ISSN / EISSN : 1907-3062 / 2407-2230
Published by: Universa Medicina (10.18051)
Total articles ≅ 243
Latest articles in this journal
Universa Medicina, Volume 41, pp 71-78; https://doi.org/10.18051/univmed.2022.v41.71-78
Background Fournier gangrene (FG) is a life-threatening disease, commonly found in diabetic and immunocompromised patients. Recent studies suggested the use of new parameters apart from the commonly used Fournier gangrene severity index (FGSI), such as the neutrophil-lymphocyte ratio (NLR), the clinical use of which remains questionable. Therefore, we aimed to evaluate the role of the NLR and FGSI as a prognostic factor of mortality in patients with FG. Methods This is an analytical study with a retrospective approach involving 109 adult patients diagnosed with FG. Data were collected regarding medical history, symptoms, physical examination findings, and laboratory tests. The FGSI score and NLR were determined. Bivariate analysis was performed using chi-square test and independent t-test. Overall survival between groups was compared using Kaplan–Meier survival estimates and Cox regression test. Results Of the 109 patients, 90 survived (82.5%, group 1) and 19 died (17.43%, group 2). The cut-off point of NLR among the patients was 10.9, with a 73.7% sensitivity and 60% specificity. The area under curve value was 0.65 (95% CI; 0.524-0.754; p<0.05). The Kaplan Meier survival analysis showed that NLR was as an independent prognostic factor of mortality in FG patients (HR 5.177; 95% CI; 1.092-8.471; p<0.05), but Cox regression analysis showed that NLR and FGSI were not significant prognostic factors of mortality (p=0.09 and p=0.179; respectively). Conclusion This study demonstrated that NLR and FGSI are not important as prognostic tools for FG mortality.
Universa Medicina, Volume 41, pp 90-99; https://doi.org/10.18051/univmed.2022.v41.90-99
Nearly 35 million cases and one million deaths over the nine months of the COVID-19 pandemic have been reported worldwide. Africa and some countries with endemic parasitic infections had a low incidence of COVID-19. By contrast, the United States and several European countries, having a non-endemicity of parasitic infections, recorded a high incidence of COVID-19. Some parasites have an immunomodulatory mechanism that can induce an immune tolerance state in the infected persons by balancing pro-inflammatory and anti-inflammatory responses. Emerging reports also stated that COVID-19 and helminth co-infections may have more hidden outcomes than predictable ones. Hence, the aim of this literature review is to show and identify that an increase in the number of regulatory immune cells due to the immunomodulatory role of a pre-existing parasitic infection could reduce the risk of COVID-19. This study explored the existing literature to determine the role of parasitic infections in modulating the immune response and possibly reduce the risk of COVID-19 infection in endemic countries. The mechanism of immunomodulation by parasites is the increased numbers of Treg cells, M2 macrophages, eosinophils, the Th2 cytokines IL-4 and IL-5, and the pro-inflammatory downregulation of IFN λ, TNF α, and IL-6, which play an essential role in inducing cytokine storms in COVID-19 infection. This condition will probably occur in an individual with parasitic infection in a community with limited facilities and infrastructure to treat parasitic infections, particularly in developing countries. To conclude, in endemic areas, the immunomodulatory effect of parasitic infection to reduce the risk of COVID-19 cases/deaths is a possibility if the host is immunocompetent. Herein, the current knowledge on the immunomodulatory role of COVID-19 and helminth co-infections will be discussed.
