Narra J (Journal)
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Integrated analysis of dengue transmission risk and insecticide resistance in Aedes aegypti from Vichada, Colombia
Full text linkDengue is the primary arbovirus transmitted by Aedes aegypti mosquitoes. Effective management of dengue demands a multidisciplinary approach. The aim of this study was to conduct an integrated analysis of dengue transmission, focusing on its vector mosquitoes, to establish a baseline for dengue control and prevention in an endemic region of Colombia. The study was conducted from 2015 to 2018 across four municipalities in the Vichada department near the Venezuelan border. Five complementary approaches were employed: (1) determining the natural infection rate and circulation of various dengue virus serotypes in mosquitoes; (2) evaluating the insecticide susceptibility status and examining mosquito genotypes for three knockdown (kdr) mutations linked to insecticide resistance; (3) performing a phylogenetic analysis to identify the lineage of Ae. aegypti; (4) creating risk maps for dengue transmission based on predictive models in two municipalities in the department; and (5) empowering the community. Molecular analysis using RT-PCR indicated dengue virus infections in all municipalities of the Vichada department. Eleven positive pools for serotypes DENV-1, DENV-2, DENV-3, and DENV-4 were detected. The highest minimum infection rate (MIR) was found in Cumaribo, followed by La Primavera, which showed the greatest diversity of dengue virus serotypes. Mosquitoes from all three populations showed susceptibility to malathion and lambda-cyhalothrin pyrethroid, except for mosquitoes from Puerto Carreño, which presented moderate resistance to lambda-cyhalothrin (resistance ratio of 8). Importantly, all mosquitoes had the F1534C mutation, while the V1016I and V419L mutations were found at lower frequencies. Risk classification maps for Puerto Carreño and La Primavera showed neighborhoods with high risk, indicating potential hotspots for intervention and vector control. This study established a necessary baseline for the ongoing monitoring and improvement of the early warning system for all municipalities in the Vichada department. The integrative approach employed in this study highlights the importance of incorporating these methodologies into dengue epidemiological surveillance in endemic regions
Emergency management of recurrent ovarian ectopic pregnancy in a hemodynamically unstable patient: A case report
Full text linkRecurrent ectopic pregnancy is defined as the occurrence of more than one extrauterine implantation of a fertilized ovum. Ectopic pregnancy arises when a fertilized egg fails to implant within the endometrial cavity and instead attaches to an alternative site such as the fallopian tube, ovary, or peritoneal cavity. In this report, a rare case of recurrent ovarian ectopic pregnancy in a 31-year-old patient at six weeks’ gestation is presented. The aim of this study was to highlight the clinical presentation, diagnostic challenges, and management considerations associated with recurrent ovarian ectopic pregnancy. The patient was admitted to the emergency maternal unit with severe abdominal pain. A previous history of ectopic pregnancy raised the suspicion of recurrence. The diagnosis of ectopic pregnancy was established, and the patient underwent emergency exploratory laparotomy. During the procedure, the gestational sac was identified on the surface of the right ovary. Postoperatively, the patient required blood transfusion and supportive management, and was discharged in stable condition after several days of hospitalization. Ovarian ectopic pregnancy is an uncommon but serious condition. Early diagnosis, ideally with high-resolution ultrasonography, is essential to prevent life-threatening complications such as rupture, massive intra-abdominal hemorrhage, hemorrhagic shock, and maternal mortality. This case highlights the importance for clinicians of recognizing the possibility of recurrence in patients with a prior history of ectopic pregnancy and ensuring vigilant follow-up and timely intervention
Exploring the potential of Holothuria atra extract in modulating fasting triglyceride index and obesity: In silico, in vitro and in vivo studies
Full text linkObesity remains a major global health challenge and is strongly associated with metabolic disorders, particularly cardiovascular disease. This has fueled growing interest in natural interventions that regulate lipid metabolism as potential strategies to mitigate associated risks. Among these, Holothuria atra has emerged as a candidate due to its diverse bioactive compounds, though its mechanisms of action and therapeutic efficacy remain inadequately characterized. The aim of this study was to evaluate the combined effects of H. atra extract (HAE) and exercise on metabolic regulation, with the goal of determining whether their synergistic use enhances obesity management by targeting multiple metabolic pathways. Specimens of H. atra were collected from Tablolong Beach, Indonesia, and ethanol extracts were prepared. An in-silico analysis was performed to assess drug-likeness, quantitative structure-activity relationship (QSAR) properties, and network pharmacology. In vitro test using human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) underwent