Narra J

Comparison of total and partial parenteral nutrition to achieve calorie target among treated children in the intensive care unit

2024-03-26T23:43:15+07:00

The achievement of recommended calorie targets for parenteral nutrition in pediatric patients receiving treatment in the pediatric intensive care unit (PICU) in Indonesia remains suboptimal, necessitating cautious implementation of this nutritional intervention alone. The aim of this study was to compare the effectiveness of total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) in achieving the calorie requirements of pediatric patients receiving treatments in the PICU. A cross-sectional study was conducted in the PICU at H. Adam Malik General Hospital, Medan, Indonesia, among patients aged between 28 days to 18 years. The consecutive sampling method was employed to collect samples based on predetermined inclusion and exclusion criteria. The assessments of recommended calorie achievement targets were conducted up to 240 hours after initial nutrition treatment. Other possible factors associated with the achievement of the nutrition target were also assessed between groups, such as demographic data, length of treatment, nutritional status, and underlying diseases. A total of 30 patients were included in each group (TPN and PPN). There were no significant differences in age, weight, height, sex, or underlying diseases between groups. All patients in both groups achieved the target calorie requirements after 168 hours. Our data indicated that the percentage of patients who met the target calorie requirements was significantly different at initial treatment, 72 hours, and 120 hours post-treatment between groups (all had p<0.001). The percentages of patients who met the nutritional requirements (carbohydrate and protein) were also significantly different between the TPN and PPN groups (all had p<0.001). This study highlights that the administration of PPN to children resulted in faster achievement of calorie targets compared to TPN.

Promising candidate drug target genes for repurposing in cervical cancer: A bioinformatics-based approach

2024-08-12T10:39:43+07:00

Cervical cancer is the fourth most common cancer among women globally, and studies have shown that genetic variants play a significant role in its development. A variety of germline and somatic mutations are associated with cervical cancer. However, genomic data derived from these mutations have not been extensively utilized for the development of repurposed drugs for cervical cancer. The objective of this study was to identify novel potential drugs that could be repurposed for cervical cancer treatment through a bioinformatics approach. A comprehensive genomic and bioinformatics database integration strategy was employed to identify potential drug target genes for cervical cancer. Using the GWAS and PheWAS databases, a total of 232 genes associated with cervical cancer were identified. These pharmacological target genes were further refined by applying a biological threshold of six functional annotations. The drug target genes were then cross-referenced with cancer treatment candidates using the DrugBank database. Among the identified genes, LTA, TNFRSF1A, PRKCZ, PDE4B, and PARP were highlighted as promising targets for repurposed drugs. Notably, these five target genes overlapped with 12 drugs that could potentially be repurposed for cervical cancer treatment. Among these, talazoparib, a potent PARP inhibitor, emerged as a particularly promising candidate. Talazoparib is currently being investigated for safety and tolerability in other cancers but has not yet been studied in the context of cervical cancer. Further clinical trials are necessary to validate this finding and explore its potential as a repurposed drug for cervical cancer.

Does FOXP2 gene polymorphism affect the duration of orogastric tube use in moderate to late preterm neonates? A cross-sectional study in Indonesia

2024-06-09T08:39:40+07:00

Premature and low birth weight neonates often struggle with oral intake due to immaturity or respiratory distress. Forkhead box protein 2 gene (FOXP2) is predicted to influence oral feeding ability in newborns, but studies assessing the role of this gene in influencing oral feeding ability are limited. The aim of this study was to investigate the role of FOXP2 gene polymorphism, particularly single nucleotide polymorphism (SNP) rs17137124, on the duration of orogastric tube (OGT) use in moderate to late preterm neonates. A multi-center cross-sectional study was conducted in Lhokseumawe, Aceh, Indonesia, from September 2021 to August 2023, involving neonates with 32–36 weeks gestational age. The DNA samples were isolated from the saliva, amplified using polymerase chain reaction (PCR), and the FOXP2 gene was sequenced. The associations between FOXP2 gene polymorphisms and other plausible factors on the duration of OGT use were determined using Chi-squared test, Fisher’s exact test or Pearson correlation as appropriate. Preterm neonates with the CC genotype had the longest OGT use, averaging 3 days (39.1%). TT genotype preterm neonates required OGT use for 4, 5, and 6 days (each 33.3%), while CT genotype neonates predominantly required it for 4 days (41.7%). No significant association was found between FOXP2 genotypes and OGT use duration (p=0.233). Similarly, neonates with C allele required OGT use for 3 and 4 days, while those with T allele mostly required between 4 and 6 days, with no significant association (p=0.110). Analysis using dominant (p=0.109) and recessive models (p=0.481) also showed no significant associations with OGT use duration. However, the study found significant associations between delivery mode (p=0.002) and gestational age (p=0.001) with duration of OGT use in preterm neonates. This study highlights that FOXP2 polymorphisms have limited association with the duration of OGT use among preterm neonates.

Comparative study of anti-SARS-CoV-2 receptor-binding domain total antibody titer before and after heterologous booster with mRNA-based COVID-19 vaccine

2024-12-14T05:17:54+07:00

The waning immunity following the COVID-19 vaccination become a significant concern and the immunological dynamics of vaccine-induced antibodies after vaccination need to be explored. The aim of this study was to compare anti-SARS-CoV-2 receptor-binding domain (RBD) antibody levels before and after a booster dose with heterologous COVID-19 vaccine and to identify factors influencing the levels after receiving the booster dose. A cross-sectional study was conducted in which individuals who received primary doses of CoronaVac and a booster dose with an mRNA-based vaccine were recruited using a purposive sampling technique. The titers of anti-SARS-CoV-2 RBD antibodies were measured using an enzyme-linked immunosorbent assay (ELISA), and plausible associated factors were collected using a questionnaire-assisted face-to-face interview. The Wilcoxon test was used to compare the titers before and after the booster dose, while the Kruskal-Wallis and Mann-Whitney tests, followed by multivariate linear regression, were used to assess the factors associated with RBD total antibody titers. The results showed that there was a significant increase of anti-SARS-CoV-2 RBD total antibody titers before and after receiving the booster dose (1,558.7 BAU/mL vs 140.6 BAU/mL, p<0.001). The analysis revealed that age (p=0.555), sex (p=0.254), type of vaccine (p=0.914), presence of hypertension (p=0.541), diabetes (p=0.975), chronic obstructive pulmonary disease (COPD, p=0.620), and gout (p=0.364) were not associated with anti-SARS-CoV-2 RBD total antibody titers. However, the titers of anti-SARS-CoV-2 RBD total antibody were significantly different between those with and without hyperlipidemia (p=0.021). This study suggests that a booster dose with a heterologous COVID-19 vaccine could significantly enhance immune responses against COVID-19, and therefore, this strategy may be recommended as part of preventive measures to strengthen immunity against COVID-19.

Exploring the promising therapeutic benefits of iodine and radioiodine in breast cancer cell lines

2024-08-12T10:35:55+07:00

Iodine has an anti-proliferative effect on cancer cells; however, its effects have not been explored adequately. The aim of this study was to evaluate the therapeutic potential of iodine and radioiodine by assessing their effects on the viability of various breast cancer cell lines: MCF7, SKBR3, and MDA-MB231. The viability of cells was measured in treated cells exposed to six doses of iodine (5, 10, 20, 40, 60, 80 µM) and two doses of radioiodine (3.7×10⁴ and 3.7×10⁵ Bq). A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and modified clonogenic assays were used to assess cell viability. Exposure to 80 µM of iodine significantly reduced the viability of all cell types. The cells were then exposed to a 50% inhibitory concentration (IC₅₀) dose. When the cells were exposed to the IC₅₀ dose of iodine, the MCF7 cell viability was reduced by 42.6±0.14% (IC₅₀ dose 12.88 µM), 40.2±0.08% for SKBR3 (IC₅₀ dose 11.03 µM) and 47.0±0.02% for MDA-MB231 (IC₅₀ dose 14.09 µM). All cells were also exposed to 3.7×10⁴ Bq and 3.7×10⁵ Bq radioiodine. Both doses significantly reduced the cell viability of MCF7 and SKBR3 cells compared to the unexposed control cells (all had p<0.05), while MDA-MB231 cell viability only reduced significantly after 3.7×10⁵ Bq of radioiodine exposure compared to the unexposed control cells (p<0.05). This study highlighted that iodine had a toxic effect on breast cancer cells, and radioiodine enhanced the toxicity to breast cancer cells. The types of cancer cells and doses of iodine and radioiodine influenced the effect. These findings suggest that iodine and radioiodine hold promise as therapeutic agents for breast cancer, similar to their established use in thyroid disease treatment. However, further in vivo studies are important to provide more evidence.

Can a combination of nanofat and freeze-dried human amniotic membrane enhance full-thickness wound healing? An animal study using rabbit models

2024-07-16T03:14:15+07:00

Previous studies have explored nanofat stimulating tissue regeneration and maturation, promoting remodeling through its rich content of growth factors and stem cells; however, comprehensive data on its use in full-thickness wounds remains limited. The aim of this study was to evaluate the effectiveness of combining nanofat with freeze-dried human amniotic membrane (FDHAM) for treating full-thickness wounds in a rabbit model. An animal experimental study using a post-test control group design was conducted. Thirty-six male New Zealand white rabbits (Oryctolagus cuniculus) were randomly assigned to two groups: the experimental group (received a combination of nanofat and FDHAM) and the control group (received FDHAM alone). Each group was subdivided to evaluate effects on days 3 and 7. Macroscopic evaluations of wound healing, microscopic assessment of epithelialization and measurement of epidermal growth factor (EGF) levels in the wounds were conducted on days 3 and 7 post-injury. The present study indicated that the combination treatment significantly elevated EGF levels in the wounds on both days 3 and 7 (with p<0.001 for both assessment time points). The combination of nanofat-FDHAM did not significantly accelerate epithelialization on either day 3 or 7. This study highlights that combining nanofat with FDHAM did not significantly speed up epithelialization of full-thickness wounds within the first seven days; however, it notably increased EGF levels, suggesting that nanofat may enhance the wound's biological environment.

Antioxidant, anti-collagenase, and antibacterial activities of Fucus vesiculosus silver nanoparticles

2024-05-21T08:02:10+07:00

Fucus vesiculosus is an alga with high fucoxanthin, phlorotannin, fucoidan, sterol, and astaxanthin. The silver nanoparticles of F. vesiculosus (AgNPs-Fv) are expected to have high antioxidant, anti-collagenase, and antibacterial activities. The aim of this study was to characterize the distribution and size of AgNPs-Fv and determine their antioxidant, anti-collagenase, and antibacterial activities. The distribution and size of AgNPs-Fv were measured using particle size analyzer (PSA) analysis. The nanoparticle compound and their functional groups were characterized using a scanning electron microscope (SEM) and Fourier-transform infrared spectroscopy (FTIR), respectively. The antioxidant activity of AgNPs-Fv was determined using a 1.1-diphenyl-2-picrylhydrazyl (DPPH) assay, while the anti-collagenase activity was examined using the spectrophotometric method. The antibacterial activity was assessed using an inhibition zone test, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC). Results indicated that the AgNPs-Fv had a dominant volume of about 86.3% with a diameter of 113.3 nm. SEM analysis revealed the spherical AgNPs with sizes between 27 and 54 nm. The FTIR analysis of the AgNPs-Fv absorption band at 1,046 cm^-1 demonstrated the bond between the Ag metal and the O-H hydroxyl group. The antioxidant activity of AgNPs-Fv was higher than F. vesiculosus extract (24.23±3.55 mg/L vs 47.45±3.16 mg/L). AgNPs-Fv also had a higher anti-collagenase activity compared to F. vesiculosus extract (66.74±6.352 mg/L vs 145.1±6.326 mg/L). The inhibition zone diameter of AgNPs-Fv was greater than F. vesiculosus extract. The MIC and MBC of AgNPs-Fv were 18.75 and 18.75 ppm, while F. vesiculosus extract was 37.5 and 75 ppm, respectively. These results suggested that AgNPs of F. vesiculosus had higher antioxidant, anti-collagenase, and antibacterial activities than F. vesiculosus extract alone.

HOMA-IR value in predicting retinal microvascular dysfunction

2024-12-01T12:53:52+07:00

Obesity and retinal microvasculature dysfunction are linked and impact visual acuity. The aim of this study was to determine the relationship between the HOMA-IR score and the presence of vascular dysfunction (perfusion index and flux index) of the optic nerve head (ONH) of the retina in obese patients and to determine its diagnostic performance to predict vascular dysfunction. A case-control study was conducted in 2022 involving individuals from obese and non-obese groups. Insulin resistance was measured using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score using the levels of insulin and fasting glucose. Optical coherence tomography angiography (OCT-A) was performed to evaluate the flux index and capillary perfusion of ONH. The correlation between HOMA-IR, flux index, and capillary perfusion was assessed using Pearson’s correlation, and the diagnostic performance of HOMA-IR, including sensitivity, specificity, and the area under the curve (AUC), was measured. Logistic regression was used to identify the association between the HOMA-IR cutoff score with the presence of retinal microvascular dysfunction. A total of 80 individuals were included from each obese and non-obese group. The HOMA-IR score showed significant negative correlations with the perfusion of the superior (p<0.001), inferior (p<0.001), and outer (p=0.008) regions of the retinal of ONH. For the flux index, the HOMA-IR score had significant negative correlations with the superior (p=0.001), inferior (p<0.001), nasal (p=0.003), and outer (p=0.035) regions of ONH of the retina. The receiver operating characteristic (ROC) curve analysis for the HOMA-IR score at a cutoff value of 5.51 demonstrated an area under the curve (AUC) of 0.819, with a 95% confidence interval (CI) ranging from 0.727 to 0.912, suggesting its effectiveness in detecting vascular dysfunction. Multivariate logistic regression revealed a significant association between the HOMA-IR cutoff score of 5.51 with capillary perfusion of the superior (p=0.005) and nasal region (p=0.043), as well as the flux index of the inferior (p=0.013) and outer (p=0.022) regions of the ONH. These findings suggest that HOMA-IR is a promising biomarker for predicting retinal microvascular dysfunction in obese patients.

Effect of walking and bone joint exercise on enhancing bone remodeling in menopausal women: A randomized controlled trial

2024-08-19T13:58:42+07:00

Osteoporosis increases fracture risk and reduces quality of life in menopausal women. Although physical activity, such as walking and bone joint exercise, is known to help maintain bone health, its effectiveness needs further examination. The aim of this study was to analyze the effects of physical activity, in particular walking and bone joint exercise, on enhancing bone remodeling in menopausal women. A randomized controlled trial was conducted among menopausal women and allocated into three groups: walking, bone joint exercise, and control groups. The intervention was provided for eight weeks, with the outcomes measured before and after the intervention. The study assessed five bone remodeling biomarkers: estrogen, parathyroid hormone (PTH), receptor activator of nuclear factor kappa-β ligand (RANKL), tumor necrosis factor-alpha (TNF-α), and bone mineral density (BMD). The paired sample student t-test and ANOVA were used to assess the effects of the interventions. The results indicated that, compared to pre-intervention, both walking and bone joint exercise significantly increased the estrogen (p=0.026 and p=0.023, respectively), decreased RANKL (p=0.019 and p=0.002, respectively), decreased PTH levels (p=0.022 and p=0.048, respectively) and increased the BMD scores (p=0.001 and p<0.001, respectively). In the control group, none of the remodeling biomarkers significantly changed except the mean level of TNF-α, which was increased significantly (p=0.001). This study highlights that structured exercise, such as walking and bone joint exercise, can significantly enhance bone remodeling markers in menopausal women. Therefore, implementing such physical activities into management may provide benefits to menopausal women.

Analysis of morphology, cytotoxicity, and water content characteristics of freeze-dried amnion membrane from human and bovine

2024-07-20T10:38:25+07:00

Placenta tissue has biological advantages, including anti-inflammatory, anti-bacterial, anti-fibrotic formation, and immunomodulatory properties. The amnion membrane (AM) is an inner side membrane of the placenta that faces the fetus. The main sources of amnion are humans and animals, with bovine being one of the significant sources. The aim of this study was to analyze the morphology, cytotoxicity, and water content characteristic of freeze‑dried amnion membrane (FD‑AM) from humans and bovines to measure the safety and compatibility of bovine FD-AM as an alternative to human FD-AM. This study is an observational cross-sectional study. Samples were divided into two groups: human FD-AM and bovine FD-AM groups. Both groups were examined for morphology characteristics by scanning electron microscopy (SEM), cytotoxicity by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) analysis, and water content by drying through moisture analyzer device. The morphology characteristics of bovine FD-AM and human FD-AM, as observed through SEM, showed similar results of a smooth, flat surface with no cavity and were well dehydrated. MTT assay analysis on both groups demonstrated cytocompatibility with cell viability exceeding 70% in the control group. However, human FD-AM showed a higher number of viable cells (0.19±0.01) compared to bovine FD-AM (0.12±0.03), with a statistically significant difference (p<0.05). The water content analysis revealed that both groups met the standard, with levels below 10%. While bovine FD-AM (7.19±0.45%) had slightly higher water content than human FD-AM (6.79±1.0%), the difference was not significant (p>0.05). Both human FD-AM and bovine FD-AM showed good results in morphology, cytotoxicity, and water content characteristics and compatibility. In conclusion, bovine FD-AM might be considered as an alternative to human FD-AM.

Association between tumor necrosis factor-α gene polymorphism and interleukin-6 level with mortality of neonatal sepsis

2024-07-28T15:36:21+07:00

Sepsis is a systemic infection that significantly causes morbidity and mortality among neonates, which is associated with immature immune response. Variations in the tumor necrosis factor-alpha gene (TNF-α) -308G/A may be linked to neonatal sepsis mortality by modulating interleukins (ILs) involved in the immune response cascade, such as IL-6. The aim of this study was to investigate the association between TNF-α -308G/A gene variation and IL-6 level with mortality of neonatal sepsis. A cohort of 30 neonates diagnosed with clinical sepsis was recruited. Blood culture was performed for all patients and serum IL-6 levels were examined 24 hours after suspected sepsis. Genetic analysis of TNF-α single nucleotide polymorphisms (SNP) -308G/A was conducted using polymerase chain reaction and DNA sequencing. The association was assessed based on bivariate logistic regression. We found that 12 (40%) of 30 patients had blood culture-proven sepsis. Genotype of TNF-α -308G/A stratified of the patients was 56.7% for GA and 43.3% for GG. There were no AA variations found in this study. There was no significant association between the TNF-α -308 G/A genotype and mortality in neonatal sepsis (p=0.211). Similarly, the allelic model of TNF-α -308 gene had no association with mortality (p=0.325). Additionally, there was no association between serum IL-6 level and mortality in neonatal sepsis (p=0.253). In conclusion, SNP of TNF-α -308 gene and IL-6 level are not associated with mortality in neonatal sepsis.

