Narra J (Journal)
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Development and validation of clinical prediction score for mortality in tuberculosis patients
Get PDFTuberculosis (TB) remains a global and national public health concern, with mortality posing a significant challenge in treatment programs. The aim of this study was to develop a simple risk-scoring system to predict mortality among TB patients and assess its applicability in resource-limited settings. Data from TB patient registries in Phichit Province, Thailand, covering from January 1, 2017, to December 31, 2020, were used. Eligible participants were aged ≥18 years, having completed treatment or death. A risk score was developed and internally validated using logistic regression. Coefficients were used to assign weighted points to predictors and applied to a validation cohort to assess diagnostic performance. The performance was evaluated by generating a receiver operating characteristic (ROC) curve. The study included 2,196 participants, randomly allocated into derivation (n=1,600) and validation (n=596) cohorts. The risk score included Charlson Comorbidity Index scores (1–2 points and ≥3 points) and TB meningitis. It showed an area under ROC curve (AuROC) of 74.34% (95%CI: 70.80–77.88%) with good calibration (Hosmer-Lemeshow χ2: 0.53; p= 0.97). Positive likelihood ratios for low (≤3) and high (≥6) risk were 1.06 (95%CI: 1.03–1.09) and 31.62 (95%CI: 7.23–138.37), respectively. In the validation cohort, AuROC was 79.50% (95%CI: 74.40–84.60%), with 75% and 100% certainty in low- and high-risk groups. In conclusion, this simple risk score, using routine data and two predictors, can predict mortality in TB patients. It may aid clinicians in planning appropriate care strategies. Nevertheless, the tool should undergo external validation before being implemented in clinical practice
Association of MPV, NLR, PLR and CRP on testicular salvage in testicular torsion: A systematic review and meta-analysis
Get PDFTesticular torsion, a critical urological emergency caused by twisting of the spermatic cord, poses a risk of ischemia, particularly in children who often struggle to pinpoint symptoms onset. Delay in managing testicular torsion can lead to the need for orchiectomy. The aim of this study was to assess the association between hematologic parameters—mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP)—and testicular salvage in cases of testicular torsion. Four databases (PubMed, Embase (Ovid), Science Direct, and Scopus) were systematically searched for eligible studies published up to November 4, 2024. The primary outcome was testicular salvage. Sensitivity analysis was performed using leave-one-out plot. Subgroup analysis was performed based on age, country, region, duration to orchiopexy and duration to orchiectomy. Heterogeneity was examined using I² statistics, and a random-effect model was applied. Out of 363 studies identified, nine observational studies involving 796 patients were included, with 338 (42.3%) in orchiopexy group. The meta-analysis indicated that MPV value was significantly elevated in orchiectomy group (mean difference (MD): -0.4; 95% confidence interval (95%CI): -0.62–(-0.18); p<0.01), with higher MPV levels associated with an increased likelihood of orchiectomy (odds ratio (OR): 2.12; 95%CI: 1.35–3.33; p<0.01). NLR, PLR, and CRP showed no significant association with testicular salvage, as demonstrated by pooled MD and OR analyses (p>0.05). No significant differences were observed after sensitivity and subgroup analysis (p>0.05). These findings suggest that elevated MPV levels are associated with non-salvageable testis, requiring orchiectomy highlighting its potential utility in clinical evaluation for testicular torsion
Resistance status of Aedes mosquitoes as dengue vectors and the potential of plant larvicides from Indonesia for biological control: A narrative review
Get PDFDengue fever remains a major public health threat in Indonesia, exacerbated by rising insecticide resistance in Aedes aegypti. Strategies relying on chemical insecticides, while initially effective, have led to widespread resistance in mosquito populations. This resistance is particularly pronounced in areas such as Java, where the extensive use of insecticides, including organophosphates and pyrethroids, has been documented. To address this challenge, one promising alternative is the utilization of biolarvicides derived from local Indonesian plant materials. Biolarvicides are environmentally friendly, safe, and have the potential to mitigate the adverse impacts associated with chemical insecticides. Numerous studies have explored the larvicidal properties of indigenous plants native to Indonesia, demonstrating their efficacy against A. aegypti. The aim of this study was to examine insecticide resistance in Aedes mosquitoes across Indonesia, highlighting geographical variations and underexplored regions, and exploring plant-based biolarvicides as sustainable alternatives. Biolarvicides derived from native Indonesian plants could be eco-friendly alternative for dengue vector management. Their integration into existing control strategies could significantly enhance efforts to control dengue while reducing the environmental and health risks posed by chemical insecticides