adipogenic differentiation with or without HAE treatment. This study used male Sprague-Dawley rats that were fed either a control or high-fat diet and further subdivided into groups receiving extract supplementation, swimming exercise, or a combination of both for six weeks. Liquid chromatography-mass spectrometry (LC-MS) analysis identified 6-gingerol and sarcostin as principal bioactive compounds, both of which fulfilled drug-likeness criteria. In silico analyses implicated peroxisome proliferator-activated receptor gamma (PPAR-γ) signaling as a major molecular target. In vitro tests found that HAE attenuated adipogenic differentiation of hUC-MSCs. Both HAE and exercise significantly reduced triglycerides, glucose, and the triglyceride–glucose index in rats fed a high-fat diet. The combination of HAE and exercise produced the greatest improvements, with significant reductions in glucose (p<0.01) , triglycerides (p<0.001), and the triglyceride–glucose index (p<0.001) compared to the high-fat diet control group. Collectively, these findings suggest that HAE, particularly when combined with regular exercise, improves lipid metabolism and may serve as a promising complementary strategy for obesity management
Mortality and associated factors among community-acquired pneumonia patients: A cross-sectional study in a provincial referral hospital in Indonesia
Full text linkCommunity-acquired pneumonia (CAP) poses a significant impact on the healthcare system due to rehospitalization and mortality. About one-third of hospitalized CAP patients died within one year. In addition to advanced age, vulnerable groups with comorbidities such as cancer, diabetes, and cerebrovascular disease (CVD) are more likely to suffer from severe CAP. The aim of this study was to investigate the factors linked to mortality in adult hospitalized CAP patients. The study extracted the medical records of patients aged ≥18 years, admitted to a referral hospital in Riau Province, who were diagnosed with CAP between January and December 2023. Multiple logistic regression step-wise analysis was employed to determine the factors associated with mortality in CAP patients. The study involved 334 patients with a median age of 58 years. Based on the confusion, urea, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score, 11.9% of patients had severe CAP (CURB-65 scores 3 and 4). Age was a significant predictor of severe CAP (p≤0.001). The most prevalent comorbidities were malignancy (33.2%), CVD (30.2%), and diabetes (28.4%). Mortality incidence during hospitalization reached 35.9%. Significant factors associated with mortality in hospitalized CAP patients included renal dysfunction/elevated serum urea levels (p=0.031), CURB-65 score (p=0.023), vasopressor use (p≤0.001), mechanical ventilator use (p≤0.01) and steroid use (p=0.029). However, CVD was associated with a decreased risk of mortality (p=0.019). Gram-negative bacteria predominated, accounting for 50.6% of all positive isolates. Several significant factors were associated with mortality in adult patients hospitalized with CAP at referral Hospital in Riau, including renal dysfunction, CURB-65 score, vasopressor use, mechanical ventilator use, and steroid use. This finding underscored the importance of early identification factors in CAP patients
Exploring the potential of calcium-fortified sweet potato noodles for osteoporosis prevention: Insights from in vivo rat studies
Full text linkCalcium (Ca) deficiency is a primary contributor to osteoporosis, a condition characterized by low bone density and increased fracture risk. Fortifying widely consumed foods with calcium is one approach for addressing this insufficiency. Given the popularity of noodles, adding Ca to them offers a promising approach to enhancing Ca intake within communities. The aim of this study was to investigate the effects of Ca-fortified sweet potato noodles on osteoporosis prevention. This study used 4-month-old Sprague-Dawley rats. A completely randomized design was used with four treatment groups: CS (SHAM, control diet), CO (Sham, test diet), US (OVX, control diet), and UO (OVX, test diet). Both control and test diets, which included Ca-fortified sweet potato noodles, were administered to OVX (ovariectomy-induced osteoporosis model) and SHAM (control for surgical procedure) groups for two months. At the end of the experiments, serum Ca levels were collected and analyzed for Ca and alkaline phosphatase (ALP) levels and their bones were analyzed for physical properties and bone mineral density (BMD) using X-ray analysis. Data were analyzed using one-way analysis of variance (ANOVA) followed by Duncan as a post hoc test. The intervention of Ca-fortified sweet potato noodles for two months significantly increased serum Ca levels and reduced ALP levels compared to controls, both in SHAM (Ca: 38.03±0.877 mg/dL; ALP: 355±38.0 IU/L) and OVX (Ca: 36.18±2.810 mg/dL; ALP: 340±5.5 IU/L) groups. The test diet maintained the ratio of bone weight to bone volume and preserved the Ca content in the rats' bones. OVX rats consuming the test diet for two months exhibited significantly higher femur bone strength than OVX rats consuming the control diet (test: 6.50±0.300 kg; control: 4.83±0.289 kg). There was no significant difference in BMD between the SHAM and OVX groups on the test diet, indicating that the test diet can maintain bone BMD despite accelerated aging. These findings suggest that Ca-fortified sweet potato noodles can serve as a dietary Ca source, contributing to the prevention of osteoporosis by maintaining serum Ca levels, preserving bone Ca content, as well as maintaining bone density and strength