Navigating the aftermath: Risk factors of recurrence following coronary bypass surgery in Indonesia

2024-06-25T03:07:03+07:00

Coronary heart disease (CHD) remains a leading cause of mortality in Indonesia, and coronary artery bypass graft (CABG) surgery is frequently employed to manage arterial blockages. Despite its efficacy, the recurrence of heart disease post-surgery is a significant concern, highlighting the need for a deeper understanding of its influencing factors. The aim of this study was to examine the factors associated with the incidence of heart disease recurrence after coronary bypass surgery. This study employed a prospective observational design, analyzing hospital claim data from Indonesia's Social Security Agency for Health, known as Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, from 2017 to 2022. The analysis included 5,947 patients who survived CABG surgery. Multivariable logistic regression was utilized to assess the relationship between patient demographics, comorbidities, socioeconomic status, and compliance with follow-up visits, as well as their impact on the recurrence of cardiovascular disease. The study found that 24.1% of patients experienced hospitalization recurrence. Patients with irregular follow-ups were less likely to experience recurrence (adjusted odds ratio (AOR): 0.63; 95%CI: 0.51–0.78). Other significant risk factors for recurrence included being self-employed (AOR: 2.09; 95%CI: 1.72–2.55), having comorbid conditions such as disorders of fluid, electrolyte, and acid-base balance (AOR: 3.55; 95%CI: 2.97–4.24), and experiencing cerebral infarction or stroke (AOR: 10.85; 95%CI: 8.24–14.29). In contrast, older age (AOR: 0.89; 95%CI: 0.88–0.91) and the presence of non-insulin-dependent diabetes mellitus (AOR: 0.35; 95%CI: 0.29–0.42) were associated with a lower risk of recurrence. Sex did not significantly influence the risk of recurrence (AOR: 1.18; 95%CI: 0.86–1.62). In conclusion, the study indicates a considerable rate of cardiovascular disease recurrence post-CABG in Indonesia, highlighting several key risk factors. Tailored postoperative management and strict adherence to follow-up protocols are essential for mitigating recurrence. These findings offer crucial insights for improving post-CABG health management strategies in Indonesia.

Probiotic-rich fermented milk from Lactiplantibacillus plantarum IIA-1A5: Effects on pregnancy health in the animal model

2024-08-12T16:17:56+07:00

Previous studies of Lactiplantibacillus plantarum IIA-1A5 have shown its potential as a probiotic in modulating gut microbiota and providing health benefits; however, its effects during pregnancy remain underexplored. The aim of this study was to assess the safety of fermented milk enriched with L. plantarum IIA-IA5 in pregnant mice. An experimental study was conducted at Universitas Andalas, Padang, Indonesia. Two groups of pregnant mice (Mus musculus L.) were used, each with six mice. The control group received sterilized milk (10 mL/kg body weight (BW)), while the intervention group was given fermented milk containing L. plantarum IIA-1A5 (10⁷ colony forming unit (CFU)/mL). The evaluated outcomes included maternal weight changes, fetal counts and measurements, and assessments of fetal morphology and skeletal development. Results indicated that the morphology of fetuses showed no significant differences between the control and intervention groups; both groups demonstrated normal development with no detected resorption sites, growth retardation, or hemorrhage. For skeletal development, both groups had the same bone counts, including frontal, parietal, intraparietal, exoccipital, supraoccipital, nasal, pre-maxilla, mandibular, thoracal, lumbar, sternum, and extremities. This study highlights that L. plantarum IIA-1A5-enriched fermented milk was safe, as no significant morphological or bone developmental abnormalities were observed, indicating its potential as a dietary supplement to support pregnancy health. However, further studies involving larger sample sizes may be needed to provide a more comprehensive assessment of its outcomes and safety.

Correlation of skin moisture and serum urea level with dermatology life quality index in patients with chronic kidney disease on hemodialysis: A cross-sectional study

2024-06-20T04:00:11+07:00

Chronic kidney disease (CKD) is a global health concern, with a 10% global prevalence. Its prevalence may further increase in the coming decades, thereby increasing the risk of uremic xerosis. Approximately 50–90% of patients with CKD have xerosis, leading to pruritus that affects their quality of life due to sleep disturbances, anxiety, and depression. However, the exact mechanisms underlying xerosis in CKD remain unknown. The aim of this study was to assess the correlation of serum urea levels and skin moisture with quality of life in patients with CKD. This cross-sectional study was conducted at the Universitas Sumatera Utara Hospital from March to December 2023. Patients with CKD aged ≥18 years who were undergoing hemodialysis for at least 3 months were included in this study. A translated Dermatology Life Quality Index (DLQI) questionnaire was employed to assess the patient’s quality of life. Serum urea levels and skin moisture were determined using venous blood and the Skin Moisture Checker MY-808S tool, respectively. In total, 67 patients with CKD, including 61.2% males and 32.8% individuals aged >60 years, were enrolled in this study. The mean age was 52.73±13.08 years. The mean serum urea levels, skin moisture, and DLQI scores were 154.08±49.10 mg/dL, 36.22±2.34%, and 4.67±3.98, respectively. No difference in DLQI scores was observed between normal and high serum urea levels or between dry and normal skin moisture levels (p=0.156 and p=0.804, respectively). Spearman’s correlation analysis revealed no correlation between serum urea levels and average skin moisture with DLQI (p=0.600 and p=0.353, respectively), indicating that multiple factors contribute to the dermatological quality of life in patients with CKD. Notably, DLQI in patients with CKD can be simultaneously affected by multiple factors, such as diverse sociodemographic backgrounds, coping mechanisms, and the impact of symptoms associated with CKD, other than serum urea levels and average skin moisture. Therefore, adopting a multifactorial and individualized approach is crucial to improving the DLQI scores of patients with CKD.

Employment of people with Down syndrome: A scoping review

2024-09-09T08:34:13+07:00

Down syndrome is the most prevalent genetic condition contributing to intellectual disability. Advancements in medical care have significantly increased the life expectancy of people with this condition, making employment a vital component for independent living and quality of life. The aim of this study was to examine the current literature on the employability and employment experiences of individuals with Down syndrome, focusing on the evolution of the employment rate and factors influencing employment such as cognitive and personal factors, societal attitudes, challenges, and effective support systems. Using Arksey and O’Malley's methodology, a scoping review of relevant qualitative and quantitative articles from PubMed, Scopus, Web of Science (WoS), CINAHL, and Medline was conducted. The search focused on the keywords found in the title and abstract of articles from 1980 to 2023. The search strategy utilized medical subject headings (MeSH), including "work", "Down syndrome", and "employment". All articles employing qualitative, quantitative, and mixed methods that were published in English were included. Of an initial 4,296 articles, 32 full-text articles were evaluated, and nine met the inclusion criteria. The data indicated improved employment rates for people with Down syndrome, with a recent employment rate of 53%. However, jobs are often limited to sectors like food service and are underutilizing their skills. Key factors associated with employment status include cognitive abilities, family support, and social attitudes. Despite positive perceptions, significant barriers such as systemic bias persist. Effective support systems are crucial but are often hindered by limited opportunities. In conclusion, employment opportunities for people with Down syndrome have improved, but challenges such as limited job diversity and systemic barriers remain. Comprehensive policies are recommended to promote inclusive employment practices and tailored support systems.

Enhancing oxytocin and prolactin levels to address oligogalactia through emotional management and massage in working mothers

2024-06-25T02:55:29+07:00

Emotional management, combined with oxytocin massage and breast care, offers a comprehensive approach to boost prolactin release, enhance milk production, and improve breastfeeding outcomes. The aim of this study was to evaluate the effectiveness of combining emotional management with oxytocin massage and breast care in increasing oxytocin and prolactin hormone levels to address oligogalactia in working postpartum mothers. A quasi-experimental study was conducted at Kudus Community Health Center, Kudus Regency, Central Java, Indonesia, from January to March 2024. A total of 93 postpartum mothers were randomly assigned to three groups: (1) emotional management with oxytocin massage; (2) emotional management with breast care; and (3) lactation education only. Blood samples were collected before and after the interventions to measure oxytocin and prolactin levels. The present study found that emotional management combined with oxytocin massage significantly increased oxytocin levels from 505.0±264.0 pg/mL to 600.0±231.3 pg/mL (mean difference: 103 pg/mL; p=0.002) and prolactin levels from 191.0±67.3 ng/mL to 233.0±86.8 ng/mL (mean difference: 27 ng/mL; p=0.001). The emotional management and breast care group showed a smaller increase in oxytocin (362.0±175.1 pg/mL to 418.0±185.1 pg/mL; mean difference: 23 pg/mL; p=0.048) and a significant increase in prolactin (195.0±48.8 ng/mL to 255.0±82.3 ng/mL; mean difference: 38 ng/mL; p=0.049). In contrast, the lactation education group showed no significant changes in oxytocin (p=0.756) or prolactin levels (p=0.341). In conclusion, emotional management combined with oxytocin massage significantly increased both oxytocin and prolactin levels, suggesting that integrating emotional management and oxytocin massage may be an effective strategy for postpartum lactation support.

Validity and reliability testing of the Shatri Sinulingga psychosomatic test (SSPT) questionnaire as a screening instrument for psychosomatic disorders in Indonesia

2024-10-01T09:22:07+07:00

The incidence of psychosomatic disorders is increasing in Indonesia, and therefore screening instruments that are culturally appropriate for the Indonesian population are needed. The aim of this study was to assess the validity and reliability of the Shatri Sinulingga psychosomatic test (SSPT) questionnaire as a screening instrument for psychosomatic disorders in Indonesia. An analytic descriptive cross-sectional study divided into two stages (questionnaire formulation and distribution through the Psikosom.id application) was conducted in 2023. The validity test was carried out using the product moment technique, and Cronbach's alpha assessment was carried out to evaluate the reliability of the questionnaire. A total of 372 participants were included, with a mean age of 39.24 years old. The SSPT questionnaire scores had strong correlations with the scores of hospital anxiety and depression scale (HADS) (r=0.668; p<0.001) and the Symptom Checklist-90 (SCL-90) (r=0.674; p<0.001); and moderately correlated with the score of fatigue severity scale (FSS) (r=0.505; p<0.001) and Pittsburgh Sleep Quality Index (PSQI) (r=0.492; p<0.001). The correlation coefficient (r) value of each SSPT question ranged from 0.389–0.726, and all r higher than r table with an overall Cronbach’s alpha of 0.744. The SSPT questionnaire's strong predictive performance: had a sensitivity of 75.6% and specificity of 71.4% with an area under the curve (AUC) of 81% (95%CI: 76.6–85.4%; p<0.001) to HADS; sensitivity of 80% and specificity of 58.6% with an AUC of 75.1% (95%CI: 70–80.2%; p<0.001) to FSS; sensitivity of 64% and specificity of 67.5% with an AUC of 71.2% (95%CI: 65.4–77%; p<0.001) to PSQI; and had sensitivity of 78% and specificity of 67.4% with an AUC of 80.9% (95%CI: 76.6–85.3%; p<0.001) to SCL-90. The study highlights that the SSPT questionnaire is valid and reliable to be used as a screening instrument for psychosomatic disorders in Indonesia.

Diagnostic accuracy of urinary cytokeratin fragment-19 (CYFRA21-1) for bladder cancer

2024-08-14T07:49:27+07:00

Bladder cancer is known for its high recurrence rate and requires constant patient monitoring. To confirm the diagnosis, a tissue sample from a cystoscopy is required, which the patient often avoids. Urine has the potential to be utilized as a diagnostic fluid because of its non-invasive nature and various biomarker contents. The aim of this study was to determine the diagnostic value of cytokeratin fragment-19 (CYFRA21-1) level in urine for diagnosing bladder cancer. This single-center cross-sectional study was performed with eligible inclusion were adults aged ≥18 years who presented with hematuria and suspected bladder cancer from imaging. Patients with a history of intravesical chemotherapy, radiotherapy and immunotherapy were excluded. Urine samples were collected prior to the cystoscopy. Detection of urinary CYFRA21-1 was carried out using the ELISA method. Of 154 patients included in the study, the diagnosis of bladder cancer was confirmed in 92 patients. Patients with bladder cancer had significantly higher urinary CYFRA21-1 levels compared to the non-bladder cancer group. The sensitivity, specificity, positive and negative predictive value, and positive likelihood ratio of the CYFRA21-1 were 80.4%, 43.5%, 67.9%, 60% and 1.425, respectively. The area under the curve for CYFRA21-1 was 0.608, computed from a receiver operating curve with a cut-off value of 13.3 ng/mL. In conclusion, urinary CYFRA21-1 levels have moderate diagnostic accuracy in determining bladder cancer among suspected individuals. Due to its high sensitivity, this biomarker could potentially be used alongside other screening tools for bladder cancer detection.

Intravenous administration of iron dextran as a potential inducer for hemochromatosis: Development of an iron overload animal model

2024-08-12T15:38:17+07:00

Iron overload in transfusion-dependent thalassemia patients represents a significant public health challenge due to its high mortality rate and risks of severe complications. Therefore, developing safe and effective therapeutic modalities for managing iron overload is critical, as current animal models inadequately replicate human conditions. The aim of this study was to investigate the effects of intravenous iron dextran on hepatocyte morphology, liver iron concentration, and serum iron profile changes as a model for hemochromatosis. An experimental design with a post-test-only control group method was conducted using animal models. Fifty rats were used and divided into ten groups, nine received different intravenous doses of iron dextran: 10, 20, 30, 40, 50, 60, 80, 100, and 120 mg/kg body weight (BW) and a control group received no treatment. The results showed that intravenous iron dextran starting at a dose of 10 mg/kg BW caused significant changes in liver iron concentration while starting at 20 mg/kg BW significantly affected hepatocyte morphology, transferrin levels, unsaturated iron binding capacity, serum iron levels, and transferrin saturation. Intravenous iron dextran starting at 40 mg/kg BW resulted significant changes in the level of total iron binding capacity compared to control group. In conclusion, intravenous iron dextran significantly altered hepatocyte morphology, increased liver iron concentration, and modified the serum iron profile, reflecting changes that might be observed in patients with transfusion-dependent thalassemia.

In silico analysis of Arbacia lixula-derived peptides and plasmid construction for recombinant anti-aging therapies

2024-08-13T10:11:48+07:00

Skin aging is one of the degenerative processes influenced by tyrosinase, elastase, collagenase, hyaluronidase, and matrix metalloproteinase-9 (MMP9) activity. One promising avenue for discovering antiaging therapeutics is the peptides from the Arbacia lixula spine. The aim of this study was to explore the potential of peptides from A. lixula spine as a multitarget inhibitor for recombinant antiaging therapies through in silico approaches. The crystal structure of peptides previously identified in A. lixula spine was visualized using the UCSF Chimera. The protein data bank (PDB) database was used to obtain the crystal structures of protein targets. The webservers Innovagen, AllerTop, and ToxinPred were utilized to predict the peptide's water solubility, toxicity, and allergenicity. MOE application was used to prepare all ligands and proteins, molecular docking, and visualization. Molecular dynamics simulations were carried out on the protein-ligand complexes on Yasara Dynamics application. The Benchling website was used to perform virtual electrophoresis and reconstruct the recombinant plasmid (Psb1c3). Based on the molecular docking results, peptide REGSPDLLE has the potential as a multitarget inhibitor of tyrosinase (-9.07 kcal/mol), hyaluronidase (-10.57 kcal/mol), elastase (-9.32 kcal/mol), collagenase (-10.57 kcal/mol), and MMP9 (-10.43 kcal/mol). Peptide REGSPDLLE was selected due to its strong binding affinity on the active site of each target protein and exhibits non-toxic, non-allergenic, and good water-soluble as indicated by Support Vector Machine score <0. Molecular dynamics simulations confirmed stable interactions with receptor proteins. Peptide REGSPDLLE was successfully inserted into the recombinant pSB1C3 plasmid, confirmed by virtual electrophoresis with bands at ~2000 bp and ~150 bp. Further in vitro and in vivo studies are necessary to verify the anti-aging efficacy of peptide REGSPDLLE.

Low-intensity aerobic cycle ergometer effects on lung function of myasthenia gravis patients: A randomized controlled trial

2024-07-08T05:14:16+07:00

Patients with generalized myasthenia gravis (MG) often show restrictive spirometry results. Although regular exercise and physical fitness are linked to better respiratory function, there is limited research assessing the effects of aerobic exercise on lung function in MG patients. The aim of this study was to analyze the effect of low-intensity aerobic exercise using a cycle ergometer on lung function parameters in MG patients. A randomized controlled trial with pre- and post-test was conducted at the Medical Rehabilitation Outpatient Clinic of Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, in 2023. MG patients classified as I−IIb based on the Myasthenia Gravis Foundation of America (MGFA) classification were recruited and randomly divided into treatment and control groups. The treatment group was given low-intensity aerobic exercise using a cycle ergometer, education on lifestyle changes, and breathing exercises (deep and pursed lip breathing). Lung function parameters, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and forced expiratory volume ratio (FEVR), were then measured. Measurements were conducted before and after eight weeks of low-intensity aerobic cycle ergometer exercise and compared with those of a control group. A total of 17 MG patients were included in this study. The results showed a significant increase in FVC in the treatment group (p=0.003), whereas no significant change in the control group (p=0.068). A significant increase in FEV₁ was observed both in the treatment (p=0.029) and the control group (p=0.016). There was no improvement in FEVR in either group. After the intervention, significant differences were observed in FVC (p=0.009) and FEV₁ (p=0.029) between the treatment and control groups. There was no significant difference in FEVR values after the intervention between both groups (p=0.491). In conclusion, eight weeks of low-intensity aerobic cycle ergometer exercise led to significant improvements in FVC and FEV₁ among MG patients.

The ethanol extract of Sargassum duplicatum as an ovicidal agent against Aedes aegypti

2024-08-06T08:36:27+07:00

Dengue hemorrhagic fever (DHF) is a major health concern in tropical and subtropical countries. Indonesia has DHF cases perennially every year. On the other hand, Indonesia is abundant with seaweed (Sargassum duplicatum), which can be found across its seashore. The macroalgae contains secondary metabolites with ovicidal activity; hence, it has the potential to be utilized in suppressing the Aedes aegypti. The aim of this study was to determine the ovicidal activity of S. duplicatum against the Ae. aegypti eggs. The algae were macerated with ethanol 70% before being subjected to qualitative phytochemical screenings. The ovicidal tests were conducted with an extract concentration of 50 ppm, 100 ppm, 500 ppm, 1000 ppm, and 1500 ppm, while distilled water was used as the control. The hatchability of Ae. aegypti was observed 24 hours a day for 4 days and the larval development was investigated under a microscope. Phytochemical screenings revealed that the extract was positive containing alkaloids, flavonoids, steroids, saponins, and phenols. The hatchability of Ae. aegypti eggs were significantly reduced following the S. duplicatum extract exposure for four days (p=0.000). The extract had LC₅₀ of 828.653 ppm and LC₅₀ of 1786.09 ppm for the ovicidal activity against Ae. aegypti eggs. The concentration of ethanol extract of S. duplicatum did not affect the mosquito development from larvae to adult stage (p=0.263). Further research is needed to explore the effect of specific compounds contained in the S. duplicatum and investigate their ovicidal potential.

