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Autoimmune hemolytic anemia (AIHA) may indicate the first manifestation of systemic lupus erythematosus (SLE). It is estimated that the incidence of AIHA is around 10% in patients with SLE. The first-line therapy for AIHA is corticosteroids. Nevertheless, a second-line therapy may be considered if an adequate response is not obtained. Transfusion indication in AIHA patients do not differ from other types of anemia. These indications include the degree of hemolysis, the progression of anemia, and clinical symptoms. However, blood transfusion for AIHA patients is challenging due to the limited availability of serologically compatible blood. In addition, AIHA patients who receive transfusions have an increased risk of experiencing hemolytic transfusion reactions. In this paper, we aimed to present a case report on the diagnosis of AIHA in an SLE patient treated with second-line therapy and red blood cell transfusions. The patient was a 49-year-old woman who presented with the main complaint of swelling in both legs. According to the medical history, the patient experienced petechia, abdominal distension, body weakness, and weight gain. No reports of joint pain, diarrhea, constipation, fever, shortness of breath, or yellowish skin were made. Before being referred to Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, the patient experienced high blood pressure and body swelling that were unresponsive to treatment. Once the diagnosis of AIHA was confirmed, the patient was set to receive second-line therapy and red blood cell transfusions. At the conclusion of the therapy, the patient exhibited favorable outcomes. Highlights: • This paper presents the management of autoimmune hemolytic anemia in systemic lupus erythematosus, which has been understudied in Indonesia. • This paper provides additional evidence regarding the indications and outcomes of red blood cell transfusion in a case of autoimmune hemolytic anemia.

Latar belakang. Gangguan Spektrum Autisme merupakan kelainan perkembangan saraf dengan ciri-ciri gangguan komunikasi sosial, interaksi sosial yang terbatas, dan pola perilaku yang berulang, sesuai dengan klasifikasi DSM V. Terapi yang umum digunakan adalah Applied Behaviour Analysis, tetapi Terapi Oksigen Hiperbarik menjadi fokus studi terkini yang melibatkan pemberian oksigen 100% pada tekanan atmosfer yang lebih tinggi, menjadi opsi non-invasif yang dapat menyediakan oksigen optimal untuk organ tubuh. Tujuan. Penelitian ini bertujuan mengevaluasi pengaruh TOHB pada anak ASD melalui Childhood Autism Rating Scale. Metode. Studi analitik dilakukan dengan desain pra-eksperimental one group pretest-posttest, melibatkan 15 pasien ASD dari Lakesla Drs. Med. R. Rijadi S.,Phys. Data dikumpulkan dari Januari hingga Agustus 2023. Hasil. Analisis data pre-test dan post-test menunjukkan signifikansi (p=0.001). Evaluasi aspek hubungan dengan orang lain (p=0.004), imitasi (p=0.011), respon emosional (p=0.001), penggunaan objek (p=0.008), adaptasi (p=0.007), respon mendengar (p=0.014), rasa, bau, sentuh (p=0.034), ketakutan atau gugup (p=0.009), komunikasi verbal (p=0.059 dan p=0.157), tingkat aktivitas (p=0.004), level dan konsistensi respon intelektual (p=0.025), serta kesan umum (p=0.025). Kesimpulan. Pemberian TOHB pada anak ASD dapat meningkatkan berbagai aspek fungsi sosial dan menurunkan tingkat aktivitas, rasa takut, serta gugup. Penelitian ini memberikan dasar untuk lebih memahami peran TOHB dalam manajemen ASD.

Objective: Zinc oxide nanoparticles (ZnO NPs) have various applications, but concerns about their potential adverse effects on human health, particularly the male reproductive system, have led to toxicity. This study investigates the effects of quercetin, a natural compound with anti-oxidative and anti-inflammatory properties, on ZnO NP-induced testicular toxicity in male Swiss mice. Method: In this study, 25 male mice were randomly allocated into 5 groups, each consisting of 5 mice (n=5). The groups were labelled as Control, Corn Oil, Quercetin, ZnO NPs, and ZnO NPs + Quercetin. The dosages administered were 100mg/kg for ZnO NPs and 20mg/kg for quercetin, relative to the weight of the animals. The treatments were conducted for 7 days following a two-week acclimatization period. Results: Zinc oxide nanoparticles (ZnO NPs) were found to increase testicular TNF-α, indicating inflammation at the testes which may have resulted in a significant decrease in testosterone. Malondialdehyde (MDA), an oxidative stress marker was also found to be increased at the level of the testes, in the ZnO NPs group when compared to the control group. Treatment with quercetin, however, was able to reduce the levels of inflammatory and oxidative stress markers at the testes, and restore testosterone to control levels, demonstrating its potential ameliorative effects on testicular toxicity via anti-inflammatory and anti-oxidative properties. Conclusion: The findings from this study indicated that Quercetin is a potential therapeutic agent against inflammation and oxidative stress in ZnO NPs-induced testicular toxicity.

Context: Graptophyllum pictum (L.) Griff. leaves (GPL) are traditionally used in Indonesia to treat hemorrhoids, and the anti-hemorrhoid activity of the ethanolic extract of G. pictum leaves (GPLE) has been proven scientifically. However, since it contains a variety of compounds, both hydrophilic and lipophilic, which has diverse solubility, absorption, and penetration characteristic, there is a need to be formulated to improve its effectiveness. Lipid nanocarrier formulations, such as liposome and ethosome, can be developed as the delivery system for GPLE to enhance its effectiveness. Aims: To evaluate the anti-hemorrhoid activity of the liposomal and ethosomal formulation of GPLE. Methods: The hydration method was used to prepare GPLE liposomal (GL) and ethosomal (GE) formulations. An in vivo study was conducted to evaluate the penetration and effectiveness of both formulations. The in vivo test was evaluated based on the recto-anal tissue histological observation after treatment of the formulation to croton oil-induced hemorrhoid mice. The number of inflammatory cells, goblet cells, hemorrhage area, and mucosal thickness were compared between both formulations and the extract. Results: GE had a smaller particle size, 145.7 ± 5.75 nm, with a polydispersity index (PDI) value of 0.376 ± 0.031. Meanwhile, GL showed a particle size of 407.80 ± 11.32 nm, with a PDI value of 0.389 ± 0.019. The zeta potential (ZP) of GL was -2.0200 ± 0.0513 mV and -0.0109 ± 0.0257 mV for GE. GE exhibited a better penetration and activity profile than GL, which was assumed to be correlated to its smaller particle size and component of the formulation. GE was able to penetrate up to the submucosa layer; meanwhile, GL only reached the muscularis mucosa. GE revealed better anti-hemorrhoid activity as it showed a lesser number of inflammatory cells, goblet cells, and necrosis cells. Additionally, it exhibited a smaller hemorrhage area and muscular mucose cell thickness compared to GL. However, there was no significant difference statistically. Conclusions: These findings suggest that lipid vesicles are a suitable delivery system for GPLE in the anti-hemorrhoid treatment.

Background and objectives. Biliary atresia occurs due to multifactorial etiology, and it was recently suggested that perinatal infection with TORCH, especially Cytomegalovirus (CMV), triggers inflammation of the bile ducts. This study aims to evaluate the TORCH infection on cholestasis with the occurrence of biliary atresia and its clinical manifestations. Materials and methods. A prospective single-center study was performed on 113 cholestatic infants and classified into two groups based on their positivity of immunoglobulin M and G (IgM and IgG). They were tested for CMV, Rubella, and Toxoplasmosis by a Gold Standard Diagnostics ELISA kit in our laboratory. Clinical conditions, laboratory tests (Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), and liver histopathology between the two groups were analyzed with p < 0.05, which was considered significant. Results. Out of 113 infants of cholestasis, 94.7% (n = 107) were CMV IgG-positive, followed by Rubella IgG-positive (47.8%, n=54). Rubella and toxoplasma IgM antibodies were least commonly found in cholestasis (8% and 7.1%, respectively). CMV IgG-positive status was noted to be older at the onset of jaundice. Infants with Rubella IgG-positive had less incidence of extrahepatic cholestasis (37.7% vs 62.3%) and liver fibrosis (39% vs 61%) (p0.05). Conclusion: CMV infection mostly occurs in infants with cholestasis, followed by rubella infection. TORCH infection screening may be necessary in all infants with cholestasis.

