Journal of Medicinal and Chemical Sciences
Volume:6 Issue: 11, Nov 2023

The objective of this study is to investigate the occurrence and management of acute thrombotic microangiopathy, a severe complication associated with antiphospholipid syndrome (APS), particularly in the context of catastrophic APS (CAPS) during pregnancy. The study aims to enhance the understanding of CAPS in pregnancy, improve early diagnosis, and evaluate the effectiveness of different treatment modalities. The study employed a case report methodology, focusing on a pregnant patient diagnosed with CAPS and experiencing acute thrombotic microangiopathy. The clinical presentation, laboratory findings, diagnostic procedures, and treatment interventions were documented and analysed. The treatment approach included the use of anticoagulants, glucocorticoids, and plasma exchange. The response to treatment, complications, and patient outcomes were assessed. The study observed a rapid development of liver, central nervous system, and renal lesions within a week, indicating the severity of CAPS in the pregnant patient. Despite the pregnancy termination, the patient's clinical condition did not show improvement, suggesting a lack of response similar to observations in other cases. The patient received standard CAPS treatment, except for intravenous administration of immunoglobulins. Further details were reported regarding the treatment outcomes, laboratory parameters, and imaging findings. This study highlights the challenges associated with diagnosing and managing CAPS during pregnancy, specifically focusing on acute thrombotic microangiopathy. Early diagnosis, aggressive treatment with anticoagulants and glucocorticoids, and the use of plasma exchange or intravenous immunoglobulin are crucial in achieving positive outcomes. The study suggests the consideration of alternative interventions, such as immunosuppressive therapy or targeted biologic agents, in refractory cases of CAPS. Further research is needed to elucidate the optimal treatment strategies and long-term outcomes in pregnant patients with CAPS.

The objective of this article is to study the theoretical and applied principles of the symptoms of acute and chronic viral hepatitis and the consequences of their impact on the human body. The methodological basis of this study consists of various methods of scientific knowledge, including analysis, synthesis, scientific abstraction, analogy, comparison, graphical and tabular methods, generalization, and systematization. The research reveals a significant impact of these forms of hepatitis on the human body, particularly leading to a decline in liver function and the development of associated conditions such as cirrhosis and liver cancer. The study also identifies the most common symptoms of acute and chronic viral hepatitis, including flu-like symptoms, nausea, vomiting, fever, abdominal pain, loss of appetite, fatigue, joint pain, rash, diarrhea, darkening of urine, and yellowing of the skin and eyes. These symptoms manifest at different stages of hepatitis, such as the incubation period, acute hepatitis, chronic hepatitis, cirrhosis, and liver cancer. The study proposes several preventive measures, including population immunization, adherence to personal hygiene practices and handwashing, access to clean water and sanitation facilities, safe food handling, sterilization and disinfection of items used by infected individuals, use of disposable syringes for injections and blood transfusion, and promotion of responsible sexual behavior. These measures can significantly contribute to the prevention and control of acute and chronic viral hepatitis, ultimately improving public health outcomes.

The objective of this study is to examine the challenges faced by treatment organizations and assess the current state of emergency medical care facilities in Poland and the Czech Republic during the COVID-19 pandemic. The content analysis method is used to investigate the organization of emergency medical care services during this crisis. The Health System Response Monitoring to COVID-19 (HSRM) and Health Systems and Policy Monitoring (HSPM) databases were relied upon for the analysis. Several notable aspects of patient treatment during the pandemic were revealed by the study. These included the postponement of scheduled examinations and urgent treatments, a decrease in the hospitalization rate for planned surgical interventions, limitations on medical care availability, the vacations prohibition for medical staff, staff redeployment, patient triage, and daily monitoring of intensive care beds to ensure they were filled according to planned indicators. It was concluded that treatment organizations in Poland and the Czech Republic faced significant challenges during the COVID-19 pandemic. The restrictions and limitations imposed on medical care services resulted in the postponement of non-urgent treatments and a decrease in the hospitalization rate for planned surgeries. In addition, the proactive measures taken by medical staff, such as the vacations prohibition and staff redeployment, were crucial in managing the crisis and ensuring the availability of care. The daily monitoring of intensive care beds played a vital role in maintaining the capacity to treat critically ill patients according to planned indicators. These findings highlight the need for ongoing monitoring and preparedness to effectively manage emergency medical care services during future public health emergencies.

Gonorrhea infection (GO) has a high prevalence in Indonesia, making it a significant public health concern. Effective treatment is crucial in controlling GO. However, the development of resistance has limited treatment options. Current guidelines recommend dual therapy as a syndromic approach. Treatment failures often result from a reinfection due to the barriers to therapy with sexual partners or engaging in sexual activity with newly infected partners. To prevent resistance and control its spread, transmission needs to be minimized. Various factors are associated with recovery as part of a comprehensive resistance control strategy, including appropriate medication, therapy adherence, sexual abstinence during treatment, and regular monitoring. This study utilized a retrospective cross-sectional design, analyzing medical records of Gonorrhea patients from the Sexually Transmitted Infections (STI) Outpatient Clinic, Dermatology, and Venereology Department, Dr. Soetomo Public Academic Teaching Hospital, Surabaya, between 2017 and 2021. Out of 109 GO patients, 64 met the inclusion criteria. The analysis revealed a significant association between dual therapy cure for Gonorrhea and sexual abstinence (p-value = 0.001

