Predictive accuracy of blood inflammatory markers on COVID-19 mortality

Background: The impact of COVID-19 may be more severe in developing countries. Our study aims to analyze the accuracy of several inflammatory biomarkers in predicting COVID-19 mortality, providing information about the most suitable markers for developing countries. Methods: A retrospective cohort study was conducted at Dr. Soetomo General Hospital, Indonesia, from March to June 2020. White Blood Cells (WBC) count, Neutrophil-Lymphocyte Ratio (NLR), Procalcitonin (PCT), D-Dimer, and C-Reactive Protein (CRP) have been collected from the electronic medical records. We performed survival analysis to provide the hazard ratio and Receiver Operating Characteristic (ROC) curve analysis to test for accuracy for each parameter. Results: A total of 423 patients who met the criteria for participating had a median age of 54 (IQR 45-61) years. Patients in the death group are characterized by older age and shorter length of hospitalization. The WBC, NLR, PCT, D-Dimer, and CRP are found significantly higher in the death group (P=0.000). The WBC, NLR, PCT, D-Dimer, and CRP have an Area Under the Curve (AUC) of 0.709, 0.773, 0.738, 0.721, and 0.769, respectively moderate accuracy in predicting COVID-19 patient mortality. We found that NLR is significantly more accurate than the age parameter (Z=3.527; P=0.000) but has equal accuracy with other laboratory parameters.  Conclusions: Since NLR obtained the highest accuracy, we still recommend routine complete blood count tests as prognostic biomarkers with the highest feasibility to be performed in developing countries

Performance of fecal S100A12 as a novel non-invasive diagnostic biomarker for pediatric inflammatory bowel disease:a systematic review and meta-analysis

Objective: The incidence and prevalence of inflammatory bowel disease (IBD) in pediatric patients are increasing. Currently, the diagnostic method for IBD is inconvenient, expensive, and difficult. S100A12, a type of calcium-binding protein, detected in the feces of patients with IBD has recently been suggested as a promising diagnostic tool. Hence, the authors aimed to evaluate the accuracy of fecal S100A12 in diagnosing IBD in pediatric patients by performing a meta-analysis. Methods: The authors performed a systematic literature search in five electronic databases for eligible studies up to July 15, 2021. Pooled diagnostic accuracies of fecal S100A12 were analyzed as the primary outcomes. Secondary outcomes were standardized mean difference (SMD) of fecal S100A12 levels between IBD and non-IBD groups and a comparison of diagnostic accuracies between fecal S100A12 and fecal calprotectin. Results: Seven studies comprising 712 children and adolescents (474 non-IBD controls and 238 IBD cases) were included. Fecal S100A12 levels were higher in the IBD group than in the non-IBD group (SMD = 1.88; 95% confidence interval [CI] = 1.19–2.58; p &lt; 0.0001). Fecal S100A12 could diagnose IBD in pediatric patients with a pooled sensitivity of 95% (95% CI = 88%–98%), specificity of 97% (95% CI = 95%–98%), and area under the receiver operating summary characteristics (AUSROC) curve of 0.99 (95% CI = 0.97–0.99). Fecal S100A12 specificity and AUSROC curve values were higher than those of fecal calprotectin (p &lt; 0.05). Conclusion: Fecal S100A12 may serve as an accurate and non-invasive tool for diagnosing pediatric IBD.</p

Determinant factors of treatment adherence of hypertensive patients in a rural area of Indonesia

Background: The surging prevalence of hypertension due to lifestyle brought forth an increase in degenerative diseases. Adherence is important in achieving the effectiveness of therapy. This study aims to analyze the factors affecting medication adherence in patients with hypertension.  Methods: A cross-sectional study was conducted between 20-24 February 2023 at Turirejo Village, Lawang District, Malang, Indonesia. Participants were hypertensive patients currently receiving treatment. The MMAS-8 questionnaire was used to classify adherence to medication for hypertension. Analysis with binary logistic regression test was performed on variables to display odds ratio values was conducted at a significance level of p&lt;0.05. Results: A total of 37 adults diagnosed with hypertension participated in this study. Patients were dominantly consisting of elderly (≥ 56 years old; 73.0%) and females (86.0%). Seventy-six percent of patients have low adherence, twenty-four percent of patients have moderate adherence, and no patient has high adherence. Duration of illness, knowledge, and attitude variables significantly affect adherence (low and moderate) to medication for hypertension. Multivariate analysis showed that patients with a duration of illness above 10 years (Adjusted OR 18.27; 95% CI 1.72-194.47; p-value 0.016) and positive attitude towards treatment (Adjusted OR 12.76; 95% CI 1.25-130.40; p-value 0.032, respectively) increase the possibility of moderate adherence towards the medication of hypertension. Conclusion: Improvements in factors that affect adherence to hypertension treatment are needed to increase the success of the Non-Communicable Disease Prevention Program. Further research in identifying factors of economic capacity and access to health service providers is needed to validate the results of this study

GABRA6 and SLC6A4 genotypes are correlated with the fasting blood glucose and physical fitness in the seemingly healthy young adults

