Narra J (Journal)
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Comparative analysis of hemotoxic, myotoxic, and inflammatory profiles of Calloselasma rhodostoma and Trimeresurus insularis venoms in mice
Full text linkSnakebite envenomation remains a significant medical concern, particularly in tropical regions where venomous snakes such as Calloselasma rhodostoma and Trimeresurus insularis are prevalent. Both venoms are known for their potent hemotoxic, myotoxic, and inflammatory effects, yet their differential impacts on systemic physiological pathways remain unclear. The aim of this study was to characterize the hematological, myotoxic, and inflammatory effects of C. rhodostoma and T. insularis venoms in a murine model and to explore their influence on systemic factors such as insulin-like growth factor 1 (IGF-1), which is critical for muscle repair and inflammation regulation. Mice were exposed to varying doses (20–100 µg) of C. rhodostoma and T. insularis venoms. Hematological parameters, muscle degeneration, inflammatory cell infiltration, and plasma IGF-1 levels were assessed to evaluate the venoms' systemic and local effects. Our data indicated that C. rhodostoma venom induced significant changes in blood coagulation, muscle edema, and inflammatory infiltration, with pronounced effects even at lower doses. Conversely, T. insularis venom showed a dose-dependent suppression of IGF-1 levels, highlighting its unique systemic impact. Both venoms caused severe muscle damage, characterized by structural disintegration and increased leukocyte infiltration, with C. rhodostoma eliciting a stronger inflammatory response at lower doses.Snakebite envenomation remains a significant medical concern, particularly in tropical regions where venomous snakes such as Calloselasma rhodostoma and Trimeresurus insularis are prevalent. Both venoms are known for their potent hemotoxic, myotoxic, and inflammatory effects, yet their differential impacts on systemic physiological pathways remain unclear. The aim of this study was to characterize the hematological, myotoxic, and inflammatory effects of C. rhodostoma and T. insularis venoms in a murine model and to explore their influence on systemic factors such as insulin-like growth factor 1 (IGF-1), which is critical for muscle repair and inflammation regulation. Mice were exposed to varying doses (20–100 µg) of C. rhodostoma and T. insularis venoms. Hematological parameters, muscle degeneration, inflammatory cell infiltration, and plasma IGF-1 levels were assessed to evaluate the venoms' systemic and local effects. Our data indicated that C. rhodostoma venom induced significant changes in blood coagulation, muscle edema, and inflammatory infiltration, with pronounced effects even at lower doses. Conversely, T. insularis venom showed a dose-dependent suppression of IGF-1 levels, highlighting its unique systemic impact. Both venoms caused severe muscle damage, characterized by structural disintegration and increased leukocyte infiltration, with C. rhodostoma eliciting a stronger inflammatory response at lower doses
Comparative predictive value of APACHE-II, SAPS-II and GRACE scores for mortality in acute coronary syndrome (ACS) patients: Evidence from Indonesia intensive cardiovascular care unit registry
Full text linkThe Global Registry of Acute Coronary Events (GRACE) score is acknowledged for its ability to predict in-hospital mortality among patients with acute coronary syndrome (ACS). However, intensive care physicians often employ general prognostic scores such as Acute Physiologic and Chronic Health Evaluation II (APACHE-II) and Simplified Acute Physiology Score II (SAPS-II) to predict the mortality of ACS patients. However, their predictive values are not well-determined in predicting mortality in ACS treated in the cardiovascular care unit (CVCU). The aim of this study was to evaluate the performance of APACHE-II and SAPS-II scores in comparison with GRACE scores in predicting the CVCU mortality and in-hospital mortality of ACS patients admitted to CVCU. A multicenter retrospective cohort study was conducted using data from a registry of patients admitted to 10 hospitals in Indonesia between August 2021 and July 2023. This study evaluated the APACHE-II, SAPS-II, and GRACE scores for patients with ACS upon admission to CVCU. The area under the curve (AUC) of the receiver operating characteristic (ROC) was utilized to assess the discriminative ability for predicting mortality. Among the 12,950 admitted patients, 9,040 were diagnosed with ACS, and 6,490 patients were included in the final analysis. All three scoring systems had relatively good