ENCAPSULATION OF PARTIALLY PURIFIED BROMELAIN FROM PINEAPPLE CORES IN ALGINATE-PECTIN BEADS AS A TARGETED ANTIPLATELET AGENT

Objective: Oral administration of bromelain can decrease its bioactivity once it makes contact with stomach acid. Therefore, bromelain was loaded into alginate (Alg), pectin (Pec), and alginate-pectin (AP) beads to control its release into the intestines and avoid degradation. Methods: Crude bromelain was purified by ammonium sulfate precipitation and the dialysis process. In vitro releases and kinetics studies of bromelain-loaded alginate-pectin beads were carried out using an acid and phosphate buffer medium. The beads were characterized using physical analysis, Fourier-Transform Infrared Spectroscopy (FTIR) analysis, and Differential Scanning Calorimetry (DSC) analysis. Results: The dialysis fraction of bromelain has a specific activity of 67.93 U/mg, 3.05 times that of crude bromelain. That fraction was encapsulated in Alg, Pec, and AP beads with a range of encapsulation efficiency around 82.70–91.39%. Bromelain-loaded pectin and AP19 beads were chosen to study in an in vitro release based on their swelling properties and encapsulation efficiency. Bromelain-loaded AP19 beads have lower release than bromelain-loaded pectin beads in both dissolution mediums. The cumulative releases of AP19 are 9.99 and 87.81% in 0.1 N HCl and phosphate buffer medium, respectively. Bromelain-loaded P and AP beads both follow the zero-order kinetics model and the dissolution mechanism of the beads is non-Fickian with a combination of diffusion and erosion. The in vitro antiplatelet activity of dissolution aliquots (20.51 and 18.48%) is lower than its dialysis fraction (56.04%). Conclusion: This in vitro research data shows promising potency for AP as a carrier for oral administration of bromelain as an antiplatelet agent

HUBUNGAN FAKTOR RISIKO TERHADAP LUARAN PASIEN STROKE ISKEMIK BERULANG DI RUANG SERUNI A RSUD DR. SOETOMO SURABAYA PERIODE JANUARI – DESEMBER 2014

Pendahuluan: Faktor risiko stroke yang tidak terkontrol dapat menyebabkan stroke berulang. Kejadian stroke berulang mencapai 25% dari seluruh kejadian stroke Tujuan: Untuk membuktikan adanya hubungan antara faktor risiko terhadap luaran pasie stroke iskemik berulang. Metode: Desain penelitian ini adalah studi cross-sectional. Hubungan faktor risiko dengan luaran diuji dengan analisis chi-square. Result: Didapatkan 103 pasien yang terdiri dari 58 laki-laki dan 45 perempuan. Mayoritas terkena stroke iskemik berulang tipe trombotik (83.5%) dan pasien berusia antara 45-60 tahun (49.5%). Faktor risiko paling banyak pada pasien adalah hipertensi tahap 2 (54.4%). Faktor paling banyak menyebabkan luaran membaik pada pasien adalah riwayat tanpa kelainan jantung (92%). Sedangkan faktor risiko terbanyak pada pasien dengan luaran meninggal adalah dislipidemi (92.86%).. Conclusion: Jenis stroke dan riwayat dislipidemi memliki hubungan bermakna dengan luaran stroke (p=0.001 and p=0.003)

DISSOLUTION KINETICS OF PARTIALLY PURIFIED BROMELAIN FROM PINEAPPLE CORES (ANANAS COMOSUS [L.] MERR.) ENCAPSULATED IN GLUTARALDEHYDE-CROSSLINKED ALGINATE-GUAR GUM