Korean Ginseng (Panax ginseng C.A. Meyer) is a high‐value herb with many pharmacological benefits due to its primary active compound, ginsenosides. The most ginsenosides are known to be thermolabile and susceptible to degradation at high‐temperature processing. Our previous studies revealed that the optimum parameters related to the P. ginseng tissue culture protocol, particularly for hairy root propagation of Cultured Roots of Mountain Ginseng (CRMG)‐88, was using a lab‐scale bioreactor. The next stage involves screening for a suitable post‐harvest treatment, i.e., drying, will be production of the best quality ginsenoside content. This study therefore aimed to examine the ginsenoside content by using a fluidised bed dryer (FBD) on the ginseng roots. Our results showed that FBD produced a significantly higher of total ginsenoside content (5.386 ± 1.167%), compared to control (3.750 ± 0.641%). FBD‐dried CRMG‐88 also appeared lighter in colour and more voluminous with a Loss on Drying (LOD) of 6.448 ± 1.900%. This study concluded that fluidised bed drying is superior in retaining ginsenoside content and has the potential for large‐scale application.

Abstract Globally, bread wheat (Triticum aestivum) is one of the most important staple foods; when exposed to drought, wheat yields decline. Although much research has been performed to generate higher yield wheat cultivars, there have been few studies on improving end-product quality under drought stress, even though wheat is processed into flour to produce so many foods, such as bread, noodles, pancakes, cakes, and cookies. Recently, wheat cultivation has been affected by severe drought caused by global climate change. In previous studies, seed shrinkage was observed in wheat exposed to continuous drought stress during seed development. In this study, we investigated how progressive drought stress affected seed development by metabolomic and transcriptomic analyses. Metabolite profiling revealed the drought-sensitive line reduced accumulation of proline and sugar compared with the water-saving, drought-tolerant transgenic line overexpressing the abscisic acid receptor TaPYL4 under drought conditions in spikelets with developing seeds. Meanwhile, the expressions of genes involved in translation, starch biosynthesis, and proline and arginine biosynthesis was downregulated in the drought-sensitive line. These findings suggest that seed shrinkage, exemplifying a deficiency in endosperm, arose from the hindered biosynthesis of crucial components including seed storage proteins, starch, amino acids, and sugars, ultimately leading to their inadequate accumulation within spikelets. Water-saving drought tolerant traits of wheat would aid in supporting seed formation under drought conditions.

Background: The prevalence of TMD (temporomandibular disorder) in children and early adolescents varies widely. TMD can cause permanent facial deformities and affect occlusion and speech, which will affect growth, development, and quality of life. For prevention, early detection is needed. However, early detection is often not possible due to a lack of understanding of the normal shape of the condyle. Research on the normal shape of the condyle and symmetry in children and early adolescents has not been much done. Purpose: To evaluate the shape of normal condyles in a population of children and early adolescents aged 4–19 years and determine the most dominant shape and symmetry. Methods: 220 mandibular condyles of 110 children aged 4–19 years (mean 11.4 years) were analyzed retrospectively using an orthopantomograph. Condyle types in primary, mixed, and permanent dentition were categorized according to Yale (convex, rounded, flat, angled) and Chaudhry classification (oval, diamond, bird beak, crooked). Right and left mandibular condyle symmetry was observed according to a previous study by Ribeiro. Results: In primary, mixed, and permanent dentition, the most dominant condyle shapes were (Yale, Chaudhry): 91.6% rounded, 100% oval; 95.8% rounded, 97.9% oval; 98% rounded, 97% oval, respectively. Asymmetry in the right and left mandibular condyles was not found in primary dentition; there were 2 cases in mixed dentition and 3 cases in permanent dentition. Conclusion: In children and early adolescents aged 4–19 years, the normal condyles found are: rounded, convex, angled (Yale), and oval, diamond, or bird beak (Chaudhry). The condyles are dominated by rounded and oval shapes. The incidence of asymmetry in the right and left mandibular condyles probably increases with age.

Latar belakang. Epilepsi adalah gangguan neurologis yang paling umum. Obat anti epilepsi dapat menyebabkan efek samping neurokognitif, motorik, dan perilaku. Penelitan ini dilakukan untuk mengetahui apakah terdapat perbedaan antara pemberian monoterapi dengan politerapi pada fungsi kognitif pasien anak. Tujuan. Mengetahui perbedaan fungsi kognitif anak yang mendapatkan obat anti epilepsi Metode. Penelitian ini merupakan penelitian observasional analitik dengan studi potong lintang. Penelitian dilakukan di Poliklinik Neurologi Anak RSUD Dr. Moewardi dalam kurun waktu bulan Agustus 2021 sampai Januari 2022. Penilaian fungsi kognitif anak pada pasien epilepsi menggunakan instrumen PedsQL Cognitive Functioning Scale. Uji Mann-Whitney and Kruskal-Wallis digunakan untuk menganalisis data. Hasil. Dari 40 anak dengan epilepsi, 15 mendapatkan monoterapi dan 25 politerapi . Pasien dengan monoterapi memiliki skor PedsQL Cognitive Functioning Scale rata-rata 82,7±5,59, kemudian pasien dengan politerapi memiliki skor rata-rata 52,9 ±3,81. Hasil analisis menunjukkan jenis terapi dengan nilai p=0,001, lama pengobatan dengan nilai p=0,013 dan frekuensi kejang dengan nilai p=0,012. Kesimpulan. Pasien dengan monoterapi memiliki skor PedsQL Cognitive Functioning Scale rata-rata lebih baik daripada pasien dengan politerapi. Fungsi kognitif pasien anak dengan epilepsi berhubungan dengan jenis terapi, lama rawat, dan frekuensi kejang.

Background: Periodontitis is an inflammatory disease of the teeth-supporting tissues caused by microorganisms. Robusta coffee bean extract has antibacterial properties due to its caffeine, flavonoids, trigonelline, and chlorogenic acid contents. The robusta coffee bean extract also regulates alveolar bone healing through bone remodelling. Aim: The study aimed to investigate robusta coffee bean extract to inhibit bacterial growth and accelerate bone repair in vitro and in vivo. Methods: This study used the paper disc diffusion method with the research group of robusta coffee bean extract with concentrations of 50%, 25%, 12.5%, 6.25%, and negative control, as much as 20 and dripped onto the disc paper then placed on the surface of the agar media that had been inoculated with bacteria. The diameter of the inhibition zone was measured. Twenty periodontitis rat models were given 0.05 ml of the robusta coffee bean extract on the molars and put in a periodontal pocket for seven days. Rats were decapitated, and alveolar bone tissues were stained with HE and IHC staining. The number of osteoclasts, osteoblasts and BMP-2 was counted using a microscope. Statistical test with Kruskal Wallis followed by Mann Whitney showed a p-value of

Global warming has led to the expansion of arid lands and more frequent droughts, which are the largest cause of global food production losses. In our previous study, we developed TaPYLox wheat overexpressing the plant hormone abscisic acid (ABA) receptor, which is important for the drought stress response in plants. TaPYLox showed resistance to drought stress and acquired water-saving traits that enable efficient grain production with less water use. In this study, we used TaPYLox to identify ABA-dependent and -independent metabolites in response to drought stress. We compared the variation of metabolites in wheat under well-watered, ABA treatment, and drought stress conditions using the ABA-sensitive TaPYLox line and control lines. The results showed that tagatose and L-serine were ABA-dependently regulated metabolites, because their stress-induced accumulation was increased by ABA treatment in TaPYLox. In contrast, L-valine, L-leucine, and DL-isoleucine, which are classified as branched chain amino acids, were not increased by ABA treatment in TaPYLox, suggesting that they are metabolites regulated in an ABA-independent manner. Interestingly, the accumulation of L-valine, L-leucine, and DL-isoleucine was suppressed in drought-tolerant TaPYLox under drought stress, suggesting that drought-tolerant wheat might be low in these amino acids. 3-dehydroshikimic acid and α-ketoglutaric acid were decreased by drought stress in an ABA-independent manner. In this study, we have succeeded in identifying metabolites that are regulated by drought stress in an ABA-dependent and -independent manner. The findings of this study should be useful for future breeding of drought-tolerant wheat.

