Narra J (Journal)
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Hypocapnia and its relationship with in-hospital mortality in acute heart failure patients: Insights from the Indonesian multicenter ICCU registry
Get PDFAcute heart failure (AHF) presents serious risks for hospitalized patients. The aim of this study was to explore the relationship between arterial partial pressure of carbon dioxide (PaCO2) levels and outcomes in AHF patients admitted to the intensive cardiovascular care unit (ICCU), utilizing data from the IndONEsia ICCU Registry (One ICCU Registry). A multicenter retrospective observational study was performed covering data between August 2021-2023. Participants were categorized by PaCO2 levels: hypocapnia (<35 mmHg), normocapnia (35–45 mmHg), and hypercapnia (>45 mmHg). The primary outcomes included ICCU mortality, in-hospital mortality, and 30-day mortality, whereas the length of the stays in the ICCU or hospital and ventilation requirement were set as the secondary outcomes. Mortality risks were assessed using Cox proportional hazards models. Of the 1,870 patients, 1,102 (58.96%) had hypocapnia, 645 (34.5%) had normocapnia, and 123 (6.5%) had hypercapnia. Hypocapnia patients had significantly higher ICCU, in-hospital, and at 30-day mortality rates compared to normocapnic patients (all p<0.001), along with longer lengths of stay in ICCU and in hospital (p<0.001). Hypocapnia significantly increased noninvasive and mechanical ventilation requirement compared to normocapnia patients. Multivariate analysis identified factors impacting patients’ survival, including age, treatment with angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARBs) drugs, and severity scores such as the quick sequential organ failure assessment (qSOFA) and simplified acute physiology score II (SAPS II). In conclusion, hypocapnia in AHF patients could increase in-hospital, ICU and 30-days mortality rates and length of hospital stays, as well as noninvasive and mechanical ventilation requirements
Spectrum of rare EGFR mutations in Indonesian lung adenocarcinoma: Findings from an 8-year analysis of 4,778 cases highlighting the need for advanced targeted therapies
Get PDFLung cancer patients in Indonesia exhibit a high prevalence of epidermal growth factor receptor (EGFR) mutations, with a substantial proportion attributed to rare or uncommon variants. The clinical significance of rare EGFR mutations lies in their differential sensitivity to tyrosine kinase inhibitors (TKIs). While they are frequently resistant to first- and second- generation TKIs, they often respond to third-generation TKIs, necessitating tailored treatment options. The need for improving access to advanced targeted therapies in Indonesia also highlights the importance of conducting research on rare EGFR mutations. The aim of this study was to identify the spectrum and frequency of EGFR mutations in patients with lung adenocarcinoma in Indonesia. A cross-sectional observational study with total sampling was conducted from January 2016 to April 2024 to investigate EGFR mutation profiles in lung adenocarcinoma patients. Samples were acquired from patients with a confirmed anatomical pathology diagnosis from various healthcare centers across Indonesia. A total of 4,778 samples were analyzed using real-time quantitative polymerase chain reaction (RT-qPCR) on various specimen types to determine EGFR mutation prevalence and patterns. Associations between demographic data and EGFR mutation status were assessed. EGFR mutations were detected in 54.6% of samples, with common mutations (exon 19 deletions/insertions and point mutation L858R) comprising 76.2% of positive cases and rare mutations (exon 20 insertions, point mutation G719X, S768I, T790M, and L861Q) accounted for 20.3%. Significant associations were found between geographic origin, age, and sex with EGFR mutation status. This study confirms substantial genetic variability and geographical differences in EGFR mutations among Indonesian lung adenocarcinoma patients, emphasizing the urgent need for further research to prompt enhanced molecular diagnostics and targeted therapies in the region
Identification of differentially expressed genes in resting human skeletal muscle of sedentary versus strength and endurance-trained individuals using bioinformatics analysis and in vitro validation
