availability, and the need for more competent human resources, collaboration with the private sector is expected to address these gaps. Overall, the development of fire stations and the transformation of firefighter roles create an integrated mitigation system based on infrastructure, education, and community empowerment, making Gresik safer, more resilient, and sustainable.

Indonesia must improve its higher education so graduates may benefit society and the economy. It looks at how well lecturers do their jobs, which is an important part of the total quality of education. This study did a literature review on higher education in Indonesia using a qualitative method. This shows how important it is to provide regular professional development, make a thorough method for evaluating performance, enhance infrastructure and resources, encourage partnerships within the industry, and set up mentoring programs. The study also shows how important it is to know how to use technology, how to teach online, how to work with people from different fields, and how to have clear job paths. To help lecturers do a better job, it is important to encourage new ways of teaching, set up useful feedback systems, and ensure there is enough staff support. The study's conclusion is that attempts to improve the performance of lecturers can make higher education in Indonesia better. The people who make decisions and run schools need to know these results if they want to make Indonesian higher education more competitive and relevant to the global knowledge economy.

The development of information technology has facilitated the rise of online child prostitution cases in Indonesia; however, the application of criminal sanctions against perpetrators has yet to fully reflect the principle of justice. This study aims to analyze the application of criminal sanctions for users of child prostitution services based on the theory of justice, through a case study of Decision Number 1172/Pid.Sus/2024/PN Sby. The research employs a normative legal approach with normative juridical techniques. The research population includes all legal materials related to criminal sanctions for child prostitution, with the sample consisting of court decisions, statutory regulations, and legal literature selected through purposive sampling. The research instruments include a document analysis guide, with data analyzed using normative descriptive-analytical qualitative techniques. The findings show that the judge imposed a prison sentence of 4 years and a fine of IDR 120,000,000 under the Human Trafficking Law, rather than the Child Protection Law as demanded by the prosecutor. The judge's considerations emphasized mitigating factors more than the protection of the child victim. The study concludes that the application of criminal sanctions has not been optimal in providing a deterrent effect and delivering justice to victims, thus highlighting the need for policy reform with stricter sanctions and sentencing guidelines that prioritize the best interests of the child.