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Presenting a conceptual model for decision support systems in infertility: A developmental study
No full textBackground: Infertility is the inability to conceive after a year of trying, resulting in unintentional childlessness. A clinical decision-support system can enhance diagnosis, reduce costs, improve access, and increase treatment accuracy.
Objective: This study aimed to present a conceptual model for decision support systems in infertility.
Materials and Methods: This developmental study, conducted from April-November 2024 in 3 steps. First, PubMed, Scopus, and Web of Science databases were investigated to identify data for decision support systems in infertility. Next, search engines like Google, Yahoo, and Bing, along with artificial intelligence tools such as ChatGPT, Gemini, and Perplexity, helped identify similar systems. Lastly, opinions from 32 infertility experts were collected via a researcher-made questionnaire, with reliability confirmed by Cronbach’s alpha of 0.78 and validity confirmed by content validity ratio of 0.60.
Results: In the first step, 16,310 articles were identified; 10 were selected after removing duplicates and applying inclusion and exclusion criteria. In the second step, 71 relevant systems were identified in search engines; 58 were excluded, leaving 13 for further analysis. In the third step, a researcher-designed questionnaire was distributed to 32 experts, yielding key agreement rates of 94% for monitoring and follow-up, 94% for sperm analysis data, 90% for abortion data, and 82.5% for infertility information from health magazines. Requirements grouped into 4 categories: main features (10 elements), patient info management (19 elements), fertility prediction data (16 elements), and secondary features (3 elements). The model’s overall agreement was 85%.
Conclusion: Developing a decision-support system for infertility could enhance clinical care and outcomes; however, challenges include standardizing validation methods and considering ethnic diversity
Pharmaceutical and Therapeutic Applications of Royal Jelly for Ocular Surface Diseases: A Comprehensive Review
No full textOcular surface diseases (OSDs) are conditions that affect the eye’s surface layers, including the cornea, conjunctiva, and glandular network, causing discomfort, visual disturbances, and tear film instability. OSDs include dry eye disease (DED), blepharitis, meibomian gland dysfunction, keratitis, conjunctivitis, and related disorders. These diseases represent a leading cause of ocular morbidity and are often accompanied by chronic inflammation, irritation, redness, and pain. Royal Jelly (RJ), a substance produced by worker bees, has been widely studied in ophthalmology for its therapeutic properties, including its ability to restore tear secretion, treat glaucoma and DED, and inhibit the production of reactive oxygen species (ROS). RJ is rich in proteins, fatty acids, and phenolic compounds, which contribute to its anti-inflammatory, antioxidant, antibacterial, vasodilatory, antitumor, and cholesterol-lowering properties. This review examines the pharmacological benefits of RJ, strategies to optimize its formulation, and methods for developing eye drop formulations—such as microemulsions and eye gels—for the treatment of OSDs. The literature supports RJ as a complementary therapy for OSDs due to its reported anti-inflammatory, antioxidant, and antimicrobial properties. Although preliminary studies are promising, more extensive clinical trials are required to establish standardized treatment protocols and confirm the efficacy and safety of RJ. The therapeutic potential of RJ components lies in their immunomodulatory properties, making them a compelling option for the treatment of OSDs. Further research is necessary to clarify their role in ocular regenerative medicine and expand their applications in clinical practice
Differential Diagnosis of Corneal Manifestations in Hypovitaminosis and Retinitis Pigmentosa
No full textPurpose: To report on the diagnostic and therapeutic approach in a patient with retinitis pigmentosa (RP), hypovitaminoses, and bilateral corneal involvement.
Case Report: A 62-year-old woman, diagnosed with RP, presented with photophobia, sudden bilateral visual decline, and known long-term night blindness. Ophthalmic examination showed corneal perforation in the right eye, corneal ulcer in the left eye, and bilateral corneal hypoesthesia. She had undergone bariatric surgery and recently suspended vitamin supplementation. Blood tests revealed hypovitaminoses A, D, D3, and E. The patient underwent tectonic keratoplasty in the right eye and received topical therapy in the left eye, and then restarted vitamin supplementation as recommended by the nutritionist. Significant functional recovery was documented in both eyes at 1-, 3-, and 10-month follow-ups.
Conclusion: The case highlights the importance of an integrative approach that includes comprehensive history taking, targeted laboratory work-up, as well as accurate differential diagnosis, especially given the potential multifactorality of ocular symptoms and signs
Should Serum Eosinophil Count Be Considered When Treating Pneumonia?
No full textAim: Eosinopenia is recognized as a potential indicator of infection, particularly in elderly patients and those requiring intensive care. While its established role in sepsis and various bacterial infections is documented, there are limited data on the impact of eosinophil levels in community-acquired pneumonia. This study aims to evaluate the association between low eosinophil counts and the predictive outcomes of pneumonia.