Get PDFUnderstanding the molecular mechanisms underlying skeletal muscle adaptation to different training regimens is essential for advancing muscle health and performance interventions. The aim of this study was to investigate molecular and genetic adaptations in the resting skeletal muscle of sedentary individuals compared to strength- and endurance-trained athletes using bioinformatics and in vitro validation. Differentially expressed genes (DEG) analysis of the GSE9405 dataset was conducted. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed, followed by protein-protein interaction (PPI) network analysis and receiver operating characteristic (ROC) analysis. To validate the bioinformatics findings, the expression of two identified genes was assessed using real-time polymerase chain reaction (PCR) in professional athletes and age-matched non-athletes. Analysis of RNA expression profiles from the GSE9405 dataset identified 426 DEGs, with 165 upregulated and 261 downregulated in trained individuals. Enrichment analysis highlighted pathways related to metabolic efficiency, mitochondrial function, and muscle remodeling, all crucial for athletic performance. PRKACA and CALM3 were identified as key upregulated genes in trained individuals with central roles in these pathways. The area under the curve (AUC) values for CALM3 and PRKACA were 0.8558 and 0.8846, respectively, for differentiating the two groups. Validation in human samples confirmed that CALM3 expression was significantly higher in athletes (p=0.001), suggesting its critical role in muscle adaptation. However, PRKACA expression differences between the groups were not statistically significant (p=0.321). These findings provide insights into gene-level responses to long-term training, offering a basis for targeted interventions to enhance muscle health and athletic performance
Examining the interplay between endometriosis and later-life cerebro-cardiovascular diseases: A systematic review, meta-analysis, and trial sequential analysis
Get PDFBeyond gynecological issues, women with endometriosis have a significant risk of cardiac outcomes. Despite this evidence, the extent and mechanisms of the association remain unclear. The aim of this study was to evaluate the association between endometriosis and the incidence of cerebro-cardiovascular disorders. Using preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines, seven databases were searched as of October 14, 2024, for observational studies assessing the association between endometriosis and cerebro-cardiovascular disorders. The main outcome was major adverse cardiovascular and cerebrovascular event (MACCE) while the secondary outcomes included all-cause mortality, cerebrovascular accident (CVA), ischemic heart disease (IHD), myocardial infarction (MI), arrhythmia, and heart failure (HF). Bias was assessed with the risk of bias in non-randomized studies of exposures (ROBINS-E) tool. Odds ratios with 95% confidence interval (CI) were calculated using random-effects meta-analysis. Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Robustness was assessed via sensitivity analyses and trial sequential analysis (TSA). Out of 3,141 studies, nine cohort studies encompassing 1,670,589 women (follow-up 7–28 years) were included. Endometriosis was associated with 24% higher odds of MACCE incidence (95%CI: 1.18–1.31, moderate certainty). In addition, having endometriosis increased the odds of CVA by 49% (95%CI: 1.20–1.85, high certainty), IHD by 64% (95%CI: 1.31–2.05, low certainty), MI by 53% (95%CI: 1.18–1.98, high certainty), arrhythmias by 24% (95%CI: 1.12–1.37, high certainty), and HF by 13% (95%CI: 1.03–1.25, high certainty). Endometriosis did not significantly associate with all-cause mortality. Sensitivity analyses and TSA reinforced all of these findings. In conclusion, endometriosis was significantly associated with increased odds of cerebro-cardiovascular disorders. Future research should clarify the underlying mechanisms and develop targeted prevention strategies
Striving for smoke-free families: Wives’ role in Gayo Lues, Aceh-Indonesia
Get PDFSmoking remains a prevalent habit in many households, particularly in regions where cultural norms strongly accept tobacco use. The aim of this study was to examine the influential role of wives in Gayo Lues, Aceh, Indonesia, in promoting smoking cessation within their families. Amidst cultural norms that widely accept smoking, these wives employed both persuasive and, occasionally, coercive methods to encourage healthier behaviors among family members. Utilizing a qualitative approach with Participatory Action Research (PAR), data were collected through in-depth interviews with seven wives who have firsthand experience with smoking behaviors in their families. The findings revealed that wives in Gayo Lues act as both health monitors and guardians, balancing emotional support with firm boundaries to foster a smoke-free home environment. Their roles extended beyond traditional caregiving, as they actively shape family health outcomes. In conclusion, this study underscored the importance of empowering wives as health advocates in public health efforts, particularly in culturally conservative settings. Future research could further explore the broader socio-cultural dynamics influencing wives’ health advocacy roles and assess the sustainability of these behaviors over time
