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Motor improvement in Parkinson’s disease patients receiving caffeine adjuvants: A double-blind randomized controlled trial in Indonesia
Get PDFParkinson's disease (PD) manifests as a movement and brain function disorder characterized by symptoms such as resting tremors, rigidity, bradykinesia, and postural instability, leading to disability among patients. The use of psychostimulants such as caffeine has been associated with the improvement of motor symptoms in PD patients; however, studies regarding the effect of caffeine adjuvant therapy on motor function among PD patients in the Indonesian population are lacking. The aim of this study was to evaluate motor improvement as measured by the change in scores of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) among PD patients receiving caffeine adjuvant. A double-blind randomized controlled trial (RCT) was conducted among PD patients at Dr. Soetomo General Academic Hospital and Universitas Airlangga Hospital, Surabaya, Indonesia, from April to August 2023. A total of 27 patients were enrolled and randomly assigned to an intervention (receiving caffeine adjuvant, n=15) and control group (receiving placebo, n=12). Motor improvement was measured using the UPDRS III score prior to intervention and three weeks after. The Chi-squared test was used to analyze the difference in UPDRS III scores between the two groups. Motor improvement, as demonstrated by a reduction in the UPDRS III score, was observed in patients receiving caffeine adjuvant compared to those receiving placebo (80.0% vs 16.7%; p=0.004). Regarding the safety profile, only four out of 15 (26.6%) patients treated with caffeine reported minor adverse events. These conditions improved over time during the intervention. None of the 12 patients in the placebo reported adverse events. This study provides valuable insights into the initial dosage of caffeine that improves motor function in PD patients with minimum adverse effects
Prevalence of major INSTI and HIV-1 drug resistance mutations in pre- and antiretroviral-treated patients in Indonesia
Get PDFIndonesia has one of the highest HIV infection rates in Southeast Asia. The use of dolutegravir, an integrase strand transfer inhibitor (INSTI), as a first-line treatment underscores the need for detailed data on INSTI drug resistance mutations (DRMs). Currently, there is a lack of comprehensive data on DRMs INSTI and other HIV drug resistance in Indonesian patients, both pre- and post-treatment. The aim of this study was to identify the subtypes and drug resistance mutations of the protease, reverse transcriptase, and integrase genes in both treatment-naive and ARV-treated patients in Bandung, West Java, Indonesia. A cross-sectional study was conducted involving HIV-positive patients at Hasan Sadikin Hospital, Bandung, Indonesia, from September 2022 to January 2023. The patients were categorized into two groups: ARV-treated and pre-treatment patients. Peripheral blood mononuclear cells (PBMCs) were processed for DNA extraction, followed by amplification and sequencing of the pol gene to detect mutations and subtypes. The study found that the predominant subtype was CRF01_AE, accounting for 85.4% and 69% of pre-treatment and treated patients, respectively, followed by recombinant forms such as A1/CRF01_AE, CRF01_AE/CRF02_AG, subtype B, and other subtypes. Among ARV-treated/INSTI-naive patients, major INSTI DRMs R263K and Y143H were identified, while pre-treatment patients exhibited accessory integrase DRMs. The most common DRMs detected were non-nucleoside reverse transcriptase inhibitor (NNRTI) DRMs, with prevalences of 14.6% and 7% in pre-treatment and ARV-treated patients, respectively. In conclusion, CRF01_AE emerged as the predominant subtype in both pre-treatment and ARV-treated patients in Bandung, underscoring the necessity for ongoing surveillance of integrase DRMs, particularly given the presence of major INSTI DRMs in patients undergoing INSTI treatment
Comparative analysis of synovectomy and total knee replacement in knee joint synovial chondromatosis: A case series