Materials and Methods: Patients admitted with community-acquired pneumonia in our clinic between January and July 2023 were retrospectively evaluated. The demographic, clinical, and laboratory data, comorbidities, length of hospital stay, need for oxygen treatment, or non-invasive mechanical ventilation (NIV) support, and outcome of the infection were recorded. Additionally, complete blood count and biochemical test results were collected.
Results: The study population comprised 116 patients (62 female and 54 male), with a mean age of 68.27±14.67 (21-91). Oxygen support was needed in 56 patients, while 21 cases required NIV; 21 patients were admitted to the intensive care unit (ICU), and 11 patients succumbedto the infection. Although no significant difference was found in eosinophil counts and percentages between patients requiring oxygen and those who did not, or between ICU admissions and discharges, a statistically significant difference was observed between patients who died and those who survived (P < 0.001). Notably, 91% of the deceased cases exhibited absolute eosinopenia (eosinophil count < 50/μL). Receiver operating characteristic (ROC) analysis indicated that eosinophil counts below 15/μL predicted mortality.
Discussion: In our study, eosinopenia observed at hospital admission was identified as a significant marker of mortality in community-acquired pneumonia.
Conclusion: Our findings suggest that eosinopenia, which is readily detectable in routine complete blood counts can serve as a valuable prognostic indicator in pneumonia cases
Familial Mediterranean Fever: Perspective and Round on Uncertainties
No full textIntroduction: Familial Mediterranean fever (FMF) is a hereditary periodic fever characterized by its autosomal recessive nature. The complexity of its presentation and response to treatment poses significant challenges in diagnosing and managing FMF patients. This article aims to shed light on the primary disagreements concerning FMF diagnosis and management, presenting them in a more accessible format through a simplified flowchart based on existing FMF recommendations.
Methods: To conduct this review, we scoured several electronic databases, including PubMed, Google Scholar, and connected papers focusing on FMF recommendations, guidelines, challenges, and conflicting viewpoints. Our search terms included ‘familial Mediterranean fever’ and ‘recommendation’; ‘familial Mediterranean fever’ and ‘guideline’; ‘familial Mediterranean fever’ and ‘update’; ‘familial Mediterranean fever’ and ‘controversies’; ‘familial Mediterranean fever’ and ‘difficulty’. Additionally, we checked the reference lists of relevant journals for further information.
Results: To facilitate understanding, we utilized four algorithmic graphics to summarize the recommendations.
Conclusion: The diagnosis of FMF patients demands a high level of suspicion, particularly in unusual presentations. By highlighting conflicting points and offering a simplified algorithmic flow chart, physicians can better assess the likelihood of FMF, initiate appropriate treatment, and adjust medication dosages as necessary
Assessing the Efficacy of Osteopathic Manipulative Therapy (OMT) in Managing Chronic Back Pain: A Narrative Review
No full textBackground: Osteopathic manipulative therapy (OMT) has attracted attention as a management modality for chronic low back pain (CLBP), a very common and costly problem in primary care. This narrative review intends to evaluate the efficacy of OMT in real-life situations beyond the confines of a predetermined study protocol.
Methodology: The search started with a review of the current literature through published articles on the following search engines: PubMed, Google Scholar, and Scopus. It used combinations of different keywords in various forms, including osteopathic manipulative therapy/treatment, low back pain, and chronic back pain.
Discussion: Several studies point that OMT successfully helps in alleviating pain and increases function in CLBP patients. Overall, patient satisfaction with OMT is quite high. However, challenges arise from the inconsistencies in its usage among osteopathic physicians. Extensive research indicates that OMT may lead to outcomes such as decreased pain intensity, reduced disability, and lower medication usage. However, further studies are required to assess the usefulness of osteopathic techniques in CLBP treatment. Recent trends on OMT suggest that it is useful in the management of CLBP.
Conclusion: Although research supports OMT’s acceptance, barriers remain to its complete integration into the medical field. Additional studies should address the existing evidence lacunae concerning other conditions related to chronic pain management. While it is easier said than done, finally incorporating OMT into real practice will bring all the benefits it is capable of through more effective treatment of the patients
An Infrequent Offender in Hematochezia: Jejunal Gastrointestinal Stromal Tumor
No full textIntroduction: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal (GI) tract. They originate from the interstitial cells of Cajal and exhibit the characteristic cytogenetic marker c-Kit, also known as CD117. While often asymptomatic, life-threatening GI bleeding is one of the possible clinical presentations. Diagnosis relies on imaging, endoscopic or cross-sectional, while histology confirms the diagnosis. Surgery is the therapeutic option of choice in non-metastatic resectable GIST, while targeted molecular therapies are recommended for metastatic or nonresectable lesions.
