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Background & Aims The Pre-TACE-Predict model was devised to assess prognosis of patients treated with trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). However, before entering clinical practice, a model should demonstrate that it performs a useful role. Methods We performed an independent external validation of the Pre-TACE model in a cohort that differs in setting and time period from the one that generated the original model. Data from 826 patients treated with TACE for naïve HCC (2008-2018) were used to assess calibration and discrimination of the Pre-TACE-Predict model. Results The four risk-categories identified by the Pre-TACE-Predict model had gradient monotonicity, with median survivals of 52.0, 36.2, 29.9, and 14.1 months respectively. However, predicted survivals systematically underestimated observed survivals (R2: 0.667). A recalibration was adopted maintaining fixed the prognostic index and modifying the baseline survival function. This resulted in an almost perfect calibration (R2: 0.995) in all the four risk categories. Cox regressions showed that aetiology and macrovascular invasion, included in the Pre-TACE-Predict model, had no prognostic impact in the present study population, and that coefficients for tumour size and multiplicity were overestimated. The c-index was similar to that of the m-HAP-III, but higher than those of HAP, m-HAP-II and the six-and-twelve models. Conclusions The recalibration of Pre-TACE-Predict model improved the estimation of survival probabilities of HCC patients treated with TACE. The highest discriminatory ability of the Pre-TACE-model in comparison to other available models, together with risk stratification and recalibration, makes it the best prognostic tool currently available for these patients.

Background An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). Aims We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Methods Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching. Results The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9–64.0]) was not significantly different from the observed (47.0 months [35.0–58.9]; p = 0.43) and adjusted (44.9 months [33.4–56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. Conclusions A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.

Primary and disseminated lymphoma of the female reproductive tract are rare types of lymphoma. However, in the setting of solid organ transplant, recipients have an approximately doubled risk of acquiring and dying from malignancy. Multiple treatment modalities are available for post-transplant lymphoproliferative diseases (PTLD), including chemotherapy, radiotherapy, surgery, and immunosuppression radiotherapy. We report a case of a 61-year-old female with multifocal nodal diffuse large B-cell lymphoma and a history of a renal transplant secondary to IgA nephropathy who developed metastatic diffuse large B-cell lymphoma to the uterus. While the baseline incidence of PTLD is elevated when compared with lymphoma in the general population, metastatic uterine lymphoma is rare. Awareness of reproductive organ involvement by lymphomas and increased malignancy risk in organ transplant patients are important considerations for diagnostic evaluation, including radiologic assessment.

Diabetes melitus (DM) adalah penyakit kronis yang terjadi baik ketika pankreas tidak menghasilkan cukup insulin, atau ketika tubuh tidak dapat secara efektif menggunakan insulin yang dihasilkannya. Tujuan mengetahui aktivitas buah pare terhadap target molekuler antidiabetes secara literature review. Analisis dan tinjauan pencarian web sistematis dilakukan pada literatur penelitian yang berkaitan dengan buah pare digunakan untuk aktivitas DPP4, PTP1B, α-glukosidase, dan peningkatkan kadar GLUT4. Data dikumpulkan dari beberapa jurnal dengan kriteria inklusi. Data diekstraksi dan data sintesis. Studi literatur review senyawa charantin, cucurbitacin, dan momordicoside D secara bersamaan mengaktivasi reseptor TGR5 dan GLP1 untuk menghambat DPP4, senyawa cucurbitane 25-O-methylkaraviagein D dikaitkan dengan keberadaan –OH memiliki aktivitas penghambatan terhadap enzim PTP1B, senyawa 3β, 7β, 25-trihydroxycucurbita-5,23(E)-dien-19-al, charantal, charantoside XI, dan 25ξ- isopropenylchole-5, 6-ene-3-O- D-glukopiranosida diprediksi memiliki afinitas mengikat sisi aktif protein sehingga menghambat α-glukosidase, dan senyawa charantin, vicine, polypeptide-p, 5-,19-epoxy-3-, 25-dihydroxycucurbita-6,23 (E) -diene dan 3- 7-, 25-trihydroxycucurbita-5,23 (E)-dien-19-al. dapat meningkatkan jumlah GLUT4 pada permukaan sel.

Background: Neoadjuvant chemotherapy is the initial therapy and the main pillar of treatment for locally advanced breast cancer (LABC). Currently, there is marker that widely accepted as a predictive factor for chemotherapy response in LABC. Elevated serum interleukin-6 (IL-6) levels and tumor sites have been proposed as prognostic markers for breast cancer. In this study, we aimed to examine the association between serum IL-6 levels with clinical response after the administration of neoadjuvant chemotherapy. Methods: This study is an observational analytic study with a cohort prospective character to determine the relationship between IL-6 serum levels and clinical response to anthracycline-based neoadjuvant chemotherapy in locally advanced breast cancer (LABC) patients at Dr. Soetomo General Hospital during April 2021 to September 2021 with a total sample of 38 patients. Results: Fourteen patients (77.8%) had a positive response in the low IL-6 level group and 4 patients (22.2%) had a negative response. In high IL-6 level group, 4 patients (40%) had a positive response and 16 patients (80%) had a negative response. The cut off of 15.495 pg/mL was used as cut off value for IL-6 to predict the clinical response to chemotherapy. The sensitivity, specificity, PPV, NPV, and accuracy of IL-6 to predict the clinical response after chemotherapy were 80.0%, 77.8%, 80.0%, 77.8%, and 78.9%, respectively. Conclusion: There is a relationship between serum IL-6 levels and clinical response to anthracycline-based neoadjuvant chemotherapy regimens in locally advanced breast cancer (LABC) patients. Keywords: interleukin-6, clinical response, locally advanced breast cancer.

The incidence of bleeding is increased in high risk patients with critical conditions in Intensive Care Unit (ICU). Appropriate prophylaxis medicine is necessary to reduce the incidence of stress ulcer bleeding during hospitalization in ICU which further can minimize the cost of patient care in the ICU. Currently, lansoprazole and pantoprazole are used as a stress ulcers prophylaxis. Nevertheless, there has not been sufficient evidence proving their effectiveness. This study was aimed to compare the effectiveness and cost between iv lansoprazole and iv pantoprazole as a stress ulcer prophylaxis in ICU. In this retrospective observational study, the data were obtained from medical records of all patients admitted to ICU in a District Hospital in Yogyakarta from January 2014 until December 2016. Effectiveness of therapy were obtained from objective data in the medical record by looking at the incidence of major (clinically significant) and minor (overt gastrointestinal) bleeding. Chi-square analysis was performed to analyze the difference of bleeding incidence. The average cost was presented as Expected Monetary Value (EMV), which consisted of the cost of prophylaxis and treatment of bleeding. The difference in average cost was analyzed using independent t-test. A total of 119 patients were included in this study. There were 62 patients in the lansoprazole group and 47 patients in the pantoprazole group. Forty eight patients (77,4%) from lansoprazole group and 35 patients (61,4%) from pantoprazole group did not experience any GI bleeding. There was no statistical difference in the incidence of GI bleeding between the two groups (CI 95%, P-value = 0.057). The EMV of lansoprazole group was higher than pantoprazole group IDR 645.122,57 and IDR 511.629,39 respectively. In conclusion, there was no significant difference regarding the effectiveness between iv lansoprazole and iv pantoprazole as stress ulcer prophylaxis. Costs for the prophylaxis of stress ulcers is lower on the use of pantoprazole compared to lansoprazole.

