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Background: Previous studies have linked genetics to knee osteoarthritis. Angiotensin-converting enzyme (ACE) gene I/D polymorphism may cause OA. However, evidence remains inconsistent. This study examines knee OA risk and ACE gene I/D polymorphism., Methods: We explored Europe PMC, Medline, Scopus, and Cochrane Library using keywords. Three assessment bias factors were assessed using the Newcastle-Ottawa Scale (NOS). Criteria for inclusion: (1) Split the study population into knee OA patients and healthy controls; (2) Analysed the ACE gene I/D polymorphism; (3) Case-control or cross-sectional surveys. Studies with non-knee OA, incomplete data, and no full-text were excluded. The odds ratio (OR) and 95% confidence intervals (95% CI) were calculated using random-effect models., Results: A total of 6 case-control studies consist of 1,226 patients with knee OA and 1,145 healthy subjects as controls were included. Our pooled analysis revealed that a significant association between ACE gene I/D polymorphism and risk of knee OA was only seen in the dominant (DD + ID vs. II) [OR 1.69 (95% CI 1.14 - 2.50), p = 0.009, I2 = 72%], and ID vs. II [OR 1.37 (95% CI 1.01- 1.86), p = 0.04, I2 = 43%] genotype models. Other genotype models, including recessive (DD vs. ID + II), alleles (D vs. I), DD vs. ID, and DD vs. II models did not show a significant association with knee OA risk. Further regression analysis revealed that ethnicity and sex may influence those relationships in several genotype models., Conclusions: Dominant and ID vs. II ACE gene I/D polymorphism models increased knee OA risk significantly. More research with larger samples and different ethnic groups is needed to confirm our findings. After ethnicity subgroup analysis, some genetic models in our study showed significant heterogeneities, and most studies are from Asian countries with Asian populations, with little evidence on Arabs., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Mustari MN et al.)

Schistosomiasis, caused by Schistosoma trematode worms, represents a significant global health challenge. This review offers a thorough examination of the disease's epidemiology, transmission dynamics, diagnostic modalities, and treatment options. Diagnostic techniques encompass direct parasitological methods, immunological assays, DNA/RNA detection, and biomarker utilization, each with distinct advantages and limitations. There is an urgent need for improved diagnostic tools with enhanced sensitivity and specificity. Praziquantel remains the cornerstone of treatment, exhibiting efficacy against all Schistosoma species, while the potential of artemisin derivatives in combination therapy is also explored. In this review, we focus on the importance of praziquantel administration as the central aspect of schistosomiasis treatment, highlighting ongoing efforts to optimize its utilization for improved patient outcomes.

Objectives: To investigate the challenges and opportunities for implementing smoke-free areas (SFAs) within eight area categories using the WHO Framework Convention on Tobacco Control as a framework for analysis., Design: This study used qualitative methods (in-depth interviews and document reviews). All transcripts from the interviews and formal documents were coded using NVivo V.11 software and analysed using an inductive thematic analysis., Setting: Banda Aceh, Indonesia., Participants: Seventy-three participants were interviewed, stratified by ages (18-59 years): policymakers (n=4), SFA implementers (n=33), SFA's non-compliance prosecutors (n=2), SFA observers (n=4), communities/respected figures (n=30); and 10 documents were reviewed., Results: Barriers to the effective implementation of SFAs were identified: conflict of interests of Banda Aceh authorities in implementing SFA policies; inadequate monitoring, evaluation and implementation of SFAs among involved actors; inadequate public communication of SFAs to communities; and misunderstanding of 'enclosed areas' as SFAs. However, some important opportunities were identified: the Ministry of Education promotes SFA at schools; and smoking prohibition as part of sharia and other religions' recommendations., Conclusions: This research is the first study to examine SFAs to understand the challenges and opportunities for improving SFA policy implementation by interviewing various key respondents in Banda Aceh (religious leaders and respected figures). These key stakeholders' roles are crucial to enhance the implementation of SFA policies in Banda Aceh (currently suboptimal) and other populous Muslim areas in Indonesia or other countries because smoking contradicts Islamic teachings and other religions' tenets. Further, the findings propose policymakers and involved agencies strengthen public communication, execution, monitoring and evaluation, and enforcement of SFA policies in Aceh. Finally, the application of methods and results from this study to other local areas in Indonesia or other developing nations is necessary to facilitate further understanding more about the applicability, advantages and limitations of this study., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aim: Critical illness conditions such as sepsis are often accompanied by altered hormone levels, which may result in decreased thyroid axis activity. This condition aims to provide metabolic substrates for vital organs such as the brain and immune system. Significant alteration of the thyroid axis in critical illnesses such as sepsis known as Low-T3 Syndrome which is associated with increased mortality. This study aims to determine the association between severity of sepsis and thyroid function profile as a predictor of mortality in sepsis patients., Methods: An observational study involving 62 subjects with sepsis and septic shock. Serum was measured using Enzyme-linked Immunosorbent Assay (ELISA) method. Statistical analysis used Mann-Whitney, Kruskal-Wallis, and Spearman's correlation tests. Statistical test results are significant if the p-value <0.05., Results: The median fT3 level was lower in the septic shock group 13.94 pg/ml (7.71-19.93) compared to the sepsis group 20.15 pg/ml (11.08-37.15) where there was a significant difference (p<0.001). There was a significant correlation between The Sequential Organ Failure Assessment (SOFA) score and fT3 levels (R: -0.270, p=0.032). The non-survivor group had a lower median fT3 level 16.56 pg/ml (7.71-30.03) compared to the survivor group 17.50 pg/ml (10.32-37.15) where there was a significant difference (p<0.036)., Conclusion: Based on the severity of sepsis, the more severe the sepsis condition, the lower thyroid function levels are obtained where decreased thyroid function levels can be a prognosis indicator to predict mortality in sepsis patients.

