Narra J (Journal)
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Role of pediatric risk of mortality (PRISM IV) score at 24 and 72 hours of hospitalization in predicting mortality among critically ill pediatric patients treated in PICU
Get PDFPediatric patients with multiple organ failures in the pediatric intensive care unit (PICU) are at a higher risk of mortality. Assessing the mortality risk when patients are admitted to PICU is important to allocate treatment and care properly. The aim of this study was to compare the performance of the PRISM IV score within the first 24 and 72 hours to predict mortality in the PICU. Demographic, clinical, and laboratory data were collected to compute the PRISM IV in the first 24 and 72 hours among critically ill pediatric patients in the PICU at H. Adam Malik General Hospital, Medan, Indonesia, from April 2021 to February 2022. The comparison of the PRISM IV scores and its components within the first 24 and 72 hours was analyzed using the Wilcoxon test, Student’s independent t-test or McNemar test. The role of PRISM IV score in predicting mortality was assessed using the receiver operating characteristic (ROC) curve. Out of 35 pediatric patients, 17 (48.6%) of them died. Platelet count (p=0.022), pCO2 (p=0.026), HCO3 (p=0.009), total CO2 (p=0.015), and base excess (p=0.001) were statistically different between 24 and 72 hours groups. The area under curve (AUC) for the first 24 hours using PRISM IV scores was 47.4% with p=0.792 (95%CI, 27.7%–67.1%). Meanwhile, the AUC of 72 hours group was 65.4%, p=0.121 (95%CI, 47.1%–83.6%). This study suggested that PRISM IV scores in the first 24 and 72 hours may not be a reliable screening tool for predicting mortality. However, further studies are suggested to validate these findings
Role of serum estradiol and C-telopeptide on musculoskeletal pain in menopausal women
Get PDFMusculoskeletal pain is one of the common symptoms of menopause syndrome throughout the world. Estradiol is the most potent and abundant derivative of estrogen and is associated with musculoskeletal pain, stiffness, and depressed mood during the menopausal transition. C-telopeptide is a molecule released during osteoclastic bone resorption and degradation of type I collagen, which is reported to have higher levels in individuals with musculoskeletal pain. An observational analytical study with a cross-sectional design was used in this research. Estradiol and C-telopeptide levels were measured in this study using enzyme-linked immunosorbent assay (ELISA). Musculoskeletal pain was assessed using the Nordic Musculoskeletal Questionnaire (NMQ) and the Menopause Quality of Life Questionnaire (MENQOL). Musculoskeletal pain was determined if the participant answered “yes” on questions number 12, 14 and 25 on the MENQOL. Data analysis was performed using the independent Student t-test for normally distributed data and the Mann-Whitney test for non-normally distributed data. A correlation test was performed using the Pearson correlation test for normally distributed data and the Spearman correlation test for non-normally distributed data. The results showed a non-significant relationship between estradiol and C-telopeptide levels with musculoskeletal pain assessed using the NMQ or MENQOL questionnaires. The correlation test also showed no correlation between estradiol and C-telopeptide levels in women with and without musculoskeletal pain
Inhibition of B-cell activating factor activity using active compounds from Physalis angulata in the mechanism of nephrotic syndrome improvement: A computational approach
Get PDFNephrotic 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
Navigating the aftermath: Risk factors of recurrence following coronary bypass surgery in Indonesia
Get PDFCoronary 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
Norwegian scabies in human immunodeficiency virus and tuberculosis-infected child: A case report
Get PDFNorwegian scabies is a rare scabies with the manifestation of thick crusts of the extremities of the skin that contain eggs and mites. Several conditions in which scabies infection is easily transmitted include immunocompromised, home nursing, and severe neurological disorder. The aim of this case report was to present a thorough analysis of a comprehensive resource for the management of Norwegian scabies patients, with a specific focus on individuals who also have HIV or other immunocompromising diseases. A 1-year-and-7-month-old boy was presented to the hospital with a chief complaint of a thick crust that he had experienced for four months. It began as a red papule in the lower extremity, then crusted and spread to the whole body. The patient kept scratching due to itching, had a recurrent fever and diarrhea for three months, and cough for one month. The patient was diagnosed with human immunodeficiency virus (HIV) and pulmonary tuberculosis at three months, suspected to get the infection from the parents. Sarcoptes scabiei was found from microscopy examination of skin scraping. The patient received holistic treatment, including antiretroviral drugs, antituberculosis medication, scabies treatment, and malnutrition treatment. Appropriate scabies treatment aimed at peeling crusted skin, relieving itching, and increasing the patient ability to use the extremities. Comorbidity conditions caused by HIV and pulmonary tuberculosis should also be treated to optimize the outcome. The patient was discharged in good condition with sanitation education and regular follow-up at the outpatient clinic. This case highlights that Sarcoptes scabiei infestation may be a clue to an immunocompromised condition. Holistic therapy aiming to cure underlying infection, infestation and underlying nutrition and psychosocial problems must be addressed to fully cure this high-burden case
