Universa Medicina (UnivMed) is an official scientific publication of the Faculty of Medicine Universitas Trisakti and is a peer-reviewed open-access journal. Universa Medicina is a four-monthly medical journal that publishes new research findings on a wide variety of topics of importance to biomedical science and clinical practice. Universa Medicina is a general medical journal that focuses on all aspects of human health. Accredited journal based on Ministerial Decree of the Minister of Research and Technology / Head of National Research and Innovation Agency of the Republic of Indonesia with First Grade (Peringkat 1, Sinta 1, Garuda) No. 148/M/KPT/2020 Volume 38 Number 3, 2019 to Volume 43 Number 2, 2024. The Univ Med journal has been indexed and abstracted and displayed in Clarivate Analytics Web of Science Core Collection Database (Emerging Source Citation Index) (Q4 JCR) 2023, 2024, Dimensions-Digital Science, CABI, ASEAN Citation Index, DOAJ, Chemical Abstract Services (CAS), ROAD, National Library of Medicine, ICMJE, ICI, and SINTA. Imprint information Author Guidelines Make a Submission
Faculty of Medicine, Universitas Trisakti
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Bench to bedside and beyond: evolving trends in translational research
Copyright (c) 2025 Juhi Aggarwal https://creativecommons.org/licenses/by-nc-sa/4.0
An integrative review on the shadow of abuse in pediatric head trauma
Introduction Abusive head trauma (AHT) is a significant public health issue that can lead to severe neurological damage or death in childhood. Often difficult to detect, AHT carries long-term consequences and requires high diagnostic vigilance. This integrative review aims to synthesize the current evidence on abusive head trauma in pediatric patients by identifying distinguishing diagnostic criteria, clinical patterns, and risk factors, in order to support early recognition, accurate diagnosis, and effective intervention strategies by healthcare professionals. Methods This integrative review aimed to systematically include studies published between 2020-2025 and the literature search was conducted in April-June 2025. The databases searched included PubMed and Web of Science. The keywords included in the search were "Abusive head trauma", "child abuse", "non-accidental head injury", "health care professional", "pediatric head trauma". The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) tool. Results The findings were synthesized under four main themes: diagnostic indicators and differentiation, epidemiological risk factors, short-term clinical outcomes, and long-term developmental effects. Elevated glucose levels (>300 mg/dL), the diagnostic “triad” (subdural hematoma, retinal hemorrhage, and encephalopathy), and increased plasma osteopontin levels were identified as critical diagnostic clues. Additionally, household composition and caregiver characteristics emerged as significant risk factors. Conclusion This integrative review highlights the necessity of identifying high-risk environments and implementing preventive strategies. The evidence presented offers practical, evidence-based insights to support healthcare professionals in accurately diagnosing and managing AHT. It also underscores the need for multidisciplinary prevention efforts and post-trauma monitoring. Ultimately, this study seeks to enhance clinical awareness and improve early identification and intervention strategies for children suffering from abuse-related head trauma.
Copyright (c) 2025 Semra SÖNGÜT https://creativecommons.org/licenses/by-nc-sa/4.0
Fragrance preference of essential oil blends for reducing stress and sleep problems in adult women
Background Aromatherapy with a blend of essential oils is an alternative treatment for stress and sleep disturbances, providing stress relief and sleep enhancement, while increasing the efficacy and scent appeal. This study aimed to formulate an essential oil blend with the potential to reduce stress and enhance sleep quality, and to identify the most preferred blend based on participant satisfaction. Methods A cross-sectional study was conducted involving 63 female volunteers aged 25 - 50 years. Three formulations (A, B, and C) of essential oil blends were developed, each with a distinct scent profile—floral, unisex, and aromatic. A preference test was conducted using a sensory evaluation method, assessing participants’ satisfaction of the blends through inhalation. Preferences were quantified using a structured scoring system. Formula B was the most popular and was further refined into two recipes, B1 and B2. B2 emerged as the preferred option, and its primary component was identified using gas chromatography-mass spectrometry (GC–MS). Results Formulation B, rich in bergamot oil, received significantly higher hedonic ratings than Formulation A (p<0.05) and was the most preferred in interviews. Participants recommended a milder, more balanced scent for relaxation and sleep. While B1 and B2 showed no significant differences, B2 was chosen for its higher bergamot content, fresher unisex profile, and reduced floral notes. GC–MS analysis identified limonene, menthol, and linalool as its main components. Conclusion This study demonstrated that an essential oil blend predominantly composed of bergamot oil was most favored by the volunteers, indicating its potential benefits for promoting relaxation.
Copyright (c) 2025 Kanchanapa Sathirachawan, Kosum Chansiri, Deeprom Sirikate , Phakkharawat Sittiprapaporn, Ruttachuk Rungsiwiwut, Somrudee Saiyudthong https://creativecommons.org/licenses/by-nc-sa/4.0
Angiogenesis in rheumatoid arthritis: epidemiology, pathogenesis, signal transduction pathways, and nano-targeted therapeutic strategies
Angiogenesis is the formation of new blood vessels from existing vessels. In rheumatoid arthritis (RA), new blood vessels maintain a chronic inflammatory state by transporting inflammatory cells to the site of inflammation. Rheumatoid arthritis is a chronic autoimmune disorder that affects approximately 1% of the global population, with a higher prevalence in women. It is characterized by synovial inflammation, hyperplasia, and angiogenesis, leading to joint destruction. Understanding the pathogenesis of RA, particularly the mechanisms driving synovial angiogenesis, is crucial for the development of targeted therapies. Fibroblast-like synoviocytes (FLS) and endothelial cells play key roles in RA pathogenesis by secreting pro-inflammatory cytokines and growth factors, such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-1β, IL-6, and vascular endothelial growth factor (VEGF). These mediators activate multiple signaling pathways, including VEGF, nuclear factor kappa light chain enhancer of activated B cells (NF-κB), phosphatidylinositol-3 kinase (PI3K)/AKT, mitogen-activated protein kinase (MAPK), wingless-related integration site (Wnt), and the Janus kinase (JAK)/ signal transducer and activator of transcription (STAT), which contribute to synovial angiogenesis, inflammation, and joint damage. A literature search was conducted on PubMed, ScienceDirect, SpringerLink, and Google Scholar databases for sources published in English from 2015 to 2025, using the terms “nanotechnology rheumatoid arthritis,” “angiogenesis,” “synovial inflammation,” “pro-inflammatory cytokines,” “disease-modifying antirheumatic drugs,” and “signal transduction pathways”. Current treatments for RA include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs) (conventional synthetic, biological, and targeted synthetic). An informative overview of anti-angiogenic strategies for treating RA, which may provide new perspectives for developing nanoagents, is opening new horizons in the fight against RA. This review covers RA epidemiology, pathogenesis, and signal transduction, as well as current therapies and their limitations, highlighting the need to develop new treatment strategies that target angiogenesis in RA.
