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Objective: A single layer of tightly spaced cells, known as the endothelium, rests on the posterior side of the cornea. This endothelium regulates the stroma’s relative dehydration, which is essential for corneal clarity. Cell therapy is an innovative method being used to repair various corneal abnormalities. Mesenchymal stem cells (MSCs) are now one of the most significant types of stem cells scientists have studied. This study aimed to evaluate the role of MSCs for corneal endothelial regeneration. Methods: A systematic review was performed by searching for articles from reputable databases with many study-type references, including PubMed, Cochrane Library, Science Direct, and Google Scholar, up to January 2024. The resulting data were displayed using the 2020 PRISMA flowchart and evaluated using the PRISMA 2020 checklist. Most of the included studies were in vivo and used topical application and anterior chamber injection as the administration routes. Results: Based on the findings of this review, MSCs increased corneal endothelial cell density, improved the defect area and corneal transparency, facilitated endothelial cell regeneration and wound healing, and decreased neovascularization and corneal pro-inflammatory cytokines as compared to controls. Conclusion: Administration of MSCs into the anterior chamber could increase regeneration and proliferation of corneal endothelial tissue.

Background: Besides being commonly used to treat high blood pressure, beta blockers are a family of drugs that are primarily used to regulate irregular cardiac rhythms. Nebivolol is a third generation of beta blockers, which is highly cardioselective, about three times as selective as bisoprolol. In this study, we aimed to evaluate Nebivolol's effectiveness and safety in comparison to other beta blockers. Methods: We searched the online databases PubMed, ScienceDirect, and Cochrane Library for relevant RCTs evaluating Nebivolol's effect on hypertension management. Relative risk (WRR) and weighted mean difference (WMD), with a 95% confidence interval (CI) were utilized to quantify the impact of nebivolol medication in the treatment of hypertension using a random effects model. Results: Twelve RCTs are included in the study, the patient numbers in every attempt ranged from 42-273 and 1456 patients in all were included in this review. Nebivolol does not significantly reduce SBP, DBP and HR compared to other beta blockers (WMD −0.57 mmHg, 95% CI [−1.55;0.42 mmHg] p=0.12 ; WMD −0.27 mmHg, 95% CI [−1.36;0.82 mmHg] p=0.63 ; WMD 0.10 BPM, 95% CI [−4.11;1.31 BPM] p=0.96, respectively). Patients treated with Nebivolol has significantly lower LDL-C (WMD -8.88 mg/dL, 95% CI [−15.28; -2.48 mg/dL] p=0.007) and significantly higher HDL-C (WMD 2.30 mg/dL, 95% CI [0.75; 3.84 mg/dL] p=0.004. Conclusions: According to this study's findings, nebivolol is well tolerated and decreases LDL-C. And higher HDL-C than other beta blocker agents. This review does not recommend nebivolol as first-line treatment in hypertension as Nebivolol does not significantly reduce blood pressure and HR of patients.

Objective: To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19. Methods: We conducted a systematic search across four databases following the PRISMA statement guidelines. Studies reporting ferritin levels and mortality of regular hemodialysis patients with COVID-19 were included. Employing the random-effects model, we performed a meta-analysis to determine the mean difference in serum ferritin levels between the studied groups, along with their corresponding 95% confidence intervals. The meta-analysis was carried out using Review Manager 5.4 and Stata 16. Results: A total of 1 013 patients from seven studies were included in this study. Our meta-analysis showed higher mean serum ferritin in the deceased compared to surviving regular hemodialysis patients with COVID-19, with a mean difference of 449.43 ng/mL [95% CI (244.07, 654.80), P

The secretome of stem cells consists of a spectrum of bioactive factors secreted by stem cells grown in culture mediacytokines,chemokines, and growth factors in addition to extracellular vesicles (exosomes and microvesicles). Easeof handling and storage of secretomes along with their bioactivity towards processes in skin aging and customizabilitymakes them an appealing prospective therapy for skin aging. This systematic review aims to investigate the potentialusage of ascorbic acid (AA)-supplemented stem cell secretomes (SCS) in managing skin aging. We extracted articlesfrom three databases: PubMed, Scopus, and Cochrane. This review includes in vitro, in vivo, and clinical studiespublished in English that discuss the correlation of AA-supplemented-SCS with skin aging. We identified 1111 articlesfrom database and non-database sources from which nine studies met the inclusion criteria. However, the studyresults were less specific due to the limited amount of available research that specifically assessed the effects of AAsupplementedSCS in skin aging. Although further studies are necessary, the AA modification of SCS is a promisingpotential for improving skin health.