Staphylococcus aureus is a Gram-positive pathogen that is commonly associated with bovine mastitis, which is an infectious condition affecting the udder of cows. The objective of the present study is to evaluate the antimicrobial efficacy of methicillin, amoxicillin, and ampicillin for detecting methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from cases of bovine mastitis. Methodologically, it was established to carry out the antimicrobial activity using the plate disc diffusion method (Kirby-Bauer) with the use of amoxicillin and ampicillin at 2 µg and 10 µg, also following the recommendations of the Clinical and Laboratory Standards Institute. To detect resistant methicillin strains, oxacillin was used at 1 µg, and cefoxitin at 30 µg. The study was conducted against 50 strains of the bacteria under investigation, which were isolated and identified. The applied treatments demonstrated a highly significant effect (p<0.05). In addition, a resistance of 50% and 60% to concentrations of 2 µg of amoxicillin and ampicillin, respectively, was observed. Furthermore, a resistance of 60% and 68% to 10µg of amoxicillin and ampicillin, respectively, was observed, indicating that Staphylococcus aureus is developing mechanisms that confer antimicrobial resistance. To further investigate this, the antimicrobial activity was conducted using 1 µg oxacillin discs and 30 µg cefoxitin, revealing that 36% and 32% of the isolates were resistant to these drugs, respectively. Phenotypically, 32% (n=16) of the isolates were identified as methicillin-resistant Staphylococcus aureus (MRSA), demonstrating resistance to all beta-lactams tested.

Coronavirus 2019 (COVID-19) is a highly infectious disease. It has spread throughout the world in a short period and this widespread outbreak has caused many problems in medical institutions and universities. The purpose of this study was to investigate the effect of e-learning with a blended visual, analytical, and practical approach on the rate of cognitive and psychomotor learning of the practical course of Nursing Principles and Skills in nursing students during the COVID-19 pandemic. A quasi-experimental research design was used in this study. To conduct the research, 30 first-semester nursing students who had taken the course "Nursing Principles and Skills" were selected. The teacher divided the students into two groups of 15 students (experimental and control groups), and then before starting the practical class according to the faculty program, 8 virtual sessions in a blended form started for the experimental group. Before the intervention, the mean score of cognitive learning was equal to 4.66±3.11 in the experimental group and 4.53±2.94 in the control group. The mean score of psychomotor learning was equal to 0.86±0.74 in the experimental group and 0.8 ± 0.86 in the control group. After the intervention, the mean scores of cognitive learning were equal to 16.89±5.47 and 10.93±4.55 in the experimental and control groups, respectively, while the mean scores of psychomotor learning were equal to 18.33±3.85 and 12.46±5.05 in the experimental and control groups, respectively. During the COVID-19 pandemic, all human societies underwent unwanted changes. This pandemic caused damages to various economic, social, medical, and even educational institutions. The use of e-learning with a blended approach can improve the rate of cognitive and psychomotor learning in medical students.

Left ventricular hypertrophy (LVH) is a common cardiac condition characterized by the thickening and enlargement of the left ventricle as the main pumping chamber of the heart. Atrial fibrillation (AF) is a prevalent arrhythmia with major risk factors such as becoming older, heart failure, left ventricular hypertrophy, coronary heart disease, and hypertension. This study aimed to measure the prevalence of Left Ventricular Hypertrophy (LVH) in patients with Atrial Fibrillation (AF) and hypertension.

From September 1, 2018, to February 28, 2019, this cross-sectional study was carried out on a group of 100 patients who had both AF and hypertension. The study took place at multiple healthcare facilities in Sulaimani City, including the Cardiac Tertiary-Specialization Hospital, Shar Hospital, Emergency Unit, and Shahed Dr. Hemen Hospital. All of the patients had a thorough evaluation that included an echocardiogram, an ECG, a comprehensive physical examination, height, and weight. Data were analysed using SPSS with descriptive statistics, t-tests, Chi-square tests, and contingency tables.

In 56% of AF patients, there was the evidence of left ventricular hypertrophy; of whom, 35.7% had mild, 35.7% had moderate, and 28.6% had severe disease. A strong and significant relationship was found between older age, ex-smoking, chronic atrial fibrillation, medication use, hypertension, and a longer duration of hypertension in AF patients with a high prevalence of left ventricular hypertrophy.

Left ventricular hypertrophy is frequently observed among patients with atrial fibrillation.

Hemophilia-A is a sex-related hereditary bleeding disorder, like the general populations, mortality from cardiovascular diseases is currently responsible for one-third of deaths in hemophilia patients. A case controlled study was carried out on fifty children; twenty five male with hemophilia-A compared to twenty five healthy male children.12 lead surface ECG, 24 hour holter monitoring and basic echocardiography assessment were done for all participating children. ECG recording revealed that increased heart rate (b/min), QTc/msec, the maximum and QT dispersion in the hemophilia children vs. the control, increased QT dispersion by 24 hour holter in hemophilia children. Reduced time domain parameters for HRV (ms) in hemophilia children were compared to the healthy controls. A significant difference was observed between the diseased and healthy group in the number and frequency of the subject with increased QTc dispersion more than 70 ms detected by ECG, but not by holter. There was an increase in QT dispersion in children with hemophilia that put them at risk for developing dysrhythmia, sympathy-vagal imbalance detected by the presence of depressed HRV, and also exposed them to cardiac morbidities and sudden cardiac death.