Comparative assessment of smartphone‐based digital planimetry for wound area measurement
Get PDFAccurate wound area measurement is essential for effective wound care as it helps determine the progression of healing in patients. The aim of this study was to compare two wound area measurement techniques wound tracing (manual planimetry) and imitoMeasure (smartphone-based digital planimetry) with standard ImageJ-based digital image analysis in a rabbit wound healing study. The study involved 291 wounds categorized into small, intermediate, and large wounds. ImageJ was used as the reference method for comparisons. The intraclass correlation coefficient (ICC) was computed to assess the agreement and reliability between different wound measurement techniques. A mountain plot was used to assess the agreement between measurement methods, and a Bland-Altman plot was used to evaluate the agreement and concordance between measurement methods. The time required for analysis (processing time) was also compared. The study revealed that the imitoMeasure consistently demonstrated a greater level of agreement with ImageJ, especially in small and intermediate wounds. The ICC values indicated substantial agreement between ImageJ and imitoMeasure, with an exceptionally high ICC value for small wounds. Mountain plots revealed that the imitoMeasure had better agreement with ImageJ across all wound sizes. Bland-Altman plots further supported these findings, with wound tracing exhibiting wider limits of agreement and greater variability than imitoMeasure. ImitoMeasure consistently proved to be the quickest method across all wound sizes, whereas wound tracing required the longest processing time. These findings indicate that the imitoMeasure is a more reliable and consistent method for measuring the wound area, in particular for small and intermediate wounds
Network analysis of the relationship between self-management, self-efficacy, and quality of life among diabetes mellitus patients
Get PDFDiabetes mellitus (DM) requires constant self-management and self-efficiency, which affects the quality of life among patients. It is important to understand the complex interplay between these factors to improve the results of treatment. The aim of this study was to explore the relationship between self-management, self-efficacy, and quality of life among diabetes mellitus patients. A cross-sectional study of 363 diabetes patients from three public hospitals in Cao Lanh City, Vietnam, was conducted. Self-management, self-efficacy, and quality of life were assessed using the 35-item Diabetes Self-Management Instrument (DSMI), the 6-item Self-Efficacy for Managing Chronic Disease Scale (SECD6), and the 5-item European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L), respectively. Network analysis was performed to visually describe the relationship between self-management (which includes five domains of self-integration, self-regulation, interaction with health professionals and other significant people, self-monitoring, and medication adherence), self-efficacy, and quality of life. The network analysis showed that self-monitoring had the highest centrality. Two subscales of self-management, adherence and self-integration, were directly and positively correlated with quality of life, while the interaction was directly and negatively correlated with quality of life. Self-efficacy was positively correlated with self-regulation and self-monitoring, while it was negatively correlated with adherence. A direct positive correlation was also found between self-efficacy and quality of life. In conclusion, these findings highlight the pivotal role of self-management and self-efficacy in enhancing quality of life. Future studies should focus on patient education interventions to enhance adherence and self-efficacy, ultimately improving the quality of life in people with diabetes
Analysis of specialist doctors' behavior towards SGLT2 inhibitors prescription in Indonesia: A qualitative study
Get PDFSodium-glucose cotransporter-2 inhibitors (SGLT2is) have a broad range of clinical indications and are recommended by various guidelines for the management of diabetes, heart failure, and chronic kidney disease. However, prescribing rates for these agents are suboptimal towards various intended indications in many countries, including Indonesia. The aim of this study was to analyze the prescribing practices of SGLT2is among endocrinologists, cardiologists, and nephrologists in Indonesia. A qualitative method was utilized to provide a comprehensive understanding of this phenomenon. Semi-structured online interviews were performed with 18 participants, comprising seven specialized doctors as primary informants; eight key informants representing pharmacies, governmental bodies, and pharmaceutical marketing representatives; and three patients as supplementary informants. Furthermore, closed observations of two specialist doctors