Helicobacter pylori sabA, hopQ and hom genotypes as potential genetic biomarkers for gastric mucosal inflammation
Get PDFHelicobacter pylori infection drives heterogeneous gastric pathologies, yet genotype-phenotype correlations in diverse populations remain underexplored. The aim of this cross-sectional study was to investigate the associations between H. pylori virulence genotypes (sabA, hopQ, hom family) and histopathological severity in gastric mucosa among 113 Indonesian dyspepsia patients (mean age: 49.6 years; male predominance: 64.6%). Whole-genome sequencing characterized virulence genotypes, while histopathological grading system using the Updated Sydney System assessed inflammation, atrophy, and bacterial density in the antral and corporal gastric regions. Phylogenetic analysis elucidated strain relatedness. Key genotype frequencies included sabA "on" (40.6%, 43/106), hopQ type I (53.7%, 43/80), and homCL (82.4%, 75/91). Statistical analysis revealed sabA "on" status significantly associated with elevated antral bacterial density (odds ratio (OR) 2.70 and 95% confidence interval (95%CI) 1.10–6.60, p=0.027). The homC variants (homCL/homCS) demonstrated robust associations with chronic inflammation severity (OR: 3.04; 95%CI: 0.99–9.36, p=0.046) and atrophy progression (OR: 4.78; 95%CI: 1.00–22.86, p=0.035), in contrast to the hopQ genotype, which showed no histopathological association. These findings indicated that sabA and homC as critical determinants of gastric microenvironment modulation, potentially through sabA-mediated colonization efficiency and homCL-babA synergistic interactions. While histological profiles predominantly indicated mild atrophy, widespread severe chronic inflammation signals latent progression risks
Evaluating socio-demographic, behavioral, and maternal factors in the dual burden of malnutrition among school-aged children in Batam, Indonesia
Get PDFMalnutrition among school-aged children in urban-industrial settings presents a dual burden of undernutrition and overnutrition. The aim of this study was to examine factors influencing the nutritional status of elementary school children in Batam, Indonesia. A case-control study was conducted in Batam, focusing on children aged 6–12 years, with malnourished cases (undernutrition and overnutrition) and well-nourished controls, along with their mothers. Respondents were selected through stratified random sampling from public elementary schools. Inclusion criteria encompassed children enrolled in these schools, while exclusion criteria involved children with chronic health conditions. Data were collected via structured interviews utilizing validated questionnaires, anthropometric assessments (weight-for-age and height-for-age), and parent-reported socioeconomic, behavioral and family characteristics. Statistical analysis involved binary logistic regression to identify significant risk factors associated with malnutrition. A total of 188 children, including 94 malnourished cases (40 undernutrition and 54 overnutrition) and 94 well-nourished controls. The findings revealed significant differences between cases and controls in socioeconomic factors (pocket money (p=0.027), family income (p=0.042)), behavioral factors (sedentary activity (p=0.019), dietary habits (p=0.037)) and family factors (maternal BMI, p=0.011; maternal nutritional knowledge, p=0.004; parenting style, p=0.035). Dominant risk factors for malnutrition (undernutrition or overnutrition) included poor dietary habits (adjusted odds ratio (aOR): 0.451; 95%CI: 0.225–0.901; p=0.024), maternal obesity class II (aOR: 0.126; 95%CI: 0.030–0.535; p=0.005), and low maternal nutritional knowledge (aOR: 0.294; 95%CI: 0.124–0.696; p=0.005). Targeted family-centered interventions focusing on dietary practices and maternal education are therefore recommended to address this issue
Comparison of anti-SARS-CoV-2 IgG seropositivity among vaccinated, unvaccinated, and COVID-19 survivor individuals: A cross-sectional study in Palembang, Indonesia
