Medical Journal of Indonesia
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Vitamin D in regulating immune response in patients with recurrent pregnancy loss: a case-control study
No full textBACKGROUND Recurrent pregnancy loss (RPL) is linked to lower vitamin D levels and altered immune responses, though unclear mechanisms. This study aimed to identify the effect of vitamin D on the balance between interleukin (IL)-10/IL-17A in women with RPL.
METHODS This case-control study was conducted at the Bint Al-Huda Teaching Hospital, Thi-Qar Governorate, Iraq, from August 2022 to March 2023. Three study groups were included: RPL (47 women), non-aborted pregnant (40 women), and control (38 women). The sera concentrations of IL-17A, vitamin D, and IL-10 had been quantitatively detected using ELISA. SPSS was used for statistical analysis.
RESULTS Women with RPL had significantly lower vitamin D levels (19.6 ng/ml) and higher IL-17A levels (35.66 ng/l) than the non-aborted pregnant (23.46 ng/ml, 24.04 ng/l) and control groups (25.69 ng/ml, 19.87 ng/l). IL-10 levels were substantially depleted in the RPL group (3.96 pg/ml), leading to a statistically lower IL-10/IL-17A ratio (0.19) than in the non-aborted pregnant (0.58) and control (1.60) groups. Regression analysis revealed a valuable positive association between vitamin D and IL-17A in all groups and between vitamin D and IL-10/IL-17A ratio in RPL and control groups. Vitamin D was also significantly associated with IL-10 in the non-aborted pregnant group. However, no statistical relationship was reported between vitamin D and IL-10 levels in the RPL and control groups.
CONCLUSIONS Increased IL-17A and decreased IL-10 contributed to unexplained RPL. The IL-10/IL-17A ratio predicted endometrial function, and vitamin D affects these cytokines, potentially reducing inflammation
Effects of lung recruitment maneuver using mechanical ventilator in preterm infant microcirculation: a clinical trial
No full textBACKGROUND Preterm infants often require continuous positive airway pressure due to immature respiratory tracts. Bronchopulmonary dysplasia (BPD) manifests as prolonged oxygen dependence until 28 days of age and is classified into mild, moderate, or severe forms. The lung recruitment maneuver (LRM) aims to reopen collapsed alveoli, enhancing oxygenation during mechanical ventilation using the assist control volume guarantee mode (MV-AC/VG). This study aimed to evaluate the impact of LRM on alveolar and endothelial injuries, neonatal microcirculation, and its relation to BPD reduction or mortality in preterm infants.
METHODS This study was conducted from March 2021 to April 2022 at Cipto Mangunkusumo and Bunda Menteng Hospitals, Jakarta. The participants are <32 weeks infants with severe respiratory distress syndrome requiring MV-AC/VG, divided into LRM and control groups (n = 55 each). The alveolar injury was assessed using plasma surfactant protein-D (SP-D), endothelial injury by flow cytometry for endothelial microparticles (CD-31⁺/CD-42-), and neonatal microcirculation via transcutaneous-artery CO2 gap (TcPCO₂-PaCO₂) and transcutaneous O2 index (TcPO₂/PaO₂) measurements at 1 and 72 hours post-ventilation.
RESULTS LRM did not negatively affect preterm infants (24–32 weeks) undergoing invasive mechanical ventilation. At 72 hours, no significant differences were observed in alveolar (SP-D) and endothelial injury (CD-31+/CD-42-), nor in BPD reduction or mortality by 36 weeks.
CONCLUSIONS LRM is a beneficial intervention for enhancing respiratory support and microcirculation in preterm infants. Among survivors, LRM reduced the time to achieve the lowest FiO2 (60.0 versus 435.0 hours, p<0.0001), shortened respiratory support duration (25.0 versus 36.83 days, p = 0.044), and improved TcO2 index (1.00 versus 1.00, p = 0.009)
Natural remedies in burn care: a systematic review and network meta-analysis
No full textBACKGROUND Burn injuries are a global public health issue that impact healing time and cause complications. While silver sulfadiazine (SSD) cream is commonly used for treatment, research indicates that SSD can hinder the wound healing process. Natural alternatives like Aloe vera, honey, and amniotic membranes have shown promise in promoting wound healing. This study aimed to evaluate their efficacy by their wound healing time and infection rate.
METHODS 3 independent reviewers conducted a literature search across 6 databases (Cochrane Central Register of Controlled Trials, PubMed, ScienceDirect, Taylor & Francis, Wiley, and ProQuest). Quality assessment was conducted using the Cochrane Risk of Bias 2 tool, while network meta-analysis was performed using the netmeta package in R. The variable in this study is the average time to burn wound healing and infection occurrence by analyzing MD data or OR of each intervention, with 95% CI to calculate the efficacy.
RESULTS A total of 3,434 patients from 37 studies were included. In the analysis of 26 studies comparing the healing time to SSD, A. vera has the best efficacy (MD: −4.75; 95% CI: −8.67 to −0.86), followed by amniotic membrane (MD: −4.71; 95% CI: −7.45 to −1.97), and honey (MD: −4.25; 95% CI: −6.76 to −1.73). Meanwhile, the occurrence of infection analysis in burn wounds across 24 studies highlighted that honey has the lowest infection rate (OR: 0.09; 95% CI: 0.04 to 0.23) and was the only statistically significant finding when compared to SSD.