Universa Medicina, Volume 41, pp 64-70; https://doi.org/10.18051/univmed.2022.v41.64-70
BACKGROUND Syphilis is a global health problem, especially in developing countries including Indonesia. Treponema pallidum, the etiologic agent of syphilis, cannot be cultured in vitro. Syphilis has several clinical manifestations, making laboratory testing a very important aspect of diagnosis. Microscopic examination may support the diagnosis but is rarely used in Indonesia. The aim of this study was to evaluate negative staining using the light microscope to detect T. pallidum in syphilitic lesions. METHODS A cross-sectional study was conducted involving 27 subjects who came to several dermato-venereology clinics in Jakarta. Exudates were collected from genital ulcers, condylomata lata, and dry mucocutaneous rash on palms and soles of syphilis patients. Negative staining using one drop of Indian ink was used to examine for treponemas under the light microscope at 10x100 magnification. RESULTS Microscopic examination using negative staining showed a few clusters of small and spiral shaped bacteria. Of the 39 specimens from 27 subjects, microscopic examinations were successfully done on 10 specimens. Observations could only be conducted on 5 specimens, 3 (60.0%) of which showed the morphology of spirochetes. This examination is the easiest method for detecting the bacteria. Moreover, the bacteria that were isolated from painless genital ulcers could be observed more clearly than those from erythematous maculopapular lesions. CONCLUSION Treponema pallidum was successfully detected by microscopic examination in all moist lesions, but was difficult to detect in dry lesions. Negative staining under the light microscope appears to be simple, affordable, and available in most microbiology laboratories in Indonesia.
Universa Medicina, Volume 41, pp 56-63; https://doi.org/10.18051/univmed.2022.v41.56-63
Background Death and the anxiety of it becomes more apparent when confronted with a chronic disease. The aim of this study was to determine the level of death anxiety among patients with depression and schizophrenia, and the relationship between severity of the symptoms and death anxiety in these patients. Methods A cross-sectional study was conducted on 29 patients with a depressive disorder, 18 with schizophrenia spectrum disorder and 31 healthy subjects, through face-to-face interviews. The general severity of the psychiatric disorder was measured using the Clinical Global Impression Scale (CGI). The severity of depressive symptoms was measured using the Beck Depression Inventory (BDI). Psychosocial performance was measured using the personal and social performance scale (PSP). To evaluate death anxiety, the Bochum Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0) was used. One-way ANOVA and Pearson correlation tests were used to analyze the data. Results Regarding the BOFRETTA attitude scale, the schizophrenic patients (23.1±9.12) showed significantly higher scores than healthy subjects (18.4 ±4.56) and depressive patients (19.8 ± 5.20) (p<0.050). The healthy controls achieved the least scores of BOFRETTA anxiety scale followed by depressive (30.67±10.33) and schizophrenic patients (31.30±12.18). However, there were no significant between-group differences regarding this scale. We found significant correlations of all BOFRETTA dimensions (attitude, anxiety, sum score) with CGI, PSP and BDI. Conclusion There was a significant relationship between the severity of symptoms and death anxiety in both depressed and schizophrenic patients. However, the latter showed a more negative attitude towards death.
Universa Medicina, Volume 41, pp 47-55; https://doi.org/10.18051/univmed.2022.v41.47-55
Background Diabetes mellitus (DM) is known to increase the risk of infection including tuberculosis (TB). Some studies also showed that 2-15% of latent TB infection (LTBI) will progress to active TB. This study aimed to obtain the prevalence of LTBI and to determine the risk factors of LTBI in patients with type 2 diabetes mellitus (T2DM). Methods This was a cross-sectional study on 242 adult T2DM patients. For LTBI screening we performed the interferon gamma release assay (IGRA) (Quantiferon TB Gold Plus test) and for confirmation of active TB (pulmonary TB) we performed GeneXpert MTB/Rif sputum examination and chest X-ray. Glycosylated hemoglobin (HbA1c) levels, smoking history and BCG scar were collected. Multivariate logistic regression was used to analyze the data. Results Positive IGRA results were found in 99 of 242 uncomplicated T2DM patients while LTBI was found in 82 patients (33.8%). There were significant differences between T2DM patients with latent TB and T2DM patients without infection in HbA1c and specific IFN-ã levels (TB1 minus nil and TB2 minus nil), i.e. 8.5% and 7.6%, 2.5 IU/mL and 0.06 IU/mL, and 2.6 IU/mL and 0.08 IU/mL, respectively. Multivariate analysis showed that the risk factors for LTBI in T2DM patients were smoking history, HbA1c >7%, and no BCG scar. Conclusions Because LTBI is prevalent in T2DM, it is important to screen for it in T2DM patients due to the risk of developing severe active TB. Absence of a BCG scar and high HbA1c levels are strong predictors of LTBI in T2DM patients.