Background: Latent tuberculosis is defined as a state of persistent immune response stimulated by Mycobacterium tuberculosis antigens with no evidence and signs of active TB . Health workers have a high risk of developing latent TB disease due to occupational exposure from patients. High sensitivity CRP (hs-CRP) assays have been developed for special values that may indicate low-grade inflammatory lesions as is true in measurement of latent tuberculosis infection. Factors that affect CRP levels are gender and age. Our study is conducted to asses effect of age and gender on Hs- CReactive protein leves serum on health worker with latent tuberculosis and healthy control., Method: This research is a cross sectional study using primary data. The research was conducted at Wahidin Sudirohusodo Makassa Hospital and Community Center For Lung Health In South Sulawesi. Studied subject were recruited by consecutivesampling, in which the patient who met the inclusion criteria and then the serum HsCRP test was measured. Data analysis was performed using SPSS version 25., Result: During the study period , 80 subjects met the inclusion criteria. At age ≤ 32 years, the mean HsCRP was found to be lower in latent TB than in healthy controls, but not statistically significant (p>0.370). At age >32 years, the mean HsCRP was found to be higher in latent TB than in healthy controls, but not statistically significant (p>2.49). In males, the mean HsCRP was found to be higher in latent TB than in healthy controls, but not statistically significant (P =0.584). In women, the mean HsCRP was found to be lower in latent TB than in healthy controls, but not statistically significant (P =0.712)., Conclusion: Serum HsCRP levels were found to be higher in latent TB subjects with increasing age and male gender but not statistically significant., Competing Interests: Conflict of interest The authors have none to declare., (Copyright © 2022 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

The risk factors most strongly associated with knee osteoarthritis (OA) are old age and obesity. However, few studies have evaluated the interaction between aging and obesity in conjunction with inflammatory markers and knee OA severity as part of a complete assessment of knee OA management. Therefore, this study aims to evaluate the interaction between obesity, age, inflammation [including the I/D polymorphism of angiotensin converting enzyme-1 (ACE-1)], and the severity of knee OA., Methods: A total of 80 knee OA patients were included in this cross-sectional study. The severity of knee OA was determined based on the Kellgren-Lawrence system. All patients underwent physical and radiological examination; monocyte chemoattractant protein 1 (MCP-1) markers were measured. The parameters of the ACE-1 gene were examined with sequencing DNA., Results: There was a significant relationship between age and severity of knee OA ( P =0.007), with subjects aged greater than or equal to 65 having a 3.56-fold higher risk of developing moderate to severe OA than subjects aged less than 65. There was a significant difference between body weight and knee OA severity ( P =0.026), in which subjects weighing greater than or equal to 60 kg had 3.14 times the risk of experiencing severe knee OA. Multivariate regression analysis indicated that age was the strongest independent variable for knee OA severity compared with body weight. MCP-1 levels were significantly higher in mild knee OA than in moderate to severe knee OA. The DD genotype of the ACE-1 gene increases the risk of severe knee OA by four times in subjects aged greater than or equal to 65 compared to subjects aged less than 65. However, the DD genotype of the ACE-1 gene does not increase the risk of severe knee OA in subjects weighing greater than or equal to 60 kg., Conclusion: While obesity and age were found to be associated with the severity of knee OA, age emerged as the independent risk factor for knee OA severity. Furthermore, MCP-1 levels were significantly higher in cases of mild knee OA compared to severe knee OA. It was observed that the DD genotype of the ACE-1 gene increases the risk of severe knee OA in individuals aged 65 years or older., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background The number of people suffering from depression has increased in recent times. In the Aseer region alone, 3.8% of the population suffers from depression, and one of the causes is believed to be dry eye disease (DED). Objectives This research aims to investigate the relationship between depression and dry eye disease among people living in Saudi Arabia's Aseer region. Methodology The study is cross-sectional, and data was collected from 401 participants living in Aseer, Saudi Arabia. Data was collected with the help of a well-structured questionnaire, and results are extracted by analyzing the model using SPSS. Findings The study discovered a positive and significant relationship between dry eye disease and depression. A total of 36.7% of the participants had dry eye symptoms and 23.7% were diagnosed with depression, stress, or anxiety. Conclusion Our study concludes that patients suffering from dry eye disease are more likely to get depressed because, according to our analysis, there is a correlation between dry eye disease and depression. Dry eye disease is a condition that is not only affecting the elderly but the young alike. Saudi Arabia's healthcare authority should create awareness about this health issue with the help of seminars, print, and social media., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alamri et al.)

