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Objective: Extended-spectrum beta-lactamase-producing bacteria pose a significant threat to public health due to their resistance to commonly used antibiotics. This meta-analysis aims to determine the prevalence and distribution of extended-spectrum beta-lactamase-producing bacteria in Indonesia., Methods: This systematic review and meta-analysis adhere to PRISMA guidelines to estimate the prevalence of extended-spectrum beta-lactamase-producing bacteria in Indonesia from 2008 to 2024. Systematic searches were conducted by PubMed, ScienceDirect, Google Scholar, and Index Medicus, and data were analyzed using a random-effects model to address heterogeneity., Results: A systematic search yielded 1160 records. After duplicate removal and eligibility screening, 64 studies were included in the qualitative synthesis, and 48 were suitable for quantitative analysis. The pooled prevalence of extended-spectrum beta-lactamase-producing-producing bacteria in Indonesia was 46.38% (95% CI: 39.55%-53.21%) with significant heterogeneity (I 2  = 99.05%), reflecting substantial variability in methodologies, populations, and regional contexts. While Sumatra shows the highest prevalence at 63.99% (95% CI: 62.09%-65.89%) and Kalimantan the lowest at 15.24% (95% CI: 9.45%-21.02%), these findings must be interpreted with caution due to the significant heterogeneity. In hospitals, the prevalence was 47.13% (95% CI: 39.71%-54.54%), and in community was 47.26% (95% CI: 26.47%-59.95%). Adults had a higher prevalence (44.56%, 95% CI: 35.48%-53.64%) than children (32.38%, 95% CI: 20.85%-43.91%). The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli was 57.84% (95% CI: 45.97%-69.72%), and Klebsiella pneumoniae was 51.03% (95% CI: 41.19%-60.86%)., Conclusion: These findings highlight the urgent need for stringent infection control measures, tailored surveillance programmes, and effective antibiotic stewardship in Indonesia to mitigate the impact of extended-spectrum beta-lactamase-producing bacteria on public health. The substantial heterogeneity underscores the complexity of antimicrobial resistance epidemiology in Indonesia, necessitating cautious interpretation of pooled prevalence and standardised methodologies for future research to ensure accurate prevalence estimates., (© 2025 John Wiley & Sons Ltd.)

Introduction: Hypertension is the leading noncommunicable disease case affecting 1.28 billion individuals worldwide, with most cases located in low- and middle-income countries. While there are numerous techniques for treating mild to moderate hypertension, properly controlling severe or resistant hypertension poses substantial challenges. Ultrasound-based renal denervation (uRDN) has emerged as a promising non-pharmacological approach. This study aims to investigate the safety and efficacy of uRDN in hypertensive patients., Methods: The literature search across PubMed, ScienceDirect, BMJ Journals, ProQuest, and Springer databases yielded 419 articles. A total of 395 articles were filtered, leading to 24 articles assessed for eligibility and overall analysis, which resulted in eight included studies for quantitative synthesis. Quality appraisal used RoB 2.0, while meta-analysis used RevMan 5.4., Results: Our analysis results indicated significant improvements in 24-hour, daytime, and home ambulatory blood pressure measurements, favoring the uRDN over control. The mean difference (MD) for 24-hour measurements was -0.84 mmHg [95% CI -1.14, -0.55; p < 0.00001], for daytime measurements -1.27 mmHg [95% CI -1.59, -0.95; p < 0.00001], and for home measurements -1.98 mmHg [95% CI -2.32, -1.64; p < 0.00001], with moderate heterogeneity observed. Office ambulatory measurements also favored the uRDN with a significant MD of -1.51 mmHg [95% CI -1.91; -1.10; p < 0.00001]. Funnel plots revealed some outliers, indicating true heterogeneity among the studies., Conclusion: uRDN was associated with a significant reduction (-2.32 to -0.10 mmHg) in blood pressure of hypertensive patients., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2025 Ramadhan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Dysregulation of renin-angiotensin-aldosterone system (RAAS) often leads to hypertension and severe cardiorenal complications. Although RAAS-targeted therapies have proven effective, it remains yet optimal in reducing cardiovascular events. The aim of this study was to evaluate the efficacy and safety of angiotensin receptor neprilysin inhibitor (ARNI) compared to control in patients with hypertension. The primary outcomes were systolic and diastolic blood pressure (BP) control, along with the incidence of adverse events. A systematic review and meta-analysis was conducted according following PRISMA guidelines. A comprehensive literature search was performed across five databases: PubMed, ScienceDirect, EBSCO, Cochrane, and ProQuest, with studies identified up until October 3, 2024. The study included nine clinical trials that met the predefined eligibility criteria: (1) randomized clinical trials; (2) adult patients diagnosed with hypertension; and (3) comparison of ARNI versus control, reporting either BP control or adverse events. Quality appraisal using RoB 2.0 revealed that eight studies had a low risk of bias, and one had a high risk of bias. The pooled analysis demonstrated that ARNI is significantly more efficacious in achieving targeted systolic BP as compared to the control group (OR: 1.80; 95%CI: 1.41 - 2.30; p  < 0.001; I² =0%), and there was no statistical difference for the efficacy on diastolic BP compared to control (OR: 0.92; 95%CI: 0.75- 1.13; p  = 0.45; I² =75%). The incidence of adverse events was not associated with ARNI (OR: 1.07; 95%CI: 0.90-1.27; p  = 0.46; I² =72%). In conclusion, ARNI demonstrated a favorable outcome only in systolic BP, but in diastolic BP which could be associated with inadequate duration of observation. Further studies are warranted to assess BP-lowering effect and safety profile of ARNI in a longer observation time., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s).)