Case Report: Our patient presented with melena and symptomatic anemia with no apparent source of bleeding on initial esophagogastroduodenoscopy (EGD). Abdominal imaging revealed a lobulated vascular mass in the proximal jejunum, which was surgically resected and confirmed to be a low-grade spindle cell type GIST without metastasis. His postoperative course was uneventful, and he remains asymptomatic with no evidence of recurrence on follow-up imaging at 8 months.
Conclusion: This case highlights the importance of a structured diagnostic approach in GI bleeding and provides a brief review of the current literature on GIST. In the current era of advanced endoscopic techniques, GIST remains one of the clinical scenarios in which surgical intervention still holds the upper hand in definitive patient care for GI luminal bleeding
Risk Management in Clinical Laboratory Based on ISO 15189:2022 for Plasma-based Testing of Prothrombin Time and Activated Partial Thromboplastin Time
No full textIntroduction: In the new ISO 15189:2022 standard, risk management in the clinical laboratory has been hugely emphasized. The purpose of detailed risk analysis and management is to eliminate the known risk factors as much as possible and to minimize the residual risk to an acceptable level. We chose to give precedence to plasma-based tests for Prothrombin time (PT) and activated partial thromboplastin time (aPTT) to conduct a more thorough risk analysis. These tests involve multiple sensitive steps and are overly critical for patient care as test results are self-sufficient to start the treatment.
Methods: We applied risk control measures using FMEA (failure mode and effects analysis) based risk analysis process in every step including all phases of the testing process.
Results: Many risk factors were identified; control measures and continuous surveillance processes were put in place to avoid recurrence of high-risk events that could affect the test results.
Conclusion: It was concluded that with stringent risk management processes in place, risk could be reduced significantly thus minimizing the impact on patient results
The Legal Protection of Biodiversity and the Environment in Indonesia
No full textIn an effort to protect and manage natural resources, Indonesia has issued various policies and laws. One of them is Law No. 32 of 2009 concerning Environmental Protection and Management, which pays great attention to the conservation of natural resources and their ecosystems. However, even though there is a clear legal framework, implementation in the field still faces various challenges, both in terms of policy and implementation at the regional level. Several factors such as budget constraints, land use conflicts, and weak supervision have caused this conservation to not run optimally. Indonesia has various legal regulations that support the preservation of biological resources. One of them is Law No. 5 of 1990 concerning Conservation of Biological Natural Resources and Ecosystems, which is the main legal basis for protecting flora and fauna and their habitats. This law includes the establishment of conservation areas such as nature reserves and national parks, which aim to maintain biodiversity. In addition, Law No. 41 of 1999 concerning Forestry also regulates forest management and includes measures to prevent deforestation and forest degradation. This law is complemented by a moratorium policy on new permits in primary forest areas and peatlands, which has been proven to be able to reduce the level of deforestation in Indonesia. The writing method used in this scientific paper is the normative legal writing method, which uses references to literature, library materials, and applicable legal regulations as data sources. This is also known as library research or a method used to collect data from various literatures
The Role of Law in Tackling Climate Change
No full textClimate change is a significant change in climate, air temperature, and precipitation over a long period of time (from decades to millions of years). Law plays a vital role in addressing climate change, through regulatory frameworks, policies, and sanctions to reduce greenhouse gas emissions, protect natural resources, and promote sustainable adaptation and mitigation. National and international laws play a vital role in regulating various aspects of climate change, from emission control to natural resource management. Various countries make policies to reduce the causes of global warming, given that its impact is massive and unpredictable. Early awareness of global warming is expected to reduce and keep the environment safe. Global warming can affect the weather, increasing temperatures, causing icebergs in the northern part of the earth to melt, causing the land to narrow. On October 3, 2009, the Government of the Republic of Indonesia ratified and enacted Law Number 32 of 2009 concerning Environmental Protection and Management. In the point of consideration, it is explained that increasing global warming causes climate change, which worsens the decline in environmental quality. Therefore, environmental protection and management are needed. Environmental protection and management are systematic and integrated efforts made to preserve environmental functions and prevent environmental pollution and/or damage, which include planning, utilization, control, maintenance, supervision, and law enforcement. The method used in this study is a literature study. Data collection from the literature study is taken from various sources such as the internet, journals, and books. Sources from the internet are taken from Google Scholar, Google Books, and websites. The data that has been obtained is then described using a descriptive method, which is not only descriptive but also sufficient and easy-to-understand