The prevalence of hypertension in the world in 2000 according to WHO worldwide there were 972 million people or 26.4% of the earth's inhabitants experienced hypertension. Of the 972 million people with hypertension, 333 million are in developed countries and the remaining 63 million are in developing countries, including Indonesia. Knowing the description of the incidence of controlled and uncontrolled hypertension at the Malingping Health Center in 2021. Descriptive research design. Samples were taken using the purposive sampling technique, namely 119 patients who came for treatment at the Malingping Health Center. The results were analyzed univariately. Based on the results of the study, it can be seen from 106 respondents who were not controlled (81.1%), while those who were controlled were 13 respondents (10.9%). Age of hypertensive patients included in the groupage > 60 years as many as 62 samples (52.1%). The sex of the patients was mostly female, namely 88 samples (73.9%). The incidence of hypertension sufferers in the working area of ​​Malingping Health Center is still uncontrolled, in the age group > 60 years and female.

In heart failure with reduced ejection fraction, the interventional landscape has recently expanded. New transcatheter approaches are emerging for both mitral and tricuspid secondary (functional) regurgitation. Transcatheter therapies for mitral and tricuspid valve require a more tailored approach than for the aortic valve, because of more heterogeneous clinical scenarios, anatomic features, and mechanisms of valvular lesions.

Simple Summary This review proposes a comprehensive overview of the main prognostic systems for HCC classified as prognostic scores, staging systems, or combined systems. Prognostic systems for HCC are usually compared in terms of homogeneity, monotonicity of gradients, and discrimination ability. However, despite the great number of published studies comparing HCC prognostic systems, it is rather difficult to identify a system that could be universally accepted as the best prognostic scheme for all HCC patients encountered in clinical practice. In order to give a contribute in this topic, we conducted a study aimed at externally validate the MESH score and the CNLC classification using the ITA.LI.CA database. Abstract Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.

Purpose of review To review current evidence on the pathophysiology of COVID-19-related acute respiratory distress syndrome (ARDS) and on the implementation of lung protective ventilation. Recent findings Although multiple observations and physiological studies seem to show a different pathophysiological behaviour in COVID-19-ARDS compared with 'classical' ARDS, numerous studies on thousands of patients do not confirm these findings and COVID-19-ARDS indeed shares similar characteristics and interindividual heterogeneity with ARDS from other causes. Although still scarce, present evidence on the application of lung protective ventilation in COVID-19-ARDS shows that it is indeed consistently applied in ICUs worldwide with a possible signal towards better survival at least in one study. The levels of positive end-expiratory pressure (PEEP) usually applied in these patients are higher than in 'classical' ARDS, proposing once again the issue of PEEP personalization in hypoxemic patients. In the absence of robust evidence, careful evaluation of the patient is needed, and empiric settings should be oriented towards lower levels of PEEP. Summary According to the present evidence, a lung protective strategy based on low tidal volume and plateau pressures is indicated in COVID-19-ARDS as in ARDS from other causes; however, there are still uncertainties on the appropriate levels of PEEP.

Severe dengue virus infection often causes proteinuria through several mechanisms, such as leakage of plasma proteins caused by higher protein filtering in the kidneys. The condition of proteinuria in patients with dengue shock syndrome will affect the management, prognosis, and mortality of patients with dengue virus infection. The objectives of this study were to determine the presence of protein in urine samples in patients in which IgG/IgM dengue was detected, to determine the presence of protein in urine samples in patients without dengue infection, and to determine the relationship between proteinuria in dengue patients and the degree of disease severity. The study was conducted in March-June 2020 at the Clinical Laboratory and Inpatient Clinic of Vita Medika Kepung, Kediri Regency. The method used was the consecutive sampling technique. The minimum sample size was 100 respondents with criteria for suspected dengue infection, onset fever > 4 days, age > 2 years, and no indication of other infectious diseases (blood and urine), divided into two groups, group with positive dengue infection and non-dengue group. The results showed that proteinuria was detected in 26% of respondents, secondary dengue infection and positive serological test of IgG, IgM only IgG were detected in 24 (92.3%) respondents and positive IgG and IgM were found in 2 (7.7%) respondents, this was shown by the p-value = 0.000 in the Chi-Square test with a Prevalence Ratio (PR) value of 11,987. In addition, Chi-Square test results indicated that a higher urine protein/albumin led to more severe disease, with p-value = 0.012 and 0.025 (p

Hemoglobin is an iron-carrying oxygen transport protein protein in red cells in the blood of mammals and other animals. Hemoglobin consists of iron which is the carrier of O2. High and abnormal hemoglobin levels occur due to hemoconcentration due to dehydration. The number of red blood cells and hemoglobin molecules is not always increasing and decreasing simultaneously, for example the decrease in red blood cells along with slightly elevated or normal hemoglobin levels occur in cases of pernicious anemia, as well as slightly elevated or normal hemoglobin levels of hemoglobin decreases, occurs in iron deficiency anemia. The purpose of this research is to know the effect of green bean extract on changes of hemoglobin (Hb) level in Pregnant Women. The research design used was pre experimental research. The population in detail is all Pregnant Women, with acidental sampling technique in obtaining a sample of 16 people. The research instrument used is observation sheet and digital hemoglobin gauge and statistic test used is T test. The result of research of hemoglobin level before giving of green bean has average value (mean) is 10,494 and hemoglobin level after giving of green bean has average value (mean) is 11.238 this indicates an increase of hemoglobin level in student result of research done shows that there is an increase of Hb level in get p value 0,756 and 0,89. Then the T.Test data distribution test can be concluded p value

Abstract Importance The most common screening tool for depression is the Patient Health Questionnaire-9 (PHQ-9). Despite extensive research on the clinical and behavioral implications of the PHQ-9, data are limited on the relationship between PHQ-9 scores and social determinants of health and disease. Objective To assess the relationship between the PHQ-9 at intake and other measurements intended to assess social determinants of health. Design, Setting, and Participants Cross-sectional analyses of 2502 participants from the Baseline Health Study (BHS), a prospective cohort of adults selected to represent major demographic groups in the US; participants underwent deep phenotyping on demographic, socioeconomic, clinical, laboratory, functional, and imaging findings. Interventions None. Main Outcomes and Measures Cross-sectional measures of clinical and socioeconomic status (SES). Results In addition to a host of clinical and biological factors, higher PHQ-9 scores were associated with female sex, younger participants, people of color, and Hispanic ethnicity. Multiple measures of low SES, including less education, being unmarried, not currently working, and lack of insurance, were also associated with higher PHQ-9 scores across the entire spectrum of PHQ-9 scores. A summative score of SES, which was the 6th most predictive factor, was associated with higher PHQ-9 score after adjusting for 150 clinical, lab testing, and symptomatic characteristics. Conclusions and Relevance Our findings underscore that depression should be considered a comorbidity when social determinants of health are addressed, and both elements should be considered when designing appropriate interventions.