Copyright (c) 2025 Joan Blin, Mohd Rohaizad Md Roduan, Roslida Abd Hamid https://creativecommons.org/licenses/by-nc-sa/4.0
Bortezomib in multiple myeloma management
Multiple myeloma (MM) is a hematologic malignancy characterized by the uncontrolled proliferation of plasma cells, leading to complications such as bone lesions, renal dysfunction, and immune suppression. Over the past three decades, its incidence has risen significantly, attributed to factors such as aging populations and improved diagnostic methods. Treatment strategies have evolved considerably, transitioning from alkylating agents and high-dose chemotherapy to targeted therapies, including proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs). Bortezomib, a first-in-class PI, has revolutionized MM management by inhibiting proteasome activity, thereby inducing apoptosis in malignant plasma cells. This review evaluates the efficacy, safety, and clinical applications of bortezomib, both as monotherapy and in combination with dexamethasone, IMiDs, and conventional chemotherapies. Key clinical trials, such as VISTA and SUMMIT, demonstrate its superiority over traditional regimens, improving response rates and survival outcomes. However, its use is associated with adverse effects, including peripheral neuropathy, hematologic toxicities, and gastrointestinal disturbances, necessitating dose modifications and supportive care. Emerging combinations with monoclonal antibodies and novel agents further enhance therapeutic potential, though optimal sequencing remains under investigation. Systematic literature search was performed using PubMed and Cochrane to identify relevant studies on the applications of bortezomib. The search was inclusive of all publications up to May 2025, without restriction by publication year, to ensure a thorough review of research on bortezomib. Studies focusing on multiple myeloma (MM) and the efficacy of bortezomib were prioritized. A broad set of keywords was employed reflecting the diverse applications of bortezomib in MM treatment. The search strategy was designed to capture a wide range of relevant studies. By synthesizing evidence from 77 studies, this review highlights bortezomib’s pivotal role in MM treatment while addressing challenges in toxicity management. Future research should focus on refining combination strategies and minimizing side effects to maximize long-term patient outcomes.
Copyright (c) 2025 Hrishik Iqbal, Mohammad Nazmul Islam, Srikumar Chakravarthi, Mohammad Chand Jamali, Rezwan Ahmed Mahedi, Sadia Afrin, Pujita Roy, Fahadul Alam, Md.Shajalal Reza, Νikolaos Syrmos https://creativecommons.org/licenses/by-nc-sa/4.0
Foley catheter guided by semi-rigid ureterorenoscopy in the treatment of bladder diverticulum: a case report
Background A bladder diverticulum can be the consequence of a congenital abnormality or acquired as a result of trauma, infection, or outlet obstruction. Despite advancements in laparoscopic techniques, to date, precise intraoperative identification of diverticula remains a significant challenge. The aim of this case report was to offer an alternative technique using a foley catheter guided by semi-rigid ureterorenoscopy to facilitate bladder diverticulum identification during laparoscopic diverticulectomy. Case description A 77-year-old male patient presented with complaints of burning sensation during urination and reported frequent episodes of urinary tract infection over the past several months. Cystographic imaging revealed a large diverticulum located on the left posterior bladder wall. Non-contrast abdominal computed tomography (CT) scan identified a 10×10 mm calculus in the left inferior renal calyx. The patient was diagnosed with a bladder diverticulum. Subsequently, laparoscopic transperitoneal diverticulectomy was performed using a foley catheter guided by semi-rigid ureterorenoscopy for diverticulum identification and excision. The procedure commenced with cystoscopy to localize the diverticulum. Four trocars were inserted: two 12 mm and two 5 mm. A pneumoperitoneum pressure of 14 mmHg was maintained throughout the surgery. The diverticulum was clearly visualized during the operation, and excised successfully without injuring adjacent structures. Postoperative recovery was uneventful. Conclusion The use of a foley catheter guided by semi-rigid ureterorenoscopy may serve as an effective alternative for intraoperative identification of bladder diverticula, particularly in laparoscopic and resource-limited settings.
Copyright (c) 2025 Made Kresna Yudhistira Wiratma, Ahmad Zulfan Hendri, Eko Subekti https://creativecommons.org/licenses/by-nc-sa/4.0
The effect of self-foot massage on anxiety and sleep quality in nursing students: A single-blind randomized controlled study
Background Anxiety and poor sleep quality have always caused problems for nursing students. Today, self-foot massage is considered adjunctive therapy for reducing anxiety and improving sleep quality. This study aimed to evaluate the effects of self-foot massage on anxiety levels and sleep quality among nursing students with high anxiety. Methods An experimental study with pre-test and post-test control groups, included 40 first-year nursing students who met the inclusion criteria (intervention= 20, control= 20). The students were randomized into intervention and control groups using block randomization. A block size of four was employed to maintain equal group sizes. State Anxiety Inventory (SAI) and Pittsburgh Sleep Quality Index (PSQI) were used to collect the data. In the self-foot massage group, subjects attended foot massage sessions at the same time every day for 10 days. Independent t-test and Chi-square method was used to analyze the data. Results The intervention group performing self-foot massage demonstrated significantly lower mean scores for PSQI (7.70 ± 1.5) and SAI (34.10 ± 4.82) compared to the control group, whose mean scores were 8.00 ± 2.65 and 38.80 ± 3.04, respectively (p=0.03; p=0.021). These differences indicate improved sleep quality and reduced anxiety in the intervention group. Subjective sleep quality was also found to be better among participants in the intervention group. However, no significant differences were observed between the groups in the PSQI subcomponents (p>0.05). Conclusion Self-foot massage can be considered as a potential therapeutic intervention that improves sleep quality and reduces anxiety among nursing students with high level anxiety.
Copyright (c) 2025 Kezban KORAŞ SÖZEN, Songül GÜNGÖR https://creativecommons.org/licenses/by-nc-sa/4.0
24-hour movement guidelines: is there more to seek than time standards for health?