Sepsis results in a life-threatening organ dysfunction due to the dysregulation of organ dysfunction detection, risk stratification, prognosis, and treatment is crucial for sepsis and septic shock. Several widely-available biomarkers are including white blood cells count (WBC), neutrophil-lymphocyte ratio (NLR) C-reactive protein (CRP), and procalcitonin (PCT), lactate levels. Presepsin (P-SEP) and mid-regional pro-adrenomedullin (MR-ProADM), are other two important biomarkers currently under investigation. In addition, clinical scoring system such as the Sequential Organ Failure Assessment (SOFA) and the Acute Physiology and Chronic Health Evaluation (APACHE)-II scores are combined. Furthermore, comorbidities and the underlying infections should be considered. In this study, we evaluated the potency of septic shock predictor in sepsis patients at Dr. Kariadi Hospital Semarang, Indonesia between June and August 2019. A total number of 59 patients, consisted of 19 sepsis and 40 septic shock who fulfilled the Sepsis-3 criteria were enrolled. Biomarkers, scoring system and other variables were evaluated within 24 hours of emergency department (ED admission. Bivariate and multivariate logistic regression analyses as well as receiver operating characteristic curve analysis were used to predict the development of septic shock. A combination of five biomarkers (WBC count, PCT, P-SEP, MR-ProADM, and lactate) plus SOFA score and additional risk variables (skin and soft tissue infection, and hypertension) performed better for predicting septic shock than any single factor.

To determine the effective volume of eugenol on day 3 in the inflamed pulp. Experimental research with a posttest-only control group design The experimental animals used were 28 male Sprague-Dawley rats. The maxillary right molar tooth was prepared with a size of 1 mm and a depth of 1 mm. Eugenol was dropped on cotton pellets according to the treatment group, namely 0.1 µL, 0.08 µL, and 0.02 µL, and aquadest as a negative control was then put into the cavity and closed with a temporary seal. Rats were decapitated after 3 days, prepared, and stained with hematoxylin and eosin. Results were read with a 100x magnification microscope at 3 fields of view and with imageJ software. The average number of macrophages in the cotton pellet application group with 0.1 µL eugenol volume was 22, the 0.08 µL eugenol volume group was 6.71, the 0.02 µL eugenol volume group was 44.43, and the negative control group was 34.29. The results of the one-way ANOVA test showed a significance of 0.000 (p<0.05). Eugenol volumes of 0.08 µL had the lowest average number of macrophages compared to eugenol volumes of 0.01 µL and 0.02 µL, and based on the post hoc test, there was a significant difference (p<0.05).

The present study was designed with the aim of comparing the radiological findings of the CT scan of the lungs of patients with Delta and Omicron variants of COVID-19 hospitalized in the intensive care unit. This was a retrospective comparative study conducted during the fifth peak of COVID-19 in Iran, August to November 2021 (the predominance of Delta variant) and March to April 2022 (the predominance of Omicron variant) in Qom, Iran. Radiologic findings of lung CT scans reported by a single radiologist were compared between these two cohorts. To analyze the collected data, SPSS version 22 statistical software is used through chi-square or fisher exact test, independent t-test, and Mann-Whitney test. A p-value of lower than 0.05 was considered as statistically significant. The total number of 50 patients in Delta (mean age of 58.68±14.77 years, 56% male) and 46 patients in Omicron (mean age of 70.45±18.02 years, 47% male) periods were included in study. Lesions of Right middle lobe (RML), left upper lobe (LUL), and Lingual lobes were more common in Delta period than Omicron (P<0.05). GGOs were more common in Delta period than in the Omicron ‎ (P=0.013).  There were no Unilateral GGOs during the Delta period, while 9 of 32 (28.1%) patients having GGO lesions in Omicron era had unilateral ones (P<0.001). Peripheral lesion was not differentiating Omicron from Delta. Crazy Pavings, Parenchymal bands, Halo signs, and Pleural effusions were more common in omicron period than in the Delta (P<0.05). Total Chest CT severity score was statistically higher in Delta period (22.75±5.24 units) than Omicron period (13.97±9 units). There were the significant differences in the radiologic characteristics between the two variants. This study suggests that with evolving the virus variants, while severity of lung involvement has decreased, GGOs of COVID-19 might have tended to manifest as unilateral lesions with more specific radiographic features.

Autoimmune hemolytic anemia (AIHA) is an infrequent etiology of anemia during pregnancy, and its occurrence in the postpartum period is even more uncommon. This study presents the case of a 27-year-old woman who exhibited severe anemia and thrombocytopenia six weeks after delivery. Hemolysis was confirmed upon evaluation, and a diagnosis of AIHA was established based on a positive direct antiglobulin test (DAT) and the presence of autoantibodies targeting red blood cells (RBCs). Treatment with steroids resulted in an improvement in the patient's hemoglobin levels. The demographic characteristics observed in our case align with prior research, which has documented mild anemia during pregnancy, lower gestational age, and decreased fetal birth weight in primary AIHA cases. Furthermore, thrombocytopenia can be manifested in AIHA during pregnancy, necessitating long-term monitoring of such patients. The AIHA rarity as a causative factor for anemia during pregnancy, particularly in the postpartum period, underscores the significance of including AIHA in the differential diagnosis for severe anemia. Moreover, extended follow-up care is essential for managing these patients. Employing a multidisciplinary approach to prenatal care facilitates the identification and management of rare complications, such as AIHA.