Get PDFMeasurement of anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody levels provides evidence of prior infection or vaccination. Persistent vaccine hesitancy underscores the importance of robust, evidence-based data to inform policy decisions. The aim of this study was to compare anti-SARS-CoV-2 IgG seropositivity among vaccinated individuals, unvaccinated individuals, and coronavirus disease 2019 (COVID-19) survivors in the community during the pandemic. In this cross-sectional study, 517 participants were enrolled, including 167 vaccinated individuals, 97 COVID-19 survivors, and 253 unvaccinated individuals, selected through multistage cluster sampling of 40 clusters. Anti-SARS-CoV-2 IgG seropositivity was defined as ≥50 AU/mL. Multivariable logistic regression was performed to evaluate associations between group type and seropositivity, adjusting for demographic factors, COVID-19 symptoms, hypertension, and body mass index (BMI). Vaccinated individuals demonstrated significantly higher odds of seropositivity compared with unvaccinated participants (odds ratio (OR)=5.60; 95% confidence interval (CI): 2.36–13.27). Covariates independently associated with seropositivity (p<0.05) included the presence of COVID-19 symptoms, hypertension, and BMI. Vaccination was strongly associated with increased anti-SARS-CoV-2 IgG seropositivity in the community, independent of clinical and demographic factors. These findings support ongoing vaccination campaigns and highlight the relevance of comorbidities and symptomatic history in shaping humoral immune responses
Determinants of mortality in relationship between clinical and laboratory characteristics with the outcomes of children with diphtheria: A cross-sectional study at a national hospital of Sumatra region in 2020–2023
Get PDFIn 2017, diphtheria outbreaks occurred in several provinces in Indonesia; however, the epidemiological data in the country is limited. The aim of this study was to determine the association between clinical findings and laboratory parameters associated with mortality of children with diphtheria. A retrospective cohort study was conducted at Haji Adam Malik General Hospital, Medan, Indonesia, covering diphtheria patients from January 2020 to December 2023. All patients aged 1–18 years clinically diagnosed with diphtheria were considered eligible. The associations between demographic characteristics, clinical features, immunization status, complications, and laboratory profiles with mortality were determined using Fisher's exact test, and the odds ratio (OR) with a 95% confidence interval (95%CI) was calculated. Our data indicated that the clinical characteristics of myocarditis (p=0.005) and airway obstruction (p=0.003) were associated with mortality. There was also a significant association between thrombocytopenia (p=0.020) and mortality in diphtheria patients. Patients with airway obstruction were 13 times more likely to have an increase in mortality compared to patients without airway obstruction. This study highlights that clinical and laboratory characteristics could be associated with in-hospital mortality of diphtheria cases, and therefore, pediatricians should be aware of the presence of those characteristics to prevent the mortality of the patients
Impacts of digital social media detox for mental health: A systematic review and meta-analysis
Get PDFThe impact of social media has been significant on various aspects of life, particularly mental health. Growing concerns about the adverse effects of social media use have prompted the exploration of experimental interventions, defined as digital detox interventions. However, it remains unclear whether digital detox interventions are effective for mental health outcomes. The aim of this study was to provide comprehensive insights into the effects of digital detox interventions on various mental health outcomes, including depression, life satisfaction, stress, and mental well-being. Following the PRISMA guidelines, systematic searches were carried out in online databases, including PubMed and ScienceDirect, within the publication range of 2013 and 2023. A total of 2578 titles and abstracts were screened, and 10 studies were included in the analysis. A risk of bias assessment was conducted using RoB 2.0 and the Newcastle-Ottawa scale, while statistical analysis was conducted using RevMan 5.4.1. Our data indicated a significant effect of digital detox in mitigating depression with the standardized mean difference (SMD: -0.29; 95%CI: -0.51, -0.07, p=0.01). No statistically significant effects were discerned in terms of life satisfaction (SMD: 0.20; 95%CI: -0.12, 0.52, p=0.23), stress (SMD: -0.31; 95%CI: -0.83, 0.21, p=0.24), and overall mental well-being (SMD: 0.04; 95%CI: -0.54, 0.62, p=0.90). These data underscore the nuanced and selective influence of digital detox on distinct facets of mental health. In conclusion, digital detox interventions significantly reduce depressive symptoms, suggesting that intentional reduction or cessation of digital engagement may help alleviate contributing factors. However, no statistically significant effects were observed in mental well-being, life satisfaction, and stress. This discrepancy may be due to the complex nature of these constructs, involving various factors beyond the scope of digital detox interventions