Masa postpartum merupakan masa ketika terjadi berbagai perubahan pada wanita setelah bersalin, baik perubahan fisiologis, psikologis, maupun sosio kultural dan spiritual. Perubahan tersebut memerlukan adaptasi untuk menyesuaikan diri dengan pola hidup setelah proses persalinan dan peran barunya. Dukungan sosial dan komunikasi sangat diperlukan untuk mencegah terjadinya depresi akibat berbagai perubahan setelah melahirkan. Penggunaan aplikasi digital merupakan media yang dapat meningkatkan dukungan, komunikasi antar sesama anggota untuk berbagi pengalaman. Beberapa penelitian telah membuktikan bahwa pemanfaatan Aplikasi digital dapat mencegah terjadinya depresi pada ibu post partum. Study ini bertujuan untuk mengetahui keefektifan penggunaan aplikasi digital dalam mencegah depresi postpartum. Penulis melakukan kajian literatur dengan pendekatan sederhana dari 10 artikel tentang pemanfaatan Aplikasi digital dalam mencegah depresi postpartum dalam periode 2015-2020. Hasil yang diperoleh adalah: Aplikasi digital mampu membantu para ibu dalam mendapatkan akses informasi tepat waktu, dapat memberikan kemudahan dalam mencari informasi, dan dapat membantu untuk mencegah terjadinya depresi postpartum. Berdasarkan hasil temuan ini, maka aplikasi digital sangat diperlukan dalam pelayanan keperawatan untuk memfasilitasi komunikasi dan edukasi terhadap masyarakat, khususnya ibu postpartum sehingga depresi dapat dihindari.

Portal vein embolization with N-butyl-cyanoacrylate plus iodized oil generates greater and faster liver regeneration as seen at CT compared with standard polyvinyl alcohol particles plus coils, all...

Background: There are various microorganisms which caused pneumonia in developing countries such as Indonesia. The diagnosjs of pneumonia is still mainly confirmed by Chest X-ray which is unspecific to determine the etiology of pneumonia due to its low accuracy. On the other hand, the higher accuracy diagnostic tool, Computed Tomography (CT) scan, is not cost-effective. Therefore, an alternative diagnostic tool with high precision, affordability, and user-friendly is highly needed. Lung ultrasound (LUS) is an alternative diagnostic device. This study aims to investigate the diagnostic accuracy level of LUS in diagnosing pneumonia. Methods: Literature-researches was done in five databases namely PubMed/MEDLINE, ScienceDirect, Proquest, Cochrane and EBSCO/MEDLINE using keywords according to the clinical scenario. The articles were appraised with CEEBM worksheet. Results: Four articles met the inclusion and exclusion criteria. Sensitivity of LUS ranged around 85-97% and specificity ranged around 8694%. All appraised articles recommended the use of LUS for its high sensitivity in confirming diagnosjs of pneumonia and other lung diseases, and its favorable bedside use especially for critically ill patients. Lung US was also considered as being more inexpensive with less radiation exposure compared to CT scan or other radiographic imaging. Conclusion: Examination using LUS had a high diagnostic value in confirming the diagnosis of pneumonia.

Introduction: Dentigerous cyst is a pathological epithelial cavity that surrounds an unerupted tooth crown. Dentigerous cysts are usually associated with impacted teeth, mandibular third molars, first and second premolars and canines. Dentigerous cysts can occur at any age, but most cases of these cysts occur at the age of approximately 20 years. Men are affected more often than women. Purpose.To find out how the mechanism of dentigerous cysts. The cyst cavity is lined with epithelial cells derived from the epithelial enamel that is reduced from the tooth-forming organs. According to its pathogenesis, the pressure exerted by an erupted tooth on the follicle can block venous flow leading to accumulation of exudate between the reduced enamel epithelium and the crown of the tooth. These cysts are mostly due to fluid accumulation either between the reduced enamel epithelium and the enamel or between the layers of the enamel organ. This fluid accumulation occurs as a result of the pressure exerted by the erupting tooth on the affected follicle, which blocks venous flow, thus inducing rapid transudation of serum in the capillary walls. Discussion: The expansion of the dentigerous cyst causes the release of bone resorbing factor and an increase in the osmolarity of the cyst fluid as a result of the discharge of inflammatory cells, the discharge of residual epithelial enamel and tooth enamel, and desquamation of epithelial cells into the lumen of the cyst. In theory, the fluid will cause cystic proliferation. because the hyperosmolar content produced by cellular breakdown and cell products causes an osmotic gradient to pump fluid into the lumen of the cyst or it can also be said that an increase in the osmolarity of cyst fluid is the result of a shortcut to inflammatory cells and desquamation of epithelial cells into the lumen of the cyst resulting in a dentigerous cyst. Conclusion: The dentigerous cysts that surround the unerupted dental crowns are caused by the accumulation of fluid either between the reduced enamel epithelium or between the layers of the enamel organs. Dentigerous cysts can cause infection, pain, swelling, root dislocation, and resorption of adjacent tooth roots.