Sugarcane Mosaic Virus (SCMV) infection is one of the most serious problems that can result in severe yield loss of sugarcane. Since the symptoms of SCMV infection are similar to other biotic and abiotic stress symptoms, the development of a rapid diagnostic with high precision is required. The use of laboratory animals such as rabbits is required for antibody production in immunoassay‐based detection. However, due to its many advantages, specific chicken egg yolk immunoglobulin (IgY) has received considerable attention as an alternative antibody production in immunodiagnostics for infectious diseases. In this study, IgY antibody against SCMV recombinant coat protein (CP) was successfully obtained from chicken blood serum and tested to compare its efficacy against antibody from rabbit (IgG) using immunocapture reverse transcription‐polymerase chain reaction (IC‐RT‐PCR). The result showed that IgY and IgG could detect 0.1 g SCMV infected leaves using 1000‐times‐diluted antibodies. The IgY antibody was also confirmed to be reproducible and potentially applicable in plant disease diagnostics using an antibody‐based detection.

Diphtheria is an acute infectious disease caused by the bacterium Corynebacterium diphtheriae. Accurate and prompt diagnosis is essential for effective case management, predicting disease prognosis, preventing complications, and ensuring cost-effective medical intervention. This study aimed to assess the variety of clinical symptoms exhibited by pediatric diphtheria cases during an outbreak. An observational cross-sectional study was conducted using data from the medical records of pediatric diphtheria cases at Sulianti Saroso Infectious Disease Hospital from November 1, 2017, to February 28, 2018. The study involved 202 cases, and statistical analysis was performed using the chi-square test. Out of the 202 cases, 58.4% were male. Age distribution was 2–5 years: 24.8%, >5–12 years: 45.5%, and >12 years: 18.8%. Anamnestic findings revealed the presence of fever in 88.1% of patients, pain upon swallowing in 73.3%, and cough in 55.4%. Clinically, every patient exhibited pseudomembrane formations. Other findings included bilateral tonsillar involvement in 53%, lymphadenopathy in 40.1%, bullneck in 17.8%, and snoring in 7.9%. Four significant variables were associated with the diphtheria diagnosis: fever, snoring, bullneck, and snoring (p

Background: Caesarean sections have become the most popular method for delivering twin babies because of the safety concerns associated with a natural birth. This study aims to identify the maternal characteristics and obstetric parameters that serve as risk factors influencing caesarean delivery in twin pregnancies by comparing women delivering via caesarean section and vaginal birth. Methods: A retrospective chart review design was used to analyse 47 women with multiple pregnancies from the medical records at a primary referral hospital in East Java, Indonesia. Women delivering vaginally were then compared with women who underwent a caesarean section to identify any differences between the groups. Results: In our study, more women delivered by caesarean section (n=35) than by vaginal birth (n=12). Women were more likely to undergo a caesarean section if they had a previous history of undergoing a caesarean section (OR 16.5; 95% CI 1.91-142.49; p=0.02). Similar to previous studies, we found that foetal malpresentation significantly increase the risk of caesarean delivery (OR 8.25; 95%CI 0.95-71.09; p=0.03), while labour augmentation decrease the likelihood of caesarean section (OR 0.20; 95% CI 0.49-0.81; p=0.03). There was also a significant older patients in the caesarean section groups (OR 1.26; 95% CI 1.09-1.45 ; p=0.00). Conclusions: The percentage of multiple pregnancies delivered via caesarean section is quite high. Other larger cohort study are warranted, since many factors were involved in the decision of caesarean section.

Highlights: • Vitamin D supplementations in different doses yield different outcomes. • Multi-day vitamin D administration of 1000-6000 IU in patients with COVID-19 has more positive impacts than a single high dose of vitamin D. • Patient morbidity, length of hospitalization, and patient mortality improved with multi-day vitamin D administration. Abstract: This meta-analysis aimed to determine whether there is any optimal dose of vitamin D for morbidity, length of hospitalization, and mortality in patients with COVID-19. We conducted a comprehensive search in three online databases for eligible studies until February 28, 2022. Odds ratio (OR) and standardized mean difference (SMD) were applied as summary statistics of primary outcomes. The study quality of the literatures collected was assesed using the Cochrane risk of bias tool version 2 (RoB 2). Eight randomized clinical trials (RCT) were included in the study. In our analysis, we found that there was no significant difference in morbidity when vitamin D was administered to COVID-19 patients [OR=0.50 (95% CI=0.13-1.96); SMD=-0.14 (95% CI=-0.55-0.28)]. Duration of hospitalization [SMD=-0.12 (95% CI=-0.39-0.15)] and mortality [OR 0.47 (95% CI=0.19-1.17)] of COVID-19 patients in five studies also showed no significant difference compared to patients who do not take vitamin D. However, when we analyzed two other studies, we found that in patients who did not take vitamin D, mortality was lower [SMD=0.43 (95% CI=0.29, 0.58)]. Compared to a single high dose of vitamin D, the multi-day vitamin D administration of 1000-6000 IU in patients with COVID-19 resulted in improved patient morbidity, length of hospitalization, and patient mortality.

Instrumental support is concrete and tangible, for instance, helping to provide food or accompanying patients to health care facilities. However, its impact on medication adherence among tuberculosis patients in Indonesia needs to be explored. This study aimed to examine the impact of instrumental support from family on tuberculosis patients’ adherence to medication in Bogor City, West Java Province, Indonesia. A cross-sectional study involving 106 participants with an age average of 39.7 (SD = 14.9) was conducted in 12 primary health care (PHC). The independent variables (age, sex, education, employment status, wealth index, and the distance between home and PHC) of instrumental support from family was assessed using MMAS-8. In contrast, the dependent variable of medication adherence was assessed using a self-reported instrument. Multivariate binary logistic regression was used in the analysis and indicated that participants receiving family support were more likely to adhere to medication protocol (95% CI = 1.1–6.3; p-value = 0.029). Instrumental support from family was associated with medication adherence among tuberculosis patients in Bogor City, West Java Province, Indonesia. It is necessary to design further comprehensive interventions in the community setting to encourage the family to support tuberculosis patients following medication protocol.

Rapid increasing cases of Monkeypox infections in countries around the world, forcing medical professionals to be prepared to prevent it becoming the next global pandemic. We conducted the study to determine knowledge, attitude, and perception of doctors regarding preparedness for 2022 human monkeypox infection. This cross-sectional design research was conducted on 2-5 of August 2022, by circulating an online survey link to all internal medicine residents at the medical faculty of Universitas Sriwijaya, Dr. Mohammad Hoesin hospital Palembang Indonesia. The survey contained questions about the respondent's characteristics, knowledge, attitudes and perceptions about Monkeypox infection. A total of 75 residents agreed and completed the survey and were analyzed, with a mean age of 31 years, and 49 men (65.3%). Respondents’ knowledge of monkeypox is not very good. Almost all respondents knew that monkeypox was transmitted by direct contact, but only 53.4% knew that monkeypox was not transmitted airborne, 34.7% not sexually, and only 18.7% answered correctly that there was no specific therapy. The percentage who answered in doubt ranged from 20-30%. Respondents' attitudes and perceptions were quite good. Almost all equipped themselves with personal protective equipment and try to find information about monkeypox by attending seminars, downloading guidelines and reading online articles. A total of 58 people (77.3%) were willing to be vaccinated against monkeypox. Residents must increase the correct knowledge about this disease in order to be able to manage appropriately if they encounter cases of monkeypox infection.

COVID-19, a pandemic caused by the SARS-CoV-2 infection, has many fatal complications related to neurological and cardiovascular events such as seizures and arrhythmia leading to cardiac arrest. The direct and indirect mechanisms of SARS-CoV-2 played a significant role to generate its clinical manifestation. Near-sudden unexpected death in epilepsy (SUDEP) is a reversal of cardiopulmonary arrest in an epileptic patient which is very dangerous if not treated well. Here we present a 27-year-old man with VF and near sudden unexpected death due to status epilepticus (SE) and COVID-19 infection that was successfully managed in a rural area emergency setting. Prompt treatment in the emergency room followed by supportive management is important for patient survival. This rare and complex case possibly happened and should be differentiated whether the cause is COVID-19 or SUDEP to establish definitive management though the supportive management is still the same. Prevention of COVID-19 complications and SUDEP should also be done to reduce morbimortality.