Get PDFSynovial chondromatosis is a rare disorder characterized by cartilaginous growths within the joint lining, often confused with conditions like pigmented villonodular synovitis and rheumatoid arthritis. Primary treatment typically involves surgical synovectomy to remove the affected tissue and loose bodies. Documented cases are limited globally. The aim of this study was to present a case series of synovial chondromatosis and evaluate the functional outcomes by assessing the post-surgical Musculoskeletal Tumor Society (MSTS) score following different surgical interventions (synovectomy alone versus synovectomy with total knee replacement) in a resource-limited setting. Four cases of synovial chondromatosis were reported. A 61-year-old woman with a soft tissue tumor underwent synovectomy and total knee replacement on the right knee, then experienced a periprosthetic infection requiring revision arthroplasty, resulting in an MSTS score of 24. Another case was a 48-year-old woman who had a synovectomy for a lump on the right knee, also achieving an MSTS score of 24. Two additional cases involved women in their mid-to-late 60s who underwent synovectomy for knee lumps, with post-operative MSTS scores of 21 and 19, respectively. This case series underscores the diagnostic and management challenges of synovial chondromatosis in the knee joint, demonstrating various surgical interventions. This case series also suggested that the post-operative MSTS scores were slightly higher (indicating better outcomes) for synovectomy alone compared to synovectomy with total knee replacement, highlighting the need for further research to determine the most effective treatment approach
Diagnostic accuracy of urinary cytokeratin fragment-19 (CYFRA21-1) for bladder cancer
Get PDFBladder cancer is known for its high recurrence rate and requires constant patient monitoring. To confirm the diagnosis, a tissue sample from a cystoscopy is required, which the patient often avoids. Urine has the potential to be utilized as a diagnostic fluid because of its non-invasive nature and various biomarker contents. The aim of this study was to determine the diagnostic value of cytokeratin fragment-19 (CYFRA21-1) level in urine for diagnosing bladder cancer. This single-center cross-sectional study was performed with eligible inclusion were adults aged ≥18 years who presented with hematuria and suspected bladder cancer from imaging. Patients with a history of intravesical chemotherapy, radiotherapy and immunotherapy were excluded. Urine samples were collected prior to the cystoscopy. Detection of urinary CYFRA21-1 was carried out using the ELISA method. Of 154 patients included in the study, the diagnosis of bladder cancer was confirmed in 92 patients. Patients with bladder cancer had significantly higher urinary CYFRA21-1 levels compared to the non-bladder cancer group. The sensitivity, specificity, positive and negative predictive value, and positive likelihood ratio of the CYFRA21-1 were 80.4%, 43.5%, 67.9%, 60% and 1.425, respectively. The area under the curve for CYFRA21-1 was 0.608, computed from a receiver operating curve with a cut-off value of 13.3 ng/mL. In conclusion, urinary CYFRA21-1 levels have moderate diagnostic accuracy in determining bladder cancer among suspected individuals. Due to its high sensitivity, this biomarker could potentially be used alongside other screening tools for bladder cancer detection
Effects of iopromide contrast agents on kidney iNOS expression and tubular histopathology alterations
Get PDFContrast-induced acute kidney injury is a common complication marked by reduced kidney function within 48 hours of contrast administration. The aim of this study was to evaluate renal function, anatomy, and molecular changes at 24 hours, 48 hours, and 72 hours post-iodinated contrast media (ICM) administration. This true-experimental study used a post-test-only control group design. Rats underwent unilateral nephrectomy, followed by intravenous injection of ICM using iopromide 370 mg iodine/mL per rat at a dose of 231 mg iodine, and were then divided into four groups: control (C), rats terminated at 24 hours after iopromide administration (E24), rats terminated at 48 hours after iopromide administration (E48), and rats terminated at 72 hours (E72) after iopromide administration, with eight rats per group. Renal function (BUN and SCr levels) remained unchanged after 24, 48, and 72 hours of iopromide administration. Iopromide increased renal tubular damage, as shown by higher histopathological scores for loss of brush border and tubular necrosis, except for proteinaceous casts, where histopathological scores increase especially within the first 24 hours and decrease after 72 hours. Iopromide significantly altered iNOS expression in the glomerulus at 24 and 48 hours, and iNOS expression was decreased after 72 hours. iNOS expression in the intrarenal vascular and tubules was unaffected by iopromide administration. In conclusion, this study found no changes in renal function parameters, improvement in proteinaceous casts, and increased iNOS expression in the glomerulus, offering new insights into the effects of contrast on kidneys