Universa Medicina, Volume 41, pp 37-46; https://doi.org/10.18051/univmed.2022.v41.37-46
Background Streptococcus pneumoniae causes pneumococcal disease, which is responsible for millions of deaths worldwide. Various pneumococcal vaccine candidates have been developed to prevent S. pneumoniae infection, one of which is an epitope-based vaccine. This study aimed to prove that intranasal immunization with each of the five S. pneumoniae RrgB epitopes can induce a mucosal immune response by increasing the β-defensin-2 concentration through upregulation of interleukin (IL)-22 expression. Methods An experimental laboratory study was conducted using 28 male Wistar rats aged 3-4 months, that were randomly divided into 7 groups containing four rats each. Group 1 was given 40 mL of phosphate-buffered saline (PBS) only (control group). Group 2 was the adjuvant group that received 40 mL PBS containing 2 ìg cholera toxin B (CTB), and groups 3-7 were immunized with 40 mL PBS containing a combination of adjuvant and one of the five different S. pneumoniae RrgB epitopes. The concentrations of IL-22 and β-defensin-2 from nasal rinse examination were measured by means of ELISA. The Kruskal-Wallis test, followed by the Mann-Whitney post-hoc test were used for statistical analysis. Results Rats immunized with the adjuvant-epitope combination had significantly higher β-defensin-2 and IL-22 levels than the control group (p=0.030; p=0.018, respectively), according to the Kruskal-Wallis test. And the Mann-Whitney statistical test, showed there was a significant increase in β-defensin-2 and IL-22 levels. Conclusions Intranasal immunization with epitope 1 of the S. pneumoniae RrgB can increase β-defensin-2 expression significantly and has a greater potential to be developed into a pneumococcal vaccine.
Universa Medicina, Volume 41, pp 29-36; https://doi.org/10.18051/univmed.2022.v41.29-36
Background Iron deficiency anemia (IDA), a type of anemia with an increasing global frequency, is more common in women than men in the population. In IDA, the sensitivity of erythrocytes to oxidants is increased and their lifespan is shortened. Oxidative stress is an imbalance between free radicals and antioxidant molecules which is one of the potential biochemical mechanisms involved in the pathogenesis of IDA. In our study, we aimed to determine the levels of oxidant and antioxidant markers by assessing the levels of total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase-1 (PON-1), and myeloperoxidase (MPO) in women with IDA. Methods This was a cross-sectional study involving 47 women with IDA aged ³40 years and 47 women volunteers. The levels of TAS, TOS, OSI, PON-1, and MPO were determined spectrophotometrically using appropriate kits. Non-parametric Mann Whitney-U tests were used to analyze the data. Results The levels of antioxidants TAS (1.42 mmol Trolox equiv./L) and MPO (54.00 U/L) in the IDA group were significantly lower than in the control group [TAS (1.67 mmol Trolox equiv./L) and MPO (89.00 U/L)] (p=0.000 and p= 0.019, respectively). However, TOS (6.25 ìmol H2O2 equiv./L) level in the IDA group was significantly higher than in the control group (4.13 ìmol H2O2 equiv./L) (p=0.000), but PON-1 was not significantly different between the two groups (p=0.375). Conclusion In women with IDA, the oxidant-antioxidant balance is impaired, resulting in oxidative stress. Therefore, IDA in adult women must receive adequate attention in clinical practice.