Comparison of pre- and post-implantation of Indonesian-made plates in fracture patients: Functional, radiological, biomechanical and chemical analyses
Get PDFBone implants are important in the recovery of fractures and degenerative diseases. Although many implants have been marketed, study on Indonesian-made plates is still limited. The aim of this study was to assess the patients’ functional and radiological improvements and biomechanical and chemical changes of Indonesian-made plates used in long bone fractures. retrospective study was conducted at Semen Gresik Hospital, Gresik, Indonesia. This study included adult patients with long bone fractures who had surgeries with Indonesian plates. Functional improvement (assessed using disabilities of arm, shoulder, and hand (DASH) or lower extremity functional scale (LEFS)) and radiological data (assessed using radiographic union score (RUS)) were assessed in week 4 and month 6, 12, and 15 after surgery. Biomechanical changes (hardness and roughness test) and chemical analysis were assessed after 15 months of use. The normality of the data was tested with Shapiro-Wilk while data analysis was conducted using paired Student t-test or Friedman test as appropriate with type of data. Our data indicated that the DASH and LEFS functional scores had significant improvement over the follow-ups indicating functional recovery. RUS scores also improved over time, indicating a good healing process. Hardness tests on post-surgery implants showed a decrease in hardness of 7.3% and an increase of 3.3% in roughness. Chemical analysis showed a reduction in chemical levels in the implant of 7.8%, indicating durability and minimal toxicity. This study highlights that Indonesian implants have been proven safe to use in fractures. Further examinations with a larger sample and a longer duration of monitoring are recommended for stronger validity
Aspirin-clopidogrel combination therapy for ischemic stroke patients: Clinical efficacy and cost-effectiveness analyses in low-resource setting
Get PDFUnderstanding the cost-effectiveness of aspirin-clopidogrel combination therapy is crucial in determining its influence on coagulation parameters, specifically prothrombin time (PT) and activated partial thromboplastin time (APTT). The aim of this study was to assess the cost-effectiveness and clinical impact of using the aspirin-clopidogrel combination compared to aspirin alone in managing ischemic stroke. Employing an observational research design, inpatient ischemic stroke cases receiving the aspirin-clopidogrel combination were compared to those treated with aspirin alone. Focusing on the hospital's perspective on costs, the research specifically analyzed medical expenses without discounting costs or effects. The analysis involved comparing the direct medical costs and coagulation parameters between the two treatment groups. Our data revealed that the aspirin-clopidogrel combination demonstrated superior cost-effectiveness over aspirin alone, indicated by the incremental cost-effectiveness ratio (ICER) values for PT (IDR -246,930/second) and APTT (IDR -119,270/second). This indicated that the combination therapy was associated with lower costs while yielding better clinical parameter values. The ICER analysis placed the aspirin-clopidogrel combination in the southeast quadrant, marking its dominance over aspirin monotherapy by demonstrating higher effectiveness at lower costs. These results suggest that combination therapy might be a favorable alternative for managing ischemic stroke, presenting a viable option for consideration in clinical practice. The findings underscore the potential economic and clinical advantages of employing the aspirin-clopidogrel combination in routine stroke management protocols
Antioxidant, anti-collagenase, and antibacterial activities of Fucus vesiculosus silver nanoparticles
Get PDFFucus 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
Intravenous administration of iron dextran as a potential inducer for hemochromatosis: Development of an iron overload animal model
Get PDFIron 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
Exploring the anti-inflammatory and anti-apoptotic properties of phloroglucinol on pancreatic cells in diabetic models: In silico and in vivo study
Get PDFPancreatic 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