Toxicity assessment and bioimaging potential of carbon dots synthesized from banana peel in zebrafish model
Get PDFZebrafish serve as a pivotal model for bioimaging and toxicity assessments; however, the toxicity of banana peel-derived carbon dots in zebrafish has not been previously reported. The aim of this study was to assess the toxicity of carbon dots derived from banana peel in zebrafish, focusing on two types prepared through hydrothermal and pyrolysis methods. Banana peels were synthesized using hydrothermal and pyrolysis techniques and then compared for characteristics, bioimaging ability, and toxicity in zebrafish as an animal model. Pyrolysis-derived banana peel and hydrothermal-derived banana peel showed blue emission under ultraviolet light, indicating excitation-dependent behavior. To test their potential application for bioimaging, a soaking method was used using zebrafish that showed fluorescence intensity in the eyes, abdomen, and tail of zebrafish. Toxicity comparison showed that pyrolysis-derived banana peel had lower toxicity with 50% lethal concentrations (LC50) of 1707.3 ppm than hydrothermal-derived banana peel (LC50 993 ppm) in zebrafish. Both types of carbon dots showed significant differences (p<0.05) in hatching rates at 96 and 120 hours of exposure. Of the two methods for carbon dot synthesis from banana peel, the pyrolysis method had a higher toxicity threshold than the hydrothermal method, as indicated by the LC50 value and the number of zebrafish embryos that died, hatched delayed, and experienced malformation during their development
Impact of early-life malaria exposure on childhood stunting: A case-control study in high endemic malaria area, Papua, Indonesia
Get PDFPapua faces public health challenges as a region with high malaria endemicity and a very high prevalence of stunting. Infectious diseases are one of the risk factors for stunting. The aim of this study was to investigate the effect of early-life malaria exposure on stunting among children in Papua. The study was conducted in 14 public health centers (PHCs) in Papua in 2023. Six hundred eighty-one children (227 stunted and 454 non-stunted) were selected using simple random sampling. The study data were gathered from medical records, structured parent interviews, and direct anthropometric measurements of the children. Chi-square tests were performed to determine unadjusted OR, while adjusted OR was calculated using multivariate analysis. The height-for-age z-score was calculated using WHO Anthro version 3.2.2. The results showed that 45.1% of mothers who had malaria during pregnancy had stunted children. The average z-score height-for-age of children from mothers who experienced malaria during pregnancy vs those who did not was -1.69±1.23 vs -1.41±1.55. Among the 84 children who had malaria under one year old, 45.2% experienced stunting. The average z-score height-for-age of children who had malaria under one year old vs those who did not was -1.83±1.24 vs -1.38±1.6. In the unadjusted analysis, malaria during pregnancy (OR 1.74; 95%CI: 1.06–2.87), malaria in children under one year old (OR 1.78; 95%CI: 1.12–2.83), low birth weight status (OR 1.82; 95%CI: 1.08–3.05), family income (OR 1.75; 95%CI: 1.09–2.81), and mother’s ethnicity (OR 1.45; 95%CI: 1.05–2.01) were associated with stunting incidence in children. In the multivariate analysis, mother’s ethnicity (aOR 1.41; 95%CI: 1.00–1.97) and low birth weight status (aOR 1.72; 95%CI: 1.00–2.94) were the only risk factor for stunting. This study suggests a potential association between early-life malaria exposure and stunting in children. In malaria-endemic areas, health interventions targeting malaria prevention during pregnancy and early childhood are necessary to reduce the risk of stunting
Oxygen saturation profile in traumatic brain injury animal model after propofol administration