Endotracheal intubation is a routine procedure in the ICU that may save a patient's life. The stridor probability after extubation increases with a smaller cuff-leak volume. This research aimed to estimate the efficiency of the cuff leak test vs. laryngeal U/S in identifying post-extubation stridor in prone surgical patients under general anesthesia. Seventy-five adults with ASA status I or II who would be undergoing prone, general anesthetic, and elective spine surgery took part in this prospective cohort research. All patients underwent a complete medical history, physical examination, laboratory tests, and laryngeal ultrasonography. Cases were examined for post-extubation syndrome (PES) and the necessity for reintubation. PES occurred only in 15 (20%) patients. Cut-off pressure, CLT for PES, and air column width before deflation were insignificantly different between the entire population and the PES group. ACWD was a significant predictor of PES incidence at a cut-off value of 0.8 mm, AUC = 0.715, and P = 0.02 with 71.43% sensitivity, 78.33% specificity, 43.5% PPV, and 92.2% NPV. CLT was an insignificant predictor of PES incidence. The US measurement of ACWD is a reliable method of forecasting PES.

Virgin olive oil filtration is a pre-treatment usually used before bottling to facilitate suspended particle removal and reduce the moisture content so that the quality and organoleptic properties are preserved during storage. In the current study, samples of virgin olive oils were subjected to different clarification and filtration techniques such as (1) commercial filtration (CF) using diatomaceous earth as a filter aid, (2) clarification by insufflating of carbon dioxide, and (3) argon gas. All treated samples as well as control unfiltered (UF) virgin olive oil (VOO) were bottled under dark conditions in diffused daylight glass bottles and kept at room temperature for six months. Basic quality indices (free acidity (FA), peroxide value (PV), and extension coefficient) and total polar phenol were determined within respected time of analysis during the storage period of six months. In addition, microbial quality was evaluated by determination of yeasts and molds, total plate count, Bacillus cereus, and clostridium perfringens. The main results showed that at the end of the storage, acidity increased in all samples with time in both storage conditions, whereas samples stored in dark more stable compared to those stored under diffused daylight. On the other hand, clarified samples with CO2 showed significant stability compared to the rest of the samples stored under diffused day light. Peroxide values (PV) and K232 increased in all stored samples. Moreover, K270 increased with time, and showed more stability in samples stored in dark. Total polar phenols decrease in all samples, but showed no significant difference among all samples after 180 days of storage. Microbial results revealed the presence of yeasts and molds in all samples at the beginning of storage, and then disappeared after 135 days for all samples except UF. Total plate count, Bacillus cereus, and clostridium perfringens were not found in any stored VOO.

In our own experiment, we studied microscopic changes in the anterior wall of the left ventricle of young, middle-aged, and old rats on the 30th day after exercising. Plasmorrhagia, edema, stasis, bruising, dystrophic-necrotic changes, and eventually atrophic and sclerotic changes with the proliferation of connective tissue, an expansion of fibroblasts, and collagen synthesis emerge against the backdrop of tissue hyperemia typical of general venous hyperemia. In contrast to the young rats, the middle-aged rats have more severe lesions, while the old rats exhibit lesser alterations than the first two age groups. Compared to the control, an immunohistochemical examination of Desmin expression indicated peculiar morphodynamics. Morphometric analysis revealed that the number of intercalated discs is stable in young rats compared to control groups, rises in middle-aged rats (24.17%), and decreases in older rats (23.67%) compared to control. The intercalated discs in all three cell types mostly undergo disintegration, fragmentation, and shortening with a decrease in size. Compared to older rats, the experiment shows that sustained physical strain initially triggers the onset of adaptive, compensatory hypertrophy processes in striated and smooth muscle tissues. The compensating mechanism is disrupted when there are morphological alterations like acute heart failure and myocardial infarction, risk factors for acute hyperemia, venous and capillary congestion, edema, hemorrhage, and dystrophic and necrotic changes with the destruction and reduction in the size of intercalated discs. These conditions also cause functional weakening, decreased myocardial contractility, and hypoxic damage and are risk factors for acute heart failure and myocardial infarction.