CONCLUSIONS Aloe vera and amniotic membrane are effective for wound healing, while honey is particularly effective in preventing wound infection in patients with burn injuries
Association between high serum levels of soluble vascular cell adhesion molecule-1 and obesity in women
Full text linkBACKGROUND Obesity and metabolic disorders are associated with persistent low-level inflammation connected to soluble vascular cell adhesion molecule-1 (sVCAM-1). Recent research highlights its connection to endothelial dysfunction in female obesity. This study aimed to investigate the relationship between sVCAM-1 levels and obesity-related risk factors in women from Kirkuk City, Iraq.
METHODS A case-control study was conducted on 90 women aged 20–50, including 43 participants with obesity and 47 healthy controls. Blood samples were collected, processed, and analyzed to measure various biochemical markers, including sVCAM-1. Logistic regression analysis was utilized to examine the association between sVCAM-1 levels and obesity-related parameters. Correlation analysis was performed to assess associations with body mass index (BMI). Statistical analysis was conducted using SPSS software version 23.0.
RESULTS Correlation analysis revealed that BMI was significantly correlated with alanine aminotransferase (r = 0.37, p = 0.011), uric acid (r = 0.30, p = 0.04), insulin (r = 0.37, p = 0.01), homeostatic model assessment of insulin resistance (r = 0.47, p = 0.002), and sVCAM-1 (r = 0.53, p = 0.001). These results suggest that elevated sVCAM-1 levels may serve as predictive biomarkers for increased insulin resistance in obese individuals. These findings indicate that sVCAM-1 is strongly linked to female obesity and insulin resistance.
CONCLUSIONS This study confirms the potential use of sVCAM-1 as a prognostic biomarker for obesity-related metabolic disturbances and its role in identifying individuals with a higher risk of developing insulin resistance
Comparing suturing techniques and materials in hypospadias repair: a prospective cohort study
No full textBACKGROUND Various techniques are available for hypospadias surgery, but the most effective suturing techniques and suture materials remain debated. This study aimed to evaluate the outcomes of hypospadias repair using various suturing techniques and materials.
METHODS This prospective cohort study was conducted from August 2023 to August 2024 and included all patients who underwent hypospadias surgery at Cipto Mangunkusumo Hospital. We compared the outcomes of 2 suturing techniques (interrupted versus continuous) and 2 suture materials (6-0 polydioxanone [PDS] versus poliglecaprone 25) used for neourethra suturing. Follow-up assessments were conducted at 1, 2, and 4 weeks postoperatively, and subsequently every 3 to 6 months, focusing on complications.
RESULTS 162 participants were included, with a mean age of 6.27 (3.99) years and a mean follow-up period of 20.39 (14.25) weeks. Complications occurred in 31 patients (19.1%), with a significant association between hypospadias type and complication occurrence (p = 0.039). Complication rates were 9.4% in distal, 12.5% in midshaft, and 26.8% in proximal cases. No significant differences were found between suturing techniques (interrupted: 19% versus continuous: 12%, p = 0.429) or suture materials (6-0 PDS: 22% versus 6-0 poliglecaprone 25: 9%, p = 0.998). Subgroup analyses by hypospadias type also showed no significant differences by suture type or technique (all p>0.05), although a trend toward significance was noted in proximal cases (p = 0.062).
CONCLUSIONS The choice of suturing techniques and suture materials does not affect complication rates in hypospadias repair, allowing surgeons to decide based on personal expertise and preference
Artificial intelligence, the state-of-the-art in scientific editing
No full text[No abstract available
Laparoscopic Tenckhoff catheter insertion technique with Alken telescopic metal dilator in pediatric population
Full text linkBACKGROUND End-stage renal disease (ESRD) is a major public health concern worldwide, with peritoneal dialysis (PD) offering a key alternative to hemodialysis. Flow restriction due to catheter migration is a common complication, affecting 7–26% of patients with PD. This study aimed to reduce complications in pediatric patients by examining a novel laparoscopic Tenckhoff catheter insertion technique using an Alken telescopic metal dilator.
METHODS In a prospective observational study conducted between September 2018 and October 2022, 33 pediatric patients with ESRD underwent laparoscopic Tenckhoff catheter insertion using a combination of laparoscopic and Seldinger techniques with Alken dilators. This approach involves rectus sheath tunneling using a nephrostomy puncture needle, wire insertion, and dilatation of up to 15 Fr using Alken telescopic metal dilators under laparoscopic guidance. Survival analysis was used to assess catheter survival and complication rates.
RESULTS The mean (standard deviation [SD]) patient age was 11.92 (3.7) years, with a median follow-up of 21.3 months. Catheter survival was 84.8%, with 5 catheter withdrawals due to infections (4 cases) or obstruction (1 case). Early and late complications, including exit-site infection, peritonitis, and catheter obstruction, occurred annually at rates of 0.10, 0.03, and 0.02 episodes per patient, respectively. No pericatheter leakage occurred.
CONCLUSIONS This novel laparoscopic Tenckhoff catheter insertion technique using an Alken telescopic metal dilator become a simple and minimally invasive method, and associated with high catheter survival and low complication rates. Therefore, further comparative studies are recommended