Long non-coding RNAs as prognostic biomarkers in non-muscle invasive bladder cancer: A systematic review

2024-08-09T04:46:20+07:00

Traditional prognostic tools for non-muscle invasive bladder cancer (NMIBC) often overestimate progression and recurrence risks, underscoring the need for more precise biomarkers. While long non-coding ribonucleic acids (lncRNAs) have been reviewed in bladder cancer, no review has focused on NMIBC. The aim of this study was to address this gap by investigating the role of lncRNAs in predicting NMIBC survival and progression. A systematic review was conducted using PubMed, Scopus, and Cochrane databases as of July 31, 2024. Prognostic studies investigating the association between lncRNA expression and survival outcomes, such as cancer-specific survival, disease-free survival, recurrence-free survival, or overall survival, using Kaplan-Meier curves or hazard ratios, were included. A total of three studies were analyzed, involving 279 NMIBC patients and focusing on three lncRNAs: urothelial cancer associated 1 (UCA1), growth arrest-specific 5 (GAS5), and up-regulated in non-muscle invasive bladder cancer (UNMIBC). Increased UCA1 expression was strongly associated with poor disease-free survival (hazard ratio (HR): 1.974; 95%CI: 1.061–3.673; p=0.032) and progression-free survival (HR: 3.476; 95%CI: 1.187–10.18; p=0.023). Reduced GAS5 expression was significantly associated with poor disease-free survival (HR: 2.659; 95%CI: 1.348–5.576; p=0.005) and progression-free survival (HR: 6.628; 95%CI: 1.494–29.40; p=0.013). Higher level of UNMIBC was strongly associated with poor recurrence-free survival (HR: 2.362; 95%CI: 1.504–4.837; p=0.007). In conclusion, lncRNAs have potential as prognostic biomarkers in NMIBC, with UCA1 and UNMIBC overexpression and GAS5 underexpression being significant in predicting disease recurrence and progression, highlighting the clinical relevance of monitoring these lncRNAs to improve prognosis and guide treatment decisions.

Neuroprotective and inflammatory biomarkers in pediatric drug-resistant epilepsy: Interplay between GDNF, IL-1β and vitamin D 25-OH

2024-10-21T04:16:06+07:00

Drug-resistant epilepsy in pediatric patients is associated with neuroinflammation and neurodegeneration. Vitamin D 25-OH exerts neuroprotective effects, while glial cell line-derived neurotrophic factor (GDNF) and the proinflammatory cytokine interleukin-1β (IL-1β) are implicated in the mechanisms of neuroinflammation and epileptogenesis. The aim of this study was to investigate the relationship between vitamin D 25-OH, IL-1β, and GDNF levels with seizure severity and frequency in children with drug-resistant epilepsy. A cross-sectional study was conducted at Adam Malik Hospital, Medan, Indonesia, among children with drug-resistant epilepsy. Vitamin D 25-OH, IL-1β and GDNF levels were measured using enzyme-linked immunosorbent assay (ELISA). Epilepsy severity was assessed using the Hague Seizure Severity Scale (HASS), while seizure frequency was assessed using the Global Assessment of Severity of Epilepsy (GASE). The present study identified a significant correlation between GDNF levels and epilepsy severity, as measured by the HASS score (r=0.318; p=0.006). However, no significant correlation was observed between vitamin D 25-OH or IL-1β levels and epilepsy severity or seizure frequency (p>0.05). IL-1β levels correlated significantly with GDNF levels (r=0.525; p=0.001), but IL-1β did not directly correlate with seizure frequency or epilepsy severity. In conclusion, GDNF levels significantly correlated with epilepsy severity, suggesting that GDNF may serve as a potential biomarker for assessing epilepsy severity. However, further studies investigating the role of GDNF as a potential neurotrophic factor in the pathophysiology of epilepsy and its possible application as a therapeutic target are important.

Unveiling the impacts of metformin on hepatocellular carcinoma: A bioinformatic exploration in cell lines

2024-07-03T04:35:27+07:00

The most common type of liver cancer is hepatocellular carcinoma (HCC), accounting for 75–85% of cases. Despite its associated side effects, sorafenib remains the standard treatment for HCC. Given the critical need to improve therapeutic efficacy while minimizing adverse effects, alternative drugs must be thoroughly investigated. Numerous studies indicate that combining sorafenib with metformin results in a more favorable treatment profile. The aim of this study was to employ bioinformatics methodologies to elucidate the molecular pathways and genetic underpinnings of metformin's efficacy in HCC treatment. Genes associated with metformin and its action against HCC (Huh-7 and HepG2 cells) were acquired from the NCBI-GEO data collection by utilizing pre-determined keywords. Subsequently, pathways implicated in metformin-mediated HCC treatment were analyzed through the Kyoto Encyclopedia of Genes and Genomes (KEGG). Our analysis revealed the involvement of multiple pathways, with metabolic pathways implicated in 80% of the total cases. Neurodegenerative pathways were involved in only around 60% of the total cases. These findings align with the multifaceted mechanisms of metformin’s action, encompassing adenosine monophosphate-activated protein kinase activation, apoptosis induction, insulin regulation, anti-inflammatory responses, and modulation of cell proliferation. This comprehensive investigation sheds light on the intricate molecular landscape underpinning metformin's therapeutic efficacy in HCC, thereby informing potential avenues for optimizing treatment strategies.

Effects of iopromide contrast agents on kidney iNOS expression and tubular histopathology alterations

2024-08-03T09:14:37+07:00

Contrast-induced acute kidney injury is a common complication marked by reduced kidney function within 48 hours of contrast administration. The aim of this study was to evaluate renal function, anatomy, and molecular changes at 24 hours, 48 hours, and 72 hours post-iodinated contrast media (ICM) administration. This true-experimental study used a post-test-only control group design. Rats underwent unilateral nephrectomy, followed by intravenous injection of ICM using iopromide 370 mg iodine/mL per rat at a dose of 231 mg iodine, and were then divided into four groups: control (C), rats terminated at 24 hours after iopromide administration (E24), rats terminated at 48 hours after iopromide administration (E48), and rats terminated at 72 hours (E72) after iopromide administration, with eight rats per group. Renal function (BUN and SCr levels) remained unchanged after 24, 48, and 72 hours of iopromide administration. Iopromide increased renal tubular damage, as shown by higher histopathological scores for loss of brush border and tubular necrosis, except for proteinaceous casts, where histopathological scores increase especially within the first 24 hours and decrease after 72 hours. Iopromide significantly altered iNOS expression in the glomerulus at 24 and 48 hours, and iNOS expression was decreased after 72 hours. iNOS expression in the intrarenal vascular and tubules was unaffected by iopromide administration. In conclusion, this study found no changes in renal function parameters, improvement in proteinaceous casts, and increased iNOS expression in the glomerulus, offering new insights into the effects of contrast on kidneys.

Comparison of success rates in early stages of in vitro fertilization (IVF) in women with and without endometriosis

2024-07-24T04:31:48+07:00

Endometriosis remains a significant challenge for reproductive-aged women and is frequently associated with infertility. Although in vitro fertilization (IVF) is used to address infertility in women with endometriosis, its effectiveness in this context is still debated, particularly in developing countries such as Indonesia, where IVF remains a major challenge. The aim of this study was to investigate the success rates of early stages of IVF in women with and without endometriosis. A retrospective cohort study was conducted at the Graha Amerta Fertility Clinic, located within Dr. Soetomo Academic General Hospital in Surabaya, Indonesia. The quantity and quality of oocytes (the number of oocytes obtained by ovum pick-up (OPU) and the number of metaphase II (MII) oocytes), fertilization quality (the number of two-pronuclei oocytes and fertilization rate), embryo development quality (cleavage rate and blastocyst rate), biochemical pregnancy, clinical pregnancy, and live birth rate were collected from IVF patients between 2017−2022. Independent Student’s t-test or Mann-Whitney test was used accordingly for comparison analysis. A total of 410 IVF patients were included in the study; 93 had endometriosis, while 317 had no endometriosis. Oocyte quantity obtained by OPU (p=0.016) and oocyte quality (p=0.045), as measured by the number of MII oocytes, were significantly lower in the endometriosis group compared to the non-endometriosis group. However, there were no significant differences between the two groups in terms of the number of two-pronuclei oocytes (p=0.105), fertilization rate (p=0.987), cleavage rate (p=0.467), blastocyst rate (p=0.128), biological pregnancy rates (OR: 0.98; 95%CI: 0.60–1.60; p=0.940), clinical pregnancy rate (OR: 0.69; 95%CI: 0.39–1.24, p=0.219), or live birth rate (p=0.609). These findings suggest that while endometriosis may reduce oocyte quantity and quality, it does not significantly impact the success rates of IVF.

Comparison of inflammatory mediator cytokine responses to inactivated virus platform COVID-19 vaccines between elderly and young adult populations

2024-09-23T08:14:18+07:00

The coronavirus disease 2019 (COVID-19) pandemic has encouraged global vaccine research, yet vaccine effectiveness in the elderly remains a concern due to immunosenescence. The aim of this study was to compare the cytokine response elicited by an inactivated virus-based COVID-19 vaccine between elderly and young adults, focusing on key cytokines involved in cellular and humoral immunity: tumor necrosis factor-alpha (TNF-α), interleukin (IL)-2, IL-6, IL-10, and interferon-gamma (IFN-γ). A cross-sectional study was conducted in the Jakarta-Bogor region of Indonesia from January 2023 to December 2023. The study population was divided into two age cohorts: elderly (60−85 years) and younger adults (30−40 years). Blood samples were collected twice, after the first booster dose and four weeks after the second booster dose. Serum cytokine concentrations were measured using Luminex assays with microparticles conjugated to monoclonal antibodies against TNF-α, IL-2, IL-6, IL-10, and IFN-γ. Comparisons of the cytokine levels were conducted using Student’s t-tests or Mann-Whitney U tests as appropriate. A total of 74 individuals were included, with 37 each in the elderly and young adult groups. The results showed significant differences in cytokine responses between the two age groups. After the first booster, the levels of IL-6 and IFN-γ were significantly higher in young adults compared to the elderly. After the second booster, the levels of IL-6 were still significantly higher in the young adult group compared to the elderly group (p=0.001). Data indicated that after the second booster dose, the levels of TNF-α increased significantly in the young adult group only (p=0.004), while the levels of IL-2 (p=0.040) and IFN-γ (p=0.006) increased in the elderly group only compared to after the first dose. IL-10 levels increased in both groups (both had p=0.020). This study highlights that young adults had stronger pro-inflammatory responses, while the elderly relied more on IL-2 and IFN-γ for T-cell immunity, suggesting the need for vaccination strategies for the elderly to optimize immune responses.

Potential of soybean-velvet bean combination tempe in improving cognitive function

2024-08-30T04:07:53+07:00

Velvet bean is a native Indonesian legume containing L-dopa, yet it remains underutilized. The aim of this study was to analyze the effects of different types of tempe (soybean, velvet bean, and their combination) on cognitive function, brain histology, dopamine levels, and serum β-amyloid in rats, as well as to identify the parameters most influencing cognitive function, including brain mass and volume, hippocampal neuron count, and dopamine and β-amyloid levels. An experimental study was conducted using a completely randomized design with one factor: the protein source of diet. Five rat groups were included based on protein sources: non-protein, casein control, soybean tempe flour, velvet bean tempe flour, and a combination of soybean and velvet bean tempe flour. This study examined cognitive performance by measuring maze completion time, while brain mass and volume, hippocampus histology for neuron cell counts in the dentate gyrus section, cornu ammonis 1 (CA1), and cornu ammonis 3 (CA3), brain dopamine and β-amyloid serum levels were measured after eight weeks of intervention. Our data indicated that rats deprived of protein had significantly slower maze completion times (p<0.001), underscoring the importance of protein in cognitive processes. Rats treated with non-protein rations had significantly lighter brain masses (p<0.001) than other treatments. Histological analysis of the hippocampus showed that the three types of tempe rations helped maintain the number and density of neuron cells in the dentate gyrus and CA3 of the hippocampus. Additionally, the protein in the ration could increase dopamine levels and suppress serum β-amyloid levels. There was a strong correlation between brain volume and neuron cell density in the dentate gyrus section of the hippocampus with cognitive function. These results highlight the promising role of combination tempe in increasing cognitive function, brain mass and volume, dopamine levels, and suppressing serum β-amyloid.

Prevalence and associated risk factors of musculoskeletal disorders among information technology (IT) professionals: A systematic review

2024-07-19T08:31:53+07:00

Musculoskeletal disorders (MSDs) are a growing concern among information technology (IT) professionals. Understanding the specific risk factors associated with MSDs among employers, occupational health practitioners, and IT professionals may reveal effective preventive measures. The aim of this study was to examine the prevalence and identify the risk factors associated with MSDs among IT professionals. A comprehensive literature search was conducted on several databases, including PubMed, Scopus, ScienceDirect, ProQuest, Online Library Wiley, Springer, Web of Science, and manual searches to identify relevant studies published between 2013 and 2023. The search strategy employed appropriate keywords related to IT professionals, musculoskeletal disorders, prevalence, and risk factors. Two reviewers independently assessed each article using PRISMA guidelines and the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist for Prevalence Data. Data extraction was performed, and a narrative synthesis was conducted to summarize the findings. Our search yielded a total of 1159 records, with 13 studies finally included in this review. The selected studies were from several countries and contained a total of 4632 participants. The prevalence of MSDs was reported with a maximum rate of 89% and a minimum rate of 20%, reflecting the overall percentage of affected individuals and including data on specific body areas affected. Identified risk factors from the selected studies include work duration, experience, sex, strenuous back positions, smoking, physical inactivity, MSD history, uncomfortable workstation setting, mental stress, insufficient sleep, body posture, exercise status, alcohol consumption, prolonged sitting, workspace, job demands, overexertion, breaks during work, and excessive usage of smartphones.

GSTA1 gene polymorphisms are associated with cyclophosphamide effectiveness in lupus nephritis patients: A case-control study in Indonesia

2024-07-29T08:25:25+07:00

Glutathione-S-transferase alpha-1 (GSTA1) is an enzyme with high conjugation activity against aldophosphamide, a metabolite of cyclophosphamide and promoter polymorphisms in GSTA1 may influence the cyclophosphamide effectiveness. The aim of this study was to evaluate the effectiveness and side effects of cyclophosphamide in lupus nephritis patients, using GSTA1 variants as predictors. A case-control study was conducted at Hasan Sadikin Hospital, Bandung, Indonesia, involving 100 lupus nephritis patients from February 2023 to January 2024. The PCR-Sanger sequencing was used to genotype five selected single nucleotide polymorphisms (SNPs) in the GSTA1 promoter: -52 A>G, -69 T>C, -513 A>G, -567 G>T, and -631 G>T. The endpoint was assessed after six doses of cyclophosphamide by evaluating renal function, disease activity and side effects. Results indicated that six doses of intravenous cyclophosphamide treatment improved renal function and disease activity in the patients, as evidenced by significant changes in serum creatinine (0.79 vs 0.69 mg/dL), dipstick proteinuria (3.00 vs 1.50), creatinine clearance (98.50 vs 109.50 mL/min), and Modified Systemic Lupus Erythematosus Disease Activity Index 2000 (M-SLEDAI-2K) score (8.61 vs 6.95). The AG genotype at -513 A>G was associated with reduced cyclophosphamide effectiveness (odds ratio (OR): 0.19; 95%CI: 0.19–0.60; p=0.019). The GT genotype at -631 G>T independently increased the progression of anemia (OR: 2.41; 95%CI: 0.26–22.12; p=0.040). This study highlights that the presence of GSTA1 variants affected cyclophosphamide effectiveness in lupus nephritis patients, with heterozygous polymorphisms at -513 (AA to AG) and -631 (TT to GT) predicting reduced effectiveness of cyclophosphamide by enhancing GSTA1 promoter activity, while anemia further exacerbated lupus nephritis disease severity. GSTA1 polymorphism was not associated with the presence of alopecia, amenorrhea, gastrointestinal disorders, and leukopenia during cyclophosphamide therapy.

Global prevalence and contributing factors of transplant renal artery stenosis in renal transplant recipients: A systematic review and meta-analysis

2024-11-19T09:49:48+07:00

Transplant renal artery stenosis (TRAS) is a serious complication of renal transplantation, with its prevalence and associated factors remaining inconclusive. The aim of this study was to assess the global prevalence and risk factors associated with TRAS incidence in renal transplant recipients. We conducted a meta-analysis by collecting data on the prevalence and factors associated with TRAS from articles in Scopus, Embase, and PubMed. The prevalence of TRAS was determined using a single-arm meta-analysis. The factors associated with TRAS were determined using Mantel-Haenszel analysis or inverse variance analysis. Out of 28,599 articles from the searches, 31 of them were included in the analysis. The global prevalence of TRAS was 6% among renal transplant recipients. Diabetes mellitus, hypertension, longer duration of dialysis before transplant, deceased donor, acute rejection, delayed graft function, longer cold ischemic time, and prolonged peak systolic velocity were associated with an increased risk of TRAS. Age, gender, peripheral artery disease (PAD) comorbidity, causes of end-stage renal disease (ESRD), previous dialysis modality, and cytomegalovirus infection were not associated with TRAS incidence. In conclusion, the global prevalence of TRAS in renal transplant recipients is relatively high, and some of the contributing factors to the development of TRAS are preventable. These findings could serve as a guideline for informing the management of TRAS in the future.

Tuberculosis treatment outcomes and associated factors: A retrospective study in West Nusa Tenggara, Indonesia

2024-11-04T07:35:18+07:00

Successfully treating tuberculosis (TB) could significantly help reduce its spread. The aim of this study was to identify factors associated with successful TB treatment. A retrospective study was conducted in West Nusa Tenggara, Indonesia, using data from the National TB Information System (SITB) covering patients from January 1 to December 31, 2022. Patients were classified into two groups: those with successful treatment outcomes (cured or completed treatment) and those with unsuccessful outcomes (including treatment failure, loss to follow-up, or death). Univariate and multivariate logistic regression analyses were performed to identify factors associated with treatment outcomes, providing odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). A total of 2,225 TB patients (1,382 males and 843 females) were included in the study. Of these, 2,048 (92.1%) achieved successful treatment outcomes. Univariate analysis indicated that older age (OR: 0.47; 95%CI: 0.28–0.78) and a high number of AFB in sputum smears (OR: 0.23; 95%CI: 0.09–0.66) were associated with a higher likelihood of unsuccessful TB treatment. In contrast, having no HIV infection (OR: 13.44; 95%CI: 6.22–29.08), clinical TB cases (diagnosed clinically rather than bacteriologically) (OR: 1.50; 95%CI: 1.04–2.20) and longer duration of TB treatments were associated with successful treatment outcomes. Multivariate analysis suggested that the TB treatment durations of 4–6 months (aOR: 1256.95; 95%CI: 431.89–3658.19) and 7–12 months (aOR: 575.5; 95%CI: 99.1–3342.06) were associated with a significantly higher likelihood of success compared to durations of 0–3 months. In conclusion, this study highlights that a minimum treatment duration of three months was crucial for increasing the likelihood of successful TB treatment. These findings emphasize the importance of comprehensive support programs to ensure adherence to treatment guidelines and improve outcomes.