OBJECTIVE: This review investigated the efficacy of probiotics and/or synbiotics in gestational diabetes mellitus treatment by targeting insulin resistance, lipid metabolism, and anti-inflammatory effects in an updated trial. DATA SOURCES: The literature review was performed using the key words “Probiotics,” “Synbiotics,” and “Gestational Diabetes” in several databases, including PubMed, ScienceDirect, and the Cochrane Central Register of Controlled Trials. STUDY ELIGIBILITY CRITERIA: Eligible publication was screened independently by 2 reviewers. Studies included provided at least 1 of the following outcomes: (1) blood glucose marker, including fasting blood glucose level, fasting serum insulin level, and homeostasis model assessment insulin resistance; (2) blood lipid profiles, including triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol; and (3) nitric oxide and C-reactive protein. METHODS: All studies were reviewed using the critical appraisal Cochrane risk-of-bias tool for randomized trials. The descriptions of the extracted data were guided by the Preferred Reporting Items for Systematic Reviews 2020 statement with the Grading of Recommendations Assessment, Development, and Evaluation approach. This study was registered on the International Prospective Register of Systematic Reviews database (identification number: CRD42022375665). RESULTS: From 13 randomized controlled trials involving 896 patients, individuals with probiotic had significant reduction on homeostasis model assessment insulin resistance (mean difference, −0.72; 95% confidence interval, −1.07 to −0.38; I2, 96%; P=.00), fasting blood glucose level (mean difference, −3.79; 95% confidence interval, −6.24 to −1.34; I2, 93%; P=.00), and insulin level (mean difference, −2.43 mg/dL; 95% confidence interval, −3.37 to −1.48; I2, 54%; P=.00). Meanwhile for profile lipid, significant reduction of the mean difference was observed in the triglyceride (mean difference, −17.73 mg/dL; 95% confidence interval, −29.55 to − 5.9; P=.003) and C-reactive protein (mean difference, −1.93 dL; 95% confidence interval, −2.3 to −1.56; P=.00). CONCLUSION: Probiotic and synbiotic supplementations reduced the risk of insulin resistance and improved glycemic control, blood lipid profiles, and inflammation in women with gestational diabetes mellitus. Probiotics may be a viable option for gestational diabetes mellitus treatment; however, large-scale, well-designed randomized controlled trials with longer follow-up periods are required before they can be recommended to patients.

Introduction: Specific guidelines regarding the safest and most effective anesthetic procedure for patients undergoing pars plana vitrectomy have not been established. Regional anesthetic use has increased in recent years. Regional anesthetic techniques can be needle-based (retrobulbar and peribulbar) and cannula-based (sub-Thenon’s block). This research aimed to compare the efficacy of sub-Thenon’s anesthesia and peribulbar block in vitrectomy surgery. Materials and Methods: This study was a prospective randomized controlled single-blind pilot. Thirty subjects were divided equally into sub-Thenon’s and peribulbar groups. Subjects were randomized by permuted block randomization with a single-blind method. Eye drops of 1% tropicamide and 5% phenylephrine were used to achieve pupil dilation. Local anesthetic used was 0.5% propacaine hydrochloride. Sub-Thenon anesthesia was achieved by 2.5 mL llidocaine 2% and 2.5 mL bupivacaine, whereas peribulbar block by 4 mL lidocaine 2% and 4 mL of bupivacaine 0.5% injection. The observed outcome variables included the numerical rating scale (NRS) at trocar insertion, anesthetic onset, and anesthesia duration. Results: The NRS during trocar insertion under sub-Thenon’s compared with peribulbar was comparable (P = 0.28). The onset of sub-Thenon’s versus peribulbar anesthesia is 6 versus 10 min (P = 0.74). Duration of anesthesia under sub-Thenon’s versus peribulbar anesthesia was 73.3 ± 30 versus 68 ± 26 min (P = 0.32). The results of multivariate analysis showed there were no differences in pain scale on trocar insertion, the onset of anesthesia, and duration of anesthesia between sub-Thenon’s and peribulbar anesthesia after controlling for confounding variables. Conclusion: There are no differences in trocar insertion pain scale, onset, and duration of anesthesia between sub-Thenon’s anesthesia and peribulbar anesthesia.