Copyright (c) 2025 Leandro Dragueta Delfino https://creativecommons.org/licenses/by-nc-sa/4.0
Predictors of persistent high disease activity after methotrexate treatment in rheumatoid arthritis patients
Background Methotrexate (MTX) is the firstline therapy for rheumatoid arthritis (RA). However, 30–40% of RA patients exhibit poor response. Identifying early factors associated with persistent disease activity is critical to guide treatment. This study aimed to identify predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients. Methods A retrospective cohort study was conducted involving 204 RA patients who had completed six months of MTX therapy. The primary outcome was DAS28-ESR score at six months. Independent variables included baseline erythrocyte sedimentation rate (ESR), cumulative doses of MTX and low-dose methylprednisolone (LDM), and rheumatoid factor (RF) status. Simple and multiple logistic regression was used to analyze the data. Results Significant differences in ESR and cumulative MTX dose were observed between low and high disease activity groups. Multivariate analysis identified four independent predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy: disease duration >11 months (AOR =0.45; 95% CI 0.23–0.89; p=0.025); age at onset >50 years (AOR 0.48; 95% CI 0.24–0.94; p=0.038); cumulative MTX dose >85 mg (AOR 4.75; 95% CI 1.55–14.64; p=0.006); ESR >66 mm/hr (AOR 2.32; 95% CI 1.11–4.89; p=0.026). Conclusion Greater cumulative methotrexate dose (>85 mg) was the most influential predictor of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients. These findings may assist clinicians in identifying patients at risk for poor MTX response and support timely therapeutic adjustments.
Copyright (c) 2025 Ayu Paramaiswari, Nyoman Kertia, Deddy Achadiono, Armin Sinarta, Dhite Nugroho https://creativecommons.org/licenses/by-nc-sa/4.0
Effectiveness of medium-chain triglyceride diet and low glycemic index therapy in drug-resistant childhood epilepsy: a systematic review, meta-analysis, and meta-regression
Background Drug-resistant epilepsy (DRE) challenges clinical management, with many patients failing to find relief. Medium-chain triglyceride diet (MCTD) and low glycemic index therapy (LGIT) are emerging variants of the ketogenic diet. MCTD and LGIT show promise but lack clear efficacy data. The purpose of this systematic review was to evaluate and compare the efficacy of MCTD and LGIT in the management of pediatric patients with DRE. Methods Four databases were searched (PubMed, Embase, Scopus, and Cochrane Library) from November 2024 to February 2025. Two independent reviewers meticulously screened titles, abstracts, and full texts, ensuring adherence to predefined criteria. Data extraction encompassed study characteristics, participant demographics, intervention details, and outcomes, including seizure frequency, percentage reduction, and adverse events. Statistical analyses were performed using R 4.2.2 software, assessing heterogeneity with Cochrane Q and I² and utilizing random-effects and common-effects models. Results From 1489 articles found, 487 duplicates were removed, 897 were excluded based on title and abstract screening, and of the 47 full-text articles assessed for eligibility, 31 articles were excluded, resulting in 16 articles (9 MCTD and 7 LGIT) included in this review. The pooled estimates for the proportion of children achieving seizure freedom, ≥90% seizure reduction, and ≥50% seizure reduction following the intervention were comparable between the MCTD and LGIT groups. Based on the random-effects model, the overall success proportion of MCTD in reducing seizure frequency was 0.20 [95 % Confidence Interval (CI), 0.14-0.27] (p<0.01). Meanwhile, in the LGIT group, the overall success proportion was 0.27 [95% CI,0.14- 0.45] (p<0.01). Conclusion Both MCTD and LGIT demonstrate comparable efficacy, and no definitive conclusion can be drawn regarding the superiority of one diet over the other.
Copyright (c) 2025 Elbert Wiradarma, Herlyani Khosama, Finny Warouw, Windy M. V. Wariki, Seilly Yunita Jehosua, Junita Maja Pertiwi https://creativecommons.org/licenses/by-nc-sa/4.0
Analysis of serum levels of B cell activating factor and soluble B cell activating factor receptor with disease activity in systemic lupus erythematosus
Background Systemic lupus erythematosus (SLE) is caused by B-cell hyperactivity, which stimulates the production of autoantibodies, leading to the formation of immune complexes and resulting in tissue damage. Increased B-cell activation is associated with disease activity in SLE. The cytokine B-cell Activating Factor (BAFF) and its soluble BAFF receptor (sBAFF-R) play a crucial role in B-cell activation and survival. Their serum levels may serve as potential biomarkers for SLE severity. This study aimed to compare serum levels of BAFF and sBAFF-R between SLE patients with mild, moderate, and severe disease activity. Methods A cross-sectional study was conducted involving 33 female SLE patients. Subjects were divided into mild, moderate, and severe disease activity groups. Disease activity was assessed using Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) scores. Serum BAFF and sBAFF-R levels were measured using ELISA. Data were analyzed using the Kruskal–Wallis and Mann-Whitney tests. A p-value < 0.05 was considered statistically significant. Results The median serum BAFF level in SLE patients was 0.51 ng/mL, and 4.66 ng/mL in sBAFF-R level.There was a statistically significant difference in serum BAFF and sBAFF-R levels between mild, moderate, and severe disease activity among SLE patients (p<0.0001). Conclusion Increased serum levels of BAFF and sBAFF-R may influence disease activity in SLE. Serum concentrations of BAFF and sBAFF-R were found to be associated with disease severity, including mild, moderate, and severe categories. These findings suggest that serum BAFF and sBAFF-R levels may serve as potential biomarkers for assessing SLE activity.
Copyright (c) 2025 Raveinal Raveinal, Dwitya Elvira, Muhamad Delfin https://creativecommons.org/licenses/by-nc-sa/4.0
Type 2 diabetes mellitus and recent treatment options in adolescents and young adults
Although type 2 diabetes mellitus (T2DM) has historically been thought of as a disease that mostly affects adults, its incidence among adolescents and young people has been rising in tandem with the rising rates of childhood obesity. There is no evidence to support the best course of treatment for T2DM in this age group despite the undeniable benefits of lifestyle adjustment for obese kids. Early diabetes start is linked to extended exposure to the disease and a greater likelihood of chronic issues, which impact more individuals during their working years and highlight the negative social effects of the condition. Additionally, there is mounting evidence that juvenile diabetes cohorts exhibit an aggressive phenotype that contributes to the early onset of problems that negatively affect life quality and negatively impact long-term results, increasing the possibility of a future public health emergency. Relevant studies were identified through a systematic search of PubMed, ScienceDirect, and Google Scholar for articles published between 2019 and 2025 using the keyword “Adolescents and (T2DM or Insulin Resistance)”. Type 2 diabetes in young people is a serious global public health issue now. Many significant obstacles must be overcome to treat T2DM that develops in young people, including a lack of effective treatment alternatives and limitations in carrying out therapeutic research. The US Food and Drug Administration has approved metformin, glimepiride (Amaryl), and insulin as treatments for teenagers and young adults with type 2 diabetes, despite therapeutic medication studies. Given modified pharmaceutical laws, it is probable that further anti-diabetic drugs will be included in the arsenal of treatment choices available to teenagers and young adults with T2DM. The epidemiology and current understanding of the pathophysiology, risk factors, consequences, and therapy of T2DM in adolescents and young adults are discussed in this review.