Asnake Balche Bade,1 Teshale Ayele Mega,2 Getandale Zeleke Negera3 1School of Pharmacy, Institute of Health Science, Arbaminch University, Arbaminch, Ethiopia; 2School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia Regional State, EthiopiaCorrespondence: Teshale Ayele MegaAddis Ababa University, P.O. Box: 9086, Addis Ababa, EthiopiaTel +251 91 3144738Email tesh.ayu2016@gmail.comBackground: Clinicians use sputum culture conversion as an interim indicator of the efficacy of multi-drug resistant tuberculosis (MDR-TB) treatment and to determine treatment duration. Yet, limited studies have been published in Ethiopia.Objective: The objective of this study was to determine the predictors of delayed culture conversion among patients receiving MDR-TB treatment at selected treatment centers in Ethiopia.Patients and Methods: A multi-center observation study was conducted among MDR-TB patients in South and Southwestern Ethiopia from April 14 to May 14, 2019. The data of patients treated from January 2013 to July 2019 were reviewed using a data abstraction tool. The data were analyzed. Descriptive statistics was computed using SPSS version 21 software program. Cox regression was used to identify predictors of delayed culture conversion. Hazard ratios with a two-sided p-value < 0.05 were considered statistically significant.Results: Of 200 included MDR-TB patients, 108 (54%) were males. Majority,159 (79.5%) of the patients had a culture conversion time of less than two months, while 15 (7.5%) had delayed culture conversion (greater than 120 days). Patient’s registration group (after loss to follow- (adjusted hazard ratio (AHR)=16.215, 95% CI [3.839, 68.498]), after treatment failure (AHR=12.161, 95% CI [2.516, 58.793]), history of previous TB treatment (AHR=4.007, 95% CI [3.115, 62.990])) and low BMI (AHR= 1.257; 95% CI [0.725,1.547] were identified as a risk factors for delayed culture conversion.Conclusion: Our finding showed that nearly 80% of the patients achieve sputum culture conversion by the second month of treatment. Delayed culture conversion was more likely among patients with malnutrition (BMI< 18.5kg/m2), after treatment failure, previous TB treatment, and after lost to follow-up.Keywords: culture conversion, predictors, MDR-TB, Ethiopia

Renal Disease was a chronic disease that the most attacking people in Indonesia. Damage to this vital organ in the human body greatly affected a person's health condition, one of which was anemia. This study aimed to determine the effectiveness of Durante hemodialysis PRC transfusions on hemoglobin levels. The method used was Pre-experimental design, with the One group pre-post test design approach. With a sample of 49 patients who underwent regular hemodialysis at RSUD dr. Iskak Tulungagung. Data were obtained by direct observation. Processed by computerized methods with a statistical t-test, the significance level (α) was 0.05. The study results showed that the hemoglobin levels of the pre-Durante hemodialysis PRC transfusion patients were 4-5 mg/dl (53.06%), and the hemoglobin levels of the post-Durante hemodialysis PRC transfusion patients were 6.1-7 mg/dl (34.69%). The results of statistical tests showed that there was an increase in hemoglobin levels in patients who received Durante hemodialysis PRC transfusion by 1.22 mg/dl because p-value = 0.000 < 0.05 (α) means that there was an effect. It could be concluded that the delivery of Durante hemodialysis PRC transfusion could help increase hemoglobin levels. This finding was very helpful for chronic Renal Disease patients undergoing hemodialysis, who have been using erythropoietin preparations because PRC transfusions were cheaper and more effective when compared to using erythropoietin preparations

Background and aims: In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods: We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival. Results: MaVI prevalence was 11.1%, and median survival of these patients was 6.0months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4months in those with PS>1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions: MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

Background: Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. Aims: To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. Methods: A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. Results: A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels ( PConclusions: The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.

Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin &gt, 3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (&lt, 100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. Conclusions. Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.

Background: Sorafenib is the gold standard therapy for the advanced hepatocellular carcinoma (HCC). No scoring/staging is universally accepted to predict the survival of these patients. Aims: To evaluate the accuracy of the available prognostic models for HCC to predict the survival of advanced HCC patients treated with Sorafenib included in the Italian Liver Cancer (ITA.LI.CA.) multicenter cohort. Methods: The performance of several prognostic scores was assessed through a Cox regression-model evaluating the C-index and the Akaike Information Criterion (AIC). Results: Data of 1129 patients were analyzed. The mean age of patients was 61.6 years, and 80.8% were male. During a median follow-up period of 13 months, 789 patients died. The median period of Sorafenib administration was 4 months. All the prognostic scores were able to predict the overall survival (p

The synergic combination of D-dimer (as proxy of thrombotic/vascular injury) and static compliance (as proxy of parenchymal injury) in predicting mortality in COVID-19-ARDS has not been systematically evaluated. The objective is to determine whether the combination of elevated D-dimer and low static compliance can predict mortality in patients with COVID-19-ARDS. A “training sample” (March–June 2020) and a “testing sample” (September 2020–January 2021) of adult patients invasively ventilated for COVID-19-ARDS were collected in nine hospitals. D-dimer and compliance in the first 24 h were recorded. Study outcome was all-cause mortality at 28-days. Cut-offs for D-dimer and compliance were identified by receiver operating characteristic curve analysis. Mutually exclusive groups were selected using classification tree analysis with chi-square automatic interaction detection. Time to death in the resulting groups was estimated with Cox regression adjusted for SOFA, sex, age, PaO2/FiO2 ratio, and sample (training/testing). “Training” and “testing” samples amounted to 347 and 296 patients, respectively. Three groups were identified: D-dimer ≤ 1880 ng/mL (LD); D-dimer > 1880 ng/mL and compliance > 41 mL/cmH2O (LD-HC); D-dimer > 1880 ng/mL and compliance ≤ 41 mL/cmH2O (HD-LC). 28-days mortality progressively increased in the three groups (from 24% to 35% and 57% (training) and from 27% to 39% and 60% (testing), respectively; p < 0.01). Adjusted mortality was significantly higher in HD-LC group compared with LD (HR = 0.479, p < 0.001) and HD-HC (HR = 0.542, p < 0.01); no difference was found between LD and HD-HC. In conclusion, combination of high D-dimer and low static compliance identifies a clinical phenotype with high mortality in COVID-19-ARDS.

Background & Aims: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, monofocal hepatocellular carcinoma (HCC) is classified as early (BCLC A) irrespective of its size, even though controversies still exist regarding staging and treatment of large tumours. We aimed at evaluating the appropriate staging and treatment for large (>5cm) monofocal (HCC). Methods: From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5cm; SEM-HCC), 163 patients with larger tumours (>5cm; LEM-HCC) and 1048 intermediate stage patients (BCLC B). Results: LEM-HCC patients had a worse overall survival (OS) than SEM-HCC (31.0 vs 49.0months; P&nbsp

Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. Results: The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

The determinants of child marriage are triggered by complex social, economic, cultural, political and legal disparities. This research method used a cross sectional study. The research sample was 192 women who were married in 2018-2019 in the Campalagian District. This study aims to determine the effect of the age of marriage on the health of ibn and infants in the District of Campalagian. Chi-square test was used to analyze data. The results of the bivariate analysis showed that the age of marriage had an effect on the health of the newborn (p value = 0.003). However, the age of marriage on maternal health during pregnancy, maternal health at delivery, use of contraceptive methods, service standards for birth weight, and support from husbands do not have a significant effect. After conducting bivariate analysis using moderator variables, the results showed that. There is an effect of the age of marriage based on the age of the husband (p value = 0.017) and the husband's education (p value = 0.024) on maternal health at delivery. There is an effect of the age at marriage based on the husband's age (p value = 0.023), the wife's education (p = 0.008), and the husband's education (p = 0.009), on the health of the newborn. It can be concluded that the age of marriage has an effect on the health of the mother and baby and/or if it includes the age and education factors of both the respondent and the partner.