Psychosocial and emotional well-being of Syrian refugee children and adolescents in Jordan: In-camp versus out-of-camp comparative analysis
Get PDFThere is a notable gap in understanding how different living arrangements influence the psychosocial and emotional well-being of Syrian refugee children and adolescents. Moreover, limited literature exists on the comparison between in-camp and out-of-camp living situations. The aim of this study was to compare the psychosocial and emotional status between camp and non-camp Syrian refugee children and adolescents living in Jordan. A nationwide school survey was conducted in Jordan from December 2022 to April 2023 and targeted children (8–11 years) and adolescents (12–18 years), encompassing Jordanians, Syrians, and Palestinians, both in camps (camp refugees) and urban areas (urban refugees). In this paper, the analysis was limited to Syrian refugees. A total of 1,420 children and 1,249 adolescents were included. Children in camps had higher rates of hyperactivity (12.7% vs 8.3%) and total difficulties (19.3% vs 13.9%) compared to urban dwellers. However, they had lower rates of bedtime problems (12.8% vs 17.0%) and problematic internet use (19.9% vs 34.8%). Camp adolescents had higher rates of separation anxiety disorder (44.0% vs 37.8%) and conduct problems (22.2% vs 15.0%), but lower rates of poor physical functioning (43.3% vs 52.3%) compared to urban adolescents. Adjusted analysis showed lower odds of generalized anxiety disorder (OR=0.59), problematic internet use (OR=0.39), and bedtime problems (OR=0.67) for camp children. However, they had higher odds of emotional symptoms (OR=1.47), hyperactivity (OR=2.08), and overall difficulties (OR=1.50). Camp adolescents had higher odds of overall difficulties (OR=1.49) but lower odds of poor physical functioning (OR=0.67) compared to urban adolescents. In conclusion, children in refugee camps had lower rates of problematic internet use and bedtime issues but higher rates of hyperactivity and overall difficulties than urban children. Similarly, camp adolescents faced more total difficulties but reported better physical functioning than their urban peers. The complex interplay between living conditions and well-being underscores the need for tailored mental health interventions for displaced populations
Recent update on cerebral sparganosis: A bibliometric analysis and scientific mapping
Get PDFHuman sparganosis, a parasitic infection prevalent in Asia, can progress to cerebral sparganosis, a severe condition with significant neurological symptoms. Diagnosis and treatment are challenging due to its clinical similarity to other infections, highlighting the need for improved detection and management strategies. The aim of this study was to observe research trends, key contributors, gaps in the existing knowledge, diagnosis challenges, effective treatment options, and prevention strategies, providing recommendations for future research directions and clinical practice improvements on cerebral sparganosis. A bibliometric analysis was conducted by extracting 139 documents from the Scopus database in June 2024. The retrieved data were analyzed using the R package's Bibliometrix (Biblioshiny) and VOSviewer. Spanning 97 different sources, the research exhibited an annual growth rate of 2.5%. Annual scientific production revealed fluctuating research activity with peaks in 2010 and 2011 and notable citation peaks in 1996 and 2005, indicating pivotal studies that significantly influenced subsequent research. Early studies focused on diagnosis and specific parasites, while recent studies (2010–2024) have increasingly addressed clinical outcomes, treatment strategies, and advanced diagnostic techniques. Trends revealed a shift towards clinical and diagnostic advancements, with recent emphasis on diagnostic imaging, immunoassays, and the relationship between cerebral sparganosis and brain tumors. In conclusion, the studies on cerebral sparganosis underscore the potential for enhancing clinical practice by improving diagnostic accuracy, informing treatment decisions, and implementing targeted screening efforts based on epidemiology and risk factors. Recommendation to further study needs to notify the cerebral sparganosis in high-risk countries with similar socioeconomic and cultural characteristics to endemic regions, including Indonesia