Copyright (c) 2025 Md Nadeem Bari; Md Rizwan Ansari; Mohammad Anwar, Imran Mohammad https://creativecommons.org/licenses/by-nc-sa/4.0
Optimizing prehospital care: a comprehensive review of evidence-based protocols for tension pneumothorax management
It is of the utmost importance to diagnose and treat tension pneumothorax (TPX) as soon as possible, because if not recognized and treated, it may swiftly cause collapse of the respiratory and circulatory systems. An estimated 5% of people with serious thoracic injuries may die from this avoidable cause, making it a leading cause of death in trauma and prehospital situations. Methods for diagnosis, procedures for intervention, and strategies for training are the primary foci of this study, which aims to provide a synthesis of evidence-based protocols for the prehospital treatment of TPX. A literature search was done on Pubmed and Google Scholars databases to identify the relevant literature from 2015 to 2025. This review focuses on the use of point-of-care ultrasonography to improve diagnosis accuracy and assesses the effectiveness of needle decompression and finger thoracostomy as first-line therapies. We will go over the main research that back these methods, how they differ between regions, and the difficulties of implementing them in prehospital care. Standardized training methods and further studies on appropriate intervention strategies are two of the significant gaps in the literature that are pointed out in this review. These results provide suggestions for improving prehospital care, increasing survival rates, and enhancing clinical practice. This review highlights current evidence-based strategies for diagnosing and managing tension pneumothorax (TPX) in prehospital settings. It emphasizes advancements such as point-of-care ultrasound (POCUS) and interventions such as needle decompression and finger thoracostomy. The review also addresses challenges in protocol implementation, especially in developing EMS systems such as in Saudi Arabia, citing issues such as training disparities, limited resources, and system readiness.
Copyright (c) 2025 Abdullah Alsamhari, Rafiulla Gilkaramenthi, Bader Hussain Alamer, Albaraa Jebreel, Hamdi Hasan Abdulbari, Saad M. Mushawwah, Lara Altaezi https://creativecommons.org/licenses/by-nc-sa/4.0
Hepatoprotective effects of celery in diethylene glycol induced toxicity in rats
Background Diethylene glycol (DEG) is a contaminant in pharmaceutical solvents and potentially induces hepatotoxicity. Celery is hepatoprotective due to its antioxidant properties. The objective of this study was to evaluate the hepatoprotective effects of celery on DEG-induced liver injury in rats. Methods An experimental laboratory study was conducted involving 25 male Wistar rats weighing 200 grams. They were randomized into five groups (5 rats in each group). Group A served as the control group, while Group B received oral administration of DEG at a dose of 3 g/kg BW twice daily for three days, following six days of food and water administration. The other three groups received DEG at 3 g/kg BW following six days of celery extract once daily administration of 100 mg/kg BW (C), 200 mg/kg BW (D), and 400 mg/kg BW (E). After 14 days, all rats were sacrificed. Observations were conducted macroscopically and microscopically using H&E staining. Liver damage was scored, Kruskal-Wallis followed by the Mann-Whitney was used to analyze the data. Results Macroscopic and microscopic examinations of the liver tissue in the celery groups revealed normal histological architecture with a significant reduction in liver damage. The ethanol extract of celery demonstrated hepatoprotective effects, as evidenced by a statistically significant reduction (p<0.05) in the activation of Kupffer cells, sinusoidal dilation, hepatocyte degeneration, and necrosis. Conclusion Celery has a protective effect against DEG-induced liver damage in rats based on the reduction in Kupffer cell activation, sinusoidal dilation, hepatocyte degeneration, and necrosis.
Copyright (c) 2025 Heny Ekowati, Syaikah Syahidah Waluyo, Nialiana Endah Endriastuti https://creativecommons.org/licenses/by-nc-sa/4.0
Galectin-3 and galectin-1 interactions in breast cancer therapy
Galectins, a family of β-galactoside-binding proteins, play critical roles in tumor progression, angiogenesis, and immune evasion, making them significant therapeutic targets in cancer treatment. By binding β-galactoside containing glycoconjugates, galectins modulate immune responses, apoptosis, and tumor development. The increasing recognition of their oncogenic roles has led to the development of carbohydrate- and peptide-based inhibitors that competitively bind to the carbohydrate recognition domain (CRD), disrupting galectin-mediated immune evasion, T-cell apoptosis, and angiogenesis. Given their intricate functions in the tumor microenvironment, a comprehensive evaluation of galectin inhibitors is warranted. This review synthesizes recent advancements in galectin-targeted therapies, including their mechanisms of action, efficacy in preclinical models, and potential synergy with chemotherapeutic agents and monoclonal antibodies. Despite promising developments, challenges remain in optimizing treatment regimens, overcoming resistance mechanisms, and identifying predictive biomarkers for patient stratification. Patient stratification, based on molecular or genetic profiles, is essential for enhancing therapeutic efficacy and ensuring personalized treatment approaches. A systematic literature search (2014–2024) was conducted using Google Scholar, ProQuest, Science Direct, and Scopus databases, with key terms including galectin inhibitors, cancer therapy, tumor microenvironment, immune evasion, and targeted therapy. This review highlights the role of galectin-1 and galectin-3 in breast cancer therapy, emphasizing their impact on tumor progression, immune modulation, and resistance to conventional treatments. Further translational research is necessary to refine clinical applications, optimize combination strategies, and establish biomarkers that enhance the integration of galectin inhibitors into existing treatment paradigms.