Spring-assisted cranioplasty (SAC) for the treatment of craniosynostosis uses internal springs to produce dynamic changes in cranial shape over several months before its removal. The purpose of this study was to report the first Egyptian experiences with SAC in the treatment of children with sagittal synostosis and evaluate the preliminary outcome. A total of 17 consecutive patients with scaphocephaly underwent SAC with a midline osteotomy along the fused sagittal suture and insertion of 3 springs with bayonet-shaped ends across the opened suture. Operative time, blood transfusion requirements and length of ICU, total hospital stay, and complications graded according to Oxford protocol classification were recorded. Spring removal was performed once re-ossification of the cranial defect occurred. All patients successfully underwent SAC without significant complications. The mean age at surgery was 6.8 months. The mean time of the spring insertion surgery was 63 minutes (SD 9.7). Blood transfusion was needed in less than half of the patients (41.2%).The mean duration of hospital stay was 3.2 days. The mean timing of spring removal was 5.5 months (SD 0.4). The mean time of the second surgery (spring removal) was 22.8 minutes (SD 3.6). In conclusion, SAC can easily be incorporated into the treatment armamentarium of craniofacial surgeons. The technique offers a safe and minimally invasive option for the treatment of sagittal craniosynostosis with the benefit of limited dural undermining, minimal blood loss, operative time, anesthetic time, ICU stay, and hospital stay., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Introduction: Indonesia ranks the fifth highest in child stunting among Asian countries. Aceh, a westernmost province in Indonesia recorded the highest prevalence of stunting in children under two years old in the nation. Our study investigated the current government efforts on child stunting reduction activities since the introduction of Governor Regulation No. 14/2019., Methods: The study investigated the current efforts of Aceh governments and relevant actors on child stunting reduction using in-depth interviews, document reviews and focus group discussions., Results: Thirty-five (35) respondents including policy makers were interviewed, four focus group discussions (15 each group) were conducted, and various official documents were reviewed. Various challenges for reducing child stunting in Aceh were identified: inadequate knowledge and skills of Posyandu cadres on child stunting; reluctance to consume iron and folic acid (IFA), and supplementary foods (PMT Bumil) by many pregnant women due to perceived annoying effects and unappetizing taste; work engagement, insufficient breast milk production and inadequate support from husbands failing to achieve exclusive breastfeeding among nursing women; inadequate provision of complementary fortified foods for children 6-23 months; lack of clean water, waste management and WASH practices., Conclusion: The intervention on both nutrition-specific and nutrition-sensitive factors was found to be insufficient in Aceh. Although WASH (water, sanitation and hygiene) practices are the most important contributors to child stunting, only the health agency plays a singular role in reduction efforts by focussing on specific factors. Coordination between relevant agencies to address both factors is required to achieve the effectiveness of child stunting reduction and prevention in Aceh., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Alzheimer's disease (AD) is a brain disorder that eventually causes memory loss and the ability to perform simple cognitive functions; research efforts within pharmaceuticals and other medical treatments have minimal impact on the disease. Our preliminary biological studies showed that Repeated Electromagnetic Field Stimulation (REFMS) applying an EM frequency of 64 MHz and a specific absorption rate (SAR) of 0.4 - 0.9 W/kg decrease the level of amyloid- β peptides (A β ), which is the most likely etiology of AD. This study emphasizes uniform E/H field and SAR distribution with adequate penetration depth penetration through multiple human head layers driven with low input power for safety treatments. In this work, we performed numerical modeling and computer simulations of a portable Meander Line antenna (MLA) to achieve the required EMF parameters to treat AD. The MLA device features a low cost, small size, wide bandwidth, and the ability to integrate into a portable system. This study utilized a High-Frequency Simulation System (HFSS) in the design of the MLA with the desired characteristics suited for AD treatment in humans. The team designed a 24-turn antenna with a 60 cm length and 25 cm width and achieved the required resonant frequency of 64 MHz. Here we used two numerical human head phantoms to test the antenna, the MIDA and spherical head phantom with six and seven tissue layers, respectively. The antenna was fed from a 50-Watt input source to obtain the SAR of 0.6 W/kg requirement in the center of the simulated brain tissue layer. We found that the E/H field and SAR distribution produced was not homogeneous; there were areas of high SAR values close to the antenna transmitter, also areas of low SAR value far away from the antenna. This paper details the antenna parameters, the scattering parameters response, the efficiency response, and the E and H field distribution; we presented the computer simulation results and discussed future work for a practical model., Competing Interests: Conflicts of Interest The authors declare no conflicts of interest regarding the publication of this paper.