ABSTRACT BACKGROUND: The effect of weight loss (WL) on histopathological aspects of non-alcoholic fatty liver disease (NAFLD) may provide further insights into the dynamics of hepatic recovery after WL. OBJECTIVE: To analyze the effects of pre-operative WL on insulin resistance- and NAFLD-related histology in individuals undergoing bariatric surgery (BS) with or without pre-operative WL. DESIGN AND SETTING: A matched cross-sectional study was conducted at a public university hospital and a private clinic in Campinas, Brazil. METHODS: An analytical, observational, cross-sectional study was conducted using prospectively collected databases of individuals who underwent BS and liver biopsy at either a public tertiary university hospital (with pre-operative WL) or a private clinic (without pre-operative WL). Random electronic matching by gender, age, and body mass index (BMI) was performed and two paired groups of 24 individuals each were selected. RESULTS: Of the 48 participants, 75% were female. The mean age was 37.4 ± 9.6. The mean BMI was 38.9 ± 2.6 kg/m2. Fibrosis was the most common histopathological abnormality (91.7%). Glucose was significantly lower in the WL group (92 ± 19.1 versus 111.8 ± 35.4 mg/dL; P = 0.02). Significantly lower frequencies of macrovesicular steatosis (58.3% versus 95.8%; P = 0.004), microvesicular steatosis (12.5% versus 87.5%; P < 0.001), and portal inflammation (50% versus 87.5%; P = 0.011) were observed in the WL group. CONCLUSION: Pre-operative WL was significantly associated with lower frequencies of macro- and mi- crovesicular steatosis, portal inflammation, and lower glycemia, indicating an association between the recent trajectory of body weight and histological aspects of NAFLD.

Mangrove plants in Indonesia are the largest in the world, both in terms of area quantity (+42,550 km2) and number of species (+45 species). Mangroves are a diverse group of salt tolerant plants that grow in intertidal tropical and subtropical forests and represent a rich biodiversity of plants, animals and microorganisms. Acanthus ilicifolius is one of the true mangrove plants which is used as medicine. This literature review aims to determine the study of benzoxazolinone compounds in jeruju plants (Acanthus ilicifolius) from previous studies and to determine the methods, plant parts and solvents used. The literature review method related to the jeruju plant (Acanthus ilicifolius) uses an electronic data base google scholar. Nuclear Magnetic Resonance (NMR) spectroscopy analysis method is one of the spectroscopic methods widely used in previous studies, because NMR spectroscopy is useful in determining the structure of a chemical compound, both proton (1H) and carbon (13C) NMR. Jeruju leaf extract contains alkaloids, flavonoids, polyphenols, phenyletanoid glycosides and coumarin compounds. The methanol fraction of jeruju leaf extract has a pharmacological effect to inhibit edema (inflammation). The extraction method used is maceration, because this method is simple method and most widely used. Meanwhile, the solvents that are more widely used are methanol and ethanol solvents.

Jajanan adalah makanan yang dipersiapkan dan dijual oleh pedagang kaki lima di jalanan dan tempat-tempat keramaian umum lainya. Dampak negatif jangka panjang yang ditimbulkan dari jajanan tidak sehat salah satunya adalah kemungkinan terjadinya anemia dan stunting. Tujuan kegiatan ini adalah untuk meningkatkan pengetahuan siswa tentang jajanan sehat dalam mencegah anemia dan stunting kepada masyarakat. Metode yang digunakan dalam pelaksanaan penyuluhan menggunakan metode observasi dan wawancara langsung yang dilaksanakan di SMP Swasta Cenderamata Kecamatan Medan Denai Kota Medan. Penyuluhan dilakukan anggota berjumlah 6 orang yang terdiri dari 2 oarang Dosen, dan 4 orang mahasiswa Hasil kegiatan pengabdian masyarakat menunjukkan bahwa siswa yang paham tentang jajanan sehat sebelum dilakukan penyuluhan ditemukan sebanyak 26 siswa (87%) yang belum dan sebanyak 4 siswa (13%) yang paham. Sedangkan setelah dilakukan penyuluhan terdapat adanya peningkatan dimana ditemukan sebanyak 28 siswa (93%) yang paham dan sebanyak 2 siswa (7%) yang belum paham. Disimpulkan bahwa ada peningkatan pengetahuan siswa tentang jajanan sehat dalam mencegah anemia dan stunting. Kegiatan ini diharapkan dapat berkembang dan terlaksana secara berkelanjutan sehingga manfaatnya dapat mencakup kepada masyarakat luas.

Background. Diabetes mellitus (DM) is one of the leading health emergencies of the 21st century and among the top ten causes of death among adults globally in 2017. Although Ethiopia has been victimized by the growing prevalence of DM, data regarding in-hospital mortality among admitted diabetic patients in Ethiopia, specifically in Jimma Medical Center (JMC), are lacking. Objective. The aim of the study is to assess in-hospital mortality and its predictors among DM patients admitted to Jimma Medical Center. Methods. A hospital-based prospective observational study was employed involving 120 diabetes patients admitted to JMC from October 01, 2020, to June 30, 2021. Data were collected on variables related to the patient, disease, medication, and clinical outcomes. Data were entered into Epidata version 4.6.0.4 for cleaning and exported to SPSS version 23.0 for analysis. Kaplan–Mayer and cox-regression analyses were used to compare the survival experience and to determine the predictors of clinical outcomes, respectively. Hazard ratio with its two-sided p value

Objective: To revisit data and highlight management of STEMI multi-vessel disease and explore culprit-only versus multi-vessel PCI and optimal timing to achieve complete revascularization. Methods: A 67 years old male with chest pain at rest 2 hours before admission with a history of smoking one pack of cigarette every day, was presented to the hospital. Physical examination was within normal limit with normal hemodynamically; however, elevated cardiac troponin was identified. Electrocardiogram showed STEMI anteroseptal wall with ischemic inferior wall, leading toSTEMI anteroseptal wall, Killip I diagnosis. Primary PCI was performed and multi-vessel disease was found. A complete revascularization single-staged procedure was performed due to his persistent chest pain. PCI of these coronary stenoses is beneficial to reduce risk of cardiac death and recurrent infarction. However, some issues related to PCI of non-culprit coronary arteries lesion and optimal timing to do complete revascularization is still a dilemma. Results: Related to data from some trials, e.g PRAMI, CvLPRIT, DANAM-3-PRIMULTI, COMPARE-ACUTE, COMPLETE, and some meta-analyses, showed benefit and safety of routine PCI of non-culprit lesions as a preventive strategy to reduce morbidity and mortality. Data showed reduce future morbidity and mortality in this setting. Meanwhile, the optimal timing of complete revascularization is still a matter of debate, although some data showed benefit of index procedural PCI. Conclusion: PCI of non-culprit lesions of myocardial infarction is consistently beneficial over culprit-only revascularization in patients with STEMI multi-vessel disease, despite the debate on the optimum timing for complete revascularization in this setting.

Objective: To describe a case of an adult patient with uncorrected Tetralogy of Fallot (TOF) who suffered from Infective Endocarditis (IE) that involved the tricuspid and aortic valves. Methods: On October 2019, a-twenty-year-old male with uncorrected TOF was admitted to the emergency department of Dr. Hasan Sadikin General Hospital with a chief complaint of fever. The echocardiography showed the presence of vegetation on the tricuspid valve and aortic valve. The patient was given empirical antibiotics therapy for IE treatment. The serial blood cultures did not yield any organism growth and the transthoracic echocardiography evaluation showed healed vegetation after 21 days of antibiotics treatment. Results: A high turbulence in small VSD and valvular stenosis, as found in TOF, can injure the endocardial surface. While bacterial adherence to the injured endocardial surface can cause IE, no specific criteria available for diagnosing IE in congenital heart disease (CHD) patients compared to other population. In CHD patients, it is necessary to consider the diagnosis of IE presenting with signs of infection or fever. Our patient was known to have uncorrected TOF and was admitted to the hospital with a chief complaint of fever. The uncorrected TOF was complicated by an unusual form of aggressive vegetation involving multiple valves. Conclusion: The incidence of IE in uncorrected TOF is around 4%. Patient is advised to receive a corrective surgery for the cardiac anomaly. Surgical repair of CHD with no residual lesion reduces the risk of IE.