Copyright (c) 2025 Vanitha Innocent Rani, Aleti Lakshmi Manohari, Uthamalingam Murali, Mohd. Imran, Mary Anelia Correya, Tamalika Chakraborty, Preenon Bagchi, Gunamoni Das https://creativecommons.org/licenses/by-nc-sa/4.0
Diabetic retinopathy: pathogenesis, pathophysiology, and treatment
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and one of the leading causes of vision impairment worldwide. Prolonged hyperglycemia initiates a cascade of molecular events including chronic inflammation, oxidative stress, advanced glycation end products, and the activation of plasma kallikrein and protein kinase C signaling pathways, which leads to endothelial damage and pericyte loss. The resulting endothelial barrier dysfunction promotes serum leakage and retinal edema, while advanced disease stages are characterized by ischemia-driven retinal neovascularization mediated by elevated intraocular vascular endothelial growth factor (VEGF) levels. Current therapeutic strategies for diabetic retinopathy include laser therapy, intravitreal administration of anti-VEGF agents or corticosteroids, and vitreoretinal surgery. Despite their efficacy, a number of patients experience suboptimal responses. Consequently, novel therapeutic approaches are under investigation, including alternative anti-angiogenic agents, gene therapies, and visual cycle modulators currently undergoing clinical trials. A comprehensive understanding of the pathogenesis and pathophysiology of diabetic retinopathy is essential to improve existing treatment modalities and address current limitations in patient outcomes. In this review, we systematically searched and analyzed articles published in English from 2014 to 2024 using PubMed, ScienceDirect, SpringerLink, and Google Scholar. Relevant search terms included “diabetic retinopathy,” “pathophysiology,” “pathogenesis,” “treatment,” and “diabetic macular edema.” This review presents recent insights into the pathogenesis of diabetic retinopathy, including oxidative stress, inflammation, and neurodegeneration, followed by an overview of its pathophysiology such as microvascular dysfunction and neovascularization. Finally, current and emerging treatment modalities, encompassing both pharmacological and surgical approaches, are discussed. This structured approach provides essential background to understand the complexity of diabetic retinopathy and recent advances in its management.
Copyright (c) 2025 Yudistira Yudistira, Kevin Anggakusuma Hendrawan, Ari Andayani, Ni Made Ari Suryathi https://creativecommons.org/licenses/by-nc-sa/4.0
Effects of dietary protein combined with high-intensity exercise in restoring skin health in male rats
Background Protein is essential for skin integrity, while exercise modulates cellular and molecular processes that regulate autophagy, mitochondrial biogenesis, and collagen synthesis. This study evaluates the combined effects of dietary protein restriction and varying exercise intensities on epidermal thickness, autophagy markers (LC3, p62), mitochondrial biogenesis (PGC1α), and collagen synthesis (Col1a1, Col3a1) in male Wistar rats. Methods An experimental laboratory study was conducted involving 32 male Wistar rats. They were randomized into 8 groups: control, low protein, low intensity, group IV, moderate intensity, moderate intensity low protein, high intensity, and high intensity low protein. Low protein diet (5%) compared to the control (24%) was given for 60 days, while the exercise regimen was eight weeks of treadmill exercise (low/10 m per minute, moderate/20 m per minute, and high intensity/30 m per minute) for 30 minutes a day, five days a week. Epidermal thickness, LC3, p62, PGC1α, Col1a1, and Col3a1 mRNA expression were measured at the end of the study. One-way ANOVA/Kruskal-Wallis followed by Tukey HSD/Mann–Whitney test was used to analyze the data. Results A low-protein diet significantly reduced epidermal thickness (p=0.048), increased LC3 (p=0.043) and p62 (p=0.011), indicating impaired skin regeneration and autophagy. However, exercise, especially at high intensities with low protein, mitigated this effect by increasing both LC3 (p=0.011) and PGC1α (p=0.011). Conclusions These findings highlight the compensatory role of exercise in maintaining tissue integrity under protein-deprived conditions in male rats. High-intensity exercise potentially enhances autophagy and mitochondrial biogenesis.
Copyright (c) 2025 Julia Windi Gunadi, Ronny Lesmana, Faysal Kastella, Vita Murniati Tarawan, Hanna Goenawan, Decky Gunawan, Diana Krisanti Jasaputra https://creativecommons.org/licenses/by-nc-sa/4.0
Systematic review and meta-analysis of antibiotic strategies for survival in patients with drug-resistant Acinetobacter baumannii infection: does quantity matter?
Background Acinetobacter baumannii is an opportunistic pathogen frequently associated with severe hospital-acquired infections, particularly in intensive care units, and is characterized by high levels of antibiotic resistance, including to carbapenems. The rising prevalence of multidrug- and pan-drug-resistant strains poses significant therapeutic challenges and underscores the need for optimized treatment strategies to improve survival outcomes. This systematic review and meta-analysis evaluates the impact of different antibiotic treatment modalities (monotherapy versus combination) on the clinical outcome of patients with Acinetobacter baumannii infection. Methods This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To find pertinent studies released up to 3 January 2025 a thorough search was done in electronic databases such as PubMed, Embase, ScienceDirect, Cochrane, EBSCOhost, Google Scholar, and Scopus. Results This systematic review and meta-analysis identified 20 studies for inclusion. No statistically significant overall survival difference was found (Pooled OR = 0.83, 95% CI [0.66- 1.03], p = 0.09), but subgroup analyses indicated that combination therapy markedly enhanced survival rates in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infection, APACHE II scores below 20, and bloodstream infections. Meta-regression suggested that age may adversely affect treatment efficacy. A trend favoring combination therapy was consistent across subgroups, despite some results not reaching statistical significance. Conclusion This systematic review and meta-analysis highlights the treatment challenges of drug-resistant Acinetobacter baumannii, particularly MDRAB, XDRAB, and CRAB strains. Combination therapy offers potential benefits in CRAB and moderate-severity cases but is not universally superior to monotherapy. Treatment outcomes are influenced by patient-specific factors such as age, infection type, and disease severity.
Copyright (c) 2025 Masrahma Reinataya De Rorna, Alfiyah Ramadhani, Muhammad Farhan Hibatulloh, Dini Agustina https://creativecommons.org/licenses/by-nc-sa/4.0
Nephroprotective effect and untargeted metabolomic analysis of celery extract against diethylene glycol induced nephrotoxicity in rats
Background Diethylene glycol (DEG) is known for its nephrotoxic effects as a contaminant. Recent investigations suggest that celery extract potentially protects against DEG-induced renal toxicity, warranting an exploration of the non-targeted metabolomic profile of celery in renal tissue. This study aimed to determine celery nephroprotective effects and identify potential biomarkers using an untargeted metabolomic celery profile in DEG-induced kidney injury in male rats. Methods An experimental study was conducted involving 24 male Wistar rats, randomized into control and three treatment groups receiving DEG at doses of 1, 3, and 5 g/BW for three days. After 14 days, all rats were sacrificed. For the celery nephroprotective and metabolomic study, 27 male rats were randomized into three groups: control, DEG group at 3g/BW, and DEG-celery group (receiving celery extract 200mg/kg BW single dose for 6 days). After 14 days, blood was tested for creatinine level and untargeted metabolomic analysis using liquid chromatography-high resolution mass spectrometry. One-way ANOVA was used to analyze creatinine data. Results Diethylene glycol at doses of 1 and 3 g/kg BW caused mild renal damage, while 5 g/kg BW resulted in moderate damage. Creatinine levels in the normal, DEG-induced, and DEG-celery groups were 0.55 ± 0.14, 0.71±0.1, and 0.86± 0.17 mg/dL, respectively, but not statistically significantly different between groups (p>0.05). DEG lead tryptophan and phenylalanine levels increased 45-fold and 123-fold, respectively. Celery reduced levels of these metabolites 21-fold and 65-fold, respectively. Conclusion Diethylene glycol led to mild to moderate renal damage. Celery effectively diminished metabolite levels associated with renal damage, specifically tryptophan and phenylalanine.