Common intestinal parasitic infections in an improved water access, sanitation, and hygiene profile setting in North Jakarta, Indonesia

2024-09-02T13:02:04+07:00

Intestinal parasitic infections (IPIs), caused by helminths and/or protozoa, continue to be a significant public health concern in Indonesia. Water access, sanitation, and hygiene practices (WASH) are influential factors for IPIs, especially among children. The aim of this study was to investigate the association between WASH and IPIs among school-aged children. A cross-sectional study involving 338 school-age children in an urban slum area in North Jakarta, Indonesia, was conducted using stool specimens subjected to microscopic and real-time polymerase chain reaction (rt-PCR) examination. The children underwent a finger-prick blood test and anthropometric measurements to determine anemia and nutritional status. Parents whose children participated in stool and blood examinations were interviewed using a modified WASH questionnaire. Helminth infections were not found in this study, whereas the overall prevalence of intestinal protozoa parasitic infection (IPPI) was 18.3% and 52.4% by microscopy and rt-PCR, respectively. Blastocystis spp. was found to have the highest prevalence (microscopy: 12%; rt-PCR: 48.6%), followed by Giardia intestinalis (microscopy: 0.6%; rt-PCR: 6.7%), Cryptosporidium spp. (microscopy: 5.1%; rt-PCR: 1.6%), and Entamoeba histolytica/dispar (microscopy: 0.6%; rt-PCR: 3.2%). Additionally, Dientamoeba fragilis was detected by rt-PCR at 4.1%. Furthermore, the discrepancies between microscopy and rt-PCR were observed in 8.9% (n=28) of the examined specimens. The majority of the respondents had a low-risk category of WASH profile. School children aged 5–10 years old (OR=2.06; 95%CI=1.27–3.33) and those who drank unprocessed cooking water (OR=1.95; 95%CI=1.07–3.57) were significantly associated with IPPI. The present study demonstrated that rt-PCR provides a better understanding of IPI epidemiology and has potential as a monitoring strategy for managing IPIs. Even though this population exhibits an adequate WASH profile and is not directly associated with IPIs, conducting a more in-depth observation of WASH facilities and practices is recommended to ensure a comprehensive assessment of the WASH profile. Additionally, engaging stakeholders in health promotion programs to ensure the sustainability of a good WASH profile and awareness of parasitic infections will be advantageous in achieving optimal urban health.

Psoriasis severity assessment: Optimizing diagnostic models with deep learning

2024-12-02T07:11:51+07:00

Psoriasis is a chronic skin condition with challenges in the accurate assessment of its severity due to subtle differences between severity levels. The aim of this study was to evaluate deep learning models for automated classification of psoriasis severity. A dataset containing 1,546 clinical images was subjected to pre-processing techniques, including cropping and applying noise reduction through median filtering. The dataset was categorized into four severity classes: none, mild, moderate, and severe, based on the Psoriasis Area and Severity Index (PASI). It was split into 1,082 images for training (70%) and 463 images for validation and testing (30%). Five modified deep convolutional neural networks (DCNN) were evaluated, including ResNet50, VGGNet19, MobileNetV3, MnasNet, and EfficientNetB0. The data were validated based on accuracy, precision, sensitivity, specificity, and F1-score, which were weighted to reflect class representation; Pairwise McNemar's test, Cochran's Q test, Cohen’s Kappa, and Post-hoc test were performed on the model performance, where overall accuracy and balanced accuracy were determined. Findings revealed that among the five deep learning models, ResNet50 emerged as the optimum model with an accuracy of 92.50% (95%CI: 91.2–93.8%). The precision, sensitivity, specificity, and F1-score of this model were found to be 93.10%, 92.50%, 97.37%, and 92.68%, respectively. In conclusion, ResNet50 has the potential to provide consistent and objective assessments of psoriasis severity, which could aid dermatologists in timely diagnoses and treatment planning. Further clinical validation and model refinement remain required.

Insertion/deletion (I/D) polymorphisms of angiotensin-converting enzyme gene and their implications for susceptibility and severity of COVID-19: A systematic review and meta-analysis

2024-04-29T09:06:16+07:00

The insertion or deletion polymorphisms of the angiotensin-converting enzyme gene (ACE I/D) have been the subject of significant research related to coronavirus disease 2019 (COVID-19). Despite this, the findings have remained uncertain and debatable. The aim of this study was to determine the associations between the ACE I/D polymorphisms and the susceptibility as well as the severity of COVID-19. A meta-analysis study (PROSPERO: CRD42022384562) was conducted by searching the articles published on PubMed, Scopus, and Embase as of May 15, 2023. Information regarding the impact of ACE I/D variant on the susceptibility to COVID-19 and its severity was collected and analyzed utilizing the Mantel-Haenszel method with a random effects model or fixed effects model, depending on the presence or absence of heterogeneity. Out of 3,335 articles, 21 articles were included, of which 13 investigated the association between ACE I/D and the risk of COVID-19 infection and 18 of them examined its influence on disease severity. The D allele of ACE increased risk of COVID-19 infection (OR: 1.41; 95%CI: 1.08–1.85; p-Egger: 0.0676; p-Heterogeneity: <0.001; p=0.0120), while ACE I allele (OR: 0.71; 95%CI: 0.54–0.93; p-Egger: 0.0676; p-Heterogeneity: <0.001; p=0.012) and II genotype (OR: 0.55; 95%CI: 0.34–0.87; p-Egger: 0.200; p-Heterogeneity: <0.001; p=0.011) decreased the risk of infection. Additionally, there was a notable association between the ACE ID genotype and an elevated likelihood of experiencing severe COVID-19 within the Asian population (OR: 1.46; 95%CI: 1.15–1.84; p-Egger: 0.092; p-Heterogeneity: 0.116; p=0.002). The presence of ACE I/D polymorphisms significantly influences the likelihood of being susceptible to and experiencing the severity of COVID-19.

Risk factors for viral hepatitis in pulmonary tuberculosis patients undergoing treatment: A systematic review and meta-analysis

2024-10-01T07:13:43+07:00

Liver injury in tuberculosis patients, associated with noncompliance with treatment, is further exacerbated by viral hepatitis, which not only directly harms the liver but also increases susceptibility to drug-induced liver injury. The aim of this study was to analyze the associated risk factors for viral hepatitis in tuberculosis patients. This systematic review and meta-analysis adhere to the PRISMA 2020 statement, and the protocol has been registered with PROSPERO (CRD42023477241). Screening and selection of articles were carried out according to predetermined inclusion and exclusion criteria, utilizing four databases: Embase, Medline, Scopus, and ProQuest. Baseline characteristics and patient-related risk factors from each included study were extracted, followed by a meta-analysis of factors that potentially had significance, with the heterogeneities also being analyzed. Of the 21 included studies out of 6,415 identified records, 12 potential risk factors for hepatitis B and 15 for hepatitis C were subjected to meta-analysis. Some key risk factors included for hepatitis B and C were HIV infection (OR: 3.42; 95%CI: 2.19–5.34 and OR: 6.99; 95%CI: 5.09–9.61, respectively), smoking (OR: 1.55; 95%CI: 1.19–2.02 and OR: 3.06; 95%CI: 1.63–5.75, respectively) and alcohol consumption (OR: 2.38; 95%CI: 1.06–5.37 and OR: 4.32; 95%CI: 2.76–6.78, respectively). Furthermore, meta-analysis indicated that other significant risk factors for hepatitis B and/or C include injecting and non-injecting drug use, multiple sexual partners, tattooing, ear-nose piercing, blood transfusion, dental interventions, homelessness, incarceration, living with prisoners, sexually transmitted diseases, and diabetes mellitus. In conclusion, patients with tuberculosis who have risk factors such as smoking, HIV, or alcohol consumption should be screened for hepatitis B and C to prevent liver injury.

Undernutrition-induced stunting-like phenotype in Drosophila melanogaster

2024-11-26T05:48:52+07:00

Stunting resulting from undernutrition is a significant global health challenge, particularly in developing countries, yet its underlying mechanisms and consequences remain inadequately understood. This study utilizes Drosophila melanogaster as an in vivo model to investigate the molecular basis of stunting. Due to the conserved nature of signaling pathways between Drosophila and vertebrates, this organism serves as an effective model for studying growth disorders. The aim of this study was to establish a Drosophila model exhibiting a stunting-like phenotype and to elucidate the molecular mechanisms underlying this condition. The stunting phenotype was induced through dietary manipulation, involving a standard nutrient-rich diet (100%) and treatment diets with reduced concentrations of sucrose, glucose, yeast, and cornmeal at 50%, 25%, and 12.5%. Phenotypic assessments included measurements of larval body size, fecundity, survival rates, and locomotor activity, alongside molecular analyses of gene expression related to metabolism, cell proliferation, and survival, using RT-qPCR. Results demonstrated that undernutrition profoundly affected D. melanogaster, causing growth retardation, reduced larval body size, diminished fecundity, and lower survival rates, though locomotor function remained unaffected. Molecular analysis revealed a significant decrease in the expression of the totA gene and notable increases in the expression of dilp5, srl, and indy genes, with no significant changes observed in the expression of the pepck gene. These findings indicate that undernutrition induces a stunting-like phenotype, likely driven by alterations in the expression of genes associated with metabolism, cell proliferation, and survival. Overall, this study establishes D. melanogaster as a valuable in vivo model for studying stunting-like phenotypes resulting from nutritional deficiencies and provides insights into the molecular pathways involved in growth impairment.

Estimate the relationship between CXCR4-SDF-1 axis and inhibitory molecules (CTLA4 and PD-1) in patients with colon cancer

2024-07-19T03:26:20+07:00

Colon neoplasia is one of the major malignancies in industrialized countries due to their Western-style food habits. It accounts for more than 50% of the population developing adenomatous polyps by the age of 70 years, but 10% of cancers in developed countries. The aim of this study was to evaluate the pathological role of the C-X-C chemokine receptor type 4/stromal-derived factor 1 axis (CXCR4-SDF-1 axis), and the inhibitory molecules PD-1 and cytotoxic T-lymphocyte associated protein 4 (CTLA-4) in postoperative colon cancer patients undergoing treatment with chemotherapy (oxaliplatin and capecitabine) and estimate the correlation between these studied factors to deeply understand the basic mechanisms and potential diagnostic or therapeutic effects. The study involved 90 patients, including 50 colon cancer patients (male and female, aged 35–65) diagnosed by oncologists at Al-Ramadi Hospital, Ramadi, Iraq. All patients underwent surgical resection and received four cycles of chemotherapy with oxaliplatin (85 mg every 21 days) and capecitabine (6 grams daily for 21 days). Additionally, 40 age- and sex-matched individuals served as the control group. For each participant, CXCR4 and SDF-1 levels were measured using ELISA and the gene expression of CTLA-4 and PD-1 were measured using RT-PCR. The colon cancer patient group showed significantly lower levels of CXCR4 and SDF-1 compared to control groups (0.163±0.012 vs 0.376±0.025 pg/mL and 0.376±0.025 vs 0.699±0.110 pg/mL, respectively, both had p=0.001). Moreover, the colon cancer patient group had significantly lower expression of PD-1 and CTLA4 compared to control group (0.102±0.029-fold vs 1.199±0.391-fold, p=0.02; and 0.302±0.140-fold vs 1.441±0.334-fold, p=0.008, respectively). In conclusion, the results suggest that CXCR4 and SDF-1 appear promising as diagnostic markers for distinguishing colon cancer patients from healthy conditions.

Secretome from hypoxic mesenchymal stem cells as a potential therapy for ischemic stroke: Investigations on VEGF and GFAP expression

2024-07-25T12:35:36+07:00

Ischemic stroke is a sudden onset of neurological deficit resulting from a blockage in cerebral blood vessels, which can lead to brain tissue damage, chronic disability, and increased risk of mortality. Secretome from hypoxic mesenchymal stem cells (SH-MSC) is a potential therapy to improve neurological deficit by increasing the expression of vascular endothelial growth factor (VEGF) and reducing glial fibrillary acidic protein (GFAP). These effects can reduce the infarction area of ischemic stroke. Therefore, the aim of this study was to analyze the effect of 150 μL and 300 μL SH-MSC injection on VEGF and GFAP expression as well as the improvement of infarction area in ischemic stroke animal model. A post-test-only experimental design with consecutive sampling was used, with Rattus norvegicus as subjects. Stromal mesenchymal stem cells (S-MSCs) were isolated from the umbilical cords of rats at 21 days of gestation. Secretome production by the S-MSCs was induced under a hypoxic condition, and subsequently isolated. The resultant secretome was administered to rats subjected to middle cerebral artery occlusion (MCAO) at doses of 150 μL (P1 group) and 300 μL (P2 group). The results showed that the infarction area was reduced in P1 (p<0.001) and P2 groups (p<0.001). SH-MSC at a dose of 300 μL increased the expression of VEGF (p=0.028) and reduced the expression of GFAP (p=0.001). In conclusion, secretome from hypoxic S-MSC could potentially improve ischemic stroke by upregulating VEGF expression and downregulating GFAP expression.

Comprehensive in silico analysis of single nucleotide polymorphism and molecular dynamics simulation of human GATA6 protein in ventricular septal defect

2024-10-01T07:43:56+07:00

Congenital heart disease (CHD) represents nearly one-third of congenital birth defects annually, with ventricular septal defect (VSD) being the most common type. The aim of this study was to explore the role of specific GATA binding protein 6 gene (GATA6) mutations as a potential etiological factor in the development of VSD through an in silico approach. Data were collected from the human gene databases: DisGeNET and GeneCards, with protein-protein interaction networks constructed via STRING and Cytoscape. Gene ontology and pathway enrichment analyses were conducted using DAVID, with data analysis in R with significance set at FDR p<0.05. Target single nucleotide polymorphisms (SNPs) of GATA6 were obtained from NCBI dbSNP, and non-synonymous single nucleotide polymorphism (nsSNP) effects were predicted using SIFT, PolyPhen-2, I-Mutant 2.0, Fathmm, MutPred 2.0, SNP&GO, and PON-P2. Conserved regions of GATA6 were analyzed using ConSurf, with functional classification, variant conservation, and stability changes evaluated in Google Colab. Multiple sequence alignment was performed using ClustalW. Mutation modeling and molecular dynamics analysis, using GROMACS, revealed that among 87 intersecting genes, 16 proteins were interconnected with GATA6, showing a centrality value of 0.4378. Gene ontology analysis highlighted atrioventricular canal development, protein-DNA complexes, and transcription factor regulation as key processes for cardiac development, especially in the ventricular septum. NsSNP and molecular dynamics analyses identified rs387906818 and rs387906820 as having the highest pathogenic potential for VSD due to amino acid structural changes.

Urinary level of 1,2-dichloroethane and its effects on blood biochemical markers among outdoor workers exposed to air pollution in Thailand

2024-07-10T06:25:15+07:00

Air contamination by 1,2-dichloroethane (1,2-DCE) is recognized as a threat across countries. Addressing this problem is challenging due to the absence of clearly defined biological standards for monitoring 1,2-DCE exposure among humans. Moreover, studies on the impacts of 1,2-DCE exposure on human health are limited. The aim of this study was to determine the level of 1,2-DCE in urine—separated into the health behavior and occupation groups—as well as its effects on blood biochemicals among overall 200 outdoor workers, with 50 working in each of the following four occupations: fishers, street vendors, public bus drivers, and traffic police in an environmentally polluted community in Thailand. The subject’s behaviors were categorized into four groups: desirable health behaviors (non-smokers and non-drinkers), non-smokers who consume alcohol, smokers who do not consume alcohol, and undesirable health behaviors (frequent smokers and alcohol consumers). Data were collected at the end of the workday using interview forms, urine, and blood samples. Urine was analyzed for 1,2-DCE, and blood was analyzed for complete blood count (CBC), liver, and kidney function enzymes. Data were analyzed using the Dunnett’s test, Kruskal-Wallis H test, and independent sample t-test according to statistical conditions. Our findings revealed that the median urinary 1,2-DCE level was 0.080 mg/L (0.022–0.462 mg/L). Subjects with undesirable health behaviors had a significantly higher urinary 1,2-DCE level (0.108 mg/L) compared to those with desirable health behaviors (0.056 mg/L), with a p-value of 0.009. Among bus drivers and local fishers, the dose of exposure was strongly associated with creatinine levels (p=0.006). No significant association was observed between exposure dose and CBC across all groups. In conclusion, the urinary samples present a small variation in 1,2-DCE concentrations and thus can be used as a benchmark baseline value for monitoring exposure among outdoor workers in areas with intense air pollution. Kidney function markers can be considered in monitoring the health effects of 1,2-DCE.

ACE inhibitors versus angiotensin receptor-neprilysin inhibitors for HFrEF management: A prospective cohort study from Indonesia

2024-09-02T02:14:04+07:00

Previous studies have reported that angiotensin receptor-neprilysin inhibitors (ARNI) are superior to angiotensin-converting enzyme inhibitors (ACEI) in treating heart failure with reduced ejection fraction (HFrEF). Unfortunately, previously published studies predominantly focused on Western populations, while the data remains insufficient in developing countries. The aim of this study was to compare the efficacies of ARNI and ACEI on patients with HFrEF in Indonesia. A prospective cohort study was conducted among heart failure patients at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Both ACEI and ARNI each consisted of 40 subjects receiving standard treatment for heart failure. Left ventricular ejection fraction (LVEF), quality of life (QoL), suppression of tumorigenicity 2 (ST2), and troponin T were measured upon admission and at the end of the follow-up. In addition, the occurrence of major adverse cardiac events (MACE) was observed during 6 months of follow-up. Paired t-test was used to compare the outcomes of ACEI and ARNI. The results revealed that KKCQ score and LVEF were improved in both ARNI and ACEI groups (each with p<0.001). A higher KCCQ overall score was observed in the ARNI group in contrast to the ACEI group (p=0.01). ARNI demonstrated superior results in improving the ejection fraction as compared with ACEI (p=0.001). Troponin T and ST2 levels exhibited no significant difference between the two groups (p=0.07 and 0.286, respectively). MACE-associated mortality (p=0.696) and rehospitalization (p=0.955) were identical between both groups. In conclusion, ARNI was more efficacious than ACEI in improving the quality of life and left ventricular ejection fraction of patients with HFrEF. However, the efficacy was not significantly different in reducing the risk of MACE.

