Bee- and Wasp-Venom Sensitization in Schoolchildren of High- and Low-Socioeconomic Status Living in an Urban Area of Indonesia.

BACKGROUND: There is not much known about venom allergy in tropical regions. Here, we studied the prevalence of specific IgE (sIgE) and skin prick test (SPT) reactivity and reported sting-related symptoms, in high- and low-socioeconomic status (SES) schoolchildren living in urban city of Makassar in Indonesia. METHODS: Children from high- (n = 160) and low- (n = 165) SES schools were recruited. Standardized questionnaires were used to record information on allergic disorders as well as sting-related symptoms. Parasitic infection, SPT reactivity, and sIgE to Apis mellifera (bee-venom) as well as Vespula spp. (wasp-venom) were assessed. RESULTS: SPT reactivity to bee- and wasp-venom was 14.3 and 12.7%, while the prevalence of sIgE was 26.5 and 28.5%, respectively. When SES was considered, prevalence of SPT to bee- and wasp-venom was higher in high-SES than in low-SES schoolchildren (bee: 22.8 vs. 5.7%, p < 0.001; and wasp: 19.6 vs. 5.7%, p < 0.001). Conversely, sIgE to both venoms was lower in high-SES than in low-SES (bee: 19 vs. 34%, p = 0.016; and wasp: 19 vs. 38%, p = 0.003). Furthermore, among SPT positive subjects, considerable proportion had no detectable sIgE to bee- (65.85%) or wasp-venom (66.67%). Altogether the sensitizations were rarely translated into clinical reaction, as only 1 child reported significant local reaction after being stung. No association with parasitic infections was found. CONCLUSIONS AND CLINICAL RELEVANCE: Sensitization against bee- or wasp-venom is quite prevalent among schoolchildren in Indonesia. The discordance between SPT and sIgE might suggest the direct (non-IgE) effect of venoms in skin reactivity. Recorded sensitizations had poor clinical relevance as they rarely translated into clinical symptoms.

The relationship between malnutrition and TH 2 immune markers: a study in school-aged children of different socio-economic backgrounds in Makassar, Indonesia.

OBJECTIVE: The burden of underweight remains a major problem in Indonesia, and at the same time, the prevalence of overweight is increasing. Malnutrition is a major determinant of health and has been linked to allergic disorders in children. We examined the relationship between malnutrition and TH 2 immune markers in school-aged children in Makassar, Indonesia. METHODS: A cross-sectional study was performed in five schools where socio-demographic characteristics were recorded. Children's standardised z-scores of body mass index (z-BMI) and age-standardised z-scores of height (z-HA) were assessed using WHO child growth standards. Skin prick test (SPT) reactivity was determined to house dust mite allergens. Helminth infection status, (growth) hormones including insulin-like growth factor (IGF-1) and TH 2 immune markers were measured. RESULTS: In total, 954 children were included of whom 21.6% were underweight and 14.8% overweight. After controlling for confounders, overweight was positively associated with leptin (GMR 3.55, 95% CI: 2.99-4.23) and IGF-1 (GMR 1.45, 95% CI: 1.15-1.82), whereas underweight was negatively associated (respectively GMR 0.57, 95% CI: 0.49-0.66 and GMR 0.78, 95% CI: 0.63-0.97). Underweight was associated with a lower eosinophil count (GMR 0.79, 95% CI: 0.64-0.97) but not with total IgE levels or SPT reactivity. Overweight was positively associated with SPT reactivity (adjusted OR 2.68, 95% CI: 1.50-4.78) but no relationship was found with the other TH 2 immune markers. CONCLUSION: Malnutrition is prominent in school-aged children in Makassar, with overweight associated with increased SPT reactivity. Therefore, interventions should focus on undernutrition, but also on overweight to prevent the increase of allergic disorders in Indonesia.

