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Infections caused by multidrug-resistant (MDR) bacteria are on the rise globally. MDR is facilitated by overexpression of efflux pump and permeability changes of membrane. Acinetobacter baumannii is a pathogenic germ that causes a major problem in infection, also, there has been an increase in the incidence of resistance to various antibiotics. The present study highlights the synergistic of ethanolic extract of Curcuma domestica (EECD) rhizome with tetracycline against multidrug-resistant A. baumannii (MDR-Ab). Assessment of Minimum Inhibitory Concentration (MIC) was determined by microdilution using 96-well plates. The synergistic effect of EECD and tetracycline was determined by checkerboard method. The effect of EECD and tetracycline combination was investigated by bacteriolytic activity and inhibition of efflux pump by Ethidium Bromide (EtBr) accumulation assay. EECD presented the MIC value 250 µg/mL against MDR-Ab. Fractional Inhibitory Concentration Index (FICI) value of EECD and tetracycline combination was 0.4, which showed their synergistic effect. Additionally, the combination of EECD and tetracycline could inhibit the efflux pump in MDR-Ab. This combination can also compromise cell integrity by altering membrane permeability thus lysing the bacteria cells. According to these results, EECD and tetracycline combination has synergistic effects at some sites of action, and thus could be used as a breakthrough to overcome infection problems due to MDR-Ab. Keywords: Acinetobacter baumannii, antibacterial, Curcuma domestica, multidrug-resistant, tetracycline

Introduction: Curcuma species have shown antibacterial activity against Pseudomonas aeruginosa. The current study was conducted to analyze the antibacterial activity of ethanol extracts of Curcuma species rhizomes, including Curcuma domestica, C. xanthorrhiza, C. mangga, C. zedoaria, and C. aeruginosa against multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa). Furthermore, the mechanism action of Curcuma species in combination with antibiotic against MDR P. aeruginosa and its chemical component were also investigated. Methods: Determination of minimum inhibitory concentration (MIC) was carried out by the microdilution method. The synergistic effects of the extract and tetracycline were determined by the checkerboard method. The effect of the combination of Curcuma species and tetracycline to prevent bacterial resistance was investigated using inhibition of biofilm formation, permeability of bacterial cell membrane, and EtBr accumulation methods. Gas chromatography-mass spectrometry (GC-MS) analysis was also performed. Results: MIC of C. domestica, C. xanthorrhiza, and C. mangga against MDR P. aeruginosa were 125, 250, and 125 µg/mL, respectively. C. xanthorrhiza ethanol extract (7.8 µg/mL) in combination with tetracycline (1.9 µg/mL) revealed a synergistic activity with Fractional Inhibitory Concentration Index (FICI) value of 0.06. The combination of C. xanthorrhiza ethanol extract and tetracycline showed inhibitory effects on biofilm formation and efflux pump of MDR P. aeruginosa. This combination also had bacteriolytic activity. GC-MS analysis led to the identification of ar-turmerone (11.63%) and xanthorrhizol (11.36%) as the major compounds. Conclusion: Combination of C. xanthorrhiza ethanol extract and tetracycline might be developed as an alternative treatment against MDR P. aeruginosa.

Background Congenital hypothyroidism (CH) is the most common congenital endocrine disorder in childhood and is one of the most preventable causes of intellectual disability (ID). Late initiation of thyroid hormone substitution therapy has a negative impact on intellectual abilities in CH patients. Objective To compare Intelligence Quotient (IQ) between children with CH who underwent early treatment among the children without CH. Methods We performed online literature searches of ScienceDirect, Pubmed, Cochrane Library, and Google Scholar. We included clinical studies that examined IQ scores in patients with early-treated CH and without CH. Review Manager 5.4 was used to perform the meta-analysis. Results Twelve studies comparing pediatric patients with and without CH were included in this meta-analysis, for a total of 808 patients. Based on data analysis, IQ levels of verbal IQ [mean difference (MD) -9.05; (95%CI -14.51 to -3.59); (P

Background Congenital hypothyroidism (CH) is the most common congenital endocrine disorder in childhood and is one of the most preventable causes of intellectual disability (ID). Late initiation of thyroid hormone substitution therapy has a negative impact on intellectual abilities in CH patients. Objective To compare intelligence quotient (IQ) between children with CH who underwent early treatment among the children without CH. Methods We performed online literature searches of ScienceDirect, Pubmed, Cochrane Library, and Google Scholar. We included clinical studies that examined IQ scores in patients with earlytreated CH and without CH. Review Manager 5.4 was used to perform the meta-analysis. Results Twelve studies comparing pediatric patients with and without CH were included in this meta-analysis, for a total of 808 patients. Based on data analysis, IQ levels of verbal IQ [mean difference (MD) -9.05; (95%CI -14.51 to -3.59); (P<0.00001)], performance IQ [MD -11.70; (95%CI -17.41 to -5.99); (P<0.00001)], and total IQ [MD -10.78; (95%CI -14.03 to -7.54); (P<0.00001)]. While verbal, performance, and total IQ of the early-treated CH group were within the normal range, they were each significantly lower than those in the non-CH group. Conclusion This meta-analysis reveals that IQ scores in earlytreated CH subjects were within normal limits, but significantly lower than that of normal controls. [ABSTRACT FROM AUTHOR]