Background: Acute coronary syndrome (ACS) is a major cardiovascular problem due to its high hospitalization and mortality rates. One of the risk factors for atherosclerosis that leads to ACS is insulin resistance (IR) which plays a role in the pathogenesis and development of cardiovascular events. This study aims to determine the relationship between IR and in-hospital outcomes in non-diabetic patients with ACS., Methodology: This was a cohort study conducted from January-June 2021. Insulin resistance was assessed using the Admission insulin resistance index (AIRI). This measurement was performed once during the patient's admission, and then the outcome was observed during hospitalization. The observed in-hospital outcomes were composite outcomes; namely, heart failure, arrhythmia, cardiogenic shock, and death. The statistical tests used were ANOVA, independent T and Chi-Square tests. Statistical test results were considered significant if p <0.05., Results: This study included 60 subjects (51 males and 9 females). Analysis revealed that AIRI was higher in patients with composite outcomes (mean 9.97 ± 4.08) than in patients without composite outcomes (mean 7.71 ± 4.06) ( p <0.05); AIRI was higher in patients with heart failure (mean 10.72 ± 3.83) than in patients without heart failure (mean 7.25 ± 3.84) ( p <0.001). Patients with IR had a higher rate of heart failure complications [OR 5.5 95% CI (1.56-19.38) ( p =0.005)]., Conclusion: There is an association between AIRI and composite outcomes. Patients with IR have 5.5 times the risk of developing heart failure., Competing Interests: The authors declared no conflict of interest., (© 2023 Journal of the ASEAN Federation of Endocrine Societies.)

(1) Background: Methylmercury (MeHg) exposure during pregnancy is an important issue due to its possible adverse health effects on fetus. To contribute the development of assessment system of Hg exposure through fish consumption and health effects on children, we examined the hair Hg levels in pregnant women and birth weight and length. (2) Methods: In 2018, a cohort study was conducted on 118 pregnant women-infant pairs from six community health centers in the northern coastal area in Central Java Indonesia. Data on mothers' characteristics during pregnancy, birth outcomes, and fish consumption were collected. Total Hg concentrations were determined from hair samples. (3) Results: The median (min-max) of the maternal hair Hg level was 0.434 (0.146-8.105) µg/g. Pregnant women living in lowland areas, near the sea, showed higher hair Hg concentration and fish consumption than those in highland areas {[0.465 (0.146-8.105) vs. 0.385 (0.150-1.956) µg/g; p = 0.043] and [(85.71 (0-500.0) vs. 49.76 (0.0-428.57) g/day; p < 0.01], respectively}. The maternal hair Hg level had no association with baby's birth weight and length. (4) Conclusions: The median maternal hair Hg is at a low level and had no association with infant birth weight and length in this study subjects.

In this paper, we follow up with our preliminary biological studies that showed that Repeated electromagnetic field stimulation (REMFS) decreased the toxic amyloid-beta (A β ) levels, which is considered to be the cause of Alzheimer's disease (AD). The REMFS parameters of these exposures were a frequency of 64 MHz and a Specific absorption rate (SAR) of 0.4 to 0.9 W/Kg in primary human neuronal cultures. In this work, an electromagnetic field (EMF) model was simulated using high-frequency simulation system (HFSS/EMPro) software. Our goal was to achieve the EM parameters (EMF Frequency and SAR) required to decrease the toxic A β levels in our biological studies in a simulated human head. The simulations performed here will potentially lead to the successful development of an exposure system to treat Alzheimer's disease patients. A popular VFH (very high frequency) patch microstrip antenna system was considered in the study. The selection was based on simple and easy construction and appropriateness to the VHF applications. The evaluation of the SAR and temperature distribution on the various head layers, including skin, fat, dura, the cerebrospinal (CSF), and grey matter, brain tissues, were determined for efficacy SAR and safety temperature increase on a simulated human head. Based on a current pulse of 1 A peak current fed to the antenna feeder, a maximum SAR of 0.6 W/Kg was achieved. A range of 0.4 to 0.6 SAR was observed over the various layers of the simulated human head. The initial design of the antenna indicated an antenna size in the order of 1 m in length and width, suggesting a stationary practical model for AD therapy. Future direction is given for wearable antenna and exposure system, featuring high efficiency and patient comfort., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflicts of interest regarding the publication of this paper.

Background: Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis (Mtb). This infection causes the release of proinflammatory cytokines that affect hemostasis. Pulmonary TB infection causes an increased activation of procoagulant factors, decreased anticoagulant factors and suppresses fibrinolysis which causes hypercoagulable. Our study is conducted to assess the association between pulmonary TB infection (PTB) with hemostatic parameters before and after intensive phase treatment., Methods: This was an analytic observational prospective cohort design. The study was conducted at the Community Center for Lung Health in South Sulawesi. Studied subjects were recruited by consecutive sampling, in which the patients who met the inclusion criteria received intensive phase of ATD treatment. PT, aPTT, fibrinogen, and D-dimer were measured before treatment and after the intensive phase of ATD. These data were analyzed using the SPSS Version 22., Results: In this study, 30 subjects are new cases of PTB. Prothrombin time, aPTT and D-dimer levels were higher in far advanced lesions and smear-positive sputum group (p<0.001). There was a significant level decrease in PT, aPTT, fibrinogen, D-dimer after intensive phase treatment (p<0.001)., Conclusion: Pulmonary tuberculosis infection is associated with hypercoagulability which is characterized by an increase in hemostatic parameters and has significant improvement after intensive phase of ATD treatment., (Copyright © 2020, Babol University of Medical Sciences.)