Health promotion model in the utilization of health services for Indonesian social security agency for health participants

2024-09-05T05:42:05+07:00

Health promotion models are essential for enhancing community health and facilitating access to quality health services. Understanding the effects of these models on the utilization of health services among participants of the Indonesian Social Security Agency for Health (Badan Penyelenggara Jaminan Sosial Kesehatan/BPJS) provides valuable insights for developing effective health promotion strategies. The aim of this study was to assess the impact of health promotion on the utilization of health services among BPJS health participants, focusing on the mediating roles of perception, self-efficacy, expected results, and social support, using structural equation modeling (SEM). A descriptive, quantitative research design was employed, involving 160 BPJS health participants at Prof. Dr. Margono Soekarjo Hospital, Purwokerto, Indonesia. Data was collected using structured questionnaires, with participants selected through purposive sampling. SEM analysis, performed using AMOS software, was utilized to examine the relationships among health promotion, perception, self-efficacy, social support, expected outcomes, and health service utilization behavior. The SEM analysis revealed that health promotion significantly influenced health service utilization behavior directly (critical ratio (CR)=2.741; p=0.011). Furthermore, health promotion had a significant effect on perception through self-efficacy (CR=2.500; p=0.012). Perception also significantly influenced behavior through self-efficacy (CR=3.789, p<0.001), while its indirect effect on behavior through outcome expectations was not significant (CR=0.908; p=0.958). Social support directly affected behavior (CR=2.267; p=0.023) and exerted both direct and indirect effects on behavior through self-efficacy (CR=3.789; p<0.001) and outcome expectations via self-efficacy (CR=6.267; p<0.001). However, self-efficacy did not significantly influence the behavior of utilizing BPJS health services through outcome expectations (CR=0.237; p=0.185). The findings indicate that health promotion significantly enhances the utilization of health services among BPJS health participants by improving perceptions and self-efficacy. Social support emerges as a critical factor in influencing health service utilization behavior and shaping outcome expectations through perception. In conclusion, future health promotion strategies should prioritize strengthening perceptions, enhancing self-efficacy, and leveraging social support to improve health service outcomes effectively.

Dual sgRNA-directed knock out survivin gene expression using CRISPR/Cas9 technology for editing survivin gene in triple-negative breast cancer

2024-07-29T10:58:00+07:00

Clustered regularly interspaced short palindromic repeats (CRISPR)-associated nuclease 9 (CRISPR/Cas9) offers a robust approach for genome manipulation, particularly in cancer therapy. Given its high expression in triple-negative breast cancer (TNBC), targeting survivin with CRISPR/Cas9 holds promise as a therapeutic strategy. The aim of this study was to design specific single guide ribonucleic acid (sgRNA) for CRISPR/Cas9 to permanently knock out the survivin gene, exploring its potential as a therapeutic approach in breast cancer while addressing potential off-target effects. Survivin gene knockout was conducted in the TNBC cell line BT549. Intron 1, exon 2, and intron 2 of the survivin gene were selected as sgRNA targets. These sgRNAs were designed in silico and then cloned into a CRISPR/Cas9 expression plasmid. The cleavage activity was assessed using an enhanced green fluorescent protein (EGFP) expression plasmid. The sgRNAs with higher cleavage activity were selected for the establishment of knockout cells. After transfecting the plasmid into the cells, the success of the survivin gene knockout was validated at the deoxyribonucleic acid (DNA) level using polymerase chain reaction (PCR) and sequencing analysis, and at the protein expression level using Western blotting. The study found that sgRNAs survin1A (targeting intron 1), survex2A (targeting intron 2), and survin2A (targeting intron 2) demonstrated higher cleavage activities compared to the other sgRNAs. However, using the single sgRNA, survex2A did not generate mutations in the survivin gene. At the protein level, survivin was still expressed, indicating that a single sgRNA was ineffective in knocking out the survivin gene. In contrast, the combination of sgRNA survin1A and sgRNA survin2A was more effective in generating mutations in the survivin gene, resulting in the deletion of the entire exon 2 and leading to a loss of survivin protein expression. In conclusion, our work provides specific sgRNAs and demonstrates the utilization of dual sgRNAs strategy in the CRISPR/Cas9 technology to knock out the survivin gene, showing potential in breast cancer therapy.

Epidemiology and population-based incidence of influenza in two communities, Bandung district, West Java, Indonesia, 2008–2011

2024-07-05T04:08:30+07:00

Influenza surveillance is important for monitoring influenza virus circulation and disease burden to inform influenza prevention and control measures. The aim of this study was to describe the epidemiology and to estimate the incidence of influenza in two communities in West Java, Indonesia, before and after the 2009 H1N1 pandemic. A population-based surveillance study in the community health care setting was conducted to estimate the annual incidence of influenza. A real-time reverse transcription polymerase chain reaction (RT-PCR) assay was used for influenza case ascertainment. A population census was implemented to calculate the population at risk and estimate community health care utilization rate. The mean annual incidence of influenza A and B, adjusted for healthcare utilization, was 1.6 (95%CI: 1.3–2.0) and 0.7 (95%CI: 0.5–1.0) per 1000 persons, respectively, with the most affected group being young and school-age children. The annual cumulative incidence of influenza A for children under five in 2009, 2010, and 2011 was 7.0 (95%CI: 4.4–11.2), 10.6 (95%CI: 7.3–15.4), and 6.3 (95%CI: 3.8–10.2). For influenza B was 4.3 (95%CI: 2.4–7.8), 2.0 (95%CI: 0.8–4.7), and 0.4 (95%CI: 0.1–2.8), respectively. This study highlights that the incidence of influenza among young and school-age children is consistently higher compared to adults and the elderly throughout these periods. These populations are potential targets for influenza vaccination in Indonesia.

Prevalence of major INSTI and HIV-1 drug resistance mutations in pre- and antiretroviral-treated patients in Indonesia

2024-07-16T23:41:27+07:00

Indonesia has one of the highest HIV infection rates in Southeast Asia. The use of dolutegravir, an integrase strand transfer inhibitor (INSTI), as a first-line treatment underscores the need for detailed data on INSTI drug resistance mutations (DRMs). Currently, there is a lack of comprehensive data on DRMs INSTI and other HIV drug resistance in Indonesian patients, both pre- and post-treatment. The aim of this study was to identify the subtypes and drug resistance mutations of the protease, reverse transcriptase, and integrase genes in both treatment-naive and ARV-treated patients in Bandung, West Java, Indonesia. A cross-sectional study was conducted involving HIV-positive patients at Hasan Sadikin Hospital, Bandung, Indonesia, from September 2022 to January 2023. The patients were categorized into two groups: ARV-treated and pre-treatment patients. Peripheral blood mononuclear cells (PBMCs) were processed for DNA extraction, followed by amplification and sequencing of the pol gene to detect mutations and subtypes. The study found that the predominant subtype was CRF01_AE, accounting for 85.4% and 69% of pre-treatment and treated patients, respectively, followed by recombinant forms such as A1/CRF01_AE, CRF01_AE/CRF02_AG, subtype B, and other subtypes. Among ARV-treated/INSTI-naive patients, major INSTI DRMs R263K and Y143H were identified, while pre-treatment patients exhibited accessory integrase DRMs. The most common DRMs detected were non-nucleoside reverse transcriptase inhibitor (NNRTI) DRMs, with prevalences of 14.6% and 7% in pre-treatment and ARV-treated patients, respectively. In conclusion, CRF01_AE emerged as the predominant subtype in both pre-treatment and ARV-treated patients in Bandung, underscoring the necessity for ongoing surveillance of integrase DRMs, particularly given the presence of major INSTI DRMs in patients undergoing INSTI treatment.

Impacts of COVID-19 on malaria elimination strategies in Asia: A scoping review

2024-10-15T23:54:16+07:00

The global malaria program has faced setbacks due to disruptions in health services caused by COVID-19 pandemic. Despite these challenges, Asia that primarily comprised of low and middle-income countries (LMICs), continues to make strides towards malaria elimination. This scoping review explored the impact of the COVID-19 pandemic on malaria control programs in Asian countries with varying levels of malaria endemicity. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was applied to search for articles published between January 2020 and May 2024 that examined the impact of COVID-19 on malaria control programs in Asia on six databases (PubMed, Scopus, Google Scholar, WHO COVID-19 Research Database, Garuda and Sinta). The findings of these articles were organized into five themes: epidemiology and surveillance, case management (including diagnosis and coinfection), vector control, prevention, and program management. Overall, 54 articles from countries with various endemicity levels were included. These studies focused on malaria epidemiology, surveillance, and case management, with few studies on vector control. The COVID-19 pandemic has affected malaria control differently in different regions. In malaria-free, low-, and high-endemic countries, malaria cases were reduced mainly due to strict public health measures such as travel restrictions, quarantines, and COVID-19-related stigma, which reduced clinic attendance. Conversely, increased malaria cases owing to increased imports, relapses of malaria cases triggered by COVID-19, social conflicts, and underreporting have contributed to this surge. The priority shift to COVID-19 has affected malaria centers, resulting in personnel shortages, budget limits, and an increased number of malaria cases and outbreaks. The pandemic has also spurred innovative malaria prevention methods, such as using social media to raise awareness in China. The COVID-19 pandemic has had a mixed impact on the number of malarial cases reported across Asia. The three main factors were travel restrictions, COVID-19-related stigma, and shifting priorities to COVID-19. Integrating malaria control and COVID-19 strategies, strengthening the healthcare system, developing flexible malaria control strategies during crises, and developing innovative solutions could mitigate these impacts.

Non-dominant handgrip strength is associated with higher cardiorespiratory endurance and elevated NT-proBNP concentrations in ambulatory male adult outpatients with stable HFrEF

2024-08-26T23:57:51+07:00

Understanding the significance of handgrip strength is essential for identifying frailty in heart failure patients. The aim of this study was to identify the association between handgrip strength and cardiorespiratory endurance while highlighting the importance of the musculoskeletal system in cardiac rehabilitation for patients with heart failure. An observational cross-sectional study was conducted at Harapan Kita Hospital, Jakarta, Indonesia, from April 2022 to April 2023, among patients with heart failure with reduced ejection fraction (HFrEF) attributed to cardiomyopathy or coronary artery disease. Patients were classified by a 6-minute walk test (6MWT) distance into <400 meters (low endurance) or ≥400 meters (high endurance). The short physical performance battery (SPPB), handgrip strength, ultrasonographic forearm muscle thickness, left ventricle ejection fraction, tricuspid annular plane systolic excursion, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured. Results indicated significant differences in non-dominant handgrip strength, gait speed, and sit-to-stand SPPB scores between patients achieving a 6MWT distance of ≥400 meters and those below this threshold, with values of 31.11±6.88 kg vs 27.66±6.66 kg (p=0.049), 0.52±0.08 m/s vs 0.61±0.13 m/s (p=0.001), and 10.71±2.47 seconds vs 12.85±4.11 seconds (p=0.014), respectively. Stronger non-dominant handgrip strength (>30 kg) was associated with higher endurance (odds ratio (OR): 3.80; 95%CI: 1.35–10.67; p=0.010) and thicker forearm muscles (>1.9 cm) as measured by ultrasonography (AUC: 0.713; 95%CI: 0.585–0.840, p=0.001). In conclusion, a cut-off of ≤30 kg for non-dominant handgrip strength could effectively stratify the male patients into a lower endurance group (6MWT ≤400 meters), which is associated with elevated NT-proBNP levels and reduced forearm muscle thickness.

Sleep quality and cognitive function on self-rated health status among the elderly: Findings from the Indonesian family life survey (IFLS-5)

2024-07-24T04:22:14+07:00

Cognitive decline poses a significant challenge for the elderly population globally. The aim of this study was to determine the prevalence of cognitive function and its associated factors among the elderly in the Indonesian family life survey’s fifth wave (IFLS-5) conducted from 2014 to 2015. The study included elderly individuals aged 60 and above, excluding proxy respondents and those with missing data. Various socio-demographic, cognitive function and health-related variables were analyzed, including age, sex, education level, marital status, residence, region, economic status, current employment, self-rated health status, happiness, sleep quality, depression, loneliness, and chronic conditions. Multivariate logistic regression analysis was used to identify the factors associated with cognitive functions among the 2,929 elderly respondents. The results revealed that 44.6% of the respondents reported poor cognitive function. In the unadjusted model, residence (OR: 0.81; 95%CI: 0.70–0.94), region of other islands (OR: 0.66; 95%CI: 0.54–0.81), sleep quality (OR: 0.53; 95%CI: 0.42–0.68), self-rated health status (OR: 1.38; 95%CI: 1.19–1.61), happiness (OR: 1.48; 95%CI: 1.22–1.79), and depression (OR: 1.22; 95%CI: 1.04–1.44) showed significant associations with cognitive function. After adjusting for confounding factors, the association remained significant for residence (OR: 0.77; 95%CI: 0.66–0.89), regions other than Java, Bali, and Sumatra (OR: 0.61; 95%CI: 0.50–0.76), self-rated health (OR: 1.28; 95%CI: 1.09–1.51), happiness (OR: 1.30; 95%CI: 1.06–1.59), and sleep quality (OR: 0.60; 95%CI: 0.47–0.78). These findings emphasize the necessity of interventions aimed at enhancing sleep quality and overall health in order to preserve cognitive function among the elderly, thus potentially improving their quality of life. Implementing comprehensive health programs could significantly enhance the overall quality of life for the aging population, especially the elderly population.

Finding the new potential research on diabetic kidney disease and hemodialysis in healthcare insurance databases: A bibliometric analysis

2024-07-09T07:35:10+07:00

To the best of our knowledge, bibliometric analysis has not been performed for studies related to diabetic kidney disease (DKD) and hemodialysis using healthcare big data. Herein, the aim of this bibliometric analysis was to identify emerging research trends in DKD and hemodialysis within healthcare insurance databases by exploring authors, co-author networks, and countries to discover new potential research areas. A bibliometric study was conducted, utilizing data obtained from the Scopus database. Keywords such as diabetic kidney disease, hemodialysis, insurance or big data, and prediction were employed. Inclusion criteria were original articles and review articles written in English published between 2010 and 2022. VOSviewer and the Bibliometrix package in R were used for comprehensive bibliometric analysis. VOSviewer facilitated keyword co-occurrence analysis to identify clusters and visualize relationships among keywords, emphasizing distinct research themes, keyword density, and network visualization. Meanwhile, Bibliometrix allowed exploration of key metrics such as prolific authors and institutions, publication trends, co-authorship networks, citations, document types, emerging trends through keyword analysis, and network visualizations, including co-authorship and keyword co-occurrence. Results from both tools were integrated for a thorough analysis. The present study yielded 2,199 articles, which was reduced to 1,828 after removing duplicates and applying inclusion criteria. This bibliometric analysis found that machine learning and artificial intelligence are emerging yet remain relatively under-researched in the context of hemodialysis and DKD. The prominence of topics such as diabetic nephropathy, non-insulin treatments, and lifestyle modifications highlighted ongoing research priorities in DKD and hemodialysis. Taiwan's dominance in publications suggested robust research activity in this field, while international collaboration underscored global interest and the potential for diverse research perspectives. The need for similar research development in Indonesia, leveraging big data and machine learning, indicates opportunities for advancing the understanding and management of DKD and hemodialysis within the region.

Early activation of macrophage-2 with IL-4 in stromal vascular fraction increases VEGF levels and adipocyte count and maintains volume of fat graft in Wistar rats (Rattus norvegicus)

2024-08-25T15:11:55+07:00

Several previous studies have demonstrated the benefits of early macrophage 2 activation fat grafts supplemented with macrophage culture. However, this approach is considered impractical in clinical settings because of intraperitoneal induction use. The aim of this study was to investigate the effect of early stromal vascular fraction (SVF) macrophage-2 activation with IL-4 on fat graft survival compared to SVF alone using an animal model for better fat graft viability. This experimental study included inguinal fat harvesting, isolated with collagenases to retrieve the SVF, and then injected with a combination of fat graft and SVF (0.3 mL) into the scalp region. The intervention group received an IL-4 intralesional injection on the third day, and the fat grafts were biopsied on days 7, 14, and 30. The primary outcomes were the final volume of the fat graft, vascular endothelial growth factor (VEGF) expression, and the adipocyte cell count using perilipin staining on immunohistochemistry examination. The group receiving IL-4 exhibited significantly higher VEGF on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Similarly, the IL-4 treatment significantly increased the perilipin concentration on days 7, 14, and 30 (p=0.008, 0.008, and 0.029, respectively). In this group, VEGF concentration was significantly increased on day 14 as compared to day 7 (p=0.009), while no significant difference was observed in the control group (p=0.090). Additionally, the IL-4 group displayed significantly less reduction of fat graft volume than the control group, as observed on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Overall, the study underscores the potential benefits of early M2 polarization in fat grafting, as well as providing practical advantages for improving fat graft volume retention.

Inhibition of B-cell activating factor activity using active compounds from Physalis angulata in the mechanism of nephrotic syndrome improvement: A computational approach

2024-05-13T09:57:49+07:00

Nephrotic syndrome, a multifaceted medical condition characterized by significant proteinuria, has recently prompted a reorientation of research efforts toward B-cell-mediated mechanisms. This shift underscores the pivotal role played by B-cells in its pathogenesis. The aim of this study was to explore potential therapeutic pathways, with specific attention given to compounds found in Physalis angulata, including withanolides, such as physalins, which constitute one of the five distinct withanolide subgroups identified in Physalis angulata. Furthermore, the study assessed the monoclonal antibody belimumab, designed to target B-cell activating factor (BAFF) and its associated receptors (TACI, BCMA, and BAFF-R). Various research techniques were employed, encompassing data mining, bioactivity analysis, Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) profiling, molecular modeling, and docking studies. Withanolide was demonstrated as a potential inhibitor for the protein BAFF, showing a binding energy of -7.1 kcal/mol. Physalin F emerged as the leading candidate inhibitor for the protein TACI, with a binding energy of -8.3 kcal/mol. Similarly, withanolide was identified as the top inhibitor candidate for the protein BCMA, exhibiting a binding energy of -7.0 kcal/mol. The most favorable interaction with BAFF-R was physalin F, which displayed a binding energy of -8.0 kcal/mol. Moreover, molecular dynamic simulation suggested that physalin F was able to maintain protein stability, hence being a good inhibitor candidate for BAFF-R and TACI proteins. The results of this investigation demonstrated substantial promise, indicating that these withanolides and withaphysalin A compounds derived from Physalis angulata offer alternative avenues for B-cell targeting. Consequently, this study presents opportunities for pioneering treatments in the management of nephrotic syndrome.