Aim: Assessed the correlation between prostate volume and intravesical prostatic protrusion with detrusor wall thickness through transabdominal sonographic examination of benign prostate enlargement (BPE). Methods: The study is a paired-group analytical observational cross-sectional study during April – July 2020. Measurements were made of prostate volume, intravesical prostatic protrusion, and detrusor wall thickness using transabdominal sonography. An analysis was carried out to determine the correlation with bivariate analysis and the calculation of the research power. Results: Thirty-four BPE patients with a mean age of 62.41 years were included in the study. The mean value of prostate volume obtained was 44.24 cc; 8.66 mm for intravesical prostatic protrusion; and detrusor wall thickness is 1.49 mm. The correlation value between prostate volume and detrusor wall thickness was 0.12 (p=0.46), while the intravesical prostatic protrusion and detrusor wall thickness were 0.37 (p=0.03). The research power for correlating prostate volume with detrusor wall thickness and intravesical prostatic protrusion with detrusor wall thickness was 10-20% and 50-60%, respectively. Conclusion: There is a very weak correlation between prostate volume and detrusor wall thickness and a weak correlation between the intravesical prostatic protrusion and detrusor wall thickness. Other variables may influence the thickness of the detrusor wall.

Background: Increasing number of cancer survivor motivates clinical practitioner to focus on chronic effect of chemotherapy agent, especially those with vascular toxicity effect, which may attenuate the incidence of thrombosis and atherogenesis. Ultrasonography examination on carotid intima media thickness (C-IMT) provides acurate result in evaluating atherosclerotic. The purposes of this research are to find out any structural changes of carotid artery, especially atheroclerosis changes in breast cancer patient after chemoteraphy. Methods: Analytic cross sectional study using a pre post test group design in breast cancer patients. Eligible subjects undergo carotid ultrasonography examination prior to chemoteraphy and after they had completed the 3 cycles of chemoteraphy for the second exam. The examination was perfomed with the same USG machine, high frequency linier transducer (>7mHz) in B-mode under the auspecies of two reputable radiologist consultant. Results: Total patients are 26, mean of age (year) is 47.15 ± 8.11. Most dominant histopathology finding is invasive carcinoma nonspecific type, in 24 patients (92.4%) and the disease stage is in stadium III in 14 patients (53.9%). Mean C-IMT (mm) prior chemotherapy is 0.51 ± 0.06 and after chemotherapy is 0.58 ± 0.05, there is an increase of 0.07 ± 0.06 (p

Background: The severity of COVID-19 infection may depend on severe inflammation and hypercoagulability mechanisms. These processes may be rapidly identified in peripheral blood tests. This study aims to determine whether components of complete blood counts are able to predict the severity of COVID-19 infection. Materials and Methods: This is a prospective, observational analytical study carried out in the Indonesian population. We included all patients admitted to our hospital for COVID-19 during a 3-month period. We obtained blood samples for complete blood count examinations upon hospital admission. Confirmation of COVID-19 infection was based on a polymerase chain reaction test. Severe COVID-19 infection was determined if the patients had a Severe Community-Acquired Pneumonia (SCAP) score of >10. We collected blood samples upon hospital admission for leukocyte, neutrophil, lymphocyte, platelet, and monocyte counts. Results: We included 131 patients consisting of 77 (58.8%) males and 54 (41.2%) females. There were significant associations between neutrophil count and SCAP score (r = 0.28; P = 0.001) and platelet count (r = 0.023; P = 0.007). Upon regression analysis, we found that every 1,000 declines in platelet count was associated with increased risk (0.8%) of severe COVID-19, whereas every 1,000 declines in the neutrophil count was associated with decreased risk (18%) of severe COVID-19. Conclusion: There is a significant, weak positive correlation between neutrophil and platelet counts and the severity of COVID-19 infection as expressed by the SCAP score.