Introduction: We examined environmental and genetic factors potentially correlated with the blood glucose and physical fitness in Kediri, East Java, Indonesia to elucidate the predominant cardiovascular disease risk.Methods:This was a cross-sectional study on 68 adults aged 18-22 years. Direct interview was conducted to get socio-economy, daily diets (rice/ R, snacks and sweets/ SS, veggies and fruits/ VF), daily activity (locomotors and non-locomotors) data. Peripheral blood-GABRA6 and SLC6A4 polymorphisms, fasting blood glucose (FBG), blood pressure, 3 fitness parameters (1 min push-up, 3 minutes step up, pulse rate after 3 minutes step-up) were measured by 2 independent and pre-trained medical doctors. Kruskal-Wallis, Chi-Square, andeta-coefficient tests were used to seek differences between genotypes and correlation strength between variables, respectively (significant if p<0.05).Results:Both gene’s genotypes showed significant correlations with the FBG (p=0.042, p=0.013, respectively); GABRA6 polymorphism significantly correlated with SU (p=0.033). There was a significant difference in the FBG between 2 VF subgroups (p=0.02). Strongest association was found between FBG and SLC6A4 (η=0.3); PR and GABRA6 (η=0.168), PU and SLC6A4 (η=0.38); SU and Locomotors (η=0.237).Conclusions:In these seemingly healthy young adults, daily diets and the genotypes of both genes have a good association with the FBG and physical fitness levels

Risk Factors Associated with Nasopharyngeal Cancer Incidences in Indonesia: A Systematic Review and Meta-Analysis

Abstract Objective: To determine the risk factors associated the incidence of NPC, particularly in Indonesia. Methods: This systematic review and meta-analysis was conducted according to PRISMA statement. Database including PubMed, Scopus, Science Direct, Web of Science, and GARUDA were retrieved. Newcastle-Ottawa scale was used to assess the quality of published study and analyse the risk of bias of included study. Random-effect model and reported pooled Odds Ratio (OR) with 95%CI was carried out in our meta-analysis. Results: A pooled of 7 studies were included in our study which included 764 participants. We found that female gender was not associated with the incidences of NPC (OR 1.45, 95% CI: 0.61-3.45, p=0.40), and smoking was highly increased the incidence of NPC (OR 4.39 95% CI (0.79-24.40), but not statistically significant (p=0.09). Furthermore, salted fish consumption and some HLA alleles were associated with increased risk. Conclusion: The incidence of NPC is not associated with female gender nor smoking habits. However, the risk of NPC is higher for those who consume salted fish and have some susceptible HLA alleles. Further investigations in larger studies are needed to confirm these findings

A review of existing neonatal hyperbilirubinemia guidelines in Indonesia [version 2; peer review: 2 approved]

Background Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required

A review of existing neonatal hyperbilirubinemia guidelines in Indonesia

Background: Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods: Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results: The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions: The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required

An Affordable phototherapy intensity meter using machine learning to improve the quality of care system for Hyperbilirubinemia in Indonesia.

Hyperbilirubinemia is more frequently seen in low and middle-income countries like Indonesia. One of the contributing factors is a substandard dose of Phototherapy irradiance. This research aims to design a phototherapy intensity meter called PhotoInMeter using readily available low-cost components. PhotoInMeter is designed by using a microcontroller, light sensor, color sensor, and an ND (neutral-density) filter. We use machine learning to create a mathematical model that converts the emission from the color sensor and light sensor into light intensity measurements that are close to Ohmeda Biliblanket's measurements. Our prototype collects sensor reading data and pairs them with Ohmeda Biliblanket Light Meter to create a training set for our machine learning algorithm. We create a multivariate linear regression, random forest, and XGBoost model based on our training set to convert sensor readings to Ohmeda Biliblanket Light Meter measurement. We successfully devised a prototype that costs 20 times less to produce compared to our reference intensity meter while still having high accuracy. Compared to Ohmeda Biliblanket Light Meter, our PhotoInMeter has a Mean Absolute Error (MAE) of 0.83 and achieves more than a 0.99 correlation score in all six different devices for intensity in the range of 0-90 μW/cm2/nm. Our prototypes show consistent reading between PhotoInMeter devices, having an average difference of 0.435 among all six devices

Predominant aspects of knowledge and practical skills among medical students with online learning during the COVID-19 pandemic era

Abstract Background: Social restrictions due to the COVID-19 pandemic have shifted most learning methods into online courses, especially for medical skills education. However, the effects of online courses on medical skill education amongst medical students are still arguable. The study aims to analyse medical students' knowledge, attitude, practice and satisfaction towards medical skills between online and offline courses. Method: We performed a case-control study conducted among 533 medical students with online (as a case group, n = 288) and offline courses (as a control group, n = 245). We evaluated three fundamental medical skills, including history taking [HT], lung physical examination [LPE], and heart physical examination [HPE]. We tested the knowledge and skills among students through theory and practical examinations. Students' attitudes and satisfaction were assessed using a validated questionnaire. Results: The scores for knowledge and practical skills among the online group were significantly higher (p = 0.016, p = 0.004, respectively). In comparison, the scores for the students' attitudes and satisfaction were substantially lower (p = 0.000, p = 0.003, respectively) compared to the control group. Most of the students in both groups passed the exam (case vs. control = 81.94%; 83.27%, respectively). Males were the only factor associated with a higher rate of passing the examination (OR 0.42, 95% CI [0.27-0.67], p = 0.000). Conclusions: Online learning could be an alternative approach on improving student's knowledge and practice towards medical skill especially amidst COVID-19 pandemic, however further consideration on student's attitude and satisfaction are mandatory to achieve appropriate competence as future general practitioner