Background: Invasive fungal infections (IFIs) significantly impact immunocompromised paediatric patients, contributing to high rates of morbidity and mortality. Despite the evolution of antifungal therapy, the efficacy and safety of combination antifungal therapies in paediatric patients, especially those with haematological malignancies, remain controversial. This systematic review and meta-analysis seeks to critically evaluate the efficacy and safety of antifungal combinations in paediatric IFIs., Methods: We will conduct a search in PubMed, ScienceDirect, Cochrane Library, BMJ and Springer databases to include randomised controlled trials and observational studies focused on combination antifungal therapies in paediatric patients under 18 years with IFIs, using COVIDENCE for data management and analysis, ensuring rigorous quality assessment and statistical integrity in synthesising data. The time frame for the search will encompass publications from the inception of each database to the present, ensuring a comprehensive coverage of the literature. The database search will not be restricted by date. The review will assess combined antifungal treatment against placebo or single-antifungal therapy, examining outcomes like response rates, survival, mortality, adverse effects, cost-effectiveness and quality of life., Ethics and Dissemination: The review will be disseminated to healthcare professionals, community groups and policy-makers via journal publication and conference presentations to help them tailor antifungal prophylaxis treatment and outcomes for paediatric patients with IFIs. The analysis will not include any individual patient data, so ethical approval is not required., Prospero Registration Number: CRD42024503620., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Chronic kidney disease (CKD) is a significant global public health issue with increased risk of atherosclerotic cardiovascular disease (ASCVD) and cardiovascular mortality. Single nucleotide polymorphisms (SNPs) on angiotensin II type 1 receptor (AT1R) A1166C and osteoprotegerin (OPG) C950T gene have received significant attention as a genetic risk factor for cardiovascular disease and CKD., Methods: This was a cross-sectional study involving 75 adults with CKD recruited from Nephrology Outpatient Clinics of Universitas Airlangga Hospital, Surabaya, Indonesia. Demographic data was obtained from interviews and medical records. The "CKD Patch" application was used to asses ASCVD and cardiovascular mortality risk scores. Statistical analysis was performed by using SPSS version 26., Results: We detected four different AT1R gene polymorphisms (A1166C, A1160C, G1170T, and G1181C) and two OPG gene polymorphisms (T950C and G1181C) in Indonesian CKD patients. A1160C and G1181C polymorphisms were novel SNPs, newly discovered in this research. No significant association was found between AT1R SNPs and kidney prognostic markers or ASCVD risk/mortality risk scores. However, for OPG C950T we found that TT genotype had a significantly higher ACR than TC or CC genotype (P=0.032). As for OPG G1181C, we found that GG genotype had a higher serum creatinine and albumin to creatinine ratio compared to GC and CC genotypes (P=0.004 and 0.029, respectively). Genotype GC for OPG G1181C was also shown to be protective for having better kidney markers and lowest cardiovascular mortality risk compared to GG and CC genotypes (P=0.018 and 0.032, respectively)., Conclusions: Increased ASCVD risk and mortality risk score was not found on individuals with AT1R gene SNPs. However, for OPG gene polymorphism, C950T and G1181C were associated with kidney progression and cardiovascular mortality.

The impact of social media has been significant on various aspects of life, particularly mental health. Growing concerns about the adverse effects of social media use have prompted the exploration of experimental interventions, defined as digital detox interventions. However, it remains unclear whether digital detox interventions are effective for mental health outcomes. The aim of this study was to provide comprehensive insights into the effects of digital detox interventions on various mental health outcomes, including depression, life satisfaction, stress, and mental well-being. Following the PRISMA guidelines, systematic searches were carried out in online databases, including PubMed and ScienceDirect, within the publication range of 2013 and 2023. A total of 2578 titles and abstracts were screened, and 10 studies were included in the analysis. A risk of bias assessment was conducted using RoB 2.0 and the Newcastle-Ottawa scale, while statistical analysis was conducted using RevMan 5.4.1. Our data indicated a significant effect of digital detox in mitigating depression with the standardized mean difference (SMD: -0.29; 95%CI: -0.51, -0.07, p =0.01). No statistically significant effects were discerned in terms of life satisfaction (SMD: 0.20; 95%CI: -0.12, 0.52, p =0.23), stress (SMD: -0.31; 95%CI: -0.83, 0.21, p =0.24), and overall mental well-being (SMD: 0.04; 95%CI: -0.54, 0.62, p =0.90). These data underscore the nuanced and selective influence of digital detox on distinct facets of mental health. In conclusion, digital detox interventions significantly reduce depressive symptoms, suggesting that intentional reduction or cessation of digital engagement may help alleviate contributing factors. However, no statistically significant effects were observed in mental well-being, life satisfaction, and stress. This discrepancy may be due to the complex nature of these constructs, involving various factors beyond the scope of digital detox interventions., Competing Interests: All the authors declare that there are no conflicts of interest., (© 2024 The Author(s).)