Diagnostic accuracy of preoperative ultrasonography-guided fine-needle aspiration biopsy in distinguishing malignancy in large thyroid nodules: A systematic review, meta-analysis, and meta-regression
Full text linkControversy persists regarding the effectiveness of ultrasonography-guided fine-needle aspiration biopsy (US-FNAB) in distinguishing malignancies in large thyroid nodules. The prevailing belief that larger thyroid nodules inherently pose a higher risk of malignancy has led to a common practice of suggesting thyroidectomy for large thyroid nodules. Herein, the aim of this study was to assess the diagnostic accuracy of preoperative US-FNAB for distinguishing malignancy in large thyroid nodules. A search for published records was carried out on 20 October 2023, utilizing the search feature available on PubMed, Scopus, Embase, and Google Scholar. Patients with large thyroid nodules (3 cm or larger) who underwent preoperative US-FNAB and postoperative histopathological tests were included. Related outcomes, including false positive (FP), false negative (FN), true negative (TN), true positive (TP), specificity, and sensitivity, were extracted from each study. Pooled specificity and sensitivity were estimated, and the summarized receiver operating characteristic (sROC) curve, along with the summarized area under the curve (sAUC), was calculated. Out of 133 articles identified across four databases, 10 studies with a total sample of 2752 patients were included. The overall diagnostic sensitivity was 72% (95%CI: 50–86%; p=0.00) and specificity was 96% (95%CI: 87–90%; p=0.00). The positive predictive value (PPV) and negative predictive value (NPV) were 93% (95%CI: 89–98%) and 75% (95%CI: 72–79%), respectively. sAUC was 93%, suggesting the diagnostic tool is accurate. Meta-regression analysis revealed that factors such as the number of samples, country (high-income vs upper-middle income), demographic characteristics (age and gender), and different thyroid size cut-off values did not significantly impact the sensitivity or specificity of US-FNAB. In conclusion, the present study confirms the reliability of US-FNAB in distinguishing malignancy in large thyroid nodules, emphasizing its role in reducing unnecessary thyroidectomy by identifying high-risk patients and challenging the conventional practice of routine thyroidectomy for large thyroid nodules
Cardiomyopathy as the forgotten symptom of systemic lupus erythematosus in children: A case report
Full text linkCardiomyopathy is a rare clinical manifestation in pediatric systemic lupus erythematosus (SLE), with only a single case reported in the literature. Its identification in pediatric SLE is challenging due to its typically subclinical presentation and low incidence, which frequently result in delayed diagnosis and management. The aim of this study was to present a unique case of dilated cardiomyopathy, a rare cardiac complication of SLE, which can be life-threatening if not promptly recognized and treated. An 11-year-old boy was admitted to the emergency department of Murni Teguh Memorial Hospital, diagnosed with SLE based on the 2019 European Alliance of Associations for Rheumatology (EULAR) criteria, with a total score of 30 and a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score of 16, indicating high disease activity. Clinical findings included oral ulcers, a non-pruritic hyperpigmented discoid macule, anemia, lymphopenia, positive both the direct and indirect Coombs tests, elevated D-dimer level, and pulmonary congestion. Initial treatment stabilized the patient condition, allowing transfer to the general ward by day five. Five days after admission, the patient developed palpitations and tachycardia, with a heart rate of 140 beats per minute. Electrocardiography showed sinus tachycardia, while echocardiography revealed all cardiac chambers dilation, left ventricular ejection fraction (LVEF) of 43%, moderate mitral regurgitation, and mild pulmonary regurgitation, subsequently diagnosed as dilated cardiomyopathy. Heart failure therapy was initiated with intravenous furosemide, oral ramipril, and digoxin. Palpitations and tachycardia resolved within two days. Following two weeks of treatment, the patient was discharged with stable vital signs. A one-month follow-up thoracic echocardiography demonstrated improved cardiomyopathy, with an LVEF of 53%. Cardiomyopathy in pediatric SLE is rare but can cause significant morbidity and mortality if undiagnosed. Its nonspecific presentation and immune-mediated pathogenesis make early detection challenging. Due to its rarity, it may be overlooked, highlighting the importance of comprehensive cardiac evaluation, including echocardiography, in children with suspected cardiac involvement
Chemical fingerprinting and antioxidant properties of Glochidion philippicum