Background: Both clinical and experimental evidence have been published over the past few decades supporting the existence of a close relationship between the elevated levels of serum uric acid with cardiovascular events and acute kidney injury (AKI). This study aimed to determine the effect of serum uric acid levels on the incidence of AKI in acute coronary syndrome (ACS) patients., Methods: A retrospective cohort study with a cross sectional design was performed. The research was conducted at Dr. Wahidin Sudirohusodo Hospital from October 2019 to December 2019. Nonrandom sampling was employed in the medical records. All patients who met the inclusion criteria were at > 18 years old and diagnosed with ACS with AKI. The demographic data of age, sex and serum uric acid levels were recorded. The data obtained were analyzed using the SPSS (Statistical Package for Social Sciences)., Results: There were 158 subjects of ACS patients with AKI and 135 without AKI. There was a significant correlation between high uric acid levels with the incidence of AKI in ACS (p<0.001). Patients with high serum uric acid levels were 9.5 times at risk of developing AKI compared to those with normal serum uric acid levels., Conclusion: High uric acid level is one of the risk factors for AKI in ACS and indicates 9.5 times at risk of developing AKI compared to normal serum uric acid level. Therefore, it is necessary to monitor serum uric acid level and kidney function in ACS patients., (Copyright © 2020, Babol University of Medical Sciences.)

Methylmercury (MeHg) is a well-known neurotoxin of the central nervous system (CNS). Neuroinflammation is one of the main pathways of MeHg-induced CNS impairment. This study aims to investigate the expressions of IL-6, MIP-2, and MCP-5, as biomarkers in relation with MeHg-induced CNS impairment and N-acetyl-L-cysteine (NAC) treatment in mice, as well as histopathological changes of brain tissue and clinical symptom such as ataxia. Twenty male Balb/c mice, aged 8-9 weeks, were divided into 4 groups and treated with saline (control), NAC [150 mg/kg body weight (BW) day], MeHg (4 mg Hg/kg BW), or a combination of MeHg and NAC for 17 days. MeHg induced the expression of IL-6, MIP-2, and MCP-5 in the serum, with median values (those in controls) of 55.06 (9.44), 15.94 (9.30), and 458.91 (239.91) mg/dl, respectively, and a statistical significance was observed only in IL-6 expression (p < 0.05). MIP-2 and MCP-5 expressions tended to increase in the cerebrum of MeHg-treated group compared with controls; however, the difference was not statistically significant. MeHg treatment also increased IL-6 expression in the cerebellum (7.73 and 4.81 mg/dl in MeHg-treated group and controls, respectively), with a marginal significance. NAC significantly suppressed MeHg-induced IL-6 and MIP-2 expressions in the serum (p < 0.05 for both), and slightly reduced MCP-5 expression in the cerebrum. Ataxia was observed in all MeHg-treated mice after 9-day exposure as well as the decrease of intact Purkinje cells in brain tissue (p < 0.05). These findings suggest that MeHg induced neurotoxicity by elevating the expression of IL-6, MIP-2, and MCP-5 and causing ataxia symptoms, and NAC reduced MeHg-mediated effects on the CNS.