Copyright (c) 2025 Triyadi Hendra Wijaya, Heny Ekowati, Hendri Wasito, Geeta Maryellen, Tasya Melinda Silitonga, Firdaus Oktavian https://creativecommons.org/licenses/by-nc-sa/4.0
Hypoxia-preconditioned mesenchymal stem cells attenuate proinflammatory cytokines in collagen loss animal model
Background Repeated ultraviolet-B (UVB) exposure induces significant collagen degradation, primarily through overproduction of reactive oxygen species, which subsequently drives an inflammatory cascade. Hypoxia-preconditioned mesenchymal stem cells (H-MSCs) constitute a promising therapeutic approach to counteract collagen loss by modulating inflammatory pathways. This study aimed to evaluate the potential of H-MSCs in regulating NF-κB p65 and IL-1β expression in a collagen loss rat model, highlighting their therapeutic efficacy. Methods Twenty-five healthy male Wistar rats were randomly assigned to five groups: K1 (healthy controls), K2 (collagen loss), K3 (collagen loss + hyaluronic acid), K4 (collagen loss + 2.5 × 10⁵ H-MSCs), and K5 (collagen loss + 5 × 10⁵ H-MSCs). Collagen loss was induced by UVB radiation (peak wavelength: 302 nm) for 2 weeks. mRNA expression of NF-κB p65 was quantified by qRT-PCR, while IL-1β levels were assessed using ELISA. The rats were maintained for 14 days before being sacrificed, to allow the H-MSCs to exert their therapeutic effects. Data analysis was by One-way ANOVA with Tukey’s post-hoc test. Results The administration of H-MSCs significantly reduced IL-1β levels in groups K4 (633.14±63.76 pg/mL) and K5 (520.80±123.82 pg/mL) compared to group K2 (931.93±205.80 pg/mL) (p<0.05), with group K5 showing the most substantial reduction. Moreover, H-MSC injection in groups K4 and K5 effectively reduced NF-κB p65 expression levels (1.13±0.50 a.u. and 0.72±0.22 a.u., respectively), compared to group K2 (2.47±0.50 a.u.) (p<0.05), with group K5 providing optimum inhibition. Conclusion This study demonstrated that H-MSCs effectively attenuate UVB-induced inflammation and modulate key inflammatory pathways.
Copyright (c) 2025 Yeni Fristiani, Agung Putra, Titiek Sumarawati, Eko Setiawan, Sugeng Ibrahim, Dodik Tugasworo Pramukarso Pramukarso https://creativecommons.org/licenses/by-nc-sa/4.0
Navigating the storm of healthcare workers burnout in the COVID-19 era: a bibliometric analysis
The COVID-19 pandemic has imposed unprecedented challenges on healthcare systems globally, significantly impacting healthcare workers (HCWs) and intensifying the incidence of occupational burnout. Characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment, burnout has been further exacerbated by pandemic-specific stressors such as resource limitations, fear of contagion, overwhelming workloads, and emotional fatigue. This bibliometric analysis systematically evaluated 2,043 peer-reviewed publications from 2019 onwards, retrieved from major databases including Web of Science, Scopus, and PubMed. Using tools such as VOS viewer, the study analysed keyword trends, author collaborations, citation metrics, and thematic clusters to map the evolving academic landscape surrounding HCWs burnout during COVID-19. The results revealed significant research diversity, with contributions from 11,156 unique authors and a collaboration index of 6.65, indicating robust interdisciplinary engagement. High research output and citation impact were observed in countries such as the United States, China, Italy, and the United Kingdom. Prominent themes included “COVID-19,” “burnout,” “mental health,” and “nurses,” highlighting the psychological toll on frontline professionals. Keyword co-occurrence and heatmap analyses demonstrated a shift in scholarly focus from the immediate crisis to long-term strategies for resilience and recovery. Despite these insights, notable disparities in research output persist, particularly in underrepresented regions such as France and several low- and middle-income countries. These imbalances may hinder the development of globally relevant, context-specific interventions. The study underscores the urgent need for inclusive, multidisciplinary collaboration to inform policy, guide mental health interventions, and enhance support systems for HCWs in current and future healthcare emergencies.
Copyright (c) 2025 Suriya Kumareswaran, Bala Murali Sundram, Thaalitha Naidu https://creativecommons.org/licenses/by-nc-sa/4.0
Threat of zoonotic malaria and strategy to overcome in Kalimantan (Indonesian Borneo) bordering Malaysian Borneo
Indonesia aims to eradicate malaria by 2030. Indonesia has the second highest disease burden in the WHO South-East Asia region, after India, accounting for 9% of all malaria cases in 2024. Malaria cases have dropped dramatically due to national strategic plans and programs, and the Indonesian Ministry of Health has certified several districts as malaria-free zones. Malaria cases in Kalimantan (Indonesian Borneo), have declined during the last two decades. Nearly all regencies within these provinces have been declared as having low malaria endemic status (API<1 per 1000 people), except for one regency in East Kalimantan Province, which showed a high endemicity level (API>5 per 1000 people). This reduced incidence, however, contrasts sharply with the zoonotic infection caused by the simian parasite Plasmodium knowlesi, which is prevalent in Malaysian Borneo. Only a few cases of P. knowlesi infection have been reported in South and Central Kalimantan Province since 2010. This difference between Kalimantan, Indonesia and Borneo, Malaysia appears contradictory given that both regions have a similar epidemiological risk of zoonotic malaria infection and share the same natural habitat. The references were tracked using various databases, such as Google Scholar, PubMed (MEDLINE) and other sources (Google engine and manual searching using a reference list). This review’s objective was to describe current malaria and zoonotic malaria, mosquito vector prevalence, and the available data from case reports along the Kalimantan border in Indonesia during the malaria elimination phase, compared with malaria distribution in the neighbouring country, Malaysian Borneo.