The presence of anti-DFS70 antibodies was considered by some rheumatologists as a tool to help exclude the diagnosis of systemic autoimmune rheumatic diseases (SARDs) such as systemic lupus erythematosus (SLE). However, several studies reported the controversial result. The golden standard for anti-DFS70 antibody detection is indirect immunofluorescence (IIF) assay. Recently, ELISA method has been developed for the anti-DFS70 detection. We aimed to investigate the presence of anti-DFS70 antibodies in SLE and non-SLE patients using IIF assay and ELISA. We evaluated 45 SLE patients who fulfilled the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, SLEDAI score >5; 15 patients with atopic dermatitis (AD) with IgE >200 IU/ml, and 30 healthy subject individuals. Anti-DFS70 antibodies were measured by ELISA and IIF assay (ANA-DFS70 Cytobeads). Differences in the anti-DFS70 prevalence in SLE and non-SLE patients were analysed using a chi-square test. The sensitivity, and specificity of ELISA were calculated by McNemar’s test. The presence of anti-DFS70 antibodies measured by IIF assay was found in 11.1% of SLE and 4.4% of non-SLE patients (p-value 0.434), while anti-DFS70 measured by ELISA was found in 17.7% of SLE and 6.6% of non-SLE patients (p-value 0.197). There was no significant difference in detecting anti-DFS70 of the two methods (p.0.05).  The ELISA has a sensitivity of 85.7% and a specificity of 94% for anti-DFS70 detection. Anti-DFS70 was detected more frequently in SLE rather than in non-SLE patients measured using both ELISA and IIF. There is good agreement between ELISA and IIF assay for the anti-DFS70 detection.

The objective of this study was to explore the alterations in end-systolic and end-diastolic volumes of the left ventricle in 12-13-week-old rats subjected to a six-week regimen of dosed swimming exercise. Swimming exercise in rats is widely acknowledged as a reliable method to study cardiac parameters and the adaptive capacity of the heart. In our investigation, we engaged 12-13-week-old male rats in a six-week dosed swimming exercise program, followed by weekly echocardiographic assessments to monitor changes in systolic and diastolic volumes of the left ventricle. We studied the echocardiographic data of the rats to evaluate the changes dynamics in systolic and diastolic volumes of the left ventricle in the study groups. The rats were divided into two groups: (1) a control group, which did not receive any load (n=6); and (2) a study group, undergoing daily 60-minute swimming exercises for six weeks with a load equivalent to 4% of their body weight attached to their tails (n=6). Significant changes in left ventricular volumes were observed solely in the study group, which endured 60 minutes of exercise with a 4% body mass load. This research marks a significant stride forward in understanding the pathogenic mechanisms influencing heart rhythm, particularly those arising from physical exertion and pathological shifts in the systolic and diastolic volumes of the left ventricle.

The utilization of traditional medicine in Indonesia is highly prevalent and favoured by the Indonesian people for maintaining health and treating ailments, drawing upon the experience, knowledge, and skills of ancestors, family, or parents. Traditional medicine, known for its natural properties and minimal side effects, is extensively employed in local healing practices to address various diseases. This is evident in literary works like Serat Kawruh and Serat Centhini. In response to the pandemic, approximately 79% of Indonesia's population turned to medicinal plants to bolster their immunity during the COVID-19 outbreak. The Indonesian government also lends support by providing online resources in the form of books that offer recommendations on the usage of several medicinal plants. The literature review followed the PRISMA guidelines. Between April and June 2022, a literature search was conducted in many databases, including Scopus, Pubmed, NCBI, and EBSCO, with an article publication timeframe of 2012-2022. Some Indonesian medicinal plants may prevent and treat COVID-19. 1300 articles on SARS-CoV-2-fighting Indonesian plants were found in various databases. After the screening, 48 qualified scientific articles were found suitable for this review article. The results found that many Indonesian local plants have a potential effect as antivirals to inhibit COVID-19. However, further experimental and animal studies are needed to investigate the antiviral activities of each plant in vitro before proceeding with clinical trials in humans.

Aromatase inhibitors (AI) are commonly used adjuvant therapy drugs for women with hormone receptor-positive postmenopausal breast cancer. Frequently AI associated side effects include severe joint and muscle pain. Aromatase Inhibitor - Associated Musculoskeletal Syndrome (AIMSS) is a condition that primarily affects the hands, wrists, and knees. This study aimed to determine the efficacy of Moringa oleifera extract as an adjuvant when taken with AI to postmenopausal breast cancer patients with ER (+), PR (+), and observed the CPK levels as inflammation indicators. The Functional Assessment of Cancer Therapy-Breast (FACT-B) can assess subjects’ emotional, physical, functional well-being, social, and also the breast cancer subscale. The research sample consisted of 40 postmenopausal cancer patients with ER (+) and PR (+) immunohistochemistry and as outpatients at the Kasuari facility, Dr. Kariadi Semarang, who experienced pain due to the administration of aromatase inhibitors. The results of the changes in CPK and FACT-B scores in the group that received additional therapy with Moringa oleifera extract were obtained in this study. The treatment group showed CPK level of post-test lower than pre-test (105.30 ± 50.19 vs. 88.10 ± 48.24, p <0,001). In addition, treatment group showed lower FACT-B score than control group (83.45 ± 5.11 vs. 75.25 ± 4.05, p<0,001). Moringa oleifera extract has a strong anti-inflammatory effect especially for patient with post-menopause breast cancer who received ER (+), PR (+), and aromatase inhibitor treatment. Its anti-inflammatory properties will upgrade breast cancer patient’s quality of life, treatment adherence, long period of breast cancer therapy and outcomes.