Full text linkGlochidion philippicum has been suggested to exhibit considerable pharmacological potential, yet its chemical composition and bioactivity remain inadequately explored. The aim of this study was to investigate the chemical fingerprint and antioxidant properties of G. philippicum leaf extracts using Fourier-transform infrared spectroscopy (FTIR) with chemometric analyses, and in vitro and in vivo evaluations. Four extraction methods (maceration, reflux, ultrasound-assisted extraction (UAE), and microwave-assisted extraction (MAE)) were optimized with water, 70% ethanol, ethyl acetate, and n-hexane as solvents. FTIR profiles were analyzed with principal component analysis (PCA), hierarchical cluster analysis, and orthogonal partial least squares discriminant analysis. An in vitro study assessing the free radical scavenging capacity was conducted using the 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and ferric-reducing antioxidant power (FRAP) methods, while in vivo evaluations were conducted using Drosophila melanogaster to measure antioxidant enzyme activity and expression of endogenous antioxidant-related genes. FTIR profiles identified functional groups contributing to antioxidant activity. In vitro assays using ABTS and FRAP methods revealed that extracts obtained with 70% ethanol and water exhibited the highest antioxidant activity, attributed to key functional groups such as C=C (aromatic), O−H (acidic), N=O (nitro), and C−O (ester). In vivo studies showed that ethanol-based MAE extracts (MAEEO) significantly improved the survival of autoinflammatory PGRP-LBΔ mutant larvae exposed to heat-killed Escherichia coli. Real-time quantitative PCR analysis indicated this effect was dependent on endogenous antioxidant gene activation. The study highlights that G. philippicum leaf extracts as a natural source of bioactive compounds with exogenous antioxidant properties, offering potential for therapeutic applications
Effects of Moringa oleifera extract on inflammaging markers, muscle mass, and physical endurance in geriatric mice model
Full text linkA comprehensive approach to managing frailty is required due to the increasing number of elderly. Physical frailty, associated with inflammatory processes and a loss of muscle mass, can significantly impair health status. The aim of this study was to determine the effect of Moringa oleifera Lam. leaf extract on frailty in geriatric mice model. An experimental study was conducted using a post-test-only control group design using Mus musculus Balb/C mice aged eight weeks. The animals were divided into five groups: negative control group received intraperitoneal injections of normal saline (0.5 cc/day) for eight weeks, positive control group received D-galactose (150 mg/kg body weight (BW)/day) only, and three treatment groups treated with 150 mg/kg of D-galactose intraperitoneally for eight weeks followed by 100 mg/kg BW, 200 mg/kg BW, and 400 mg/kg BW of M. oleifera leaf extract orally for five weeks. At the end of the study, the blood levels of malondialdehyde (MDA), transforming growth factor-beta (TGF-β) and caspase-3, as well as caspase-3 expression in skeletal muscle, skeletal muscle mass fibrosis, and physical endurance were measured. The results showed that a dose of 400 mg/kg/day of M. oleifera leaf extract had the most significant effect on lowering MDA, TGF-β, and caspase-3 expression in skeletal muscle tissue, skeletal muscle fibrosis, and improved physical endurance compared to other groups (p<0.001). This study highlights that M. oleifera leaf extract reduced frailty in geriatric mice model-induced using D-galactose by reducing inflammaging factors, thereby improving physical endurance
Zero-fluoroscopy versus fluoroscopy-guided catheter ablation in ventricular arrhythmia: A systematic review and meta-analysis
Full text linkCatheter ablation has been the go-to treatment for ventricular arrhythmia, with traditional fluoroscopy-guided and non-zero fluoroscopy (NZF) catheter ablation posing high radiation risk for operators and patients. Zero-fluoroscopy technique offers elimination of radiation risk; however, its efficacy and safety in ventricular arrhythmia patients are not well explored. The aim of this study was to systematically evaluate the effectiveness, safety, and feasibility of zero-fluoroscopy ablation on ventricular arrhythmia patients. This study only included relevant studies comparing zero-fluoroscopy and NZF in ventricular arrhythmia ablation that were identified from Scopus, PubMed, and ScienceDirect (up to June 20, 2024). The quality of the study was assessed using the ROBINS-I tool, and the meta-analysis was conducted using a random-effect model. Out of 383 studies found, nine cohort studies were included with 1.408 patients. There was no significant difference in the acute procedural success rate of the zero-fluoroscopy and NZF (relative risk: 1.01; 95%CI: 0.95–1.07; p=0.69), with a similar recurrence rate (p=0.88; for four studies; n=374), and comparable procedural time (mean difference: -19.22 minutes; 95%CI: -41.16–2.72; p=0.09). Adverse events such as pericardial effusion, pseudoaneurysm, and hematoma were similar between zero-fluoroscopy and NZF. Overall, zero-fluoroscopy catheter ablation has demonstrated non-inferiority as a treatment option for ventricular arrhythmia ablation. As zero-fluoroscopy eliminates radiation risk without compromising procedural efficacy, zero-fluoroscopy has the potential to become a widely adopted approach for catheter ablation in ventricular arrhythmia