Background and Aims: Millions of people in Indonesia have diabetes. The cluster of metabolic abnormalities has long been identified as the risk factors for type 2 diabetes and is now commonly described as metabolic syndrome/MetS. Insulin resistance takes a key role in the process of the MetS and has even been hypothesized as its underlying cause. Clinical and epidemiologic studies also indicate that inflammatory factors might be correlated with IR. Prospective studies have proved that metabolic syndrome grows during childhood/adolescence and progresses to adulthood T2DM. The purpose of this study was to investigate relationships between metabolic syndrome components and low-grade systemic inflammation with insulin resistance in non-diabetic Indonesian adolescent male., Methods: This was a cross-sectional analysis of non-diabetic adolescent male in Indonesian population (n = 128) aged between 18 and 22 years old. MetS components are based on NCEP ATP III (2004) modification for Asia Pacific population. Marker for low-grade systemic inflammation is hsCRP and insulin resistance was determined by HOMA-IR formula. Relevant measures were anthropometry, blood pressure, fasting insulin, serum glucose, lipid profiles and hsCRP., Results: Of the 128 adolescent male, we found that 16 subjects (12.5%) have central obesity; 3 subjects (2.3%) have hyperglycemia; 26 subjects (20.3%) have low HDL-c; 19 subjects (14.8%) have high triacylglycerol; 45 subjects (35.2%) have hsCRP ≥1.0 mg/dL; 4 subjects (3.1%) have high blood pressure and 39 subjects (30.5%) have insulin resistance. The association of MetS components with the risk of insulin resistance is central obesity and high triacylglycerol with OR of 24.4 (95%CI: 5.19-114.42) and 9.4 (95%CI: 3.09-28.68) consecutively. We also found that low-grade systemic inflammation (hsCRP ≥1.0 mg/dL) was strongly associated with incident of insulin resistance with OR 5.2 (95%CI: 2.31-11.64). Meanwhile, we found that high triacylglycerol level is the solely one of five MetS components which has contribution to the incident of systemic low-grade inflammation with OR 3.9 (95%CI: 1.43-10.92)., Conclusion: Central obesity and high triacylglycerol level are the important MetS components associated with IR. Systemic low-grade inflammation has been associated with insulin resistance. Identification of obesity, high triacylglycerol and high hsCRP should be focused for prevention of type 2 diabetes in non-diabetic Indonesian adolescent male., Competing Interests: Declaration of Competing Interest The authors declare nothing to disclosure regarding conflict of interest., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Chronic microvascular complications consist of diabetic nephropathy (DN), diabetic retinopathy (DR), and diabetic neuropathy. Diabetic nephropathy is assessed through albuminuria, and diabetic retinopathy is assessed through fundoscopy. Several studies have assessed the albuminuria in diabetic retinopathy but have found inconclusive results. This study aims to investigate the albumin excretion rate in patients with diabetic retinopathy., Methods: A cross sectional design was applied in this study. The diagnosis of type 2 diabetes mellitus was determined based on the anamnesis and laboratory examinations. The study was conducted at Dr. Wahidin Sudirohusodo Hospital and Hasanuddin University Hospital in Makassar during November 2018 until April 2019. The stages of diabetic retinopathy were based on funduscopic examinations. In addition, the blood pressure, BMI, albumin excretion rate, lipid profile, and HbA1C were also examined. Chi Square and Kappa tests were performed in the statistical analysis., Results: 120 subjects with type 2 diabetes mellitus were observed. Of the total subjects, the number of females within the age of 36-79 years made up the biggest fraction. There was a significant relation between hypertension comorbidity with the albumin excretion rate and grading diabetic retinopathy where the A3 and proliferative diabetic retinopathy (PDR) percentages were higher in the hypertension group at 68.8% and 54.5%. There was also a significant correlation between incidence of albuminuria with diabetic retinopathy. Particularly, proliferative diabetic retinopathy (PDR) remained associated with albuminuria, while non-proliferative diabetic retinopathy (NPDR) was related to non-albuminuria., Conclusion: Albuminuria incidence confirms association with diabetic retinopathy grading.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease and disturbed bacterial clearance. Vitamin D deficiency is sometimes observed in COPD patients and as significant roles in increasing inflammation of airway obstruction and systemic obstruction, increasing pro-inflammatory cytokine including TNF-α, reduction of bacterial clearance and increase exacerbation risk due to infection. Also, vitamin D plays significant roles in the metabolism of calcium and mineralisation of bones and regulation system of immune. TNF-α also has essential roles in pathogenesis and inflammation of COPD. Several studies that investigate the relationship between vitamin D level and serum TNF-α concentration in COPD patients are relatively uncommon, including in Indonesia., Aim: This study aimed to assess the relationship between vitamin D level and TNF-α concentration in patients on the severity of the chronic obstructive pulmonary disease., Methods: This study was a hospital-based descriptive cross-sectional study. Total samples were 50 COPD patients with the average age of older than 60 years during their enrollments at the Department of Pulmonology and Respiratory Medicine of the Dr Wahidin Sudirohusodo General Hospital Makassar in September 2018-January 2019. All procedures of the present study were reviewed and approved by the Research Ethics Committee of Medicine Faculty of Hasanuddin University. The severity of COPD was assessed according to the combination of COPD assessment stages that referred to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guideline 2015 that consisted of the combination of scoring COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) questionnaire and results of the spirometry measurement. Assessment of airway obstruction levels referred to the GOLD spirometry criteria. Determination of thoracic photographs was conducted to verify the COPD diagnosis of the severity of COPD. Determination of serum TNF-α concentration and vitamin D3 [1,25(OH)2D3] level used the ELISA method., Results: The majority of COPD patients were observed in the category of older than 60 years old accounted for 34 COPD patients (68%), and the majority of COPD patients were males accounted for 47 males with COPD (94%). The majority of COPD patients were observed in the group of D (38%). All the study subjects observed in this study were smokers, and 82% of them were in the category of heavy smokers. 21 study subjects had higher concentration of serum TNF-α (tertile 3 = 0.21-1.83 pg/dl), 20 study subjects and lower level of vitamin D (tertile 1 = 182.1-364.5 pg/dl). The majority of the study subjects (38%) were in the category of severe COPD (category D of the severity of COPD at the tertile 3) according to the GOLD Combine Assessment. Given the relationship between vitamin D level and serum TNF-α concentration on the airway obstruction, there were significant positive correlations between the increase of vitamin D levels and the increase of serum TNF-α concentrations on airway obstruction. Given the relationship between vitamin D level and serum TNF-α concentration on the severity of COPD, there were significant positive correlations between the increase of vitamin D levels (tertiles 1, 2 and 3) and the increase of serum TNF-α concentrations on the severity of COPD at p-value < 0.05. Overall, there were non-linear relationships between vitamin D level and serum TNF-α concentration on the severity of COPD., Conclusions: Serum TNF-α concentration was positively associated with airway obstruction level and severity of COPD. Low level of vitamin D was negatively associated with airway obstruction level and severity of COPD. Vitamin D3 level (1,25(OH)2D) was negatively associated with serum TNF-α concentration and airway obstruction level and severity of COPD., (Copyright: © 2019 Muhammad Ilyas, Agussalim Agussalim, Megawati Megawati, Nasrum Massi, Irawaty Djaharuddin, Syakib Bakri, Suryani As'ad, Mansyur Arief, Burhanuddin Bahar, Arifin Seweng, Prihantono Prihantono.)