discriminative ability to predict CVCU mortality with APACHE-II having better results (AUC: 0.771; sensitivity: 63.9%; specificity: 78.7%) compared to GRACE (AUC: 0.726; sensitivity: 61.7%; specificity: 73.2%) and SAPS-II (AUC: 0.655; sensitivity: 38.9%; specificity: 85.2%). To predict in-hospital mortality, APACHE-II had better results (AUC: 0.815; sensitivity: 68.7%; specificity: 80.4%) compared to GRACE (AUC: 0.769; sensitivity: 64.6%; specificity: 77.5%) and SAPS-II (AUC: 0.683; sensitivity: 41.8%; specificity: 86.2%). APACHE-II had the best single risk factor for CVCU mortality (odds ratio (OR): 1.198; 95% confidence interval (CI): 1.181–1.214) and in-hospital mortality (OR: 1.259; 95%CI: 1.240–1.279). In conclusion, APACHE-II, SAPS-II, and GRACE scores moderately predict CVCU and in-hospital mortalities, with the APACHE-II score exhibiting the highest predictive capability in ACS patients admitted to CVCU
Tackling the ST elevation in leptospirosis: A double-edged sword between bleeding and thrombosis – A case report
Full text linkAlthough leptospirosis is a well-recognized zoonotic disease, the occurrence of ST-segment-elevation myocardial infarction (STEMI)-mimicking leptospiral myocarditis, accompanied by subsequent bleeding and thrombocytopenia is an exceptionally rare finding. The dual risks of bleeding and thrombosis further complicate the management of anticoagulation and thrombolytic therapy amidst competing risks. The aim of this study was to present leptospirosis complicated by myocarditis, which mimicked STEMI, followed by bleeding and thrombocytopenia. A 61-year-old male patient was referred from a community health center to the hospital with primary complaints of chest discomfort and diaphoresis, which had started 11 hours prior to admission. These symptoms were associated with a 12-day history of intermittent fever, nausea, and vomiting. Upon physical examination, the patient appeared lethargic, with a blood pressure of 86/63 mmHg, heart rate of 107 bpm, respiratory rate of 22 breaths per minute, and temperature of 39.8°C. Electrocardiography revealed widespread ST-segment elevation. Echocardiography showed global hypokinesia with a reduced ejection fraction of 48%. Laboratory tests confirmed the presence of IgM and IgG anti-Leptospira antibodies, along with elevated high-sensitivity cardiac troponin levels. The patient was diagnosed with Weil's disease (Faine's score 32), with leptospiral myocarditis and STEMI considered as differential diagnoses. Initial management involved a loading dose of dual antiplatelet therapy (aspirin 320 mg and clopidogrel 300 mg) due to the suspected diagnosis of STEMI. However, it was later discontinued on the second day of admission due to the development of severe thrombocytopenia and minor bleeding manifestations. Following the administration of ceftriaxone 2 g every 12 hours and doxycycline 100 mg every 12 hours, the patient's condition improved. This case highlights the importance of recognizing leptospirosis as a potential cause of myocarditis and thrombocytopenia, especially when clinical signs resemble those of STEMI. Early diagnosis and careful management, including the suspension of dual antiplatelet therapy and initiation of targeted antibiotic therapy, were pivotal in preventing further complications and improving the patient's outcomes
Impact of anthropometric adiposity and excessive daytime sleepiness on endothelial function in healthcare workers: A cross-sectional analysis
Full text linkObesity and excessive daytime sleepiness (EDS) are known contributors to cardiovascular risk through their impact on endothelial function. Healthcare workers, frequently exposed to shift work, are particularly vulnerable to these risk factors. The aim of this study was to assess the relationship between anthropometric adiposity measures and EDS with endothelial function, measured via flow-mediated dilation (FMD), in healthcare workers. This cross-sectional study included 82 healthcare workers aged 20–50 years without pre-existing cardiovascular conditions. Anthropometric measures such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were collected to assess adiposity. EDS was evaluated using the Epworth sleepiness scale (ESS), with a score ≥10 indicating EDS. Endothelial function was measured via FMD, with values <7.1% indicating dysfunction. Multivariate logistic regression was used to identify predictors of endothelial dysfunction, adjusting for confounders such as age and sex. Collinearity diagnostics, including the Belsley–Kuh–Welsch method, were applied to confirm multicollinearity and refine the regression model. Overweight and