The COVID-19 pandemic that attacks the world has made the attention of all medical personnel focused on this disease. The clinical picture is similar to other infectious diseases such as malaria, dengue, influenza, etc., which often leads to misdiagnosis. We report the case of a man, 31 years old, with a history of travel and complaints of high fever persisting for more than 7 days. On physical examination, the temperature was 39-40 C, others were within normal limits. Initial platelet count was 69 x 103/µL, leukocytes was 15.52 x 109/L, CRP was 96 mg/L. The blood smear found Plasmodium falciparum, and PCR SARS-CoV-2 was positive. Chest X-ray showed pneumonia. Dihydroartemisinin-piperaquine and primaquine therapies were administered for malaria, as well as favipiravir, azithromycin, and other symptomatic therapy for COVID-19. Platelets decreased to 38 x 103/µL while D-dimer level increased (> 20 mg/L). Anticoagulant was delayed. On monitoring after therapy, the platelets returned to normal, the D-dimer level decreased, and there was no bleeding. The co-infectious conditions of malaria and COVID-19 should be suspected in patients with suggestive symptoms and travel history from endemic areas, therefore both examinations should be performed. This co-infection has the potential to cause hyper inflammation and hypercoagulation and this is associated with a poor prognosis. Appropriate treatment is needed.

Observing mitral or tricuspid valve disease in an athlete raises many considerations for the clinician. Initially, the etiology must be clarified, with causes differing depending on whether the athlete is young or a master. Notably, vigorous training in competitive athletes leads to a constellation of structural and functional adaptations involving cardiac chambers and atrioventricular valve systems. In addition, a proper evaluation of the athlete with valve disease is necessary to evaluate the eligibility for competitive sports and identify those requiring more follow-up. Indeed, some valve pathologies are associated with an increased risk of severe arrhythmias and potentially sudden cardiac death. Traditional and advanced imaging modalities help clarify clinical doubts, allowing essential information about the athlete’s physiology and differentiating between primary valve diseases from those secondary to training-related cardiac adaptations. Remarkably, another application of multimodality imaging is evaluating athletes with valve diseases during exercise to reproduce the sport setting and better characterize the etiology and valve defect mechanism. This review aims to analyze the possible causes of atrioventricular valve diseases in athletes, focusing primarily on imaging applications in diagnosis and risk stratification.

Functional mitral regurgitation (FMR) and tricuspid regurgitation (FTR) occur due to cardiac remodeling in the presence of structurally normal valve apparatus. Two main mechanisms are involved, distinguishing an atrial functional form (when annulus dilatation is predominant) and a ventricular form (when ventricular remodeling and dysfunction predominate). Both affect the prognosis of patients with heart failure (HF) across the entire spectrum of left ventricle ejection fraction (LVEF), including preserved (HFpEF), mildly reduced (HFmrEF), or reduced (HFrEF). Currently, data on the management of functional valve regurgitation in the various HF phenotypes are limited. This review summarizes the epidemiology, pathophysiology, and treatment of FMR and FTR within the different patterns of HF, as defined by LVEF.

Background: Data on the incidence of COVID-19 is reported to be increasing day by day. It impacts the health of health workers both physically and mentally; several previous studies have found that counseling can help reduce anxiety. Other studies have also proven that remembrance therapy can reduce stress levels, but the effectiveness of e-counseling has not yet been tested. Objectives: This study was to determine the effect of e-counseling to reduce stress on nurses in special wards COVID-19. Method: The research design used was a quasi-experimental design with a total sample of 58 people, 29 intervention samples, and 29 control samples. Sampling using non-probability sampling and data collection using a questionnaire which was analyzed with the Independent Sample T-Test. Result: After e-counseling therapy was carried out, the stress level of nurses could decrease significantly from 7.448 to 6.311. There were significant differences in stress levels in the intervention and control groups (69.59±6.311 vs. 49.83±8.824; p

Background: Rational prescribing is an important skill for medical doctors. Many graduates still feel insufficiently prepared to make rational prescribing and fail to demonstrate the related clinical reasoning after graduation. For these reasons, it is important to improve the medical student teaching of rational prescribing. The aim of this study is proving the effectiveness of experiential learning methods to improve rational prescribing skills of medical students. Methods: This study used a one-group pretest-posttest design. Rational prescribing courses use experiential learning methods for 6 year medical students. Every student provided evaluation of rational prescribing and clinical reasoning through pretest and posttest, and we analyzed the results by paired t test. Results: The change in the rational prescribing skill of the students is significant between pretest and posttest. However, in the hypertension case the scores are not significant between pretest and posttest. Also, the scores of clinical reasoning based on drug interaction and evidence based methods are not significant in the hypertension and otitis media cases. Conclusions: Experiential learning methods can enhance rational prescribing skill in medical students but the students were still not able to choose appropriate medications based on drug interaction and evidence based approach.

Introduction: Diabetes mellitus has been perceived as the worsening factor for coronavirus disease 2019 (COVID-19), where diabetes mellitus patients with pre-existing inflammatory condition could develop acute respiratory disease syndrome as well as multi-organ dysfunction. Managing diabetes mellitus amidst severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is also a matter of concern as several antidiabetic therapies could affect the progression of COVID-19. This study aimed to provide the clinical characteristics and outcomes of patients with both COVID-19 and diabetes mellitus receiving blood glucose lowering therapies and COVID-19 symptomatic treatments. Methods: This retrospective study was performed on 260 medical records of patients hospitalized between May 2020 to February 2021 in East Java, Indonesia. Patients were confirmed COVID-19 positive based on the results from real time polymerase chain reaction (RT-PCR) using nasal swab samples collected on hospital admission. Data included were demographic characteristics, COVID-19 symptoms, severity of COVID-19, comorbidities (other than diabetes mellitus), fasting blood glucose (FBG), and 2-hours post-prandial blood glucose (2hPBG), and outcomes. Results: Most of the patients had age range of 41–60 years old (76.1%) with more than a half of the subjects (60%) were obese. Patients with uncontrolled diabetes were distributed evenly among the COVID-19 severities (74.3% in asymptomatic group, 73.6% in mild group, and 74.1% in moderate group). There were reductions in FBG and 2hPBG levels measured before (210.75±81.38 and 271.19±100.7 mg/dL, respectively) and after the treatment (181.03±68.9 and 222.01±86.96 mg/dL, respectively). All patients received multivitamin and symptomatic treatment for COVID-19. Oral antidiabetic drug (57.6%) and insulin (28.8%) were administered to lower the blood glucose level of the patients. As many as 96.9% patients survived, while 3.1% died. Conclusion: COVID-19 could affect the blood glucose level, suggesting the importance of antihyperglycemic therapies among patients with both COVID-19 and diabetes mellitus.

Background: Cardiac computed tomography (CT) provides important insights into the geometrical configuration of the tricuspid valve (TV). The purpose of the present study was to assess the geometrical changes of TV in patients with functional tricuspid regurgitation (TR) using novel CT scan parameters and to correlate these findings with echocardiography. Methods: This single-center study enrolled 86 patients undergoing cardiac CT and divided them into two groups according to the presence or not of severe TR (43 patients with TR ≥ 3+ and 43 controls). The measurements collected were as follows: TV annulus area and perimeter, septal-lateral and antero-posterior annulus diameters, eccentricity, distance between commissures, segment between the geometrical centroid and commissures, and the angles of commissures. Results: We found a significant correlation between all annulus measurements and the grade of TR, except in regard to angles. TR ≥ 3+ patients had significantly larger TV annulus area and perimeter, larger septal-lateral, and antero-posterior annulus dimensions, as well as larger commissural distance and centroid-commissural distance. In patients with TR ≥ 3+ and controls, the eccentricity index predicted a circular shape and an oval shape of the annulus, respectively. Conclusions: These novel CT variables focusing on commissures increase the anatomical understanding of the TV apparatus and the TV geometrical changes in patients with severe functional TR.