The aging population warrants the increase of mild cognitive impairment (MCI) prevalence, a condition that could progress to dementia. Efforts have been made to improve the MCI and prevent its progression, including the introduction of Tai Chi, a Chinese traditional exercise. The aim of this systematic review and meta-analysis was to evaluate the efficacy of Tai Chi in attenuating MCI among the elderly population. Records investigating the effect of Tai Chi exercise intervention on cognitive function among elderly patients were searched systematically from PubMed, ScienceDirect, Google Scholar, and Europe PMC as of April 13, 2023. The risk of bias (RoB 2.0) quality assessment was employed in the quality appraisal of the studies included. Review Manager 5.4.1 was used for data extraction and meta-analysis, where the standard mean difference (SMD) and 95% confidence interval (95%CI) were computed. Eight randomized control trials with a total of 1379 participants were included in this meta-analysis. Six trials assessed Montreal Cognitive Assessment scores, where its pooled analysis suggested that Tai Chi was as effective as conventional exercise (SMD=0.15, 95%CI: -0.11 to 0.40, p =0.26). However, pooled analysis of the Mini-Mental Status Examination suggested that Tai Chi intervention more effectively improved cognitive function and reduced the rate of cognitive impairment in elderly patients (SMD=0.36, 95%CI: 0.18 to 0.54, p <0.01) as compared to the control group. This systematic review and meta-analysis suggest that, in some extent, Tai Chi is efficacious in improving cognitive function and slowing down the rate of cognitive impairment among elderly patients., Competing Interests: All the authors declare that there are no conflicts of interest., (© 2024 by the authors.)

A sedentary lifestyle and an unhealthy diet increase the risk of obesity. People with obesity experience adipocyte hypertrophy and hyperplasia, which increases the production of proinflammatory cytokines, thereby increasing the risk of morbidity and mortality. Lifestyle modification using non-pharmacological approaches such as physical exercise prevents increased morbidity through its anti-inflammatory effects. The purpose of this study was to examine the effects of different types of exercise on decreased proinflammatory cytokines in young adult females with obesity. A total of 36 female students from Malang City aged 21.86 ± 1.39 years with body mass index (BMI) of 30.93 ± 3.51 kg/m 2 were recruited and followed three different types of exercise interventions: moderate-intensity endurance training (MIET), moderate-intensity resistance training (MIRT), and moderate-intensity combined training (MICT). The exercise was performed at a frequency of 3x/week for 4 weeks. Statistical analysis was performed using the Statistical Package for Social Science (SPSS) version 21.0, using the paired sample t -test. The results revealed that serum IL-6 and TNF-α levels were significantly decreased between pre-training and post-training in the three types of exercise (MIET, MIRT, and MICT) ( p ≤ 0.001). The percentage change in IL-6 levels from pre-training in CTRL was (0.76 ± 13.58%), in MIET was (-82.79 ± 8.73%), in MIRT was (-58.30 ± 18.05%), in MICT was (-96.91 ± 2.39%), and ( p ≤ 0.001). There was a percentage change in TNF-α levels from pre-training in CTRL (6.46 ± 12.13%), MIET (-53.11 ± 20.02%), MIRT (-42.59 ± 21.64%), and MICT (-73.41 ± 14.50%), and ( p ≤ 0.001). All three types of exercise consistently reduced proinflammatory cytokines such as serum levels of IL-6 and TNF-α.

Analogue cheese made from sweet corn extract was expected to fulfill the people's need for cheese and as alternative cheese made from cow's milk. The use of maltodextrin as a filler and citric acid as an acidulant was expected to improve the characteristics of corn cheese. The aims of this article were to (1) determine the optimum concentration of maltodextrin, papain, and citric acid in order to produce corn milk-based cheese analogue with the best characteristics; (2) determine the characteristics of cheese analogue produced using the optimum concentration. The research design used in this study was Response Surface Methodology (RSM) based on Central Composite Design (CCD) with three factors: citric acid concentration (0.12%, 0.16%, and 0.20%), commercial papain (0.026%, 0.030%, and 0.034%), and maltodextrin (10%, 15%, and 20%). The optimum formula to produce cheese analogue with the highest protein content and yield was with the addition of 0.20% citric acid, 0.029% papain, and 20% maltodextrin. The cheese analogue produced from the optimum formula had moisture content of 61.590%, yield of 17.512%, total dissolved solids of 19.00°Brix, dissolved protein of 19.837%, acidity (pH) of 5.4, and fat of 6.976%. The sensory characteristics of cheese analogue spread from sweet corn extract are similar to those of cheese from cow's milk; i.e., it had a yellowish-white color, distinctive aroma of cheese, no sour taste, and soft texture and was easy to spread. Therefore, it was possible to explore the sweet corn as ingredient of spread cheese that has low fat content.