Hydrocephalus in children can inhibit child growth. However, if treated immediately, the patient will develop normal intelligence. In radiology, the most important problem is to detect hydrocephalus early. Currently, radiology examinations can detect hydrocephalus accurately with a CT scan to identify the presence of blockages and assess the degree. Skull radiography is used to assess the presence of advanced hydrocephalus. A comparison is carried out and assesses the relationship between hydrocephalus measurement on the ventricular and cranial index by scanogram. The study used a cross-sectional analytics design, using Picture Archiving and Communication System (PACS) data. There were 68 samples taken using consecutive sampling, obtaining ventricular index measurement results above 0.30, and patients under 12 years old. Spearman rank test showed a correlation between the ventricular index measurements and cranial index, with Spearman’s Rho (r) = 0.856 and p0.001 with linear equation Y= 2.973 + 0.005X. It revealed that the constant 2.973 indicated that if there is no B coefficient value, the participation value will be 2.973. Furthermore, regression coefficient X of 0.005 indicated that the participation value grows by 0.005 for every 1 addition of the B coefficient value with R2= 0.340.

BACKGROUND: Monitoring of iron status in chronic kidney disease patients is important, however inflammation may hinder its monitoring. Soluble transferrin receptor (sTfR) is an alternative parameter to overcome this issue, whereas ferritin play a part in the inflammation process. Hence, the correlation between the sTfR ratio and the sTfR/log ferritin ratio with conventional iron status parameters in regular hemodialysis patients is necessary to be evaluated. METHODS: A cross-sectional was conducted in the current study. As many as 5 mL of blood (2 mL for sTfR and 3 mL for serum iron and ferritin levels) was collected. sTfR level was the blood-soluble transferrin receptor level measured by the enzyme-linked immunosorbent assay (ELISA). The amount of ferritin and serum iron was determined using the immunochemiluminescent process. To evaluate the correlation, the Pearson correlation test was used. RESULTS: A total of 80 subjects was included in this study. The mean of hemoglobin was 10.25±1.66 g/dL, serum iron was 58.19±26.56 g/dL, and the median ferritin was 520.4 (49.9-3606) ng/mL. The sTfR was significantly associated only with serum iron levels with a correlation coefficient of r=-0.242; p=0.031. The sTfR/log ferritin was significantly associated with serum iron l evels (InSI)(r=-0.255, p=0.022); and transferrin saturation (r=-0.295; p=0.008). CONCLUSION: sTfR/log ferritin has a negative and significant correlation with serum iron levels and transferrin saturation, while sTfR negatively correlated with serum iron levels. sTfR and sTfR/log ferritin may be considered as an alternative iron marker in inflammation setting such as CKD. KEYWORDS: sTfR/log ferritin, iron status, serum iron, ferritin, chronic kidney disease, hemodialysis

Tujuan: Untuk mengetahui pengaruh antara walking exercise programme (WEP) terhadap cancer related fatigue (CRF) pada pasien kanker payudara di RSUP Sanglah Denpasar. Metode: Penelitian randomized controlled trial group pretest-posttest design ini dilakukan pada seluruh pasien kanker payudara yang dirawat di RSUP Sanglah Denpasar pada tahun 2018, untuk dibedakan dalam kelompok kontrol dan kelompok perlakuan (yang menjalani WEP). Pengambil data dan pengolah data disamarkan mengenai kondisi randomisasi dan perlakuan. WEP dilaksanakan selama tiga minggu yang dilakukan sebanyak 3 kali dalam seminggu selama 30 menit. Pada kedua kelompok dilakukan penilaian skor brief fatigue inventory (BFI) sebelum dan sesudah perlakuan. Data kemudian dikumpulkan dan dilakukan analisis statistik dengan SPSS 25.0. Hasil: Penelitian awalnya terdiri dari 41 peserta di kelompok intervensi dan 41 di kelompok kontrol. Dua peserta dari kelompok kontrol mengundurkan diri dari penelitian. Pada analisis skor BFI setelah latihan, ditemukan bahwa skor BFI pada kelompok intervensi menurun secara signifikan dibandingkan kelompok kontrol (2,8±1,2 vs. 0,2±0,7; p