Kecemasan menjelang menopause merupaka suatu bentuk kekhawatiran akibat adanya perubahan-perubahan, baik dari segi fisik maupun psikis, dimana ditandai dengan adanya gejala-gejala yang muncul dari segi kognitif, afektif, somatik, dan motorik. Kecemasan ibu saat menopause akan menimbulkan masalah dalam kehidupan seksual suami istri, gejala-gejala fisik dan psikologi seperti keringat berlebihan dan perasaan tidak berguna karena tidak bisa melahirkan anak lagi. Tujuan penelitian ini untuk mengetahui pengaruh peran tenaga kesehatan, peran keluarga, kondisi lingkungan fisik dan motivasi terhadap kecemasan ibu menopause di Desa Pagarawan Tahun 2018. Desain penelitian menggunakan cross sectional. Metode analisis menggunakan Smart PLS 2.0 dan dan SPSS 18. Populasi penelitianibu menopause sebanyak 68 orang. Hasil pengujian hipotesis dengan Structural Equation Model (SEM) dengan metode smartPLS menghasilkan temuan penelitian yaitu peran tenaga kesehatan (17,02%), peran keluarga (11,79%), kondisi kesehatan fisik (26,18%) dan motivasi (26,29%). Pengaruh langsung kecemasan ibu menopause sebesar 81,28% dan pengaruh tidak langsung sebesar 1,44%. Total pengaruh langsung dan tidak langsung kecemasan ibu menopause sebesar 82,72%. Motivasi merupakan faktor dominan yang sangat mempengaruhi kecemasan ibu menopause. Peneliti menyarankan agar seluruh sektor bekerja sama untuk memotivasi ibu mulai dari persiapan premenopause hingga ibu bisa beradaptasi dengan masa menopause.

Inflammatory myofibroblastic tumour is a rare entity of indeterminate biological potential with a reduced tendency for recurrence and metastasis. Although it can arise from multiple organs, the bile duct is a very rare site of origin. We report the case of a 75-year-old asymptomatic male with elevated gamma-glutamyl transferase [1575 U/L (12 - 64 U/L)] and alkaline phosphatase [271 U/L (40 - 150 U/L)]. Computed tomography showed a 17 mm hypervascular lesion in the confluence of the right and left hepatic ducts, with bile duct ectasia and right liver lobe atrophy. The patient was initially managed as having a Klatskin tumour and underwent right hepatectomy. Histology showed a spindle cell proliferation with an inflammatory infiltrate of lymphocytes, plasma cells and collagen-rich stroma, consistent with an inflammatory myofibroblastic tumour. He was discharged 30 days after admission, and nine months later remains asymptomatic. His liver function tests have normalized and follow-up tests are unremarkable.

Cough is the most frequent symptom for which patients consult with their health care provider throughout the world. This symptom could be happened not only in sick individuals but also healthy individuals. At some stage, it is distressing, inhibits normal social activities, and reduces quality of life. Besides these detrimental effects, cough is the most effective defense mechanism to eliminate foreign materials, including various pathogens, from the respiratory tract. It begins with a series of breathing maneuvers which triggers sudden expulsion of air which is divided into three phases, i.e. inspiration, compression, and expiration phase. Cough occurs due to activation of mechanical or chemical sensory receptors in the larynx and lower respiratory tract which stimulates reflex arc complex. This stimulus is then transmitted to the afferent pathway to the cough center in the medulla through the vagus nerve to trigger expiration muscles to produce cough. It is important to know the cause of cough because cough is an indicator for patients and doctors for early diagnosis and therapy of disease. Therefore, cough is classified into acute, subacute, and chronic according to its duration. Available medications for symptomatic management of cough are inadequate due to lack of proven efficacy and/or their undesirable or intolerable side effects. This article aims to provide information on cough management to improve therapeutic effectiveness and patient quality of life.

Indonesia is the 2nd country with the highest tuberculosis (TB) caseload in the world. Inappropriate TB treatment may lead to multidrug-resistance tuberculosis (MDR-TB) development. TB rapid detection is important, and very much needed, to prevent transmission and deaths due to this disease. The Xpert® MTB/RIF is proposed to address this problem. This study aimed to assess the performance of the Xpert® MTB/RIF test in West Java, Indonesia. This was a cross-sectional study conducted on MDR-TB suspects referred to Dr. Hasan Sadikin General Hospital Bandung, West Java, Indonesia, using data from the eTB Manager. The performance of Xpert® MTB/RIF testing and its validity was tested against conventional drug susceptibility testing (DST). In total, data from 4,452 MDR-TB suspects were retrieved but only 578 data that had both DST and Xpert® MTB/RIF results were included in the study. The Xpert® MTB/RIF showed a sensitivity of 88% (95%CI: 85%-91%), specificity of 66% (95%CI: 60%-72%), positive predictive value of 79% (95%CI: 75%-83%), and negative predictive value of 80% (95%CI: 74%-85%), with a detection accuracy of 79%. Xpert® MTB/RIF test in this study shows a good performance for the diagnosis of MDR-TB when compared to the Mycobacterium tuberculosis culture as the gold standard. Therefore, rapid Xpert® MTB/RIF examination is recommended for MDR-TB screening for countries with a high TB burden as a complementary tool to the reference standard test.

Lactobacillus plantarum is a Lactic Acid Bacteria (LAB) that has the potential to be used as a probiotic agent. Probiotics are antidiabetic because they can inhibit alpha-glucosidase enzymes. This study aims to was to determine the antidiabetic effects of probiotic Lactobacillus plantarum isolates of breast milk (ASI). The study was conducted at the Microbiology Laboratory of the University of Muhammadiyah Semarang and the Pharmacology Laboratory of the Semarang College of Pharmacy during the month of April-June. Experimental research with 25 male wistar mice was divided into 5 groups (K-, K+, P1, P2, P3) Alloxan monohydrate induction was carried out intraperitoneally at a dose of 150mg/kg BW. Fasting blood glucose measurements were performed at baseline (before alloxan induction), post alloxan and at the end of treatment. Diabetic mice fasting blood glucose levels shouldbe± 200 mg/dL. Suspension of Lactobacillus plantarum isolate ASI was carried out orally for 7 days. Based on the ANOVA test there were significant differences in the decrease in blood glucose with a significant value of p-value=0,0090,05. Based on the Tuckey post hoc test treatment group P1, P2, P3 there were no significant differences between treatment groups even though the dosage was different. 1 time a day treatment is an efficient dose in reducing blood glucose.

Menurut UNICEF dalam dekade berikutnya, akan ada 10 juta gadis yang potensial akan menjadi pengantin di usia yang sangat muda, jumlah ini akan meningkat 10% selama 10 tahun berikutnya, di 3 negara tertinggi yaitu India, Nigeria, dan Afrika dan termasuk Indonesia. Sumatra Barat juga mengalami titik dan contohnya, Pasaman diangkat pertama untuk incidensi pernikahan awal, total 159 pasangan. Studi ini menggunakan metode kuantitatif deskriptif dengan pendekatan Analisis Data Sekunder (ADS). Populasi adalah 760 wanita yang diambil oleh sampel sengaja dan teknik sampel sederhana dengan total 263 wanita. Instrumen yang digunakan adalah tes tabel utama, dengan tes statistik menggunakan formula chi-kuadrat berdasarkan hasil dari hubungan antara pendidikan dan tingkat pekerjaan. Bisa dikatakan bahwa dua variabel berikutnya memiliki hubungan yang signifikan dengan jumlah pernikahan awal. Kebanyakan wanita yang menikah di kantor urusan agama Rao Pasaman memiliki pendidikan tinggi dan pekerjaan, dan ada korelasi yang jelas dari tingkatan pendidikan serta umur, ketika pernikahan, yang dikategorikan sebagai signifikan.

Balantioides coli is a zoonotic enteric protozoan parasite of public veterinary health relevance and a concern in animal production and food safety. While wild cervids are recognized reservoirs for several zoonotic pathogens, little is known about the occurrence of B. coli in deer species, especially in Europe. To fill this gap, a total of 130 fecal samples from legally hunted red deer (Cervus elaphus, n = 95) and fallow deer (Dama dama, n = 35) were passively collected during two hunting seasons (October to February; 2018–2019 and 2019–2020) in Portugal. After assessment by PCR assay targeting the complete ITS1–5.8s-rRNA–ITS2 region and the 3’ end of the ssu-rRNA gene of the parasite, a prevalence of 4.2% (4/95, 95% CI: 0.2–8.3) in red deer and of 5.7% (2/35, 95% CI: 0.0–13.4) in fallow deer was found. Sequence and phylogenetic analyses allowed the identification of B. coli genetic variants A (in two red deer) and B (in two red deer and two fallow deer). This is the first molecular-based description of B. coli in European deer species, whose population have increased in density and geographical range in recent years. Continued monitoring of wild ungulates as potential vectors of parasitic infection diseases of zoonotic nature is crucial to safeguard public health and food safety.