obesity, high-risk WC, and increased risk WHtR were associated with endothelial dysfunction (p<0.001), with WHtR showing an independent association (adjusted odds ratio (AOR): 8.48; 95%CI: 2.58–27.86; p<0.001). EDS also showed a significant independent association with impaired FMD outcomes (AOR: 3.73; 95%CI: 1.23–11.26; p=0.020). Pearson correlation analysis revealed significant negative correlations between BMI (r=-0.483, p<0.001), WC (r=-0.473, p<0.001), and WHtR (r=-0.432, p<0.001) with FMD, indicating that higher adiposity levels were linked to poorer endothelial function. Obesity and poor sleep quality, even in the absence of cardiovascular disease, are associated with an increased risk of endothelial dysfunction in healthcare workers. Early intervention focusing on weight management and improving sleep quality could mitigate future cardiovascular risks in this population
Key contents of health education and their impact on improving medication adherence among hypertensive patients: A systematic review and meta-analysis
Full text linkHypertension is a global health issue with significant effects on morbidity and mortality, and medication adherence is crucial for effective management. Despite its importance, adherence remains low among hypertensive patients. Health education has been shown to improve medication adherence, though its effectiveness varies across studies. The aim of this study was to systematically synthesize evidence on the impact of health education in enhancing medication adherence among hypertensive patients. This study followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and employed the population, intervention, control, and outcome (PICO) approach to develop keywords for a search across five databases: Emerald, ProQuest, PubMed, ScienceDirect, and Scopus. All randomized control trials published between 2019 and 2024 in English, evaluating health education's impact on medication adherence in hypertensive patients aged ≥18 years were included. The protocol was registered on PROSPERO (CRD42024532890), and study quality was assessed using the CEBMa scale. Twelve high-quality articles (CEBMa score of ≥7) involving 1,827 participants were included, identifying four key themes in health education for hypertension: an overview of hypertension and complications, medication and side-effect management, healthy lifestyle modification, and medication adherence strategies. Health education significantly improved medication adherence by 33% (risk ratio (RR): 1.33; 95%CI: 1.08–1.64; p=0.008), with a medium-large effect on improving medication adherence (d=0.70; 95%CI: 0.34–1.05; p<0.0001) and a small-medium effect on reducing non-adherence (d=-0.45; 95%CI: -0.66–(-0.24); p<0.0001). Health education delivered 1 to 3 months and with individualized approaches showed better adherence outcomes compared to more than three months and group-based methods. Face-to-face education was more effective than the digital method. In conclusion, health education improves medication adherence in hypertensive patients when delivered comprehensively over 1–3 months through individualized face-to-face sessions. These findings support its integration as a key strategy in hypertension management to enhance adherence
Impact of walking exercise intensity on cartilage IL-1, TNF-α, IL-4, MMP-13 and pain threshold in osteoarthritis rat models
Full text linkPro-inflammatory cytokines produced by chondrocytes play a crucial role in activating matrix metalloproteinase-13 (MMP-13), leading to an imbalance between the synthesis and degradation of the extracellular matrix (ECM) in osteoarthritis (OA). Although regular walking exercise has been shown to reduce inflammatory cytokine levels in OA animal models, the optimal exercise intensity remains underexplored. Therefore, the aim of this study was to investigate the effects of different intensities of regular walking exercise on the levels of pro-inflammatory cytokines (interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-α)), anti-inflammatory cytokine (interleukin-4 (IL-4)), as well as MMP-13 expression in cartilage and pain thresholds in an OA animal model. A total of 30 adult male Rattus norvegicus (6–8 weeks old) were divided into five groups: (1) healthy control; (2) monosodium iodoacetate (MIA)-induce OA model; (3) OA with light-intensity walking (OA1); (4) OA with moderate-intensity walking (OA2); (5) and OA with high-intensity walking (OA3). The exercise intervention began one week after MIA injection and continued for six weeks. Pain threshold, inflammatory cytokine (IL-1, TNF-α, IL-4) levels, and MMP-13 expression were measured using an