Hyperlipidemia is the escalation level of cholesterol and triglyceride in blood. Lady finger banana peel had chemical flavonoid, tanin, and saponin contents having the activity to reduce cholesterol level. The research aimed to determine the effect of cholesterol level reduction of ethanol exctract of lady finger peel on hyperlipidemia rat. The research used twenty rats divided into five groups. Group I (negative control) was given Na. CMC of 1% b/v, group II (positive control) was given simvastatin of 1,023 mg/kgBW, group III, IV, V groups were given the extract of 500 mg/kgBW 1000 mg/kgBW, and 1500 mg/kgBW. The rats were fed a high dietary fat during treatment and induces with pristine cholesterol for twenty one days. The measurement of rat cholesterol level was conducted on day 0, 22 and 36. The result were statistically processed using One Way Anova proceeded to Post Hoc Bonferroni. The result of the research showed that the positive control group had no different tangible effect to ethanol extract of lady finger banana groups (p>0,5). In conclusion, the ethanol extract of lady finger banana had the activity in reducing cholesterol level with effective doses of 500 mg/kgBW, 1000 mg/kgBW, and 1500 mg/kgBW.

Background Antibiotic resistance (ABR) restricts the armamentarium of health-care providers against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia. Methods Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses. Results The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52–65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14–20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9–14%], Klebsiella pneumonia, 11% [95% CI: 9–13%], Proteus mirabilis, 8% [95% CI: 6–10%], Acinetobacter species, 4% [95% CI: 2–6%], Enterobacter species, 4% [95% CI: 3–5%], and Citrobacter species, 3% [95% CI: 2–4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66–86%], 84% [95% CI: 78–91%], 66% [95% CI:43–88%], 83% [95% CI:75–91%], 87% [95% CI:78–96%], 68% [95% CI:50–87%] and 71% [95% CI:46–96%], respectively. Conclusion There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program.

TESE-ICSI (testicular sperm extraction associated with intracytoplasmic sperm injection) represents a technique to attain pregnancy in couples with non-obstructive azoospermia (NOA) and other unlikely situations. Because of the poor pregnancy outcomes obtained by this procedure, we need new sperm selection techniques to improve the livebirth rate of NOA patients. Here we describe a successful micro TESE-ICSI cycle performed with sperm selected through high magnification and polarized light microscopy in a couple with two previous ICSI failures.

Introduction. Vitamin D plays a role in health overall, but hypovitaminosis D still occurs throughout the world. HIV/AIDS patients are prone to suffer from hypovitaminosis D because of the infection itself and the side effects of antiretroviral therapy. Various effort have been tried to improve the immune status of HIV/AIDS patients, one of them is by adding vitamin D. Vitamin D acts as an antiinflammatory so that it can prevent apoptosis of CD4 T cells and increase CD4 cell count. Methods. This is a randomized control trial add on a study that aims to determine the effect of vitamin D to increase in CD4 counts of HIV / AIDS patients who have received antiretroviral drugs. Subjects were HIV / AIDS patients who had received antiretroviral drugs. A total of 20 subjects were divided randomly into two groups; one group received vitamin D (calcitriol 0.5 mcg per day) for eight weeks, and the other group that received a placebo. Each group was measured of CD4 cell count before and after treatment. Results. There was a significant increase in the CD4 cell count of the vitamin D group (p = 0.046), but not in the CD4 cell count of both groups (p = 0.985). The comparison of mean CD4 cell counts between groups before treatment was not significantly different (p = 0.057), but after treatment, it became significantly different (p = 0.040). Conclusion. Vitamin D has been successful in increasing CD4 cell count in the vitamin D group, and it is recommended to give HIV / AIDS patients to increase CD4 cell count.

Background: Diabetes mellitus is an incurable disease but can be controlled by controlling blood sugar levels and improving sleep quality and quality of life in people with diabetes. The prevalence of diabetes mellitus in Banten province has increased in 2013 by 1.3%, while in 2018 it was 2.2%. Purpose: The purpose of this literature review is to determine the effectiveness of aromatherapy in patients with diabetes mellitus. Research Methods: The method used to analyze data is Systematic Literature Review. Search for articles using google scholar database, PubMed, Research Gate, and Elsevier and get eight relevant articles and analyzed using the simplified thematic approach. The article selection process is done using a PRISMA flow diagram. Results: lavender aromatherapy, bitter orange and sandalwood / sandalwood significantly affect changes in sleep quality, quality of life, anxiety and fatigue in patients with type 1 and 2 diabetes mellitus with a combination of massage therapy and foot exercises. Thus, it can be concluded that aromatherapy is effective on sleep quality, quality of life, anxiety and fatigue in patients with type 1 and 2 diabetes mellitus. Suggestion: Therefore, the use of aromatherapy can be recommended as a non-pharmacological intervention that can affect sleep quality in patients with type 2. Keywords: Aromatherapy, Sleep Quality, Quality Of Life, Fatigue, Anxiety, Diabetes Mellitus Literature: 2015 – 2020

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.

Background A consensus protocol for genetic counselling and testing of familial dementia, the Italian Dominantly Inherited Alzheimer’s and Frontotemporal Network (IT-DIAfN) protocol, has been developed in Italy by a network of expert dementia centres. The aim of this study is to evaluate feasibility and acceptability of the genetic counselling and testing process, as undertaken according to the IT-DIAfN protocol in one of the IT-DIAfN dementia research centres. Methods The protocol was tested by a multidisciplinary team at the IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy, on affected individuals with suspected inherited forms of Alzheimer’s disease (AD) or frontotemporal dementia (FTD), and to healthy at-risk relatives. The genetic counselling and testing process consisted of (i) pre-test consultation and psychological assessment (ii) genetic testing, (iii) genetic test result disclosure and (iv) follow-up consultation and psychological assessment. Results Twenty affected individuals from 17 families fulfilled the family history criteria of the IT-DIAfN protocol for suspected inherited dementia (17 for AD, 2 for FTD, 1 for inclusion body myopathy with Paget disease of bone and frontotemporal dementia) and were included in the protocol. Nineteen out of 20 affected individuals received the genetic test result (one left after the pre-test consultation being not ready to cope with an unfavourable outcome). A pathogenic mutation was found in 6 affected individuals (1 in PSEN1, 2 in PSEN2, 1 in GRN, 1 in MAPT, 1 in VCP). Eleven healthy at-risk relatives asked to undergo predictive testing and were included in the protocol. Three completed the protocol, including follow-up; one did not ask for the genetic test result after genetic testing; and eight withdrew before the genetic testing, mainly due to an increased awareness about the possible consequences of an unfavourable test result. To date, no catastrophic reactions were reported at the follow-up. Conclusions Our case series shows that a structured genetic counselling and testing protocol for inherited dementia can be implemented in both affected individuals and at-risk relatives in a research setting. The procedure was shown to be safe in terms of occurrence of catastrophic events. A formal validation in larger cohorts is needed.