(1) Background: Toxoplasma gondii is a widespread zoonotic agent that greatly impacts Public Health, being responsible for one of the most important parasitic zoonosis worldwide. T. gondii has a heteroxenous life cycle, with cats being the definitive hosts and all warm-blooded animals, including humans, being intermediate hosts. Veterinary practitioners (VP) may be at a higher risk than the general population for T. gondii infection, as they have direct and daily contact with many animal species. The aim of the present study was to ascertain if VP were more likely to be anti-T. gondii IgG seropositive than the general population, as well as to understand if age, accidents with blood-contaminated sharps (cross-blood contamination), gender, working years, and geographic regions play a role as risk factors for T. gondii infection. For this purpose, a case–control study using archived samples was performed. (2) Methods: A total of 350 veterinary practitioners were tested using a commercial semiquantitative enzyme immunoassay for anti-T. gondii IgG. From the general population, 175 anonymous volunteers (matched with cases by region, age, and gender) were studied for anti-T. gondii IgG. (3) Results: There was no statistical difference found between the presence of anti-T. gondii IgG in practitioners (26%; CI = 21.40–30.60%) and the general population (33.14%; CI = 26.17–40.12%) (p = 0.108). Univariate and multivariate analysis showed that only age (older groups) was found to be associated with a higher prevalence of anti-T. gondii IgG, with significant p values (p < 0.05) for both univariate and multivariate analysis. (4) Conclusions: To the best of our knowledge, this is the first case–control study fully focused on the prevalence of anti-T. gondii IgG in VP in Portugal, showing that there was no significant risk for T. gondii infection in veterinarians exposed daily and repeatedly to different species of animals.

COVID-19 vaccination in adolescents is important because the adolescent population has the highest incidence of COVID-19. This study aimed to explore the factors associated with COVID-19 vaccination adherence among Indonesian adolescents. This cross-sectional study involved 7986 adolescents, polled through online and offline surveys conducted in six major islands of Indonesia. The online questionnaire was distributed through popular social messaging and social media platforms. Our team also contacted schools and public places to recruit participants from remote areas. In total, 7299 respondents completed the questionnaire. Binary logistic analysis revealed that higher levels of knowledge, positive attitudes, and confidence in the COVID-19 vaccine were significantly associated with higher COVID-19 vaccination adherence in adolescents. Sociodemographic factors were also significantly associated with higher adherence to vaccination programs. Meanwhile, younger age and habitation in private housing were related to lower adherence to the vaccination program. Parental factors related to adolescent compliance were education level, household income, history of infection of family or friends with COVID-19, and working status. The national authorities and stakeholders should take extensive measures to increase attitude, knowledge, confidence, and family support among adolescence through multiple channels.

Background: The natural history of tricuspid valve regurgitation (TR) is characterized by poor prognosis and high in-hospital mortality when treated with isolated surgery. We report the preliminary echocardiographic and procedural results of a prospective cohort of symptomatic patients with high to prohibitive surgical risk and at least severe TR who underwent transcatheter edge-to-edge repair through the TriClipTM system. Methods: From June 2020 to March 2022, 27 consecutive patients were screened, and 13 underwent transcatheter TriClipTM repair. In-hospital, 30-day and six-month clinical and echocardiographic outcomes were collected. Results: Nine patients had severe, three massive and one baseline torrential TR. Sustained TR reduction of ≥1 grade was achieved in all patients, of which 90% reached a moderate TR or less. On transthoracic echocardiographic examination, there were significant reductions in vena contracta width (p < 0.001), effective regurgitant orifice area (p < 0.001) and regurgitant volume (p < 0.001) between baseline and hospital discharge. We also observed a significant reduction in tricuspid annulus diameter (p < 0.001), right ventricular basal diameter (p = 0.001) and right atrial area (p = 0.026). Conclusion: Treatment with the edge-to-edge TriClip device is safe and effective. The resulting echocardiographic improvements indicate tricuspid valve leaflet approximation does not just significantly reduce the grade of TR but also affects adjacent structures and improves right ventricular afterload adaptation.

A family environment of high conflict, coercion, and/or physical abuse presents numerous risks for children, with the potential for significant psychiatric, behavioral, and adjustment difficulties, including aggression, poor interpersonal skills/functioning, and emotional reactivity. Caregivers in such families often employ punitive or excessive parenting practices, demonstrate frequent anger and hyperarousal, and make negative attributions to the child, which creates stressful home. Alternatives for Families Cognitive Behavioral Therapy emphasizes training in intra- and interpersonal skills designed to enhance self-control and promote family functioning. Alternatives for Families Cognitive Behavioral Therapy is a third-generation, evidence-based and evidence-informed cognitive behavioral therapy approach.

ABSTRAK Remaja adalah individu yang sedang dalam tahap perkembangan transisi antara masa anak-anak dan masadewasa awal, merupakan masa yang mengalami banyak perubahan, baik secara anatomis, fisiologis, fungsi emosional dan intelektual serta hubungan di lingkungan sosial. Pernikahan dini diartikan pernikahan yang pasangan masih muda dan belum bisa memenuhi persyaratan yang telah ditentukan untuk melakukan pernikahan. Usia Remaja yang melakukan pernikahan dini beresiko tidak dapat beradaptasi dengan baik dengan lingkungan dan situasi barunya maka beresiko mengakibatkan timbulnya stres. Gejala stress dapat menjadi masalah kesehatan yang cukup serius yang dapat menyebabkan dampak secara psikologis, sosial dan ekonomi. Penelitian ini bertujuan mengidentifikasi tingkat stres dan indikator stress yang terjadi pada usia remaja yang melakukan pernikahan dini.Penelitian ini menggunakan metode deskriptif kuantitatif, dengan teknik pengumpulan data menggunakan instrument kuesioner DASS-21. Sampel yang diteliti adalah pasangan remaja telah menikah pada usia 16-20 tahun sebanyak 104 pasangan yang diambil dengan menggunakan teknik purposive sampling dan hasil penelitian dianalisa data dengan perhitungan distribusi frekuensi dan presentase (%). Hasil penelitian didapatkan bahwa setengah dari responden (46,1%) dikelompokan dalam keadaan stres normal, hampir setengahnya dari responden (29%) dikelompokan dalam keadaan stress ringan, sebagian kecil dari responden (15,3%) dikelompokan dalam keadaan stress sedang, sebagian kecil dari responden (8,6%) dikelompokan dalam keadaan stress berat, dan sebagian kecil dari responden (1%) dikelompokan dalam keadaan stress sangat berat. Simpulan penelitian ini bahwa secara psikologis, menikah pada usia dini merupakan suatu beban psikis. ABSTRACT Teenagers are individuals who are in the developmental transition from childhood to young adults. is a time of humans experience well on anatomic, physiologic, emotional changes, as well as their social and intellectual relationship. Early age marriage is defined as young couples who have not met the requirements needed to get married in marriage. Teenagers who commit early age marriage that could not adapt quite well with their new social environment may become stressful. Symptoms of stress can be quite serious health problems which can cause psychological, social and economic. This research has the aim to identity the stress level happens amongst teenagers who commit early age marriage.This research uses descriptive quantitative descriptive, which uses DASS-21 questionnaire as its instrument to obtain the data. The samples for the research are 104 teenagers couples aging from 16 to 20 whi have gotr married. That are obtained through purposive sampling and the result of research analyzed data with the calculasion of distribution frequency and percentage. The result of the research show that a half of the participants (46,1%) are categorized into normal stress, (29%) of the respondent are is categorized into mild stress, (15,3%) of the participants are is categorized into average stress, (8,6%) are in heavily stressful category, and only 1% categorized into very heavily stressful. The conclusion of this study that psychologically, married at an early age is a psychologoical burden.