A clubfoot, or the Congenital Talipes Equinovarus, is one of the most common congenital orthopedic deformities, occurs in different severity. The Ilizarov method's external fixation and gradual distraction are considered the best choice of treatment for correction of severe. The aim of this study was to evaluate the effectiveness of the Ilizarov technique in the correction of neglected clubfoot deformities. In this retrospective cross-sectional study, individuals were included in the study by census; the author treated sixteen feet in 14 children and adults with resistant club foot, the patients were treated with Ilizarov method. All patients were assessed pre operatively according to Pirani score and radiological technique and postoperatively through clinical follow up and according to the American Orthopaedic Foot and Ankle Society scores. SPSS software was used for analysis and a significance level of less than 0.05 was considered. The preoperative assessment of the patients showed that 12 (75.0%) of them were classified as having grade III Pirani scores, with a mean score of 5.063 ± 0.6551, among them 11 (68.7%) were subjected to elongation of tendo-Achilles, plantar fasciatomy, and mid tarsal osteotomy. The radiological findings, pre- and post-operatively showed a high statistical difference in relation to Talo calcaneal angle- antero-posterior, Talo calcaneal angle- lateral, and Talo first metatarsal angle. Patients’ scores showed that the outcome of 9 (56.25%) of them was satisfactory. The postoperative clinical assessment of the patients revealed that 12 (75.0%) of the patients had achieved more than 90° ankle dorsiflexion, and 13 (81.25%) had a normal foot appearance. Also, the position of the foot when standing showed that 10 (62.5%) had 5° valgus and the majority 12 (75.0%) had achieved normal gait. The application of Ilizarov technique could be considered as a convenient, efficient, and successful method for neglected clubfeet deformities.

Members of Myxococcales have been known as slime bacteria, a unique microbiome in natural habitats with complex multicellular behaviour, sliding movement, and unusual fruiting body morphologies. According to previous reports, myxobacteria typically produced diverse families of secondary metabolites with various biological functions, including antimicrobial, antiviral, and antitumor properties. This study used an MTT cytotoxicity assay to evaluate total extracts from 43 myxobacterial strains on the MDA-MB-231 breast tumour cell line. Among these, one strain was determined to produce the highest anticancer activity with IC50 values of 6.25 ± 0.07 μg/mL, 3.9 times more than doxorubicin. Based on the morphological characteristics (colonies, vegetative cells, fruiting bodies, and myxospores) and 16S rDNA gene sequence, the potent strain was classified as belonging to the genus Myxococcus (Myxococcus stipitatus) named GL41 (Accession number ON076907). Then, profiling the ethyl acetate extract from the GL41 strain was performed to analyze the principle components using liquid chromatography coupled with electrospray ionization mass spectrometry (LC-ESI-QTOF-HRMS). As a result, 5 metabolite peaks were revealed based on the exact pseudomolecular ion [M+H]+ (exactly to 0.0001 m/z) and isotopic distributions. In addition, unknown compound peaks were predicted and exhibited as the putative molecular formulas, contributing to variation among the metabolite profiles under investigation. In conclusion, LC-HRMS-based metabolite screening is an effective and rapid identification approach for discovering potent candidates for subsequent characterization.

A rare bone condition known as osteogenesis imperfecta (OI) is brought on by an inherited connective tissue abnormality. Even within families who share a common mutation, symptoms might differ widely. H, a boy, aged 12, and F, a boy, aged 10, are siblings. Since they were 5 months old and 5 years old, their main complaint was repeated fractures in the lower extremities as a result of minor trauma. Only the mother's family had the same OI clinical manifestation characteristics. Physical examination revealed no signs of dentinogenesis imperfecta, blue sclera, hypermobility of the joints, or hearing problems. They have delayed growth and mild bone deformities. Pathologic fracture, cortical thinning, osteopenia, and pseudoarthrosis were all discovered during the radiology examination. The patient has received fixation, Biphosphonate injection, supportive care, and surgery. Therapy that was both definite and supportive was used to manage the patient. We monitored both patients physical and radiological examination, as well as  the quality of life using PedsQL 4.0 Generic Core Scales aged 8-12 years for Child and Parent Report for Children before and after a year of monitoring, we observed that both the patient's symptoms and quality of life had improved.

The purpose of this study is to prove the efficacy of Curcuma longa (turmeric) extracts against soot (carbon black)-exposed rats with Ox-LDL and eNOS levels. A total of 30 rats were divided into 5 groups with 6 rats in each group. Negative control group (C-) received no treatment. The positive control group (C+) exposed to soot at a concentration of 1064 mg/m3 for 8 hours. Treatment group T1 was exposed to soot at 1064 mg/m3 for 8 hours + Curcuma longa at 1 mg/kg body weight. T2 group was exposed to soot at 1064 mg/m3 for 8 hours + 2 mg curcuma longa mg/kg body weight, and T3 group were exposed to soot at of 1064 mg/m3 for 8 hours + curcuma longa 3 mg/kg body weight. The result of T3 group had lower Ox-LDL levels and higher eNOS levels, and also the difference was significant (p>0.05) than the C+ group. We conclude that the treatment of rats exposed to 1064 mg/m3 soot particles for 8 hours with Curcuma longa extract at a dose of 3 mg/kg body weight reduced Ox-LDL levels and increased eNOS levels because curcumin from Curcuma longa extract effective to break the chain reaction from lipid peroxidation, inhibit LOX-1 expression, prevent LDL modification into ox-LDL, and decrease coupled eNOS levels that prevent NO and GSH degradation.