Effects of Nigella sativa on disease activity, T lymphocytes and inflammatory cytokine profiles in pediatric systemic lupus erythematosus: A randomized controlled trial

2024-07-08T02:49:04+07:00

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse manifestations, requiring long-term treatment that can have side effects, particularly in pediatric patients. Nigella sativa (NS) has shown potential for improving SLE symptoms due to its anti-inflammatory and immunomodulatory effects. The aim of this study was to investigate the immunomodulatory effect of N. sativa oil (NSO) on disease activity, T lymphocyte activity and inflammatory cytokine profiles in pediatric SLE patients. A randomized, double-blinded, placebo-controlled clinical trial was conducted at Saiful Anwar Hospital in Malang, Indonesia, from January 2022 to January 2023. Pediatric patients with SLE were randomly assigned to receive either one gram of NSO or a placebo containing starch in capsule form as adjunct therapy alongside their SLE primary treatment. Blood samples were collected before treatment and after eight weeks of daily capsules. Disease activity was assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K); flow cytometry was used to identify T helper lymphocytes, and serum cytokine levels were measured using ELISA. The statistical analysis tests were performed to compare the outcomes between groups at baseline or after the treatment, and within-group comparisons before and after the study period, as appropriate. A total of 32 patients were included in the study. A significant decrease in the SLEDAI-2K score was observed at post-treatment in both the NSO and placebo groups (p<0.001 and p=0.025, respectively). The percentage of T helper 17 (Th17) cells was significantly reduced in both the NSO and placebo groups post-treatment compared to pre-treatment (p=0.026 and p=0.034, respectively). Conversely, the post-treatment percentage of regulatory T (Treg) cells increased significantly in both groups. A significant reduction in interleukin (IL)-2 levels was observed in the NSO and placebo groups at post-treatment compared to pre-treatment (p=0.006 and p=0.046, respectively). Additionally, there were increases in IL-4 and IL-6 serum levels in both groups at post-treatment compared to pre-treatment (p<0.05). This study highlights that although disease activity was not significantly different between NSO and placebo groups, NSO could affect the inflammatory cytokine profiles in pediatric SLE patients.

Toxicity assessment and bioimaging potential of carbon dots synthesized from banana peel in zebrafish model

2024-09-10T23:31:57+07:00

Zebrafish serve as a pivotal model for bioimaging and toxicity assessments; however, the toxicity of banana peel-derived carbon dots in zebrafish has not been previously reported. The aim of this study was to assess the toxicity of carbon dots derived from banana peel in zebrafish, focusing on two types prepared through hydrothermal and pyrolysis methods. Banana peels were synthesized using hydrothermal and pyrolysis techniques and then compared for characteristics, bioimaging ability, and toxicity in zebrafish as an animal model. Pyrolysis-derived banana peel and hydrothermal-derived banana peel showed blue emission under ultraviolet light, indicating excitation-dependent behavior. To test their potential application for bioimaging, a soaking method was used using zebrafish that showed fluorescence intensity in the eyes, abdomen, and tail of zebrafish. Toxicity comparison showed that pyrolysis-derived banana peel had lower toxicity with 50% lethal concentrations (LC₅₀) of 1707.3 ppm than hydrothermal-derived banana peel (LC₅₀ 993 ppm) in zebrafish. Both types of carbon dots showed significant differences (p<0.05) in hatching rates at 96 and 120 hours of exposure. Of the two methods for carbon dot synthesis from banana peel, the pyrolysis method had a higher toxicity threshold than the hydrothermal method, as indicated by the LC₅₀ value and the number of zebrafish embryos that died, hatched delayed, and experienced malformation during their development.

Exploring the anti-inflammatory and anti-apoptotic properties of phloroglucinol on pancreatic cells in diabetic models: In silico and in vivo study

2024-10-24T08:25:11+07:00

Pancreatic cell damage in diabetes mellitus is closely linked to inflammation and apoptosis. This study aimed to investigate the protective effects of phloroglucinol on pancreatic cells in a streptozotocin-induced diabetic model by assessing its anti-inflammatory and anti-apoptotic mechanisms. Phloroglucinol ligand and the structures of Bax, Bcl-2, and caspase-3 proteins were sourced from the PubChem database. Molecular docking was performed using Autodock Tools and docking results were analyzed with PyRx software. In addition, during the in vivo study, the BALB/c mice were grouped into four categories: healthy control, untreated streptozotocin-induced diabetic, and streptozotocin-induced diabetic treated with two doses of oral phloroglucinol at 100 mg/kg and 200 mg/kg body weight. After 28 days, pancreatic tissues were collected for flow cytometric analysis of NF-κB, IL-6, TNF-α, and apoptotic markers (Bax, Bcl-2, and caspase-3). The docking simulations revealed specific binding interactions: phloroglucinol interacted with Bcl-2 via amino acid residues of ALA90 and TYR139, with Bax via ALA42, LEU45, ALA46, LEU47, PRO130, and ILE133, and with caspase-3 through ARG64, SER120, GLN161, CYS163, and ARG207. The binding affinities for Bax, Bcl-2, and caspase-3 were -5.0, -4.7, and -4.9 kcal/mol, respectively. In vivo, results showed that streptozotocin significantly elevated inflammatory cytokines NF-κB, TNF-α, and IL-6, along with apoptotic markers in pancreatic cells (p<0.05) compared to healthy controls. Phloroglucinol administration at 200 mg/kg significantly reduced TNF-α, NF-κB and IL-6 levels. Phloroglucinol also prevented streptozotocin-induced pancreatic cell damage through anti-apoptotic effects by downregulating Bax and caspase-3 and upregulating Bcl-2. These findings suggest that phloroglucinol may offer protective benefits in diabetic conditions by modulating apoptotic and inflammatory pathways.

Factors associated with awareness of and undergoing Pap smear tests among Jordanian women

2024-07-18T04:25:43+07:00

Several screening methods are used to detect cervical cancer, with Pap smear test is considered as one of the most reliable screening methods to diagnose cervical cancer. The aim of this study was to investigate the factors associated with awareness of undergoing Pap smear tests among Jordanian women. A cross-sectional study was conducted among 525 Jordanian women attending the outpatient maternity hospital consecutively from February to July 2023. Data encompassed demographic characteristics (age, occupation, and education), awareness of Pap smears, beliefs regarding their importance, sources of information, and the history of undergoing Pap smear tests were collected using a structured questionnaire. Of the total 525 Jordanian women, 87.6% were aware of Pap smears. The awareness varied significantly depending on age and education level. Women aged 41–50 (adjusted odds ratio (AOR): 6.0; 95%CI: 2.3–15.3) and with a university education (AOR: 2.6; 95%CI: 1.4–4.8) were associated with increased odds of being aware of Pap smears. Among the women who were aware of Pap smears, the majority (94.1%) expressed belief in the importance of undergoing Pap smear tests and 61.7% reported having undergone the procedure at least once in their lives. In the multivariate analysis, women aged 30–40 years (AOR: 1.7; 95%CI: 1.1–2.8), 41–50 years (AOR: 4.1; 95%CI: 2.3–7.3), and older than 50 years (AOR: 9.8; 95%CI: 4.2–23.0) had a higher likelihood of undergoing Pap smear tests than those of under 30 years old. Being a housewife (AOR: 1.7; 95%CI: 1.1–2.7) and those who believed in the importance of Pap smear testing (AOR: 2.6; 95%CI: 1.1–6.0) were also more likely to have a Pap smear test. Nearly half of the women who had undergone Pap smears reported doing so every 2–3 years, while 25.7% indicated annual screening. Importantly, the overwhelming majority (97.9%) preferred the procedure to be performed by a gynecologist. In conclusion, the majority of women were aware of Pap smears. Two-thirds of women reported having undergone the procedure at least once. Prevention programs targeting cervical cancer and Pap smear tests should be tailored to women with low education, younger than 30 years, and those employed to maximize screening uptake for cervical cancer.

Potential of ant nest extract (Hydnophytum formicarum) for protection of testicular morphometry, epididymal functions, and sperm quality in male rats with alloxan-induced diabetes

2024-07-30T04:49:48+07:00

Medicinal herbs, such as the ant nest plant (Hydnophytum formicarum), are promising for the management of diabetes mellitus-associated infertility. The aim of this study was to evaluate the biological activity of the ant nest plant and its capacity to mitigate the adverse effects of alloxan-induced diabetes on testicular morphology, epididymal function, and sperm quality in male rats. The tuber of the ant nest plant was extracted using methanol and then subjected to phytochemical screenings. For the experiment, 20 male white rats (Rattus norvegicus), aged 3–4 months and weighing 150–200 g, were equally divided into four groups. The ant nest extract was administered orally using oral gavage over 14 days. The testes, epididymis, and sperm were collected for weighing, morphometric measurements, and quality evaluation. Qualitative testing of phytochemical compounds indicated the presence of flavonoids, tannins, steroids, terpenoids, and phenolic compounds in the plants. The results revealed the protective effects of ant nest extract against the adverse fertility effects induced by alloxan and a high-fat diet, as observed in testicular weight (p=0.045), epididymal weight (p=0.041), and sperm quality (p>0.05).

HUVECs-derived exosomes increase neovascularization and decrease limb necrosis in hindlimb ischemia

2024-10-01T09:45:31+07:00

Chronic limb-threatening ischemia (CLTI) is the most severe manifestation of peripheral arterial disease (PAD) and imposes a significantly high burden due to its high risk of mortality and amputation. Revascularization is the first-line treatment for CLTI; however, the amputation rate remains high, and approximately one-third of patients are not eligible for this treatment. Therefore, there is an urgent need for more effective therapeutic strategies. The aim of this study was to investigate the effects and mechanisms of human umbilical vein endothelial cells (HUVECs)-derived exosomes on neovascularization and the degree of necrosis in a hindlimb ischemia model and to study the biological processes underlying their mechanisms. This is an in vivo experimental study with a post-test-only control group design. Forty BALB/c mice were randomized to receive injections of exosomes, conditioned media, and phosphate-buffered saline (PBS) one day after unilateral double ligation. A sham-operated group was also included as a control. Capillary density, arteriole lumen diameter, and histopathological necrosis were measured after seven days, while clinical necrosis was observed daily. MicroRNA profiling, in silico analysis, and transcriptomic analysis of vascular endothelial growth factor (VEGF) mRNA expression were performed to determine the possible biological processes. No amputation was found in the exosome group, as well as in the conditioned media and sham-operated groups, compared to three out of seven mice (43%) in the PBS group. The capillary density was higher in the exosome than in the PBS group (p=0.026). The arteriole lumen diameter in the exosome group was larger than in the PBS (p=0.033) and sham-operated (p=0.034) groups. The scores of clinical necrosis and histopathological necrosis in the exosome group were lower than the PBS group (p=0.005), while the histopathological necrosis scores were also lower but statistically insignificant. In silico analysis showed improvement in neovascularization and necrosis, possibly through energy regulation, PI3K/AKT and TGF-β activation, the ubiquitin-proteasome system, and tyrosine kinases receptors. HUVEC exosomes were associated with lower VEGF mRNA expression, which may indicate a more effective compensatory mechanism under ischemic conditions. The exosome group had the lowest VEGF mRNA expression compared to other groups, although the difference was not statistically significant. This study highlights that HUVECs-derived exosomes improve neovascularization and decrease necrosis in a hindlimb ischemia mice model, potentially by modulating several possible mechanisms.

Evaluation of phenolic compounds as cross-linkers to improve the qualities of halal gelatin from milkfish scales (Chanos chanos)

2024-06-27T18:25:28+07:00

Gelatin is a versatile substance extensively used in medical and pharmaceutical industries for many applications, including capsule shells, X-ray film, infusion for plasma substitute, and the fabricating of artificial tissue. Fish scale gelatin is a profitable alternative source as a halal material despite its inferior quality. An addition of phenolic cross-linker may enhance the qualities of fish scale gelatin. The aim of this study was to determine the ability of phenolics to act as cross-linkers for fish scale gelatin and to identify the factors affecting this process. Gelatin production from fish scales (Chanos chanos) was carried out through basic pre-extraction and acidic pre-extraction. Thereafter, the gelatin was reacted with 10 different phenolics (phenol, pyrocatechol, resorcinol, α-naphthol, vanillin, L-tyrosine, curcumin, gallic acid, quercetin, and tannic acid). The resultant gelatins were characterized by infrared spectrum, X-ray diffraction pattern, swelling index, degree of cross-linking, viscosity, gel strength, mechanical profile, thermal profile, and water vapor permeability. Gelatin with the most favorable characteristics was further investigated for the effects of acidity (pH 4, 7, and 10) and cross-linker concentrations (2.5–10%). The findings revealed the formation of cross-linkage through shifted vibrational peaks of amide A, amide B, and amide II in the infrared spectrum. Shifted X-ray diffraction peaks in the gelatin with phenol addition also indicated the formation of cross-linkage. Significant improvement in the gelatin characteristics, such as swelling index, degree of cross-linking, viscosity, gel strength, mechanical profile, thermal profile, and water vapor permeability, could be attributed to the addition of phenolics cross-linkers. The highest improvement was observed in gelatin added with basic tannic acid 10%. Gelatin cross-linked with basic tannic acid 10% had a moisture content of 9.24±0.14%, swelling index of 323±17%, degree of cross-linking of 69.99±0.84%, viscosity of 8.48±0.23 cP, gel strength of 151.5±6.9 Bloom, melting temperature of 213.5°C, tensile strength of 7.00±0.54 N.cm^-2, elongation at the break of 114.08±14.63%, elastic modulus of 58.45±8.20 N.cm^-2and water vapor permeability of 0.57±0.07 g.mm.m^-2.h^-1. kPa^-1. The qualities of tannic acid-cross-linked gelatin films and film-forming gel increased when manufactured under basic conditions in comparison to acidic or neutral conditions. Furthermore, increasing the quantity of tannic acid to 10% improved the overall characteristics as compared to non-cross-linked gelatin. In conclusion, tannic acid has the ability to cross-link the fish gelatin, thereby enhancing its qualities.

Predictors for 30-day mortality in hepatocellular carcinoma patients undergoing liver resection

2024-07-06T23:59:41+07:00

Hepatocellular carcinoma (HCC) ranks among the most prevalent and fatal liver cancers globally. Liver surgery, particularly resection, offers the potential for cure but poses challenges, especially in Indonesia, where patients often present in advanced stages. This study aimed to determine the intraoperative and perioperative factors associated with 30-day mortality of HCC patients undergoing liver resection at a tertiary referral hospital. The study included HCC patients undergoing liver resection at Karadi General Hospital, Semarang, Indonesia, between January 2018 and September 2023. Demographic data, intraoperative, perioperative, and postoperative factors were collected, with the primary outcome being 30-day mortality. Factors influencing 30-day survival were assessed using a log-rank test and the survival analysis employed Kaplan-Meier curves. Among 58 HCC patients who had liver resection, 62.1% were males, with a mean age was 57.27±9.56 years old. Preoperative comorbidities, notably hepatitis B, affected 34.4% of patients. Child-Pugh Score categorized 91.4% as class A. The study found a 30-day mortality rate of 10.3% with no subsequent increase in incidence. The failure-to-rescue rate (FTR) of this study was found to be 46%. Factors associated with 30-day mortality were Child-Pugh classification (p<0.001), intraoperative bleeding (p=0.001), creatinine levels (p=0.005), Clavien-Dindo classification (p<0.001), and posthepatectomy liver failure (PHLF) (p<0.001). This study suggests that pre-operative (Child-Pugh classification), intraoperative (blood loss volume) and postoperative factors (Creatinine level, Clavien-Dindo classification, and PHLF) could predict the mortality rate of HCC patients undergoing liver resection.

Evaluating the effects of sodium metabisulfite on the cognitive and motor function in Drosophila melanogaster

2024-10-28T03:23:45+07:00

Sodium metabisulfite is widely used as a preservative in many food and beverage products, yet its potential effects on cognitive and motor functions at low concentrations remain poorly understood. Evaluating learning, short-term memory, and motor activity is essential, as these functions are critical indicators of neurological health and could be impacted by low-level exposure to sodium metabisulfite. The aim of this study was to investigate the effects of sublethal concentrations of sodium metabisulfite on cognitive and motor functions using Drosophila melanogaster (fruit flies) as the model organism. Different levels of sodium metabisulfite were administered to male and female fruit flies, and their learning and short-term memory were observed. Additionally, their climbing activity with and without stressors (heat shock, ultraviolet A exposure, or energy deprivation) was examined. Our findings indicated that sodium metabisulfite did not impair learning, short-term memory, or motor activity. Furthermore, sodium metabisulfite did not affect the motor activity of fruit flies under heat, ultraviolet A, and energy-deprived conditions. In conclusion, our results suggested that the sublethal concentration of sodium metabisulfite did not harm cognitive and motor functions and did not exacerbate the effects of environmental stressors.

Burden of rheumatic diseases among people with diabetes: A systematic review and meta-analysis

2024-07-18T04:18:40+07:00

Diabetes mellitus type 2 (DM2) is a prevalent metabolic condition affecting over 500 million people globally and associated with serious comorbidities, including various rheumatologic conditions. Some studies have reported a significant association between rheumatological conditions and DM2. However, the global burden of rheumatological conditions among people with DM2 remains unknown. The aim of this study was to assess the cumulative prevalence of rheumatological conditions in DM2 patients. An extensive electronic search was conducted utilizing multiple databases of studies published until January 2024. The quality of the studies included in the review was evaluated using a modified version of the Newcastle-Ottawa Scale (NOS). The overall quality of the studies included was rated as moderate. The review included a total of 13 studies, with 830,649 DM2 patients reported to have rheumatological conditions. Eleven studies were used to determine the individual results of rheumatoid arthritis (RA), gout, and osteoarthritis (OA). The pooled prevalence of OA was 26% (95%CI: 19–32%) and the prediction interval ranged from 6% to 51%. The pooled prevalence of gout disease was 1% (95%CI: 0.0–5.0%), and the prediction interval ranged from 0% to 99%. For RA, the combined prevalence was 0.3% (95%CI: 0.2–0.5%) and the prediction interval ranged from 0% to 5%. In conclusion, this review suggests a considerable prevalence of OA among DM2 patients, while the prevalence of RA and gout was minimal. Early diagnosis and management of certain rheumatologic conditions in individuals with DM2 may help improve health outcomes and prevent premature mortality. Further research is warranted to explore and understand the mechanisms underlying the association between DM2 and rheumatological conditions.