Background. The pandemic of coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in an unprecedented public health challenge worldwide. Despite urgent and extensive global efforts, the existing evidence is inconclusive regarding the medications used for the treatment of COVID-19. Purpose. To generate an up-to-date evidence for the clinical safety and efficacy of hydroxychloroquine (HCQ) with or without azithromycin (AZ) among patients treated for COVID-19. Data Source. PubMed, Cochrane CENTRAL, LITCOVID, Web of Science, SCOPUS, BioRxiv, Embase, MedRxiv, and Wiley online library were searched from 2019/12/30 to 2020/05/23. Study Selection. Three investigators assessed the quality of the studies. Data Extraction. Data about study characteristics, effect estimates, and the quality of the studies were extracted by two independent reviewers and cross-checked by the third reviewer. Data Synthesis. The data of 6,782 (HCQ group, 3623; HCQ + AZ group, 1,020; control group, 2139) participants were included. HCQ was compared with standard care for virologic efficacy, disease progression, mortality, and adverse effects. HCQ was also compared with HCQ + AZ for QTc prolongation, admission to the intensive care unit, and mortality. The study found HCQ did not alter the rate of virologic cure (OR = 0.78; 95% CI: 0.39–1.56) and the risk of mortality (OR = 1.26; 95% CI: 0.66–2.39). The pooled prevalence for mortality was 5.8% (95% CI: 0.9%–10.8%). Moreover, HCQ did not impact disease progression (OR = 0.9; 95% CI: 0.36–2.29) but resulted in a higher risk of adverse effects (OR = 2.35; 95% CI: 1.15–4.8). HCQ was also compared against HCQ + AZ, and no difference was observed in QTc prolongation above 500 ms (OR = 1.11; 95% CI: 0.54–2.28), admission to the intensive care unit (OR = 0.92; 95% CI: 0.52–1.63), and mortality (OR = 0.88; 95% CI: 0.55–1.43). However, in the analysis of single-arm studies, about 11.2% (95% CI: 7.0%–15.5%) of patients have developed an absolute increase of QTc greater than 500 ms, and 4.1% (95% CI: 1.1%–7.1%) of patients discontinued their medication. Conclusion. This meta-analysis and systematic review, which included a limited number of poorly designed studies of patients with COVID-19, revealed HCQ is intolerable, unsafe, and not efficacious. Similarly, HCQ + AZ combination was not different from HCQ alone in curbing mortality and ICU admission.

Rainfall erosivity is one of the most important topics, linking geomorphological and climatological studies. Rainwater plays an important role in triggering soil erosion. Thus, the impact of raindrops during significant torrential episodes causes the destabilization of soil aggregates and leads to erosion. Romania is a country where dry periods alternate with the rainy ones and studying rainfall erosivity is essential due to its importance for agriculture. The highest intensity of erosion occurs during violent rainfall episodes in the summer months, this being triggered by the energy of the torrential rains, but also by the liquid runoff. The extra-Carpathian Moldova is located in the northeastern and eastern part of Romania. In this study, The Suceava Plateau, The Moldavian Plain, The Moldavian Subcarpathians and The Bârlad Plateau were considered as part of the extra-Carpathian Moldova. Four indices were used to assess the climate seasonality on a general level with focus on the summer climate conditions: De Martonne Aridity Index (IdM), Lang Factor (L), Precipitation Concentration Index (PCI) and Angot Index (K). Our results indicate moderate seasonality in precipitation concentration along the year which underlines that the region cannot be considered climaticaly prone to massive soil erosion induced by rainfall erosivity.

Background: Chronic Kidney Disease (CKD) is an emerging public health problem worldwide. The increasing cost of healthcare, particularly in developing nations like India, is a social and economic burden. Slow but progressive deterioration in kidney function leads to numerous hematological and biochemical changes. The aim of the present study is to study various changes in red cell parameters that occur in the CKD patients. Materials and Method: 50 patients with CKD were included in this study. Age, gender, RBC count; hemoglobin (Hb); hematocrit; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); MCH concentration (MCHC); and peripheral smears were studied. Results were analyzed using SPSS 20.0 version. Results: Of the 50 CKD patients on maintenance HD, the most common group sampled were male patients (72%) with the mean age of 54 (±15) years. The study revealed that Hemoglobin (Hb), Packed Cell Volume (PCV), Red Blood Cells (RBC) were low in CKD patients. The most common type of anemia was normocytic normochromic anemia, followed by dimorphic anemia. Fragmented RBCs and Spherocytes were 42% and 32% respectively. Conclusion: CKD is associated with different degrees of abnormality in hematological parameters that needs careful evaluation and management. From the CBC and peripheral smear findings the type of anemia, the degree of hemolysis can be analysed and the patients can be evaluated for the underlying cause and treated appropriately. The present study might help clinicians understand haematological profile and take necessary steps in the management.

Unhealthy diet and physical inactivity are two major factors related to degenerative diseases such as diabetes, hypertension, cancer, and it is still growing issues that mainly occurred in developing countries like Indonesia. It is a descriptive quantitative study, aims to investigate nutritional also cardiovascular health status among housewives in Tegal Regency, Central Java. Twenty adult women (33-57 years old) were voluntary and randomly signed up. Data on body weight (kg), height (cm), waist circumference (cm), hip circumference (cm), systolic-diastolic blood pressure (mm/hg) were collected by survey and measurement techniques. IBM SPSS 21 used to perform descriptive quantitative analysis for all data. Body mass index: 35% obese, 45% pre-obese, 5% overweight, 15% ideal weight. Waist circumference: 35% low category, 65% high category. Waist-to-hip ratio: 60% at risk of chronic diseases, 35% moderate, 5% good. Blood pressure: 40% hypertension stage-two, 25% hypertension stage-one, 25% elevated, 10% normal. Pre-obese and obese have found as the current nutritional status, followed by overweight. Meanwhile, hypertension has found as the current cardiovascular health status, followed by elevated blood pressure. This novel is empirical evidence for the housewife to be more physically active, and manage the diet to improve their health status.