Cerebrospinal fluid (CSF) leakage is a well-documented and significant complication that can occur following neurosurgical procedures. The association between CSF leakage and various morbidities has been extensively studied. Research on different materials as potential dura mater grafts has been conducted since 1890. The search for the optimal material for dura mater grafts remains ongoing in current research. This investigation aims to assess the incidence of CSF leakage and infection subsequent to duraplasty using xenografts in comparison to autografts.

This study aims to systematically analyze the CSF leakage and infection rates following duraplasty procedures utilizing xenografts and autografts. The research methodology includes a comprehensive search of the PubMed electronic database and a manual search of Google Scholar, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

Among the patients in the xenograft group, a total of 90 individuals out of 452 experienced complications in the form of CSF leaks and complicated pseudo-meningoceles. This study was conducted to investigate the incidence of CSF leaks and complicated pseudo-meningoceles in autografts, with a sample size of 540 patients. The results showed that 79 patients experienced these complications, with a statistically significant p-value of 0.05 and an odds ratio of 1.45 (95% confidence interval 1.00-2.10). Another aspect of the study examined the incidence of meningitis complications in xenografts, with a sample size of 400 patients. The results showed that 25 patients experienced meningitis. Among the 446 patients who underwent autografts, 11 patients (p=0.05; OR 2.10, 95% CI 1.01-4.36) experienced meningitis complications.

The analysis of duraplasty techniques shows that the use of xenografts increases the incidence of CSF leaks and pseudo-meningocele complications while raising the risk of meningitis.

Cancer is one of the primary causes of death, and almost > 40% of cancer patients experience anemia. Transfusion serves as one of the therapies given to anemic patients. Malignancy patients with decreased immune systems which are given blood component transfusion may cause transfusion reactions (Transfusion-related immunomodulation or TRIM), the mechanism of which is suspected to correlate to inflammatory cytokines, including IL-8. Blood products with a leukocyte count of <5 × 106 per unit are called leukodepleted blood products. This study aimed to observe the incidence of increased IL-8 level in malignancy patients given leukodepleted (LD) and nonleukodepleted (NLD) Packed Red Cells (PRC) transfusions. The increased IL-8 level leads a possibility of recurrence and risk of infection. This study was a quasi-experimental clinical trial conducted on 39 adult malignancy patients treated at Dr.Sardjito Hospital which were given leukodepleted and nonleukodepleted PRC transfusions, and the IL-8 levels were measured one hour before and after the transfusions. IL-8 levels in the NLD and LD groups increased significantly (p <0.05), i.e. 13.25 (8.3-25.2) pg/mL and 9.1 (8.4-10.8) pg/mL before the transfusions, and 25.4 (9.9-72.6) pg/mL and 9.8 (9.1-11.6) pg/mL after the transfusions, respectively. It showed that the increase of IL-8 levels correlated to the given PRC transfusions. There was a significant difference in the median IL-8 levels of the LD and NLD groups before and after the transfusions. The relative risk of increased IL-8 levels in nonleukodepleted PRC transfusions was 4.0 (95% CI: 1.079-14.833). Nonleukodepleted PRC transfusions have a four times higher risk of increasing IL-8 levels than leukodepleted PRC transfusions.

Febrile seizures are common in the paediatric population; the frequency of febrile seizures is significantly influenced by hereditary variables. Other variables, such as zinc and iron, may play an important role on the febrile seizures occurrence. This study aims to assess zinc and iron levels relation in febrile seizure children. Data sources published from PubMed, Proquest, Portal Garuda, and Web of Science published in 2000-2021 are carefully examined for relevant research published in English and Indonesian. We gathered and reviewed the total 30,849 journals. Only observational studies on the relationship between serum zinc and iron levels as well as the frequency of febrile seizures in children aged six months old to five years old had included. Analysis was on zinc and iron variables (SI, TIBC, and ferritin), and febrile seizures. Sensitivity analysis was performed after all the data were combined with a random effect or fixed effect model. On 30 case-control studies with a total of 4,158 patients. From zinc examination, there were 15 studies with 922 patients with seizures with fever and 666 patients with fever without seizures. The results showed that patients with fever with seizures had lower zinc levels than patients with fever without seizures (SMD= -1.36 [-1.89, -0.84], p<0.00001). On examination, ferritin and serum iron levels were found to be low compared to patients with fever without seizures, (SMD= -0.79 [-1.15, -0.43], p<0.00001 and SMD= -0.60 [-1.04, -0.16], p=0.007). Studies of total iron binding capacity found a significant difference between patients with fever and seizure compared to the patients with fever but no seizure. Serum zinc and iron levels were low in febrile seizure children. This meta-analysis discovered a relationship between low zinc and iron levels and seizure in febrile children.

Erythema nodosum (EN) is the most common form of septal panniculitis resulting from a hypersensitivity reaction in response to numerous antigens or triggers.

Case: 

A 43-year-old female presented with a chief complaint of erythematous painful non-ulcerating nodules on the lower limbs for 18 months. This was preceded by a painful, erythematous rash consisting of a few subcutaneous nodules on both limbs. A dermatological examination of the tibia region revealed multiple tender erythematous and hyperpigmented nodules. A biopsy and serology test were performed to rule out differential diagnoses. Based on the data, the working diagnosis is erythema nodosum caused by trichomoniasis and vulvovaginal candidiasis. We managed this case with metronidazole 500 mg twice daily for seven days, fluconazole 150 mg as a single dose, and non-steroidal anti-inflammatory drugs. One week after receiving treatment, her pain complaint disappeared, but the hyperpigmented macules still persisted, although they had decreased. One year after treatment, the patient's complaints did not recur.