Objective: Bromelain is susceptible to low pH and thus must be encapsulated in glutaraldehyde-crosslinked alginate-guar gum (Alg-GG) hydrogels to avoid bromelain activity degradation in the stomach. Methods: Isolated crude bromelain was purified through ammonium sulfate precipitation, sodium benzoate precipitation, and dialysis. Bromelain-loaded Alg-GG was dissolved in artificial gastric fluid and intestinal environment. Results: The bromelain fractions showed a higher specific activity (U/mg) than the crude enzyme (51.32), as follows ammonium sulfate fraction (267.70±4.67), sodium benzoate fraction (115.63±3.35), and dialysis fraction (332.22). The dialysis fraction was encapsulated in Alg-GG hydrogel containing 0.75% (v/v) glutaraldehyde through the post-loading method. The swelling ratios of the hydrogel are 188.43% at pH 1.2 and 563.83% at pH 7.4. The highest encapsulation efficiency is 72.2%. The maximum bromelain concentration released during dissolution is higher in artificial intestinal environment (1.97 mg/L) than in artificial gastric fluid (0.18 mg/L), and the maximum proteolytic activities are 1.3 and 0.15 U/mL, respectively. Data were incorporated into the zero-order, first-order, Higuchi, and Korsmeyer–Peppas models to determine the kinetics and mechanism of bromelain dissolution. All bromelain concentrations (70, 140, and 210 ppm) follow the Korsmeyer–Peppas model. The dissolution mechanism is a combination of diffusion and erosion. Both the dialysis fraction (56.59%) and the dissolution product (47.45%) showed a good in vitro antiplatelet activity. Conclusion: The present data show the promise of Alg-GG encapsulation as a vehicle for orally administered therapeutic enzymes

High-dose vs low-dose steroid in pregnancy patients with systemic lupus erythematosus and lupus nephritis: A systematic review and meta-analysis

Background: Management of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in pregnancy has been improving in recent decades. However, SLE can still lead to adverse pregnancy outcomes if not appropriately treated. Optimal dose of steroids, as one of the most commonly used for the treatment of SLE and LN in pregnancy is still a subject of debate. In this review, we determine the pregnancy outcomes in SLE and LN patients treated with low vs high doses of steroids. Methods: ProQuest, Pubmed, Science Direct, Scopus, and Web of Science were carefully searched for relevant studies published in English. A total of 2,596 studies were reviewed. We extracted the data from previous studies showing the use of steroids treatment in high-dose and low-dose related to pregnancy outcomes. We provide larger data about maternal (preterm rupture of membrane, fetal loss, pre-eclampsia, and flare up) and fetal outcomes (prematurity, small gestational age, low birth weight) receiving high vs low steroid in patients with SLE and LN in this systematic review and meta-analysis. Results: A total of 13 studies were included. Of these, one study discussed a group with LN and 12 other studies discussed SLE with related maternal and fetal outcomes. Maternal outcome in the group with low-dose steroid showed a lower risk of fetal loss (odds ratio (OR): 1.93; 95% confidence interval (CI) 1.01-3.70), but there were no differences in other maternal outcomes. The low-dose steroid group showed a better fetal outcome, with a lower risk of prematurity (OR: 3.06; 95% CI 1.98-4.71), small gestational age (OR: 2.63; 95% CI 1.15-6.00), and low birth weight (OR: 2.43; 95% CI 1.23-4.79). Conclusions: In pregnant patients with SLE or LN, high-dose steroids are associated with the high risk of fetal loss during pregnancy, preterm birth, small gestational age, and low birth weight

Markers of Renal Complications in Beta Thalassemia Patients with Iron Overload Receiving Chelation Agent Therapy: A Systematic Review

Objective: The emerging renal complications in beta-thalassemia patients have raised the global exchange of views. Despite better survival due to blood transfusion and iron chelation therapy, the previously unrecognized renal complication remain a burden of disease affecting this population —the primary concern on how iron overload and chelation therapy correlated with renal impairment is still controversial. Early detection and diagnosis is crucial in preventing further kidney damage. Therefore, a systematic review was performed to identify markers of kidney complications in beta thalassemia patients with iron overload receiving chelation therapy. Methods: Searches of PubMed, Scopus, Science Direct, and Web of Science were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify studies of literature reporting renal outcome in β-TM patients with iron overload and receiving chelation therapy. The eligible 17 studies were obtained. Results: uNGAL/NGAL, uNAG/NAG, uKIM-1 are markers that can be used as predictor of renal tubular damage in early renal complications, while Cystatin C and uβ2MG showed further damage at the glomerular level. Discussion and Conclusion: The renal complication in beta-thalassemia patients with iron overload receiving chelating agent therapy may progress to kidney disease. Early detection using accurate biological markers is a substantial issue that deserves further evaluation to determine prevention and management. © The Authors