Background: the familial nature of type 2 diabetes is manifested by the presence of insulin resistance in non-diabetic first degree relatives. Most of these studies have been performed in middle-aged and there is only few published studies in young age individuals and adolescents. This study aimed to determine the relationship between parents history of type-2 diabetes with metabolic syndrome component and insulin resistance in adolescent non-diabetic subjects., Methods: this was a cross sectional study comparing the metabolic profile, risk of metabolic syndrome and insulin resistance in non-diabetic male adolescents (17-24 years old) whose one or both parents were with type-2 diabetes. We performed anamnesis, physical examination, fasting plasma glucose, lipid profile, fasting insulin level and insulin resistance based on HOMA-IR., Results: metabolic abnormalities were more prevalent in subjects whose parents were with history of type-2 diabetes, especially their waist circumference, fasting plasma glucose, triglyceride, fasting insulin and HOMA-IR (p=0.000). There was increased risk of developing central obesity in adolescents with parental history of 19.3 fold (95%CI 2.46-151.07) and insulin resistance of 10.3 fold (95%CI 3.89-27.23). Parental history of type-2 diabetes together with metabolic syndrome component ie. waist circumference >90 cm and triglyceride ≥150 mg/dl were strong determinat factors for insulin resistance (R2=50.7%)., Conclusion: the early multiple metabolic defect can be detected in non-diabetes adolescents with parental history of type-2 diabetes. Cluster of metabolic syndrome component in these subject become  a powerful determinat factor for insulin resistance.

Low birth weight (LBW) is defined as a birth weight of a liveborn infant of <2,500 gram. In developed countries, LBW is commonly caused by preterm birth; while in developing countries, it is mostly due to intrauterine growth retardation. The concept of developmental origins of adult diseases, particularly on late-onset diseases such as hypertension and kidney disease, implies that there is a correlation between intrauterine milieu, intrauterine growth retardation, premature birth and infant feeding. The 'fetal origin hypothesis' suggests that metabolic diseases are directly related to poor nutritional status in early life.There is an inverse association between LBW and later risk of hypertension. The pathomechanism that links LBW and hypertension is multifactorial including delayed nephrogenesis, genetic factors, sympathetic hyperactivity, endothel dysfunction, elastin deficiencies, insulin resistance and activation of renin-angiotension system.

Background: The rise in childhood eye diseases has become a matter of concern in Saudi Arabia, and hence a study has been conducted on the residents of Jazan. The aim of the research was to find out the root cause of such issues and provide a solution to prevent such circumstances for it may affect the vision of children. In this study, therefore, we aimed to determine the types of childhood eye diseases in Jazan and to discuss the best ways to prevent them or prevent their effect on the vision of our children. Our institutions are working toward the longevity and welfare of the residents, and healthcare is one of the important aspects in such a field., Methods: This is a retrospective review of all patients less than 18 years of age who presented to the pediatric ophthalmology clinic of Prince Mohammed Bin Nasser Hospital, Jazan, between October 2014 and October 2015. The data, collected on 385 cases, included the age at first presentation, sex, clinical diagnosis, refractive error (RE) if present, and whether the child had amblyopia. If the child did not undergo complete ophthalmic examination with cycloplegic refraction, he/she was excluded. All data were collected and analyzed using the software SPSS. A P-value < 0.05 was considered statistically significant., Results: We reviewed the files of 385 children, with a male/female ratio of 1.1:1.0. The group aged 0-6 years made up the largest group (P = 0.01), and the ratio is an expression to define the credibility of the study using a chi-squared test. Strabismus (36.9%), RE (26.5%), ocular trauma (7.5%), infection of cornea and conjunctiva (7.3%), and keratoconus (6.2%) were the most common conditions. There was no significant difference in presentation by age group and sex among children with REs and squint. Trauma was seen more commonly among males and in the group aged 12-18 years., Conclusion: In this retrospective study, the focus was on the common childhood eye diseases that were considerably high. Hypermetropia was the predominant RE, which is in contrast to other studies where myopia was more common. However, it is important to promote public education on the significance of early detection of strabismus, REs, and amblyopia and have periodic screening in schools. The discussion of the various issues is aimed at increasing the awareness and building a support for the cause by creating the knowledge base to treat things on time and acknowledging the severity of the issues.

Endothelial progenitor cells (EPCs) are cell derived from bone marrow and the cells circulate in peripheral blood. These cells have characteristics similar to stem cells, but their ability to proliferate and differentiate is more limited. EPC discovery has changed the old paradigm in the field of vascular biology and it brings huge implications in medicine as EPCs can mediate the processes of vasculogenesis and maintain the vascular integrity. Increasing amount of EPC in the circulation is important since it has positive correlation with reendothelialization and neovascularization and they are closely linked to cardiovascular health. Thus, EPC could potentially be used for treatment of disease caused by endothelial dysfunction.