EN may be associated with a wide variety of disease processes, and its observation should be followed by finding the underlying etiology. The clinical presentation includes symmetrical, tender, erythematous, warm nodules, and raised plaques usually located on the shins, ankles, and knees. The lesions show spontaneous regression without ulceration, scarring, or atrophy, and recurrent episodes are uncommon. The EN diagnosis is based on clinical presentation and histopathological findings.

The management of erythema nodosum involves identifying the etiologic factor and focusing on eliminating exposure or treating the underlying diseases.

Multiple sclerosis (MS) is a chronic autoimmune inflammatory condition results in dysfunction of the central nervous system. There are multiple causes linked to the development of MS disease including EBV exposure, vitamin D deficiency, and iron overload. This study aims to examine the frequency of iron overload in all multiple sclerotic patients with reported iron serum levels at the National Guard Hospital (NGHA), Riyadh Center between 2015 and 2021. A chart review based cross sectional retrospective study was conducted using the Best Care System Database, developed by NGHA, to estimate the prevalence of iron overload in MS patients. Data were analyzed to identify the correlation between serum iron and ferritin levels with disease severity and activity, which were clinically assessed by the EDSS. The mean findings of blood analysis were also compared between males and females. The findings of this study showed that there was no significant relationship between disease severity and elevated serum iron and ferritin level, with p-values of 0.130 and 0.856, respectively, 54.1% of the sample had an iron level that was low/very low. The disability score of 20.3% of the sample affects their full daily activities. There was no significant difference between males and females in all means of blood analysis categories as P>0.05. Our study showed that the degree of disease severity and activity did not significantly correlate with the higher serum iron levels (p-value of 0.130). Further study is needed to investigate the iron level in the active MS plaques of the brain and spinal cord, and assess the severity in accordance to the sites of the specific plaques.

Haemoglobinopathies are genetic disorders arising due to defect in the globin chain of haemoglobin. It is relatively common amongst genetic disorders. Beta thalassemia and Sickle cell are two commonest types of haemoglobinopathy encountered and clinically range from mild or asymptomatic condition to life threatening condition requiring blood transfusions for survival. In India, haemoglobinopathies seen are both thalassemias and sickle cell syndromes. The aim of the study is to determine the prevalence of haemoglobinopathies at our tertiary care centre from the haemoglobin sample processed. Accordingly, the study estimated the haemoglobin variant by HPLC method on 100 patients over 3 years and the diagnosis of haemoglobinopathies were confirmed after taking into consideration the results of variant study, haematological parameters and clinical profile of the patients. The results revealed out of 100 patients, 27 patients showed abnormal haemoglobin variant study and the most common haemoglobinopathy observed was 17 cases of beta thalassemia trait, 4 cases of sickle cell trait, 4 cases of sickle beta thalassemia, and 1 case of haemoglobin E trait and beta thalassemia major. The abnormal haemoglobin most commonly prevalent was beta thalassemia trait which was similar to other studies done in India and many subpopulation studies. All haemoglobinopathies were advised family study for evaluation and future genetic implications. Haemoglobin E trait was diagnosed based on the retention time observed as the equipment failed to recognize the abnormal variant. One patient was on regular blood transfusion and was having beta thalassemia major haemoglobinopathy.

Lung diseases significantly impact the world regarding health, economic cost, and social and psychological well-being. X-ray images are a primary method for diagnosing lung diseases, but the manual analysis of these images can be time-consuming, subjective, and prone to inaccuracies. However, it is essential to diagnose lung diseases in a timely manner and with high accuracy to ensure effective treatment and management. This study introduces an innovative deep-learning version termed the "ESSDN-LN model" to overcome these challenges. It is a variant of the single shot detector (SSD) network. This model aims to rapidly and accurately detect and classify six types of lung disease: aortic enlargement, cardiomegaly, pleural thickening, pulmonary fibrosis, COVID-19, and pneumonia. The ESSDN-LD model was introduced in three versions: ESSDN-LDV1, ESSDN-LDV2, and ESSDN-LDV3. ESSDN-LDV1 incorporates the SSD with batch normalization, dropout regularization, and data augmentation techniques. ESSDN-LDV2 builds upon the advancements of ESSDN-LDV1 by incorporating the random search algorithm for adjusting model hyper-parameters and introducing the skip connections technique to enhance the detection performance. Furthermore, ESSDN-LDV3 further enhances the capabilities of ESSDN-LDV1 using the genetic algorithm for hyper-parameter tuning and incorporating feature fusion and skip connections techniques, thereby significantly improving the detection performance. The ESSDN-LDV3 model demonstrated exceptional performance compared to other versions, achieving a remarkable accuracy of 96.5% and a prediction time of 0.018 seconds in the seven-class classification. Furthermore, it achieved a total accuracy of 98.4% and a prediction time of 0.013 seconds in the three-class classification, encompassing Covid-19, pneumonia, and no-finding cases. These impressive results highlight the effectiveness and efficiency of the proposed method in accurately classifying lung diseases and can contribute to improved patient outcomes and treatment decisions.