Copyright (c) 2025 Diana Natalia, Willy Handoko, Sari Rahmayanti, Tri Wahyudi, Ayu Akida Abdul Rashid, Paul Cliff Simon Divis https://creativecommons.org/licenses/by-nc-sa/4.0
Mineral levels in lactating Lagos women: blood-breast milk correlation and environmental-nutritional influences
Background Lifestyle choices and environmental exposure to certain materials have been reported to alter the distribution of key electrolytes in the blood and breastmilk of pregnant women and, in some cases, worsen micronutrient deficiencies. This study aimed to determine the association of sodium, iron, potassium, and calcium ions in maternal blood with those in breast milk and how maternal lifestyle routines could affect the level of these micronutrients. Methods A cross-sectional study was conducted involving 30 breastfeeding mothers with newborns. They were administered a pre-tested questionnaire following informed consent. Blood and breastmilk specimens were obtained thereafter to determine the serum and breastmilk levels of iron, potassium, sodium, and calcium. Data were analyzed using unpaired t-tests with the significance level of p<0.05. Results A significant reduction in serum and breastmilk potassium ion levels (p<0.001 for both) was found in lactating women taking vitamin D, vitamin B, calcium, and folic acid supplements, particularly with increased serum iron levels. Conversely, exposure to paints (p<0.001), radiation (p<0.001), borehole water (p<0.05) and tap water (p<0.05) increased potassium ion levels in both blood and breastmilk. Notably, significant correlations existed between blood and breastmilk levels of sodium and potassium ions. Conclusions While breastmilk sodium and potassium ion levels are directly related to the level in the serum, supplemental intake of some vitamins as well as exposure to paints and radiation could significantly reduce blood and breastmilk potassium, thus further worsening the micronutrient deficiency (aka hidden hunger) in pregnant women.
Copyright (c) 2025 Oluwakemi Oyelowo, Christian Makwe, Abdullahi Adejare, Oyinkansola Ajulo, Cynthia Dieobi https://creativecommons.org/licenses/by-nc-sa/4.0
Prognostic factors of brain metastases affecting survival: an Indonesian cohort
Background Brain metastases (BMs) most frequently originate from primary tumors of the lung and breast, and significantly impact cancer patient prognosis. Metastases can be detected synchronously along with the primary tumor or metachronously, following treatment of localized disease. The objective of this study was to identify key prognostic factors influencing survival in synchronous metastases (SM) and metachronous metastases (MM), focusing on metastatic duration, tumor volume response, and gamma knife radiosurgery. Methods A retrospective cohort study was conducted involving 100 patients with brain metastases (48 synchronous, 52 metachronous). Age, gender, primary tumor, gamma knife status, metastasis location, peritumoral index group, volume reduction, metastatic duration, metastasis characteristics, and intensity pattern based on MRI. A Cox proportional hazards regression was used to analyze the data. Based on the Cox regression coefficients, a prognostic index was constructed. Results Calculated HR comprised MM (HR=0.49;95% CI :0.24–0.97], gamma knife treatment (HR = 0.15;95% CI: 0.07–0.29], and volume response (HR=0.40;95% CI: 0.16–0.99), all indicating a significantly reduced mortality risk. A prognostic index was calculated for all patients; those with scores ≤–1.513 were classified as low risk. Kaplan-Meier analysis showed that the low-risk group had a significantly longer mean survival period (75.52 months) compared to the high-risk group (31.43 months) (p<0.001). Conclusion Metachronous presentation, gamma knife therapy, and greater tumor volume reduction independently predict better survival. The developed prognostic index provides a clinically useful tool for personalized risk assessment and treatment planning in patients with brain metastases.
Copyright (c) 2025 Koesbandono Koesbandono, Rusli Muljadi, Ratna Sutanto, Lutfi Hendriansyah, Erna Kristiani, Carissa Faustina, Jessica Christanti https://creativecommons.org/licenses/by-nc-sa/4.0
Robotic-assisted total knee replacement: pioneering precision and the future of joint reconstruction
The advent of robotic-assisted systems has revolutionized orthopedic surgery. By enhancing precision in bone registration and resection, this technology minimizes manual errors and soft tissue damage, promising more accurate implant positioning and improved postoperative outcomes. This editorial explores the technical nuances of robotic-assisted TKR, its clinical implications, and the long-term potential for transforming patient care.
Copyright (c) 2025 Erica Kholinne, Karina Sylvana Gani, Mitchel https://creativecommons.org/licenses/by-nc-sa/4.0
Antimalarial flavonoid glycoside from Carica papaya with inhibitory potential against Plasmodium falciparum dihydrofolate reductase thymidylate synthase: an in-silico study
BACKGROUND Carica papaya is traditionally used to treat malaria. The mechanism of action of the active constituents may be determined by molecular docking. This study therefore examined the in silico antimalarial activity of selected compounds from Carica papaya using Plasmodium falciparum dihydrofolate reductase thymidylate synthase (PfDHFR-TS) as target protein. METHODS Antimalarial activity screening of Carica papaya compounds was done in silico using AutoDock 4.2 software which was equipped with Autodock tools 1.5.6 for preparation. Five compounds contained in Carica papaya leaves, i.e. quercitrin, isoquercitrin, carpaine, caricaxanthin, and violaxanthin were successfully docked with the target protein. The molecular docking method is declared valid if the RMSD obtained is not more than 2 Å. In vitro evaluation of the test compounds as antimalarials was accomplished by determining their inhibitory activity against dihydrofolate reductase thymidylate synthase (PfDHFR-TS) which plays a role in the synthesis of nucleotides needed by Plasmodium falciparum. RESULTS Validation of Plasmodium falciparum DHFR-TS with PDB ID 1J3I showed an RMSD value of 1.58 Å. The docking results showed that quercitrin, isoquercitrin, carpaine, and caricaxanthin showed negative energy values similar to the native ligand. Therefore the four compounds have good affinity for the target protein, while violaxanthin shows a positive energy value, indicating no affinity for the target protein. CONCLUSION Based on binding affinity values and molecular interactions, isoquercitrin and quercitrin have inhibitory activity against dihydrofolate reductase thymidylate synthase (PfDHFR-TS), such that they have potential as natural antimalarial candidates.