Ustundag, Fumet Duygu/0000-0001-5290-8924 WOS: 000550941000001 PubMed ID: 32693643 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is a neurotoxin that damages dopaminergic neurons. Zebrafish has been shown to be a suitable model organism to investigate the molecular pathways in the pathogenesis of Parkinson's disease and also for potential therapeutic agent research. Boron has been shown to play an important role in the neural activity of the brain. Boronic acids are used in combinatorial approaches in drug design and discovery. The effect of 3-pyridinylboronic acid which is an important sub-class of heterocyclic boronic acids has not been evaluated in case of MPTP exposure in zebrafish embryos. Accordingly, this study was designed to investigate the effects of 3-pyridinylboronic acid on MPTP exposed zebrafish embryos focusing on the molecular pathways related to neurodegeneration and apoptosis by RT-PCR. Zebrafish embryos were exposed to MPTP (800 mu M); MPTP + Low Dose 3-Pyridinylboronic acid (50 mu M) (MPTP + LB) and MPTP + High Dose 3-Pyridinylboronic acid (100 mu M) (MPTP + HB) in well plates for 72 hours post fertilization. Results of our study showed that MPTP induced a P53 dependent and Bax mediated apoptosis in zebrafish embryos and 3-pyridinylboronic acid restored the locomotor activity and gene expressions related to mitochondrial dysfunction and oxidative stress due to the deleterious effects of MPTP, in a dose-dependent manner.

Dengue is a disease caused by dengue virus infection. Diagnosis of the disease is often difficult to be upheld just by the symptoms. Therefore, laboratory diagnostics is required. The general objective of this study was to detect dengue IgG in serum samples with rapid tests and in urine samples of suspected dengue patients using ELISA. The procedure of this study consisted of three stages. First, collecting urine samples from healthy individuals and collecting blood and urine samples from suspected dengue patients; second, examining dengue IgG in serum samples of suspected dengue patients with rapid tests; and third, examining dengue-specific IgG in urine samples from suspected dengue patients and from healthy individuals with ELISA technique. Data analyzed using experimental analytics to determine the cut off point used to interpret laboratory diagnostic results. The results showed that patients with positive serum dengue IgG test at the same time also showed positive results on the examination of dengue-specific IgG in their urine samples while patients with negative serum at the same time showed negative results on the examination of dengue-specific IgG in urine samples. Dengue-specific IgG examination in urine samples with ELISA technique can be used as an alternative examination in establishing the diagnosis of dengue, in which urine samples are taken from patients with more than 4 days fever. Keywords: Dengue, IgG, Urine, ELISA Abstrak. Dengue merupakan penyakit yang disebabkan virus dengue. Diagnosis penyakit ini sering sulit ditegakkan jika hanya melihat dari gejala. Oleh karena itu, diperlukan pemeriksaan laboratorium untuk penegakkan diagnosis. Tujuan umum penelitian ini adalah untuk mendeteksi IgG dengue dalam sampel serum dengan rapid tes dan pada sampel urine pasien terduga dengue dengan menggunakan metode ELISA. Prosedur penelitian ini terdiri dari tiga tahap. Pertama, pengumpulan sampel urine individu sehat dan pngumpulan sampel darah dan urine pada pasien terduga dengue; kedua, pemeriksaan IgG dengue dalam sampel darah pasien terduga infeksi dengue dengan rapid tes; dan ketiga, pemeriksaan IgG spesifik dengue pada sampel urine pasien terduga dengue dengan teknik ELISA, yang sebelumnya sudah dikelompokkan sesuai dengan hasil pemeriksaan IgG dengue pada sampel serum dengan rapid tes, dan pemeriksaan IgG spesifik dengue sampel urine individu sehat dengan teknik ELISA. Analitik eksperimental digunakan untuk menentukan cut off dari data yang kemudian digunakan untuk menafsirkan hasil diagnostik laboratorium. Hasil penelitian menunjukkan bahwa pada pasien dengan hasil pemeriksaan IgG dengue serum positif menunjukkan hasil positif juga pada pemeriksaan IgG spesifik dengue pada sampel urinnya, sedangkan pada hasil pemeriksaan serum yang negatif menunjukkan hasil negatif pula pada pemeriksaan IgG spesifik dengue di sampel urinnya. Pemeriksaan IgG spesifik dengue pada sampel urine dengan teknik ELISA dapat digunakan sebagai pemeriksaan alternatif dalam penegakan diagnosis dengue, di mana sampel urine diambil dari pasien dengan demam lebih dari 4 hari. Kata Kunci: Dengue, IgG, Urine, ELISA

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. Performa Xpert® MTB/RIF Dalam Mendeteksi Tuberculosis Resisten Obat di Jawa Barat, Indonesia Indonesia adalah negara ke-2 dengan jumlah kasus tuberkulosis (TB) tertinggi di dunia. Pengobatan TB yang tidak sesuai dapat mengakibatkan kuman TB menjadi resisten terhadap obat TB yang disebut TB multidrug-resistances (TB-MDR). Untuk itu diperlukan alat deteksi yang mumpuni sehingga kuman TB-DR dapat segera didiagnosis dan diberikan pengobatan yang tepat; dengan demikian pencegahan dan kematian akibat TB dapat ditekan. Penelitian ini bertujuan untuk mengukur performa mesin Xpert® MTB/RIF dalam mendeteksi kuman TB-MDR di Jawa Barat, Indonesia. Studi potong lintang dilakukan dengan mengambil data dari 4452 pasien terduga TB-MDR yang terregistrasi di eTB Manager selama tahun 2012-2016 yang dikirim ke Rumah Sakit Dr. Hasan Sadikin Bandung. Walaupun demikian, hanya 578 yang memiliki hasil test kultur untuk mengetahui sensitivitas obat TB. Dari kedua test tersebut, didapatkan Xpert® MTB/RIF memiliki sensitivitas 88% (95% IK: 85%-91%), spesifisitas 66% (95%CI: 60%-72%), positive predictive value 79% (95% IK: 75%-83%), dan negative predictive value 80% (95% IK: 74%-85%), dengan akurasi 79%. Test TB-MDR menggunakan Xpert® MTB/RIF pada penelitian ini menunjukkan performa yang baik, sehingga test ini sangat direkomendasikan untuk deteksi TB-MDR yang cepat, utamanya di daerah dengan prevalensi TB yang tinggi.