Get PDFTraumatic brain injury (TBI) is a traumatic that often leads to death due to untreatable cerebral hypoxia, indicated by oxygen saturation of <90%. Cerebral hypoxia is rarely monitored and thereby often overlooked as a cause of mortality and monitoring oxygen saturation is an accurate method to detect the condition. Propofol, an anesthetic agent, is commonly used in the management of TBI; however, its effect on brain tissue and cerebral hypoxia in TBI cases is not well understood. The aim of this study was to evaluate the profile of oxygen saturation in TBI animal model after propofol administration. A laboratory experimental study was conducted, involving 18 male Rattus novergicus rats (aged 4–8 weeks with weight between 150–200 grams) divided into three different treatment groups (non-TBI, TBI without propofol, and TBI with propofol). Oxygen saturation was measured regularly from day 1 to day 8 using pulse oximetry. The oxygen saturation percentages were compared between the TBI rats with and without propofol administration using independent Student t-rest. The results revealed significant reductions of oxygen saturation levels of animals within propofol-treated TBI group compared to that of the untreated-TBI group (p<0.05), with the average oxygen saturation ranging from 80.8%±6.96% vs 86.8%±5.48%. This finding suggests a reducing effect of propofol administration on oxygen saturation levels in rats with TBI and this potentially causes cerebral hypoxia
Monkeypox virus infection and myocarditis: A review of current evidence and possible pathogenesis
Get PDFThe recent spread of the monkeypox virus (MPXV), causing monkeypox (mpox), to non-endemic areas, and the atypical and unusual clinical manifestations observed during its 2022 outbreak has focused international interest on the clinical features of the disease. Mpox is usually a self-limiting disease with mild symptoms with common manifestations, including fever and skin lesions; however, severe manifestations could occur in some vulnerable groups (children and those with impaired immune systems) and may present multisystem complications and fatal outcomes. In most cases, a fever is the first sign of disease, followed by the development of various inflammatory lesions on the skin, such as vesiculopustular rashes and ulcers. Pneumonitis, encephalitis, keratitis, secondary bacterial infections, acute kidney injury, and myocarditis are all possible outcomes of the infection. Myocarditis has been reported to be caused by orthopoxviruses, and it is a serious condition of which its pathophysiology is little understood. Recent reports have indicated myocarditis with cardiac involvement as a possible atypical and unusual consequence of the MPXV infection during present outbreak. This review provides an overview of the clinical manifestations of mpox with a special focus on its effects on the heart, including myocarditis. The evidence of the myocarditis in mpox patients and its possible pathogenesis are discussed
Implementation of Aceh Health Insurance (Jaminan Kesehatan Aceh) 2013–2021: Has health equity been achieved for all Acehnese after armed conflict?
Get PDFAceh Health Insurance (Jaminan Kesehatan Aceh—JKA) has been implemented since 2010 to increase the health equity by covering the health expenses and guaranteeing that all Acehnese are covered regardless of their economic, educational, and social statuses. However, since its implementation, there has been no study on its impact on health quality, particularly regarding the utilization of the main referral hospital (Dr Zainoel Abidin Hospital located in Banda Aceh) and the effects of the geographic accessibility and the number of specialist doctors in each regency/city on hospital utilization. This retrospective study assessed the equity factors during the Aceh Health Insurance implementation and during its integration to National Health Insurance (Jaminan Kesehatan Nasional—JKN) from 2013 to 2021 using data of travel time (time spent for travelling from the origin regency/city of referred patients to the main referral center) and healthcare resources (number of specialist doctors). The data were analyzed using Student’s t-tests, Kolmogorov-Smirnov or Mann-Whitney U test when appropriate. Williamson Index was calculated to determine the disparities of health equity between regencies. Our data indicated the noticeably increase of health facilities utilization since the implantation of Aceh Health Insurance. However, there was no equity in the use of main referral facility by the residents in Aceh - was dominated by residents who lived closer and from more populated regencies/cities. In conclusion, there are accessibility and financial hardship barriers in accessing the health care facilities during the implementation of Aceh Health Insurance that need to be addressed by the government to achieve the health equity for all Acehnese