A psychometric evaluation of the Indonesian version of the collaborative practice assessment tool (CPAT) for assessing interprofessional education and collaborative practice among health practitioners and students

2024-07-08T04:51:45+07:00

Research focus has transitioned from interprofessional collaborative practice among qualified health practitioners to the involvement of pre-qualifying students in practicing interprofessional education. It is essential to establish outcome measures to enhance the seamless integration of interprofessional education and collaborative practice. The aim of this study was to develop a culturally appropriate quality measure for assessing interprofessional education and collaborative practice for health practitioners and students in Indonesia by performing cross-cultural validation of the collaborative practice assessment tool (CPAT). The consensus-based standards for the selection of health measurement instruments (COSMIN) standards of psychometric properties were used to guide the study. The evaluation of the psychometric properties was conducted, involving meticulous structural validity evaluation based on a three-step factorial analysis (exploratory factor analysis, confirmatory factor analysis, and multi-group confirmatory factor analysis) and measurement invariance. The parameters analyzed were related to the design requirements of a measure (i.e., targeted population, study sample, and size), the internal structure (structural validity, internal consistency, and measurement invariances), and hypotheses testing for construct validity based on a validated conceptual framework. This study involved 266 practitioners and 232 students. The COSMIN standards for general design requirements were fulfilled. Structural validity confirmed the 7-factor of 48-item structure; measurement invariances indicated configural, metric, and scalar invariants in both practitioner and student cohorts. Construct validity was confirmed by meeting the COSMIN requirement, with over 75% of the tested hypotheses accepted. In conclusion, the findings suggest the newly validated Indonesian CPAT has good psychometric properties concerning internal structure (i.e., structural validity, internal consistency, and measurement invariance) and hypotheses testing, and is therefore a quality measure for assessing interprofessional education and collaborative practice with health practitioners and students in Indonesia.

Exploring links between visuospatial ability and anatomy learning in education: A bibliometric analysis and scientific mapping

2024-07-18T04:31:15+07:00

The field of medical education faces a significant challenge in teaching human anatomy, a fundamental aspect of medical science that is often perceived as complex and demanding. Understanding the shapes and anatomical structure locations is crucial for students to master the intricacies of anatomy. Visuospatial ability, which involves comprehending three-dimensional structures and their spatial relationships, plays a pivotal role in anatomy learning. The aim of this study was to examine keywords, territories/countries, the number of publications, institutions, authors, and associated journals related to visuospatial ability in anatomy learning through extensive bibliometric analysis. Data were gathered from the Scopus database, and VOSviewer was employed to conduct a bibliometric analysis. Approximately 552 eligible articles were examined in their entirety. The findings indicated that the most significant research growth occurred in 2012, with the United States of America emerging as the leading country in the field. Furthermore, Anatomical Science Education was recognized as the most esteemed journal in this field, with Wilson, T.D. being credited as the most influential author. The bibliometric data also demonstrated various approaches to improve visuospatial capacity in anatomy learning, such as utilizing virtual reality or other computer-assisted learning modalities and their integration into medical education practice. In conclusion, these findings highlight the critical role of visuospatial ability in facilitating the acquisition of anatomical knowledge and offer direction for future research in this area.

Efficacy of angiotensin receptor neprilysin inhibitor in hypertension management: A systematic review and meta-analysis of clinical trials

2024-10-03T06:20:03+07:00

Dysregulation of renin-angiotensin-aldosterone system (RAAS) often leads to hypertension and severe cardiorenal complications. Although RAAS-targeted therapies have proven effective, it remains yet optimal in reducing cardiovascular events. The aim of this study was to evaluate the efficacy and safety of angiotensin receptor neprilysin inhibitor (ARNI) compared to control in patients with hypertension. The primary outcomes were systolic and diastolic blood pressure (BP) control, along with the incidence of adverse events. A systematic review and meta-analysis was conducted according following PRISMA guidelines. A comprehensive literature search was performed across five databases: PubMed, ScienceDirect, EBSCO, Cochrane, and ProQuest, with studies identified up until 3 October 2024. The study included nine clinical trials that met the predefined eligibility criteria: (1) randomized clinical trials; (2) adult patients diagnosed with hypertension; and (3) comparison of ARNI versus control, reporting either BP control or adverse events. Quality appraisal using RoB 2.0 revealed that eight studies had a low risk of bias, and one had a high risk of bias. The pooled analysis demonstrated that ARNI is significantly more efficacious in achieving targeted systolic BP as compared to the control group (OR: 1.80; 95%CI: 1.41-2.30; p<0.001; I²=0%), and there was no statistical difference for the efficacy on diastolic BP compared to control (OR: 0.92; 95%CI: 0.75–1.13; p=0.45; I²=75%). The incidence of adverse events was not associated with ARNI (OR: 1.07; 95%CI: 0.90–1.27; p=0.46; I²=72%). In conclusion, ARNI demonstrated a favorable outcome only in systolic BP, but in diastolic BP which could be associated with inadequate duration of observation. Further studies are warranted to assess BP-lowering effect and safety profile of ARNI in a longer observation time.

Development of the Indonesian sexual quality of life scale for women (ISQOL-W)

2024-07-08T00:33:11+07:00

Sexual quality of life is greatly influenced by sexual function, yet thorough measures remain limited and vary across regions. In Indonesia, diverse cultural and religious contexts notably shape sexual quality of life. Thus, it is important to have a tool that considers both internal and external aspects. The aim of this study was to develop a valid and reliable scale that specifically measures Indonesian sexual quality of life for women (ISQOL-W), considering cultural and social factors. A total of 228 participants were recruited from April 30, 2023, to September 30, 2023. The ISQOL-W was developed through two phases: item generation and psychometric evaluation. In the first phase, 68 items were drafted based on definitions and dimensions of sexual quality of life. In the second phase, exploratory factor analysis resulted in 34 items with a loading factor greater than 0.4 (ranging from 0.41 to 0.84) which were categorized into four domains/factors: sexual-related emotion, sexual fantasy, sexual arousal, and sexual relationship. The Cronbach’s α coefficient for the overall questionnaire was 0.915, with subscale reliability ranging from 0.826 to 0.903. Further analysis revealed significant differences in ISQOL-W scores across relationship status, educational level, history of last sexual activity, and type of sexual activity. In conclusion, the ISQOL-W demonstrated robust psychometric properties, supporting its use in future studies. This study represents the first effort to develop and validate a sexual quality of life scale specifically for Indonesian women.

Aerobic exercise improves spatial memory in a rat model of meningitis

2024-08-10T05:49:55+07:00

Infections of the nervous system, such as acute bacterial meningitis, pose serious health problems that require immediate intervention. In experimental animals, exposure to lipopolysaccharide (LPS) is used to induce meningitis. Aside from drug intervention to reduce inflammation in meningitis, aerobic exercise helps to maintain the regulatory mechanisms of brain homeostasis through anti-inflammatory mechanisms. The aim of this study was to evaluate the effect of aerobic exercise on malondialdehyde (MDA), nuclear factor-kappa B (NF-κB), insulin-like growth factor 1 (IGF-1), endothelial nitric oxide synthase (eNOS), brain-derived neurotrophic factor (BDNF), apoptosis, and spatial memory. A four-week experimental study was conducted using 18 rats, which were randomly divided into three different groups (six rats per group): healthy rats as negative controls (non-meningitis), a treatment group treated with antibiotic treatment (meningitis group), and a third group (aerobic exercise group) treated with antibiotics and aerobic exercise following LPS-induced meningitis. Data were analyzed using a one-way analysis of variance (ANOVA) test, and the comparison between groups used the Bonferroni post-hoc test. The results showed that aerobic exercise significantly reduced MDA (p<0.001), NF-κB (p=0.035), and apoptosis (p=0.020) while increasing the serum levels of IGF-1 (p<0.001), eNOS (p=0.011), and BDNF (p=0.001) levels. Improvement in spatial memory was significant in the aerobic exercise group (p<0.001). This study suggested that aerobic exercise could be a promising adjunct therapy in meningitis management strategies, particularly due to its effect on improving spatial memory. Further clinical trials are needed to confirm these findings for clinical use.

Role of mothers in preventing tuberculosis in children: A scoping review

2024-07-08T04:36:29+07:00

Tuberculosis (TB) remains a significant global health challenge, especially for children. The aim of this scoping review was to investigate the role of mothers in preventing childhood TB transmission and highlight effective strategies and associated barriers. A systematic literature search was conducted using PubMed, Web of Science, and Scopus, covering articles up to January 17, 2024. The search included keywords like “mother,” “parents,” “care,” “prevention,” and “tuberculosis.” Eligibility criteria included peer-reviewed articles on maternal health interventions for TB prevention in children and published in English. The study selection process involved screening titles and abstracts, followed by full-text reviews by Rayyan Artificial Intelligence (AI). Eighteen studies were analyzed, revealing the crucial roles of mothers and healthcare workers in TB prevention. The results indicated that in South Africa, only 47% of eligible pregnant women underwent Mantoux testing, with lower rates in rural areas. The isoniazid preventive therapy (IPT) uptake rate was 79%, with geographical variations. Barriers included insufficient patient information, inadequate screening facilities, and healthcare providers' knowledge gaps. Parental involvement, particularly by mothers, is vital for adherence to TB preventive measures. Challenges in integrating TB case-finding with antenatal care and prevention of mother-to-child transmission (PMTCT) services included inconsistent screening and healthcare worker shortages. Enhancing health services, reducing stigma, and integrating TB prevention into existing programs are essential. In conclusion, this review underscores that effective childhood TB prevention requires a coordinated approach that incorporates the efforts of the mother and healthcare worker. Addressing barriers such as contact tracing gaps and diagnostic delays, alongside enhancing maternal health education and support, is essential for improving TB prevention and management. Targeted interventions and collaborative efforts are needed to reduce transmission and improve health outcomes, particularly in bridging rural-urban disparities.

Effectiveness of combined physical exercise and cognitive training in older adults with cognitive impairment: A systematic review and meta-analysis

2024-07-18T23:58:02+07:00

Falls among cognitively impaired older adults are a global concern. The aim of this study was to assess the efficacy of combining physical exercise and cognitive training to improve balance among older adults. A systematic search of databases, including Embase, Medline-OVID, CINAHL-EBSCOhost, and Central-Cochrane Library, was conducted from March 9 to April 6, 2023. The search used keywords based on the PICO question, where the population was older adults with cognitive impairment. Compared to a single therapy, the intervention involved a combination of muscle strengthening and cognitive therapy, with the outcome of falls or balance. Inclusion criteria were randomized controlled trials (RCTs) in any setting. Studies with participants under 60 years old and lacking baseline clinical assessments were excluded. EndNote 20 was used as a reference manager tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram was used to map out the number of identified records. Two investigators worked independently, and the Jadad scale was used for critical appraisal. The PROSPERO registration number is CRD42023454876. A fixed-effects meta-analysis was performed using an inverse-variance method. Four articles met the inclusion criteria, three of which were included in the meta-analysis. Studies were from Europe, New Zealand, and the Philippines, with a total sample of 255 participants and mean ages of 65.9–87.5 years. The studies used combined physical and cognitive training in one group. Results showed a significant moderate effect size (effect size (ES): 2.29; standardized mean difference (SMD): 0.41; p<0.05; heterogeneity (I²): 0%) indicating no heterogeneity. In conclusion, the combined intervention displayed the potential to improve balance for cognitively impaired older adults.

Impact of early-life malaria exposure on childhood stunting: A case-control study in high endemic malaria area, Papua, Indonesia

2024-09-23T08:27:24+07:00

Papua faces public health challenges as a region with high malaria endemicity and a very high prevalence of stunting. Infectious diseases are one of the risk factors for stunting. The aim of this study was to investigate the effect of early-life malaria exposure on stunting among children in Papua. The study was conducted in 14 public health centers (PHCs) in Papua in 2023. Six hundred eighty-one children (227 stunted and 454 non-stunted) were selected using simple random sampling. The study data were gathered from medical records, structured parent interviews, and direct anthropometric measurements of the children. Chi-square tests were performed to determine unadjusted OR, while adjusted OR was calculated using multivariate analysis. The height-for-age z-score was calculated using WHO Anthro version 3.2.2. The results showed that 45.1% of mothers who had malaria during pregnancy had stunted children. The average z-score height-for-age of children from mothers who experienced malaria during pregnancy vs those who did not was -1.69±1.23 vs -1.41±1.55. Among the 84 children who had malaria under one year old, 45.2% experienced stunting. The average z-score height-for-age of children who had malaria under one year old vs those who did not was -1.83±1.24 vs -1.38±1.6. In the unadjusted analysis, malaria during pregnancy (OR 1.74; 95%CI: 1.06–2.87), malaria in children under one year old (OR 1.78; 95%CI: 1.12–2.83), low birth weight status (OR 1.82; 95%CI: 1.08–3.05), family income (OR 1.75; 95%CI: 1.09–2.81), and mother’s ethnicity (OR 1.45; 95%CI: 1.05–2.01) were associated with stunting incidence in children. In the multivariate analysis, mother’s ethnicity (aOR 1.41; 95%CI: 1.00–1.97) and low birth weight status (aOR 1.72; 95%CI: 1.00–2.94) were the only risk factor for stunting. This study suggests a potential association between early-life malaria exposure and stunting in children. In malaria-endemic areas, health interventions targeting malaria prevention during pregnancy and early childhood are necessary to reduce the risk of stunting.

Global prevalence and potential factors influencing willingness for renal transplantation in end-stage renal disease patients: A systematic review and meta-analysis

2024-07-30T07:13:58+07:00

The prevalence of willingness to undergo renal transplantation and its potentially associated factors have been documented in multiple prior studies across different regions, yet certain findings are conflicting. The aim of this study was to determine the global prevalence of willingness for renal transplantation and identify its associated factors through meta-analysis methods. Databases such as Scopus, PubMed, and Embase were utilized for the search strategy, covering the period from April to May 2024. Data collection focused on gathering information regarding the prevalence and potential contributing factors of renal transplantation. Statistical analysis involved examining the cumulative prevalence of willingness for renal transplantation using single-arm meta-analysis. Factors associated with willingness for renal transplantation were analyzed using the Mantel–Haenszel test for categorical variables and the inverse variance method for numerical variables. A total of nine articles, covering 3935 patients with end-stage renal disease (ESRD) were included. The pooled estimates revealed that the overall prevalence of willingness to undergo renal transplantation among ESRD patients was 57% (95%CI: 0.46–0.67). Furthermore, we observed a higher likelihood of willingness among men and those of younger age, attainment of at least a bachelor's degree or higher in education, employment status, higher income levels, and a shorter duration of hemodialysis (<5 years). Our study has documented the global prevalence and potential associated factors of willingness to undergo renal transplantation, providing valuable insights for policymakers aiming to enhance the acceptance of renal transplantation.

Effects of decursinol angelate on viability and apoptosis in PC-3 prostate cancer cells: In vitro study

2024-06-08T02:37:32+07:00

Prostate cancer represents the predominant malignant neoplasm observed in the male population and ranks second in terms of mortality attributable to malignant neoplasm among men. Decursinol angelate (DA), derived from the plant Angelica gigas Nakai (AGN), has demonstrated anti-cancer effectiveness through the induction of intrinsic and extrinsic apoptosis pathways, inhibition of cancer cell proliferation, having anti-neovascularization, anti-inflammatory anti-oxidative activities and stimulating the immune process. The aim of this study was to determine the IC₅₀ dose of DA on human prostate cancer cell line PC-3, as well as to assess its effects on cell viability and apoptosis. PC-3 cells were utilized in this study due to its hormonal therapy resistance characteristics. The treatment commenced with the determination of the IC₅₀ of DA and cell viability using the CCK-8 method as a baseline dose. A combination with abiraterone acetate (AA) was performed using an escalated dose based on its IC₅₀to identify whether DA has a synergy with AA in decreasing PC-3 cell viability. Apoptosis levels were measured using flow cytometry. The research includes a control group (C) and three treatment groups: AA group, DA group, and DA+AA group. GraphPad Prism, SPSS version 25 and CompuSyn software were used for statistical analysis. This study reveals that the IC₅₀ dose of DA is 13.63 µM. The decrease of PC-3 cell viability exposed to DA occurs in a dose-dependent manner. Additionally, PC-3 cell apoptosis is significantly increased in both the DA group and DA+AA compared to the control. Moreover, no difference in apoptosis level is noted between the DA and AA groups. Notably, there is a synergy between DA and AA, where a specific dose equal to one-fourth of the IC₅₀ dose results in greater efficacy in reducing PC-3 cell viability compared to individual treatments of either DA or AA at the IC₅₀ doses. This study demonstrates the potential of decursinol angelate as a single drug or combined with abiraterone acetate to reduce viability and increase apoptosis of castrate-resistant prostate cancer cells.

Mothers’ perception of husband support during breastfeeding: A qualitative study in Indonesia

2024-07-18T02:54:04+07:00

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted maternal and perinatal healthcare worldwide, including in Indonesia. Restrictions on access to health services have forced mothers to adapt to new challenges in breastfeeding during the pandemic. The aim of this study was to evaluate mothers’ breastfeeding experiences and the role of husbands in providing support during this period. This qualitative research used a phenomenological approach. Data were collected from August to October 2022 through a focus group discussion (FGD). Participants were selected using maximum variation sampling, with eight mothers participating in the FGD. Data were analyzed using qualitative content analysis, revealing four main themes: (1) not all husbands fully supported mothers’ efforts to provide exclusive breastfeeding; (2) supportive and inhibiting factors help to provide exclusive breastfeeding; (3) mothers understood the benefits and identified the causes of failure in providing exclusive breastfeeding and complementary food for breast milk; and (4) various stressors experienced by mothers did not impede breastfeeding efforts. In conclusion, the findings highlight the need for healthcare workers, especially maternity nurses, to encourage continued breastfeeding and emphasize the importance of husbands’ support in providing exclusive breastfeeding initiatives. Interventions should be designed to actively involve husbands in supporting exclusive breastfeeding practices.

A network pharmacology approach to elucidate the anti-inflammatory and antioxidant effects of bitter leaf (Vernonia amygdalina Del.)

2024-07-24T04:59:48+07:00

The therapeutic potential of bitter leaf (Vernonia amygdalina Del.) has been established both empirically and in various scientific investigations. However, the molecular pathways related to its possible anti-inflammatory and antioxidant properties remain unclear. Therefore, the aim of this study was to elucidate the molecular interactions between bitter leaf's bioactive compounds and cellular targets involved in these activities. The compounds in bitter leaf were identified using gas chromatography-mass spectrometry (GC-MS) analysis, and subsequently, a network pharmacology approach was employed together with molecular docking and dynamics simulations. Acetonitrile (4.5%) and dimethylamine (4.972%) were the most prevalent compounds among the 38 identified by the GC-MS analysis of bitter leaf extract. The proto-oncogene tyrosine-protein kinase (SRC) demonstrated significant connectivity within the antioxidant network, highlighting its pivotal role in facilitating inter-protein communication. It also exhibited strategic positioning in anti-inflammatory mechanisms based on closeness centrality (0.385). The enrichment analysis suggested multifaceted mechanisms of bitter leaf compounds, including transcriptional regulation and diverse cellular targeting, indicating broad antioxidant and anti-inflammatory effects. Eicosapentaenoyl ethanolamide (EPEA) displayed strong interactions with multiple proteins, including SRC (-7.17 kcal/mol) and CYP3A4 (-6.88 kcal/mol). Moreover, EPEA demonstrated to form a stable interaction with SRC during a 100 ns simulation. In conclusion, the computational simulations revealed that the hypothetical antioxidant and anti-inflammatory actions of bitter leaf compounds were achieved by specifically targeting SRC. However, confirmation using either in vitro or in vivo techniques is necessary.