The objective of this chapter is to identify the latest evidence on the elderly critical patient with chronic obstructive pulmonary disease. Nine articles were analysed. The effectiveness of NIV has been demonstrated in cases of elderly critically ill patients with acute COPD. Evidence has been shown to decrease hospital stay and mortality, although long-term survival has been shown to be short. The prediction of NIV failure is multifactorial, including very old age, comorbidities, low analytical values of albumin, simplified severity index II, pH < 7.3 of arterial blood, PaCO2 (Carbon Dioxide Pressure) < 45 mmHg, CAT (COPD Assessment Test) elevated, Glasgow Coma Scale < 11, and APACHE II (Acute Physiology and Chronic Health Evaluation) 29. NIV has demonstrated efficacy in elderly patients in situations of acute COPD.

RATIONALE The "Berlin definition" of acute respiratory distress syndrome (ARDS) does not allow inclusion of patients receiving high-flow nasal oxygen (HFNO). However, several articles proposed that criteria for defining ARDS should be broadened to allow inclusion of patients receiving HFNO. OBJECTIVE To compare the proportion of patients fulfilling ARDS criteria during HFNO and soon after intubation, and 28-day mortality between patients treated exclusively with HFNO and patients transitioned from HFNO to IMV. METHODS From previously published studies we analyzed COVID-19 patients who had PaO2/FiO2 ≤300 while treated with HFNO ≥40 L/min, or NIV with PEEP ≥5 cmH2O (comparator). In patients transitioned from HFNO/NIV to invasive mechanical ventilation (IMV), we compared ARDS severity during HFNO/NIV and soon after IMV. We compared 28-day mortality in patients treated exclusively with HFNO/NIV vs. transitioned to IMV. MEASUREMENTS AND MAIN RESULTS We analyzed 184 and 131 patients receiving HFNO or NIV, respectively. 112 HFNO, and 69 NIV patients transitioned to IMV. 104 (92.9%) HFNO patients and 66 (95.7%) NIV patients continued to have PaO2/FiO2 ≤300 under IMV. 28-day mortality in patients who remained on HFNO was 4.2% (3/72) while in patients transitioned from HFNO to IMV it was 28.6% (32/112) (p

Background: Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predisposing factors could be measured by left atrial volume index (LAVI) and P-wave dispersion. Aim: This study aimed to assess P-wave dispersion and LAVI as preoperative predictors of POAF among patients who underwent Coronary Artery Bypass Graft (CABG). Methods: An analytical retrospective cohort study was performed on patients who underwent CABG. The P-wave dispersion and POAF were evaluated based on documented ECG results. LAVI size was collected from echocardiographic reports. Hazard ratios of P-wave dispersion and LAVI for POAF were analyzed using Cox proportional hazard model. Result: A total of 42 subjects (57±1 years) were included in this study. POAF occurred in 28.6% of patients at a median of 2 days after CABG. P-wave dispersion was significantly longer in patients in whom AF was developed (53.03±3.82ms vs. 44.01±1.98ms, p:0.028), while LAVI difference was not significant. The Cox proportional hazard model showed a significant association between P-wave dispersion and risk of POAF (HR 1.05, CI95%, 1.001-1.103;p=0.048). There was no association between LAVI and risk of POAF (HR1.003, CI 95%, 0.965-1.044;p=0.864). Conclusion: P-wave dispersion is a predictor of POAF in patients who underwent CABG. Risk stratification using P-wave dispersion enables clinicians to identify high-risk patients before CABG surgery.

Purpose: We aimed at assessing the impact of surveillance on long-term survival in HCC patients. Methods: From the ITA.LI.CA database, we selected 1028 cases with long (≥5 years, LS group) and 2721 controls with short-term survival (&lt, 5 years, SS group). The association between surveillance and LS was adjusted for confounders by multivariable logistic regression analysis. Survival of surveilled patients was presented both as observed and corrected for the lead-time bias, and the comparison of survival between surveillance and no surveillance groups was also performed after balancing the baseline characteristics with inverse probability weights (IPW). Results: LS patients were more frequently diagnosed under surveillance (p &lt, 0.0001), and had more favorable baseline characteristics. Surveillance was an independent predictor of LS (OR = 1.413, 95% CI 1.195–1.671, p &lt, 0.0001). The observed and the lead-time corrected survival of surveilled patients were significantly longer compared to the survival of not surveilled patients (p &lt, 0.0001 and p = 0.0008, respectively). In IPW adjusted populations, no survival differences were demonstrated between the two groups (p = 0.30). Conclusions: Surveillance, increasing early-stage diagnosis and applicability of curative treatments, is a fundamental determinant of long-term survival in HCC patients. A wide implementation of surveillance programs should be pursued in order to improve HCC patients’ prognosis.

Clinical and experimental studies show that epilepsy affects cardiac function; however, the underlying molecular mechanism has not been fully elucidated. Inwardly-rectifying potassium (Kir) channels transport K+ ions into excitable cells such as neurons and cardiomyocytes; they control the cell excitability by acting towards the repolarization phase of cardiac action potential. Kir channel expression has been previously shown to vary in epileptic brains, at the same time seizures are known to affect the autonomic nervous system. Kir channel expression in cardiac tissue is a possible mechanism for the explanation of cardiac pathology in epilepsy. We investigate the expression of Kir channels in epileptic cardiac tissue by using pentylenetetrazole (PTZ)-kindling model in rats. Our molecular analyses showed significant decrease in cardiac Kir channel mRNA and protein expression of PTZ-kindled rats. Interestingly, both Kir2.x, which directs IK1 flux in ventricular tissue and Kir3.x, which is responsible for IKACh in the atria, were observed to decrease significantly. Kir channel expression also differs between females and males. This is the first study to our knowledge in epileptic cardiac tissue showing the expression of Kir channels. Our results show that Kir channels may play a role in cardiac pathology associated with epilepsy.

Rotavirus is a major cause of acute gastroenteritis (AGE) in children worldwide. However, rotavirus outbreak has rarely been reported in Indonesia. This study aims to identify the causative agent for AGE outbreak among children in Belu, East Nusa Tenggara, Indonesia in 2018. All the samples were negative for bacteria (Salmonella, V. cholera) and Norovirus. Ten out of 11 stool samples were rotavirus-positive by immunochromatography testing. Reverse-transcription polymerase chain reaction (RT-PCR) and phylogenetic analyses revealed that rotavirus G2P[4] was the possible causative agent for the AGE outbreak, although sample size was limited. These findings suggest that the AGE outbreak was caused by rotavirus G2P[4], highlighting the importance of rotavirus surveillance. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.

Right-sided infective endocarditis (IE) is very rare and mostly occurs in the tricuspid valve, which pulmonary valve involvement in very rare. Most IE of the pulmonary valve occurs in patients with congenital heart defects. we report a case of the complications of pulmonary valve IE and pulmonary embolism which then causes pulmonary infarction in patients with VSD who have not been corrected. This case successfully underwent surgery for endocarditis/vegetation removal and septal defect closure.