were undertaken as an additional data collection method. Informants were recruited using criterion and snowball sampling methods. The Theoretical Domains Framework was used as an interview guide; all interviews were audio visual-recorded, transcribed verbatim, and subsequently analyzed for thematic content with NVivo version 12. Seven themes emerged concerning the prescribing behavior of SGLT2is: socioeconomic status, therapeutic rationality, utilization barriers, utilization optimization, the urge to prescribe, therapeutic expectations and targets, and aspects of the health system and ethical considerations. Most informants possessed favorable perspectives regarding using SGLT2is when prescribed appropriately, yet specific elements necessitate enhancement to refine therapeutic justification, including initiatives to incorporate SGLT2is into the national formulary
Associations between plasma beta amyloid and cognitive decline: A systematic review and meta-analysis
Get PDFAlzheimer’s disease is a leading neurodegenerative disorder characterized by progressive cognitive decline. Early prediction is crucial for enabling timely interventions. Plasma amyloid β-peptides (Aβ), particularly the Aβ-42/Aβ-40 ratio, have been proposed as potential non-invasive biomarkers for cognitive decline and Alzheimer’s disease risk. However, conflicting findings and methodological variability have hindered consensus regarding their clinical utility. The aim of this study was to evaluate whether the plasma Aβ levels predict dementia, Alzheimer’s disease, and cognitive decline. Studies were eligible for inclusion if they measured at least one plasma Aβ species (Aβ-40, Aβ-42, or the Aβ-42/Aβ-40 ratio) and reported outcomes related to dementia, Alzheimer’s disease, or cognitive change. Only human studies published in peer-reviewed journals were included. A comprehensive search of six databases (PubMed, PMC, SSRN, Scopus, BioRxiv, and MedRxiv) was conducted up to December 1, 2024. Risk of bias was assessed using the ROBINS-E tool, and pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. A total of 25 studies were included in the systematic review, with four contributing to the meta-analysis. Lower plasma Aβ-42/Aβ-40 ratio was not significantly associated with Alzheimer’s disease risk (pooled HR=0.8; 95%CI: 0.62–1.04), and substantial heterogeneity was observed (I²=70%, p=0.02). Individual studies varied in their findings: while some reported that lower Aβ-42/Aβ-40 ratio predicted increased Alzheimer’s disease risk, others found no association or even opposing trends. Methodological heterogeneity—including differences in sample handling, measurement techniques, and study designs—likely contributed to these inconsistencies. Overall, this review suggests that plasma Aβ-42/Aβ-40 ratio is not reliable predictors for the onset of Alzheimer’s disease or dementia. However, the substantial heterogeneity observed underscores the need for further research to clarify the potential of plasma Aβ as a preclinical biomarker
KOMPAK: Translation, cross-cultural adaptation, and validation of an instrument for assessing interprofessional collaboration between pharmacists and physicians in Indonesia
Get PDFInterprofessional collaboration is crucial for addressing the complexity of health problems, requiring contributions from various professions to enhance healthcare quality, improve patient satisfaction, and achieve better clinical outcomes. The aim of this study was to develop and validate the physicians and pharmacists collaborative practice instrument, known as KOMPAK (Kolaborasi Medis Persepsi Apoteker dan Dokter/Medical Collaboration: Perceptions of Pharmacists and Physicians) for use in Indonesia. A cross-sectional study was conducted across the western, central, and eastern rigors of Indonesia, targeting physicians and pharmacists. The study included translation (forward and backward), cross-cultural adaptation (with 30 participants), and validation using confirmatory factor analysis (CFA) among 315 physicians and 315 pharmacists. The present study found no significant changes emerged during the translation and adaptation phases. In the validation phase, the CFA results for the physician instrument indicated a Comparative Fit Index (CFI) of 0.94 (>0.92), Tucker-Lewis Index (TLI) of 0.93 (>0.92), Root Mean Squared Error of Approximation (RMSEA) of 0.055 (<0.07), Standardized Root Mean Residual (SRMR) of 0.07 (<0.08), and Cronbach’s Alpha reliability of 0.88. The pharmacist instrument yielded similar results with a CFI of 0.94 (>0.92), TLI of 0.93 (>0.92), RMSEA of 0.06 (<0.07), SRMR of 0.05 (<0.08), and Cronbach’s Alpha reliability of 0.83. The final instrument consists of 24 items. In conclusion, the KOMPAK instrument demonstrated validity and reliability, supporting its use for measuring interprofessional collaboration between physicians and pharmacists in Indonesia