Introduction: To determine the difference in the quality of life and cognitive function in patients with and without AMD. Methods: This research is an observational analytic study, a prospective cross sectional study in the polyclinic of RSUP Sanglah, Denpasar. Result: Study samples’s total are 66 people selected by consecutive sampling with 33 people in the group with AMD, and 33 people in the group without AMD. The results of the study showed the average age of the group with AMD 68 years and the group without AMD 67 years old. Most of the male sex and residence in denpasar in both groups. Most AMD with the wet type by 60.6 %. On the measurement of quality of life, it showed decreasing in all subscale in the group with AMD compared to the group without AMD with total average 27.2 % and also decreasing in cognitive function measured by MMSE in the group of AMD compared to the group of non – AMD with 6.8%, even though the MMSE score of the groups are within normal limits. All these things stated significant differences (p

Reuse of dialyzers for hemodialysis can help in bringing down the cost of hemodialysis. On the other hand reuse of dialyzer may change dialyzer integrity. This study was undertaken to determine dialyzer reuse effect on Urea Reduction Ratio (URR), Kt/V urea and serum albumin. This was prospective study in Sanglah Public General Hospital Denpasar. Inclusion criteria for this study were patients who receive hemodialysis more than 3 months on twice weekly hemodialysis. In the study we used hollow fiber or dialyzer Elisio type H-130H reprocessed with Renaline automatically by machine renatron. After each session blood urea, post dialysis weight and serum albumin were measured. Measurements was performed on the use new dialyzer, 1st reuse, 4th reuse and 7th reuse. The dialyzer was discarded, if TCV fell below 80% of baseline value. Kt/V and urea reduction ratio (URR) were calculated as measure of dialysis adequacy. A total of 23 people completed the study. There was a lack of uniformity duration of hemodialysis, so that we also performed an analysis using a uniform length hemodialysis duration (4.5 hours) with 15 samples. There were no significant difference between URR and Kt/V urea of new dialyzer and dialyzer reprocessed by renaline respectfully with p=0.131 and p=0.373. If we analyzed only using uniform time of dialysis (4.5 h) the value of URR and Kt/V urea between new and reused dialyzer not significantly different with p=0.520 and p=0.784. There was also not found significant differences between serum albumin of the use new dialyzer and reused dialyzer by the time of uniform or non-uniform, respectfully with p=0.271 and 0.073. Reuse dialyzer does not alter efficacy of hemodialysis.

Abstract In Japan, Mongolia, and Indonesia, dialysis care has been covered by national health insurance and social welfare programs as of 2022, which covers much of the cost burden. However, the proportion of this burden varies by country and Japan is the only one of these countries in which medical fees are fully covered for all dialysis patients. As systems for dialysis medical care coverage have been established, the number of dialysis patients has increased dramatically in each country. However, the cost of dialysis treatment itself is very high relative to personal income in all countries. This puts pressure on national healthcare budgets and gives rise to concerns about the sustainability of dialysis care in the future. Peritoneal dialysis (PD) is less expensive than hemodialysis (HD) in Mongolia and Indonesia, and a PD-first policy is considered effective in reducing costs. Nevertheless, an overwhelming number of patients still undergo HD. Despite the difficulties faced by these three countries in obtaining funds for dialysis treatment, among Asian countries, Mongolia and Indonesia are considered to have relatively advanced healthcare systems. It is considered that there has been progress in the provision of dialysis treatment subsidies to the citizens of these countries.