Antioxidant and immunomodulatory activities of ethanol extracts from Syzygium cumini L. Skeels and Pogostemon cablin Benth

2024-06-27T19:30:57+07:00

Syzygium cumini and Pogostemon cablin are mostly cultivated in tropical climates for culinary and perfumery purposes, yet their potential medicinal properties remain underreported. The aim of this study was to examine the antioxidant and immunomodulatory activities of ethanol extracts from S. cumini (EESC) and P. cablin (EEPC). Reflux extraction was carried out using 96% ethanol on the collected plant specimens to produce EESC and EEPC. Secondary metabolites of each extract were identified using gas chromatography-mass spectrometry (GC-MS). The extracts were measured for total phenol and flavonoid levels and 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity. The immunomodulatory activity test was carried out in vivo by assessing several parameters, including the phagocytic index via the carbon clearance method, organ indices, antibody titers, and delayed-type hypersensitivity (DTH) response, using sheep red blood cells (SRBC) as antigens. The extracts were also examined for their anti-inflammatory activity in acute and chronic inflammation models. In the DPPH antioxidant test, EESC and EEPC had IC₅₀ values of 12.33 µg/mL and 182.17 µg/mL, respectively. Both extracts showed immunosuppressant activity, marked by a phagocytic index of <1. EESC yielded lower organ indices for the liver (p=0.025 at 200 mg/kg BW), spleen (p=0.028 at 100 mg/kg BW), and thymus (p=0.032 at 200 mg/kg BW) compared to the control group. For EEPC, lower organ indices were observed in the liver at 100 mg/kg BW (p=0.005) and 200 mg/kg BW (p=0.031). In the primary antibody titer and DTH tests, both EESC and EEPC showed immunosuppressant activity at 200 and 400 mg/kg BW (p<0.05). The extracts suppressed both the innate and adaptive immune systems. Both EEPC (p=0.004) and EESC at 100 mg/kg BW (p=0.03) significantly reduced serum TNF-α levels. In conclusion, EESC and EEPC have the potential as immunosuppressive and anti-inflammatory agents.

Feasibility and pilot study of Indonesia’s first telehealth support program for gynecological cancer survivors undergoing chemotherapy

2024-07-18T23:50:06+07:00

Most Indonesian gynecological cancer survivors experience chemotherapy side effects on their physical and mental health as they face unmet needs of supportive care, which increases the likelihood of discontinuing treatment. Interventions in telehealth assist survivors in resolving these issues. The aim of this pilot study was to determine the feasibility of fighting distress, self-efficacy, health effects, and sexual (FoRSHE-X) interventions and evaluate their potential impact on distress level, side effects knowledge and management, self-efficacy, and sexual quality of life. The study involved gynecological cancer survivors who underwent chemotherapy and participated in ten weeks of individual social media-based education, tele-coaching, and teleconsultations, from September 2023 to June 2024. The study feasibility and pilot outcomes were evaluated using descriptive statistics and qualitative thematic analysis. Of the twelve women recruited, six (50%) completed the study, filled out pre- and post-intervention questionnaires, and participated in interviews. Fifty-four virtual education, coaching, and consultation sessions were performed individually. The statistical results indicated that participants were highly satisfied with the telehealth program, which significantly increased their knowledge (p=0.02), health practices (p=0.04), and self-efficacy (p=0.01). The qualitative analysis highlighted participants' and coaches' perspectives on the study’s acceptance, barriers, and recommendations. In conclusion, this pilot study suggests that a definitive trial to assess the FoRSHE-X interventions is feasible, acceptable, and can be applied not only to gynecological cancer survivors but also to other types of cancer, thereby broadening the potential impact of the study.

Impacts of Phyllanthus niruri extract on biomarker levels, macrophage count, and lesion area in an endometriotic rat model

2024-06-25T04:54:30+07:00

Endometriosis is a gynecological disorder characterized by chronic inflammation, anatomical changes, prolonged pain, and infertility. On the other hand, Phyllanthus niruri is recognized for its pharmacological effects, which might be beneficial in managing endometriosis. The aim of the study was to investigate the pharmacological effects of P. niruri as a potential therapy for endometriosis by using an animal model. An experimental laboratory study with randomized, controlled trial, pre-test, and post-test design using 40 female Wistar rats (Rattus norvegicus) was conducted at the Integrated Research and Testing Laboratory (LPPT) of Universitas Gadjah Mada, Yogyakarta, Indonesia, from February to June 2023. Endometriosis was induced in female Wistar rats by suturing a 0.5 cm² flap from the uterine horn to the peritoneal cavity. Changes in serum interleukin 1β (IL-1β), malondialdehyde (MDA), and matrix metalloproteinase 9 (MMP-9), before and after the treatment, were analyzed using enzyme-linked immunosorbent assay. Hematoxylin and eosin (HE) staining were used to evaluate lesion size and macrophage quantity. The results suggested that the P. niruri extract with a dose of 196 mg/200 g body weight (BW) could significantly attenuate serum IL-1β (p=0.004), MMP-9 (p=0.021), and MDA (p=0.021). Rats receiving the P. niruri extract (196 mg/200 g BW) had significantly higher macrophage counts (p=0.003), but similar lesion area (p=0.093) as compared with the negative control. In conclusion, P. niruri demonstrated promising therapeutical effects on endometriosis by modulating IL-1β, MDA, and MMP-9 levels, although the effect was not pronounced on macrophage counts and lesion area.

Effects of cholecalciferol supplementation on depressive symptoms, C-peptide, serotonin, and neurotrophin-3 in type 2 diabetes mellitus: A double-blind, randomized, placebo-controlled trial

2024-09-09T07:33:01+07:00

The coexistence of depression and type 2 diabetes mellitus (T2DM) can significantly worsen disease prognosis and lower quality of life. Emerging evidence suggests that vitamin D deficiency contributes to the progression of T2DM and is closely associated with the development of depression. The aim of this study was to investigate the effects of cholecalciferol on depression in patients with T2DM, exploring its mechanisms by analyzing its impact on C-peptide, serotonin, and neurotrophin-3 levels. A double-blind, randomized, placebo-controlled clinical trial was conducted at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from April 2021 to September 2022. Patients with T2DM and depressive symptoms were randomly assigned to two groups: received 4000 IU of cholecalciferol daily and received a placebo for 12 weeks. Depression was assessed using the Beck Depression Inventory-II (BDI-II) before and 12 weeks after the intervention. The levels of C-peptide, serotonin, and neurotrophin-3 were measured at the end of the fourth week of intervention using the enzyme-linked immunosorbent assay (ELISA) method. Between-group comparisons were made using independent Student t-tests and Mann-Whitney U tests. Paired Student t-tests or Wilcoxon tests were applied for within-group comparisons between pre- and post-intervention. A total of 70 T2DM patients with depression were included in this study, comprising 38 patients in the cholecalciferol group and 32 in the placebo group. C-peptide levels increased significantly in the cholecalciferol group compared to the placebo group (p=0.006). No significant differences were observed in serotonin and NT-3 levels between the cholecalciferol group compared to the placebo group. The cholecalciferol group had a significantly greater reduction in BDI-II scores compared to the placebo group (p<0.001). This trial highlights that taking cholecalciferol might help ease mild to moderate depression symptoms in patients with T2DM by enhancing c-peptide levels, though its effects on serotonin and neurotrophin-3 are still unclear.

Association between vitamin D levels with IL-6 and IL-10 in umbilical cord blood of infants

2024-06-06T07:13:09+07:00

A worldwide issue, vitamin D deficiency affects pregnant mothers and babies everywhere, including Indonesia. It involves the adaptive immune system by controlling the production of pro- and anti-inflammatory cytokines and the balance between humoral (Th2) and cell-mediated (Th1) immunity. The aim of this study was to investigate the relationship between vitamin D and the cytokines IL-6 and IL-10 in infants. It also examined the relationship between ferritin and IL-6/IL-10 in newborns. The study collected 114 umbilical cord blood samples from term-born mothers without clinical symptoms. IL-6 and IL-10 were among the cytokine profiles measured by the enzyme-linked immunosorbent assay (ELISA). SPSS was used for statistical analysis, and an in-silico investigation was carried out to examine the molecular relationships between vitamin D and IL-6/IL-10. Using the 20 ng/mL as the cut-off for vitamin D insufficiency suggested the insignificant association of vitamin D with IL-6 (p=0.42), IL-10 (p=0.76), and ferritin (p=0.47). When the umbilical cord vitamin D level was categorized into four quartiles, the association with the highest statistical significance (quartile 4 versus quartile 2) was observed for IL-6 (p<0.001), IL-10 (p<0.001), and ferritin (p<0.001). However, the linear regression did not suggest the significant correlations of vitamin D with IL-6 (p=0.40) and IL-10 (p=0.45). A significant correlation based on the linear regression was found between ferritin and IL-10 (p=0.03). Molecular docking studies demonstrated binding affinities of -8.04 kcal/mol for IL-6-vitamin D and -8.53 kcal/mol for IL-10-vitamin D complexes, with stable root mean square deviation throughout the simulations. This study contributes valuable insights into the clinical and computational analysis of the relationship of vitamin D with IL-6 or IL-10.

Effect of moderate-intensity aerobic exercise on bladder TGF-β1 and type I collagen expressions in diabetic rat model

2024-08-13T07:18:46+07:00

Transforming growth factor-beta 1 (TGF-β1) and type I collagen play crucial roles in the pathogenesis of diabetic bladder disease (DBD). Moderate-intensity aerobic exercise increases antioxidant activity to help manage DBD. The aim of this study was to evaluate the effect of moderate-intensity aerobic exercise on the expression of TGF-β1 and type I collagen in the detrusor and lamina propria of the bladder in a type 2 diabetes mellitus (T2DM) rat model. A true experimental design with a post-test-only control group design was conducted with white rats (Rattus norvegicus), divided into three groups: a T2DM model group sacrificed after T2DM induction and diagnosed with T2D from a fasting blood glucose (FBC) test (Group C), a T2DM model group that did not receive exercise (Group NE), and a T2DM model group that received moderate-intensity aerobic exercise (Group E). Moderate-intensity aerobic exercise was conducted over six weeks, with a frequency of five days per week for 60 minutes per session. The findings revealed a significant reduction in TGF-β1 expression in the lamina propria in Group E compared to Group C (p=0.004) Additionally, both Group E (p=0.002) and Group NE (p=0.028) showed a significant reduction in type I collagen expression in the lamina propria compared to Group C. These findings provide a basis for further investigation regarding the mechanism of non-pharmacologic DBD management by employing moderate-intensity exercise.

Integrating epigenetic modification and stem cell therapy strategies: A novel approach for advancing Alzheimer’s disease treatment − A literature review

2024-07-04T09:06:55+07:00

Alzheimer's disease (AD) is the most frequent form of dementia and represents an increasing global burden, particularly in countries like Indonesia, where the population has begun to age significantly. Current medications, including cholinesterase inhibitors and NMDA receptor antagonists, have modest effects on clinical symptoms in the early to middle stages, but there is no curative treatment available so far despite progress. Activating or repressing epigenetic modifications, including DNA methylation, histone modification and microRNA regulation, appears to play an important role in AD development. These alterations further enact transcriptional changes relevant to the signature AD pathologies of amyloid-β deposition, tau protein malfunctioning, neuroinflammation, and neuronal death. Here, we discuss the feasibility of targeting these epigenetic alterations as a new treatment strategy due to the reversibility of epigenetics and their ability to correct faulty gene expression. We also review the combined promise of stem cell therapies and epigenetic modulation in neurodegeneration, inflammation and cognitive decline. This combined approach may provide a multifaceted strategy to slow disease progression, replace lost neurons, and restore neural function. Despite challenges, including ethical, financial, and methodological barriers, ongoing research in epigenetic modulation and stem cell therapy holds promise for pioneering therapies in AD.

Mesenchymal stem cells for immune modulation in systemic lupus erythematosus: From bench research to clinical applications

2024-09-03T01:53:13+07:00

Systemic lupus erythematosus (SLE) is a prevalent autoimmune disease affecting multiple organ systems. Disease progression is inevitable as part of its natural course, necessitating aggressive therapeutic strategies, particularly with the use of immunosuppressants. Long-term use of steroids and other immunosuppressants is associated with significant adverse effects. Mesenchymal stem cells (MSCs) have been shown to modulate the immune response, leading to immunosuppressive effects against self-antigens. MSCs have demonstrated the ability to modulate several immune cell populations, contributing to favorable outcomes in controlling immune and inflammatory conditions. Recent evidence has shown an increase in Treg and Breg cell subsets following MSC administration, along with modulation of other immune cells, including dendritic cells, B cells, and T cells. However, the balance between MSC pro-inflammatory and anti-inflammatory phenotypic activation remains a critical factor in determining therapeutic outcomes. Various covariates also influence the efficacy of MSC therapy. The aim of this study was to provide a comprehensive overview of the utilization of mesenchymal stem cells (MSCs) in SLE treatment, leveraging their immunomodulatory and immunosuppressive capabilities. Understanding the fundamental preclinical effects of MSCs and recent findings from clinical studies may enhance the potential of MSC therapy in the management of SLE patients.

Challenges in diagnosing and treating Liddle syndrome in resource-limited settings: A case report from Indonesia

2024-07-08T10:55:52+07:00

Liddle syndrome, a rare form of monogenic hypertension, poses significant diagnostic and therapeutic challenges due to its phenotypic variability and the need for genetic testing. The rarity of the condition, coupled with the limited availability of first-line treatments such as epithelial sodium channel (ENaC) blockers, makes this case report particularly urgent and novel, highlighting alternative management strategies in resource-limited settings. The aim of this case report was to present the diagnostic challenges, therapeutic strategies, and clinical outcomes of a patient with Liddle syndrome who did not have access to ENaC blockers, emphasizing the importance of early recognition and personalized treatment. A 35-year-old female presented with resistant hypertension (190/100 mmHg) and bilateral limb weakness. Laboratory results revealed persistent hypokalemia, hypernatremia, and metabolic alkalosis. Low aldosterone levels, alongside clinical and family history, led to the diagnosis of Liddle syndrome. Genetic testing was not conducted due to resource limitations, and ENaC blockers were unavailable. The patients were managed with a combination of alternative antihypertensive agents, potassium supplementation, and a low-sodium diet. Although this approach led to modest improvements in blood pressure and motor strength, persistent hypokalemia and hypernatremia underscored the suboptimal control of the syndrome's underlying pathophysiology in the absence of ENaC blockers. This case highlights the challenges faced in resource-limited settings and the need for innovative strategies to manage rare conditions like Liddle syndrome. Liddle syndrome's diagnostic and therapeutic challenges underscore the critical importance of early recognition and access to targeted therapies. In the absence of ENaC blockers, alternative treatment strategies can provide some benefit, but they often fall short of optimal management. This case emphasizes the need for enhanced clinical awareness, improved access to genetic testing, and the development of personalized treatment approaches to achieve better patient outcomes.

Varicella challenges: A case of respiratory tract complications in an elderly patient

2024-07-24T04:25:40+07:00

Varicella, caused by the varicella-zoster virus (VZV), is rarely reported in the elderly but often complicates with pneumonia. In this case report, we present a case of varicella pneumonia in the elderly. A 60-year-old man presented to the emergency room with vesicles filled with clear fluid that had appeared all over the body for the past four days. The patient also reported fever, headache, pain when swallowing, and itching. Initially, the rash consisted of pink macules that progressed to papules, vesicles, pustules, and crusts. The patient experienced a cough and shortness of breath one day before the hospital visit but did not report any chest or abdominal pain. Notably, the patient’s two grandchildren had a history of chickenpox. The patient had been living with diabetes for five years and was undergoing treatment with insulin injections. The patient was also an active smoker for 40 years. On physical examination, several vesicles with varying degrees of redness were observed, along with yellow-black crusts, pustules, and erosions. Diagnostic tests revealed multinucleated giant cells on a Tzanck smear; pulmonary inflammation with thickening of the right hilum on a chest X-ray; extended-spectrum beta-lactamases Klebsiella pneumoniae in the sputum culture; and elevated hemoglobin A1c, blood sugar level, and liver and kidney function markers on laboratory examination. Based on the clinical findings, the patient was diagnosed with varicella, community-acquired pneumonia, diabetes, acute renal failure, and elevated transaminase enzymes. The patient was treated with acyclovir, paracetamol, salicylate 2% powder, fusidic acid 2% cream, moxifloxacin, N-acetylcysteine, curcuma, and insulin. The patient’s clinical condition improved, the complaint of dyspnea decreased, and the patient was discharged to outpatient care after eight days of hospitalization. This case highlights that while varicella is rare in the elderly, it often presents with severe varicella pneumonia, making early detection and comprehensive management essential to prevent complications and mortality.

Comparative analysis of synovectomy and total knee replacement in knee joint synovial chondromatosis: A case series

2024-08-24T18:41:19+07:00

Synovial chondromatosis is a rare disorder characterized by cartilaginous growths within the joint lining, often confused with conditions like pigmented villonodular synovitis and rheumatoid arthritis. Primary treatment typically involves surgical synovectomy to remove the affected tissue and loose bodies. Documented cases are limited globally. The aim of this study was to present a case series of synovial chondromatosis and evaluate the functional outcomes by assessing the post-surgical Musculoskeletal Tumor Society (MSTS) score following different surgical interventions (synovectomy alone versus synovectomy with total knee replacement) in a resource-limited setting. Four cases of synovial chondromatosis were reported. A 61-year-old woman with a soft tissue tumor underwent synovectomy and total knee replacement on the right knee, then experienced a periprosthetic infection requiring revision arthroplasty, resulting in an MSTS score of 24. Another case was a 48-year-old woman who had a synovectomy for a lump on the right knee, also achieving an MSTS score of 24. Two additional cases involved women in their mid-to-late 60s who underwent synovectomy for knee lumps, with post-operative MSTS scores of 21 and 19, respectively. This case series underscores the diagnostic and management challenges of synovial chondromatosis in the knee joint, demonstrating various surgical interventions. This case series also suggested that the post-operative MSTS scores were slightly higher (indicating better outcomes) for synovectomy alone compared to synovectomy with total knee replacement, highlighting the need for further research to determine the most effective treatment approach.