analgesymeter, enzyme-linked immunosorbent assay (ELISA), and immunohistochemistry (IHC), respectively. The results demonstrated a significant reduction in IL-1 and TNF-α levels, along with decreased MMP-13 expression and increased IL-4 levels, in all exercise groups (OA1, OA2, OA3) compared to the untreated OA group. Additionally, pain thresholds improved following exercise. However, no significant differences were observed among the three exercise intensities in terms of cytokine levels, MMP-13 expression, or pain threshold. This study highlights that the light-intensity regular walking exercise effectively reduces inflammation, MMP-13 expression, and pain in OA. Further research is needed to elucidate the underlying mechanisms of exercise in OA management
Antibiotic use patterns and factors associated with leukocyte decrease in COVID-19 patients with suspected secondary infections: A cross-sectional study in Indonesia
Full text linkAntibiotics are frequently prescribed to coronavirus disease 2019 (COVID-19) patients, often without evidence of bacterial superinfection, increasing the risk of antibiotic resistance and posing a public health threat. The aim of this study was to evaluate antibiotic prescribing patterns in COVID-19 patients with suspected secondary infections and to assess the association between antibiotic use and clinical outcomes, particularly leukocyte count. The study analyzed 376 hospitalized COVID-19 patients from two hospitals in Bandung, Indonesia, between 2020 and 2022. All included patients were aged ≥17 years with confirmed COVID-19, leukocyte count >11,000 μg/L, and received antibiotic therapy. The Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) and drug utilization (DU) 90% were used to assess prescribing patterns. The patients’ demographic characteristics, clinical and culture results were also collected. Our data indicated that most patients received multiple antibiotics (>2), with prescribing patterns significantly associated with age, confirmed bacterial pathogen, length of hospital stay and having tuberculosis infection. The most frequently identified pathogens included Gram-positive bacteria Staphylococcus aureus, Staphylococcus haemolyticus and Gram-negative bacteria Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. The most frequently prescribed antibiotics were azithromycin, levofloxacin, and ceftriaxone. No significant association was found between the number of antibiotics prescribed and clinical outcome (leukocyte normalization). Broad-spectrum antibiotics from the World Health Organization (WHO) AWaRe "Watch" category dominated the antibiotic prescriptions in the patients. While antibiotic selection was generally aligned with pathogen type and comorbidities, standardized guidelines remain crucial to optimizing antibiotic use, particularly in settings with limited pathogen testing
Dual anti-inflammatory and antimicrobial effects of stingless bee propolis on second-degree burns
Full text linkPropolis, a natural resinous product from stingless bees, is widely recognized for its anti-inflammatory and antimicrobial properties. However, its combined effects in addressing both inflammation and infection in second-degree burns have remained insufficiently explored. The study aimed to investigate the dual role of propolis in modulating inflammation and preventing bacterial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in a second-degree burn model. Propolis was collected from stingless bees in Gowa, South Sulawesi, Indonesia, and extracted using methanol. Second-degree burns were induced in male Rattus norvegicus, which were then divided into three groups: one treated with propolis, another silver sulfadiazine (positive control), and third with NaCl (negative control). After seven days of treatment, the expression of tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factor (VEGF) proteins in wound samples was analyzed using immunohistochemistry. The antimicrobial activity of the propolis extract was assessed using the disc diffusion assay, followed by minimum inhibitory concentration (MIC) testing. Network pharmacology analysis was also conducted to assess the anti-inflammatory activity of propolis. Results showed that propolis significantly reduced TNF-α expression and increased VEGF expression, which might enhance VEGF-mediated angiogenesis, leading to improved wound healing compared to controls. The antimicrobial tests demonstrated strong activity against MRSA and P. aeruginosa, with inhibition zones correlating with higher extract concentrations. The MIC value of the propolis extract was 198.66 µg/µL against MRSA and 212.06 µg/µL against P. aeruginosa. Network pharmacology analysis revealed key proteins, including Jun proto-oncogene (JUN), estrogen receptor 1 (ESR1), signal transducer and activator of transcription 3 (STAT3), and proto-oncogene tyrosine-protein kinase Src (SRC), involved in the regulation of TNF-α and VEGF, further supporting the synergistic effects of propolis. This study demonstrates that stingless bee propolis effectively promotes tissue regeneration and prevents infection in second-degree burns, highlighting its potential as an alternative to conventional treatments for wound care
