Narra J (Journal)
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Non-dominant handgrip strength is associated with higher cardiorespiratory endurance and elevated NT-proBNP concentrations in ambulatory male adult outpatients with stable HFrEF
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
Knowledge, attitude, and practices of midwives on premature rupture of membranes (PROM): A cross-sectional study in Samosir and Toba, Indonesia
Indonesia has a significantly higher maternal mortality ratio (MMR) than other countries in Southeast Asia, and infection is one of the most common causes of maternal deaths, of which premature rupture of membranes (PROM) can be the consequence of the infections. In primary healthcare settings, midwives play an important role in identifying and managing PROM appropriately; however, studies on their knowledge, attitudes, and practices related to PROM are limited. The aim of this study was to determine the midwives' knowledge, attitude and healthcare practice on PROM in Indonesia. A cross-sectional study was conducted among midwives at primary healthcare facilities in Samosir and Toba Regency, North Sumatra, Indonesia, from July to November 2022. The knowledge, attitude and practice towards PROM were assessed. Results showed that 57.5% of midwives had poor knowledge and 35.1% had poor attitude levels. There were 4.9% of midwives referred the patients immediately to the hospital. Our data indicated that aged 31−40 or 41−50 years, having a lower than bachelor degree and having a higher monthly number of referred PROM patients were significantly associated with poor knowledge compared to younger, having a bachelor degree, and lower monthly referral patient number, respectively. Similarly, younger, having higher degree and a having lower monthly referral number of PROM cases were associated with higher chances of having a sufficient-good attitude towards PROM. This study highlights that a significant percentage of midwives had poor levels of knowledge and attitude, and age, educational level and monthly referral number of PROM cases were associated with the level of knowledge and attitude
Correlation between circulating fibrosis biomarkers with left atrial function and left atrial volume index in rheumatic mitral stenosis
Mitral stenosis is the most common rheumatic heart disease (RHD) disorder worldwide, including in Indonesia. This pathological condition causes left atrial pressure, leading to left atrial fibrosis that affects the structure and function of the left atrial as well as the clinical condition. The aim of this study was to assess the correlation between circulating fibrosis biomarkers with net atrioventricular compliance (Cn) as a parameter of left atrial function, and left atrial volume index (LAVI) as a parameter left atrium structure of changes. A cross-sectional study was conducted at Panti Rahayu Hospital and Permata Bunda Hospital, Purwodadi, Central Java, with a total of 40 RHD patients with severe mitral stenosis. The ELISA was used to measure the levels of carboxy-terminal propeptide of type I procollagen (PICP), matrix metalloproteinase I (MMP-1), tissue inhibitor matrix metalloproteinase 1 (TIMP-1), and transforming growth factor-β1 (TGF-β1). The left atrial function was assessed by measuring Cn, and the LAVI parameters were measured to assess left atrium structure/size. The mean levels of circulating fibrosis biomarkers were as follows: PICP 153.96±89.12 ng/mL; MMP-1 1.44±2.12 ng/mL; MMP-1/TIMP-1 ratio 0.38±0.54 and TGF-β1 2.66±1.96 pg/mL. From the echocardiographic evaluation, the mean Cn was 5.24±1.93 mL/mmHg and the mean LAVI was 152.55±79.36 mL/m2. There were significant correlation between MMP-1 and MMP-1/TIMP-1 ratio with Cn (r=0.345 and r=0.333, respectively; both had p<0.05). PICP and TGF-β1 biomarkers did not significantly correlate with Cn (p>0.05). Meanwhile, none of the biomarkers had a significant correlation with LAVI (p>0.05). This study highlights that MMP-1 and MMP-1/TIMP-1 ratio are potentially to be used as markers to determine the Cn in RHD patients with severe mitral stenosis. However, further studies with a higher sample size are needed to confirm this finding
Metabolism and diabetes in Ramadan fasting: Exploring health trends and relationships through systematic literature network analysis
Ramadan fasting is widely acknowledged for its positive impacts on health, yet it also presents inherent risks, prompting a need for comprehensive exploration into its metabolic implications and its effects on diabetes. This study introduces a novel methodology called systematic literature network analysis (SLNA), which merges bibliometric analysis with systematic literature review (SLR). The aim of this study was to examine the global research landscape concerning Ramadan fasting, metabolism, and diabetes. Through the systematic search strategy, 206 relevant documents were analyzed. Through co-occurrence analysis mapping, the study uncovered four distinct cluster groups, revealing intricate relationships and evolving trends within the field. Moreover, the trajectory of research publications on Ramadan fasting from 2001 to 2023 was tracked, highlighting a growing interest in this domain. The bibliometric analysis emphasized a consensus regarding the beneficial effects of Ramadan fasting on individual health, particularly in improving lipid profiles, managing body weight, regulating glucose levels, and nutrient intake. However, significant variations in research focus were observed across predominantly Muslim countries, with notable exceptions like Indonesia and Brunei Darussalam absent among the top contributors. Furthermore, the analysis shed light on the balanced selection of research subjects by authors, indicating a nuanced approach to exploring the multifaceted aspects of Ramadan fasting, metabolism, and diabetes. These findings offer significant perspectives for researchers aiming to contextualize their studies within the wider conversation on this subject, thereby aiding in a more profound comprehension of the intricate relationship between fasting, metabolic functions, and the management of diabetes
Comparative study of anti-SARS-CoV-2 receptor-binding domain total antibody titer before and after heterologous booster with mRNA-based COVID-19 vaccine
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
Association between vitamin D levels with IL-6 and IL-10 in umbilical cord blood of infants
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
Estimate the relationship between CXCR4-SDF-1 axis and inhibitory molecules (CTLA4 and PD-1) in patients with colon cancer
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
Urinary level of 1,2-dichloroethane and its effects on blood biochemical markers among outdoor workers exposed to air pollution in Thailand
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
Exploring links between visuospatial ability and anatomy learning in education: A bibliometric analysis and scientific mapping
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
Prevalence and associated risk factors of musculoskeletal disorders among information technology (IT) professionals: A systematic review
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