Objective : The aim of the present study was to compare vertical maxillofacial growth in patients born with unilateral cleft lip and palate (UCLP) who were treated using two different surgical protocols. Design : A retrospective cohort study. Subjects : We studied 92 patients with complete UCLP (61 male and 31 female) treated at Sahlgrenska University Hospital in Gothenburg, Sweden: 46 consecutive patients born between 1965 and 1974 who underwent surgical treatment according to the Wardill-Kilner (W-K) protocol and 46 consecutive patients born between 1982 and 1989 who underwent surgical treatment according to the Gothenburg delayed hard palate closure (DHPC) protocol. Methods : We analyzed lateral cephalograms obtained at 10 years of age. Results : Patients treated according to the Gothenburg DHPC protocol had significantly greater anterior upper facial height, anterior maxillary height, overbite, and inclination of the maxilla than those treated with the W-K protocol. Both techniques led to similar posterior upper facial height. Conclusion : The Gothenburg DHPC protocol in patients with complete UCLP results in more normal anterior maxillary vertical growth and overbite and therefore increased maxillary inclination at 10 years of age.

In coronary heart disease (CHD), levels of secretory phospholipase A2 (sPLA2) are commonly increased. Serum amyloid-A (SAA) is increased in acute coronary syndromes (ACS) as well. It is needed to verify the hypotheses that sPLA2 is associated with the odds of ACS through elevation of SAA. We conducted a case-control study with 57 male patients with ACS and 30 controls matched by gender category. Levels of sPLA2, SAA, and myeloperoxidase (MPO) were measured by immunoreactive assay on the basis of a double-antibody sandwich technique. Levels of sPLA2, MPO, and SAA were significantly higher in patients than those in controls (11,359.0 ± 10,372.4 pg/mL vs. 1,320.5 ± 654.5 pg/mL, p = 0.00; 438.6 ± 310.7 ng/mL vs. 271.1 ± 176.8 ng/mL, p = 0.01; 10,995.2 ± 2,842.6 ng/mL vs. 3,861.7 ± 3,173.5 ng/mL, p = 0.00). There were significant correlations between age, visceral obesity, MPO, sPLA2, and SAA (r = 0.43; p = 0.00; r = 0.30; p = 0.00; r = 0.28; p = 0.00 and r = 0.53; p = 0.00). On multivariate logistic regression analyses, there were significant and independent associations between sPLA2 and SAA with odds of ACS [OR (95% CI) = 14.2 (2.1 to 98.6), p = 0.00; OR (95% CI) = 44.9 (6.9 to 328.4), p = 0.00]. Our findings suggest that sPLA2 may be associated with the odds of ACS compared with controls through increased inflammation, represented by elevated SAA.

Aim: to investigate the potential association between the ACE gene polymorphism, essential hypertension and pulse pressure., Methods: the study included 99 non-hypertensive and 104 hypertensive subjects. Hypertension is defined as systolic blood pressure 140 mmHg and/or diastolic blood pressure 90 mmHg. Pulse pressure refers to the differences between the systolic blood pressure and diastolic blood pressure. DNA amplication to examine ACE I/D polymorphism was conducted by Rigat-modification PCR method., Results: this study showed no significant difference in genotype distribution and allele frequency between two groups. We found PP >60 mmHg is different between ACE gene genotype. Genotype DD has a risk of 1.8 times of having PP >60 mmHg than ID genotype while DD genotype has a risk of 4.4 times of having PP >60mg than II genotype., Conclusion: this study does not support that the I/D polymorphism at ACE gene locus associated with hypertension in Makassar, South-Sulawesi, Indonesia. However, there were a significant correlation with pulse pressure independent from blood pressure.

The present study compared the height of the palatal vault in dental casts from 320 10-year-old children with unilateral cleft lip and palate (UCLP) operated on with the push-back technique according to Wardill-Kilner (W-K) with patients operated on with delayed hard palate closure (DHPC). The palatal height in patients operated on with the DHPC technique was found to be significantly higher than in patients operated on with the W-K technique. This coincides with better maxillary growth and better speech in the DHPC group.

Purpose: To report the clinical and histopathologic findings of a large sclerosing lipogranuloma of the orbit arising after a sub-Tenon's corticosteroid injection., Design: Interventional case report and review of the literature., Methods: A complete ocular and systemic evaluation was performed on a 81-year-old patient, who developed a large orbital mass subsequent to a periocular corticosteroid injection producing proptosis, ptosis, and ocular motility impairment. The lesion was biopsied and submitted for histopathologic analysis., Main Outcome Measures: Orbital, computed tomography, and histopathologic findings., Results: Histopathologic examination revealed lipogranulomatous inflammation. Specifically, this type of reaction was consistent with a diagnosis of sclerosing lipogranuloma., Conclusions: It is extremely rare to find a large granulomatous orbital lesion arising subsequent to a periocular corticosteroid injection. Only one case has been reported in the English-language literature to date. It is important to include this type of lesion in the differential diagnosis of an orbital mass seen after the injection of periocular corticosteroids.