Universa Medicina, Volume 41, pp 18-28; https://doi.org/10.18051/univmed.2022.v41.18-28
Background Type 2 diabetes mellitus (T2DM) remains a public health problem in the world, including Indonesia. The high mortality of T2DM is triggered by an unhealthy eating pattern and sedentary lifestyle. We aimed to investigate the relationship of food intake pattern and its related factors with T2DM in adults 40 years and older. Methods This was a cross-sectional study conducted on 11,022 men and women with T2DM aged 40 years and older. Major dietary patterns were collected and multiple logistic regression analysis was used to determine the effect of covariates. Statistical significance was set at a p-value of 40 years comprised 50.17% and 26.19%, respectively, of the 11,022 respondents. Individuals aged over 50 years had a higher risk of developing diabetes than those aged less than 50 years (AOR =5.67, 95% CI=1.37-21.94, p<0.05). Dietary processed meat was associated with a higher risk of T2DM (AOR = 4.9; 95% CI=1.08-22.20, p<0.05). Carbohydrate and fruit intakes were negatively associated with and protective factors for DM (AOR= 0.01; 95% CI=0.01-0.06, p<0.01; AOR = 0.35; 95% CI=0.15-0.83, p<0.01). However, physical activity was not a risk factor for T2DM. Conclusions Processed meat consumption, age over 50 years, and carbohydrate intake may increase the risk of T2DM in adults. Conversely, fruit intake may decrease the risk of T2DM in adults. There is a need to control the diet and lifestyle for the early prevention of DM.
Universa Medicina, Volume 41, pp 11-17; https://doi.org/10.18051/univmed.2022.v41.11-17
Background Cataract has been known to cause high intraocular pressure which may lead to secondary glaucoma. Some anatomical changes in cataract patients are assumed to be factors contributing to increased intraocular pressure (IOP). The changes in IOP after cataract surgery tend to help surgeons to predict clinical outcomes. Therefore, IOP control is very important in these patients. This study aimed to determine the ocular biometric parameters and pressure-to-depth (PD) ratio associated with IOP in non-glaucomatous patients who undergo cataract surgery. Methods A prospective study using secondary clinical data collected from 81 non-glaucomatous patients. Data were collected by examining each subject pre- and post-operatively. The changes in ocular biometry parameters and IOP were measured one week before surgery and 8 weeks after the surgery. Univariate and multivariate linear regression were performed to analyze the data.Results The mean anterior chamber depth (ACD) change was 0.73 ± 0.16 mm, mean PD ratio was 5.04 ± 1.16, and the mean pre-operative IOP was 16.07 ± 2.92 mmHg, decreasing by 2.35 mm Hg (14.6 %) to 13.72 ± 3.42 mm Hg at 8 weeks postoperatively. Univariate linear regression results showed a significant correlation between PD ratio and post-operative IOP (p=0.000), but no significant association was observed between PD ratio and post-operative IOP in multiple linear regression (p=0.126). However, pre-operative IOP was significantly associated with post-operative IOP (Beta=1.244; p=0.004) Conclusions Our data demonstrated that pre-operative IOP was the most influential risk factor of IOP reduction after phacoemulsification in non-glaucomatous patients.
Universa Medicina, Volume 41, pp 4-10; https://doi.org/10.18051/univmed.2022.v41.4-10
Background Increased understanding in molecular pathology of advanced non-small cell lung cancer (NSCLC) over the past decades has led to personalized treatment approaches being advocated. Epidermal growth factor receptor (EGFR) mutation that often occurs in NSCLC can be identified using immunohistochemical examinations. Moreover, clarifying the relationship between computed tomography (CT) and EGFR mutation of NSCLC might inform therapeutic decision-making. The purpose of this study was to determine the relationship between metastatic sites on primary chest CT-scan and EGFR mutation in NSCLC lung cancer patients. Methods An cross-sectional design using secondary data was conducted, involving 76 NSCLC patients. EGFR mutations were determined by immunohistochemical examination and metastatic sites by chest CT-scan with contrast. The collected metastatic sites comprised hilar and mediastinal lymphadenopathy, pulmonary nodules, and bone, liver, spleen and suprarenal metastases. A Chi square test was used to analyze the data. Results This study revealed that the highest NSCLC stage was IVb, found in 39 samples (51.3%), while 34 (44.7%) subjects had EGFR mutation. There was no statistically significant difference between metastatic site and positive EGFR mutation, although positive bone metastases (54.8%) tend to have more numerous positive EGFR mutations compared to negative bone metastases (37.7%) (p=0.142). Conclusions Patients with positive bone metastases tend to have higher positive EGFR mutation compared to negative bone metastases in NSCLC lung cancer patients. Prospective studies evaluating patients with EGFR mutation for bone metastases should be considered. This can provide information on therapeutic decision-making to obtain good clinical outcomes.