Abstract On 1 December 2019, an outbreak of coronavirus disease 2019 (COVID-19) occurred in Wuhan, China, and quickly spread around the world. In an effort to prevent transmission, global traffic flows were affected and lectures by international speakers at the 2022 Annual Meeting of the Japanese Society for Dialysis Therapy were streamed over the internet. Speakers from Vietnam, Indonesia, and Mongolia reported on the status of COVID-19 infection in dialysis patients from December 2019 to June 2022. In addition, the situation in Japan is discussed in the introduction. In Japan, the mortality rate due to COVID-19 infection in dialysis patients was approximately 20% in a national statistical survey before the introduction of the vaccine, and decreased to 3.1% with the introduction of the vaccine. In Vietnam, the mortality rate was 42% in non-vaccinated recipients and 21% in two-dose recipients, but this was reported by a single center. Mortality among dialysis patients with COVID-19 infection in Indonesia was 57%, although reported by a single center. In Indonesia, 6 million people were infected with COVID-19, and the number of COVID-19 cases among dialysis patients was estimated to be around 52,200. Mongolia was considered to be the country that was able to move to vaccination while most effectively controlling the domestic spread of severe acute respiratory syndrome coronavirus 2 compared with many other countries.

Presents the abstract 'Relationship Between Creatinine Clearance and Homocysteine in Predialytic Stage Chronic Renal Failure Patients,' by J. Wayan Sudhana, Ketut Suwitra, Jodi Sidharta Loekman and I. Gde Raka.

It has been known that carotid stiffness is a predilection for stroke. Strain elastography (SE) ultrasound (US) is one of the new modalities which can evaluate carotid artery stiffness by obtaining its tunica intima media strain value. There were no studies that show the carotid artery SE US value in stroke patients, hence become the underlying reason this study was conducted. The aim of this study was to provide an evaluation of carotid artery SE US values in stroke patients.A pair-matched case-control study was conducted on 40 case subjects and 40 controls which met all inclusion and exclusion criteria. Carotid arteries SE US value was obtained through the average of 3 region of interest (ROI) on each intima media layer of 3 level carotid arteries assessed on both sides. Diagnostic accuracy study was analysed to determine the cut off value between stiff and not stiff. Subsequently, bivariate and multivariate analyses were performed.There were 65% male on both groups with mean age 56.7 ± 13.0 on the case group and 53.8 ± 11.8 on the control group. ROC curve analysis showed that all measurement locations were reliable with high numbers (91.03–97.8%). The cut of value of carotid artery stiffness was ≥0.9333 (97.5% sensitivity and 90% specificity). Carotid artery stiffness is a major risk factor of stroke with OR 351 (p value 0.000). Multivariate analysis showed that carotid artery stiffness remained a strong risk factor of stroke (OR 467.89, p value 0,000). Other radiologist can repeat this technique with good interobserver (r = 0.782–0.985) and intraobserver reliability (r = 0.802–0.954).Carotid artery stiffness is a strong risk factor for stroke, with carotid artery stiffness SE US cut off values of ≥0.9333.

Objective. To evaluate the short-duration hyperbaric oxygen therapy (HBOT) can improve HbA1c levels, leukocyte count, and serum creatinine levels in patients with diabetic foot ulcer (DFU) Wagner 3-4. Methods. Blood samples from all DFU patients at Sanglah General Hospital, Denpasar, were taken for HbA1c, leukocyte, and serum creatinine test before debridement procedure, and the patients were then grouped into either standard therapy or standard therapy with HBOT for 10 sessions (combination therapy). At the end of therapy, all blood tests were resumed. Results. Each group consisted of 15 patients. Results of laboratory analysis before and after treatment were significant regarding decrease of HbA1c levels in standard therapy (10.98 ± 2.37 % to 9.70 ± 2.46 %; p = 0.006), HbA1c levels in combination therapy (9.42 ± 1.96 % to 7.07 ± 1.16 %; p < 0.001), and leukocyte count in combination therapy (13.97 ± 6.24 x 103 cells/μL to 8.84 ± 2.88 x 103 cells/μL; p = 0.009). The HbA1c levels at the end of therapy were significantly different between groups (p = 0.001). Serum creatinine level was decreased only in combination therapy but it was not significant. The effect size of all variables was larger in the combination therapy, but it was not significant (p > 0.05). Conclusion. The use of short-duration HBOT on DFU reduces HbA1c levels, leukocyte count, and serum creatinine levels better than standard therapy alone. This protocol would save time and effort in future HBOT implementation. This trial is registered with ClinicalTrials.gov Identifier: NCT03615755.