Background: Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex using novel CT parameters. Methods: This prospective, single-center study enrolled 22 consecutive patients with severe tricuspid regurgitation, who underwent a cardiac CT study dedicated to the right chambers. The following variables were obtained: annulus area and perimeter, septal-lateral and antero-posterior diameters, tenting height, and anatomical regurgitant orifice area. Moreover, the following novel annular parameters were assessed: distance between commissures, distance between TV centroid and commissures, and angles between centroid and commissures. Results: A significant phasic variability during the cardiac cycle existed for all variables except for eccentricity, angles, and distance between the postero-septal and antero-posterior commissure and distance between the centroid and antero-posterior commissure. There was a significant relationship between the TV annulus area and novel annular parameters, except for annular angles. Additionally, novel annular variables were found to predict the annulus area. Conclusions: These novel additional variables may provide an initial platform from which the complexity of the TV annular morphology can continue to be better understood for further improving transcatheter therapies.

Objectives: To present a rare case of Congenital Complete Heart Block (CCHB) in the setting of post-cesarean delivery of an asymptomatic young patient. Methods: A 30-year-old female patient complained of sudden weakness after C-section delivery with spinal anesthesia. She presented a slow heart rate and Complete Heart Block (CHB) on electrocardiogram (ECG). After one week of observation, the ECG still presented a CHB condition. A permanent pacemaker (PPM) with DDDR mode was then installed for this patient. Result: The etiology of CHB, especially at a young age, is unclear, hence challenging. A patient with a CCHB is difficult to diagnose, especially without any previously related symptoms. This abnormality is usually detected during routine screening not related to cardiovascular disease. The patient in this case study presented an ECG of persistent CHB from the time this patient was admitted until one week after observation. The echocardiography showed normal results. Other modalities to confirm diagnosis and evaluate the prognosis of a CCHB should be done. Conclusion: Establishing the etiology of CHB in young patients is challenging. The implantation of PPM is needed because the condition is permanent, regardless the etiology. However, implanting a permanent pacemaker is not always an easy decision, especially in young patients.

Background: Circulating into foetal circulation across the placental barrier, abnormal maternal serum lipids predispose neonates to metabolic dysfunction and thereafter affect the steroid metabolism and functions of extra-embryonic foetal tissues. Methods: A systematic review was conducted by searching PubMed–MEDLINE and the Cochrane library between January 2010 and January 2020. The included studies were English case control studies that described original data on at least one raw lipid measurement during pregnancy in healthy women who delivered large for gestational age (LGA) newborns and in healthy women with non-LGA newborns. The data extracted from 12 studies were pooled, and the weighted mean difference (WMD) in lipid levels was calculated using random effects models. A meta-analysis was performed to identify sources of heterogeneity and to describe the significant value of the collected studies. Results: Of 649 published articles identified, a total of 12 met the inclusion criteria. Compared with women who had non-LGA newborns, those who had LGA newborns had significantly higher triglyceride (TG) levels (WMD = 0.28, 95% CI −0.02 to 0.54) and lower high density lipoprotein cholestrol (HDL-C) levels (WMD = 0.08, 95% CI −0.13 to −0.03), but not have significantly lower high-density lipoprotein cholesterol (LDL-C) levels. Moreover, the levels of total cholesterol, low-density lipoprotein cholesterol, and very low density lipoprotein cholesterol (VLDL-C) were inconsistent between both groups. Conclusions: High levels of TG and low levels of HDL-C could cause births of LGA newborns whereas maternal serum of TC, LDL-C and VLDL-C cannot be used as predictor of LGA.

There have been many studies attempting to disentangle the relation between motivation and mental fatigue. Mental fatigue occurs after performing a demanding task for a prolonged time, and many studies have suggested that motivation can counteract the negative effects of mental fatigue on task performance. To complicate matters, most mental fatigue studies looked exclusively at the effects of extrinsic motivation but not intrinsic motivation. Individuals are said to be extrinsically motivated when they perform a task to attain rewards and avoid punishments, while they are said to be intrinsically motivated when they do for the pleasure of doing the activity. To assess whether intrinsic motivation has similar effects as extrinsic motivation, we conducted an experiment using subjective, performance, and physiological measures (heart rate variability and pupillometry). In this experiment, 28 participants solved Sudoku puzzles on a computer for three hours, with a cat video playing in the corner of the screen. The experiment consisted of 14 blocks with two alternating conditions: low intrinsic motivation and high intrinsic motivation. The main results showed that irrespective of condition, participants reported becoming fatigued over time. They performed better, invested more mental effort physiologically, and were less distracted in high-level than in low-level motivation blocks. The results suggest that similarly to extrinsic motivation, time-on-task effects are modulated by the level of intrinsic motivation: With high intrinsic motivation, people can maintain their performance over time as they seem willing to invest more effort as time progresses than in low intrinsic motivation.

BackgroundIncreased intra-abdominal pressure causes hemodynamic changes that may affect renal biomarkers.MethodsThis randomized, single-blind, single-center clinical trial recruited patients undergoing laparoscopic cholecystectomy at a tertiary care center in Brazil. They were randomly allocated to a standard intra-abdominal pressure group (P10-12, 10-12 mm Hg) and a low intra-abdominal pressure group (P6-8, 6-8 mm Hg). The primary outcome was the change in neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant.ResultsIn total, 64 patients completed the study-33 were given standard pressure and 31 were given low pressure. There was no significant difference in the biomarker between the groups (P = 0.580), but there was a significant difference between the time points with elevation at T1 (P < 0.001). Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups.ConclusionsIn laparoscopic cholecystectomy, pneumoperitoneum increases NGAL and cystatin C levels intraoperatively, and the use of low-pressure pneumoperitoneum does not change the course of these biomarkers.

Newer data platforms offer increased opportunity to share multidimensional health data with research participants, but the preferences of participants for which data to receive and how is evolving. Our objective is to describe the preferences and expectations of participants for the return of individual research results within Project Baseline Health Study (PBHS). The PBHS is an ongoing, multicenter, longitudinal cohort study with data from four initial enrollment sites. PBHS participants are recruited from the general population along with groups enriched for heart disease and cancer disease risk. Cross-sectional data on return of results were collected in 2017-2018 from an (1) in-person enrollment survey (n = 1,890), (2) benchmark online survey (n = 1,059), and (3) participant interviews (n = 21). The main outcomes included (1) preferences for type of information to be added next to returned results, (2) participant plans for sharing returned results with a non-study clinician, and (3) choice to opt-out of receiving genetic results. Results were compared by sociodemographic characteristics. Enrollment and benchmark survey respondents were 57.1% and 53.5% female, and 60.0% and 66.2% white, respectively. Participants preferred the following data types be added to returned results in the future: genetics (29.9%), heart imaging, (16.4%), study watch (15.8%), and microbiome (13.3%). Older adults (OR 0.60, 95% CI: 0.41-0.87) were less likely to want their genetic results returned next. Forty percent of participants reported that they would not share all returned results with their non-study clinicians. Black (OR 0.64, 95% CI 0.43-0.95) and Asian (OR 0.47, 95% CI 0.30-0.73) participants were less likely, and older participants more likely (OR 1.45-1.61), to plan to share all results with their clinician than their counterparts. At enrollment, 5.8% of participants opted out of receiving their genetics results. The study showed that substantial heterogeneity existed in participant's preferences and expectations for return of results, and variations were related to sociodemographic characteristics.

The spread of Coronavirus Disease 2019 (COVID-19) has had a serious impact on public health. The speed and extentof its spread havedemonstrated a global failure to cultivate awareness and cooperation in responseto the threat. Therefore, in order to improve public awareness and the management of public health threats, we propose a strategy to initiate global civil society. Using Walt and Gilson's policy triangle framework for policy analysis, we reviewed and analysed a series of articles and policies related to COVID-19, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the Global Health Security Agenda (GHSA), health resilience in the context of globalization, as well as other countries’ experiences. We also explored constitutional obligations, public health legislation, collaboration of civil society, and policies related to public health, as well as their implementation. Every country has its own public policy strategy for handling COVID-19. One possible solution is to expand the GHSA commitments and bind all countries that have signed the agreement to a single public policy strategy for the handling of COVID-19. The poor handling of the COVID-19 outbreak has demonstrated the need for Indonesia’s civil society collaborativelyoversee the Indonesia’s government’s implementationof its constitutional obligations. The government mustmake public health security a top priority, and collectives of educated individuals with a strong, shared vision must harness the power of non-governmental advocacy.