Unraveling the power of peptides from Cucumaria frondosa coelomic fluid as multitarget therapy of diabetic kidney disease: An in-silico study
Full text linkDiabetic kidney disease is a condition characterized by persistent albuminuria, diabetic glomerular lesions, and a reduced glomerular filtration rate in people with diabetes. Peptides in Cucumaria frondosa coelomic fluid have been proven to provide antidiabetic and anti-inflammatory activity that can be used as one of the innovations in developing a multitarget therapy, especially in diabetic kidney disease. Therefore, the aim of this study was to unravel the power of peptide-based metabolites from C. frondosa coelomic fluid as multitarget therapy for diabetic kidney disease using an in-silico study. UCSF Chimera software was utilized to construct the three-dimensional structure of coelomic fluid peptides from C. frondosa. The toxicity and allergenicity of peptides were examined using the ToxinPred and AllerTop websites, respectively. From the PDBJ database, the 3D structures of protein kinase B, alpha isoform (AKT1); vascular endothelial growth factor receptor 2 (VEGFR2); epidermal growth factor receptor (EGFR); α-glucosidase; and glucokinase were obtained. Molecular docking was carried out using MOE Software. In this in-silico study, peptide 9 (-10.32 kcal/mol), peptide 1 (-9.41 kcal/mol), and peptide 3 (-9.55 kcal/mol) were shown to act as specific adenosine triphosphate-competitive inhibitors of EGFR, AKT1, and VEGFR2, respectively. Peptide 8 (-11.06 kcal/mol) can specifically inhibit α-glucosidase by binding to its active site. Peptide 1 (-9.80 kcal/mol) is predicted to specifically inhibit glucokinase activity by blocking its active side. Molecular dynamics simulations confirmed stable interactions with receptor proteins. In conclusion, C. frondosa coelomic fluid peptides have been shown not only to alleviate diabetic kidney disease but also to stabilize blood glucose levels and prevent hyperglycemia based on in-silico analysis
Exploring adolescent girls' involvement in decision-making processes regarding child marriage: A systematic review
Full text linkChild marriage often involves adolescents aged 10–19 years and poses significant health risks and challenges to gender equality. The aim of this systematic review was to examine the involvement of adolescent girls in decision-making processes regarding child marriage and identify influencing factors. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review covered studies published between January 2014 and July 2024. The databases searched included ScienceDirect, Springer Link, PubMed, and Taylor & Francis, using terms related to adolescent girls, decision-making, and child marriage. Inclusion criteria targeted studies involving girls aged 10–19, with methods including qualitative, quantitative, longitudinal, and mixed-method, published in English. Data extraction and quality assessment followed the standards of the Joanna Briggs Institute. Of 6,967 articles, 29 met the inclusion criteria, spanning 26 countries across three continents, with 51.7% being qualitative studies. Economic pressure was identified as the primary driver of child marriage, with significant parental and community influences restricting the girls' decision-making autonomy. Parents, especially fathers, often force girls into marriage to reduce economic burdens and enhance family honor. Some adolescent girls initiate marriage to escape adverse home conditions or societal stigma. Education and strong family support emerged as protective factors, while entrenched social norms perpetuated early marriages. Comprehensive approaches including educational improvement, economic support, and social norm transformation are essential. Addressing child marriage requires multidimensional strategies, encompassing enhanced educational opportunities, economic support, and changing entrenched social norms. Future research should focus on interventions that boost adolescent girls' life skills and decision-making autonomy to delay marriage and enable informed choices