Copyright (c) 2025 Dewa Ayu Agus Sri Laksemi, I Dewa Ayu Inten Dwi Primayanti, I Wayan Surudarma, Putu Ayu Asri Damayanti, Ni Made Pitri Susanti https://creativecommons.org/licenses/by-nc-sa/4.0
Rapid isolation and characterization of Wharton's jelly-derived mesenchymal stem cells maintained in fresh-prepared human AB-serum
Background Mesenchymal stem cells (MSCs) are valued in regenerative medicine for their multipotency, proliferative capacity, and immunomodulatory properties. Wharton’s jelly-derived MSCs (WJ-MSCs) from the umbilical cord offer a non-invasive, promising source for clinical applications, because easy isolation, lack of ethical concerns, and the presence of both embryonic and adult stem cells have made them a valuable source for use in therapeutic applications and regenerative medicine. This study aimed to optimize WJ-MSC isolation and characterization methods. Methods Human umbilical cords from three healthy donors were collected post-cesarean under strict inclusion criteria. WJ-MSCs were isolated using the explant culture method, with cells adhering to T75 flasks pre-coated with 2% gelatin. Cultures were maintained in Dulbecco’s Modified Eagle Medium (DMEM) supplemented with 10% freshly prepared Human AB serum and monitored for 21 days. Flow cytometry (BD FACSAria) was performed at passages 1 and 5 to assess MSC markers CD105, CD73, CD90, and CD44, alongside the exclusion marker CD45. Results WJ-MSCs exhibited fibroblast-like morphology by passage 1 and showed robust proliferation. Flow cytometry revealed high CD44 expression (~60%) at passage 1, while CD105, CD73, and CD90 became prominent by passage 5. CD45 remained low, suggesting minimal hematopoietic contamination. Conclusion This study confirms the feasibility of isolating and expanding WJ-MSCs using DMEM with 10% human AB serum. While consistent cell growth was achieved, the 21-day culture period may require optimization for scalability, including serum concentration, substrate coatings, and oxygen levels. CPJ-MSCs may be preferable for applications demanding rapid expansion and early marker expression.
Copyright (c) 2025 Yudy Tjahjono, Sianty Dewi, Bernadette Dian Novita Novita, Hendy Wijaya, Brilliant Dwi Putra, Suryo Kuncorojakti, Lucia Hendriati, FX Himawan Haryanto Jong, Teguh Widodo, Franklin Vincentius Malonda https://creativecommons.org/licenses/by-nc-sa/4.0
In-hospital mortality and its determinant factors among patients with sepsis
BACKGROUND Sepsis is a heterogeneous syndrome characterized by a variety of clinical features. Multiple studies have identified sepsis as the leading cause of death in hospitalized patients. A comprehensive report on the incidence, clinical characteristics, and predictors of sepsis is important. This study aimed to determine the relative importance of predictors of in-hospital mortality in sepsis. METHODS A retrospective cohort study at Dr. M. Djamil Central General Hospital focused on sepsis patients. A total of 200 participants, aged 18 and older, were included based on specific criteria and recruited through consecutive sampling. Data was gathered from medical records and laboratory results to identify factors influencing mortality in sepsis patients. These factors were classified into sociodemographic, intrinsic, and extrinsic categories. Statistical analysis utilized simple and multiple logistic regression. A p-value of less than 0.05 indicated statistical significance for predicting in-hospital mortality in sepsis. RESULTS The sepsis patient mortality rate was 69.50%. Hospital-acquired pneumonia (HAP) emerged as the most common infectious diagnosis, impacting 47.50% of the patients. Type 2 diabetes mellitus (Type 2 DM) was identified as the most frequent comorbidity, present in 36.50% of cases. Multivariate analysis indicated that HAP (adjusted odds ratio [aOR] 2.32; 95% confidence interval [CI] 1.19–4.49; p=0.013) and hyperlactatemia (aOR 2.11; 95% CI 1.06–4.18; p=0.032) significantly increased the risk of mortality in sepsis patients. CONCLUSION Hospital-acquired pneumonia was the primary predictor of mortality in sepsis patients. Timely prediction and evaluation of sepsis outcomes are essential for developing strategies to reduce mortality rates.
Copyright (c) 2025 Fadrian Fadrian, Eva Decroli, Armen Ahmad, Alexander Kam, Disa Hijratul Muharramah, Genta Pradana, Vidola Yasena Putri https://creativecommons.org/licenses/by-nc-sa/4.0
HIV‑1 drug‑resistance mutations and related risk factors among HIV‑1‑positive individuals receiving first-line antiretroviral therapy
Background Acquired immunodeficiency syndrome (AIDS) remains a global health issue. Antiretroviral therapy (ART) controls HIV progression, but widespread use had led to drug resistance mutations (DRMs) such as M184V and K103N, compromising treatment efficacy. This study assessed the prevalence of these mutations and identified associated risk factors in patients with first-line nucleoside reverse transcriptase inhibitor (NRTI)-based ART. Methods A cross-sectional study was conducted involving 80 HIV patients aged > 18 years who had been on NRTI and non-NRTI (NNRTI) therapy for >6 months. Data included sociodemographic characteristics, ART adherence, opportunistic infections, viral load, CD4 count, treatment duration, ART regimen, and presence of M184V and/or K103N mutations. Genetic analysis was performed and statistical associations were assessed using simple and multivariate logistic regression. Results M184V and/or K103N mutations were detected in 8 patients (10%), significantly associated with poor ART adherence (p<0.01), detectable viral load (p<0.01) and male gender (p=0.048), but not with age (p=0.653), body mass index (p=0.661), opportunistic infections (p=0.938), CD4 count (p=0.265), and treatment duration (p=0.365). Multivariate logistic regression analysis showed that poor ART adherence was associated with a decreased risk of mutations compared to good adherence (OR = 0.73, 95% CI:0.012-0.427) and male patients had a 10-fold higher risk compared to females (OR = 10.03, 95% CI:1.033-97.350). Conclusion This study demonstrated that male gender was significantly associated with an increased risk of mutations, while poor ART adherence showed an unexpected inverse association. Strengthening adherence support programs remains essential to preventing drug resistance mutations and ensuring treatment efficacy.
Copyright (c) 2025 Dwitya Elvira, Sri Puji Rahayuningsih, Rizka Nadia, Raveinal Masri https://creativecommons.org/licenses/by-nc-sa/4.0
Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis
Background Despite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis. Methods This retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis. Results A low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR <2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131). Conclusion The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.
Copyright (c) 2024 Kadek Mercu Narapati Pamungkas, Putu Itta Sandi Lesmana Dewi, Ni Luh Putu Yunia Dewi, Ni Nyoman Gita Kharisma Dewi, Dwijo Anargha Sindhughosa, I Ketut Mariadi https://creativecommons.org/licenses/by-nc-sa/4.0