OBJECTIF: La charge de l'insuffisance pondérale reste un problème majeur en Indonésie et parallèlement, la prévalence du surpoids augmente. La malnutrition est un déterminant majeur de la santé et a été associée à des troubles allergiques chez les enfants. Nous avons examiné la relation entre la malnutrition et les marqueurs immunitaires TH 2 chez les enfants d'âge scolaire à Makassar, en Indonésie. MÉTHODES: Etude transversale dans cinq écoles où les caractéristiques sociodémographiques ont été enregistrées. Les scores z standardisés de l'indice de masse corporelle (z-IMC) et les scores z standardisés pour l'âge de la taille (z-HA) pour les enfants ont été évalués en utilisant les normes de croissance de l'enfant de l'OMS. La réactivité du test cutané (SPT) a été déterminée pour les allergènes d'acariens. L'état de l'infection par les helminthes, les hormones (de croissance), y compris le facteur de croissance analogue à l'insuline (IGF-1) et les marqueurs immunitaires TH 2 ont été mesurés. RÉSULTATS: Au total, 954 enfants ont été inclus, dont 21,6% en insuffisance pondérale et 14,8% en surpoids. Après contrôle des facteurs de confusion, le surpoids était positivement associé à la leptine (GMR 3,55, IC95%: 2,99-4,23) et à l'IGF-1 (GMR 1,45 ; IC95%: 1,15-1,82), tandis que l'insuffisance pondérale était associée négativement (respectivement GMR 0,57 ; IC95%: 0,49-0,66 et GMR 0,78 ; IC95%: 0,63-0,97). L'insuffisance pondérale était associée à un nombre plus faible d'éosinophiles (GMR 0,79 ; IC95%: 0,64-0,97) mais pas aux taux d'IgE totaux ou à la réactivité du SPT. Le surpoids était positivement associé à la réactivité du SPT (OR ajusté 2,68 ; IC95%: 1,50-4,78) mais aucune relation n'a été trouvée avec les autres marqueurs immunitaires T H 2. CONCLUSION: La malnutrition est importante chez les enfants d'âge scolaire à Makassar, avec un surpoids associé à une réactivité accrue du SPT. Par conséquent, les interventions devraient se concentrer sur la dénutrition, mais aussi sur le surpoids pour prévenir l'augmentation des troubles allergiques en Indonésie.

Non-nutritional and disease-related anemia in Indone-sia: A systematic review.

Non-nutritional anemia, the second most common type of anemia worldwide after nutritional anemia, includes the anemia of inflammation (AI) and that due to helminthiasis. In this review, we examine the contribution that non-nutritional anemia makes to incidence in Indonesia. Anemia due to helminthiasis is a common problem in Indonesia and contributes to prevalence, particularly in children under 5 years. We conducted a systematic literature review based on Google Scholar and Pubmed for non-nutritional anemia. We supplemented this with hemoglobin and chronic disease data in Makassar where prevalence and type of anemia were available. To effectively reduce anemia prevalence in Indonesia, interventions should address both nutritional and non-nutritional contributing factors, in-cluding infection and genetic predisposition.

BCG scar, socioeconomic and nutritional status: a study of newborns in urban area of Makassar, Indonesia.

OBJECTIVE: To investigate factors that determine the response to Bacille Calmette-Guérin (BCG) vaccination in urban environments with respect to socioeconomic status (SES), prenatal exposure to infections or newborn's nutritional status. METHODS: The study was conducted in an urban area, in Makassar, Indonesia. At baseline, 100 mother and newborns pair from high and low SES communities were included. Intestinal protozoa, soil transmitted helminths, total IgE, anti-Hepatitis A Virus IgG and anti-Toxoplasma IgG were measured to determine exposure to infections. Information on gestational age, birth weight/height and delivery status were collected. Weight-for-length z-score, a proxy for newborns adiposity, was calculated. Leptin and adiponectin from cord sera were also measured. At 10 months of age, BCG scar size was measured from 59 infants. Statistical modelling was performed using multiple linear regression. RESULTS: Both SES and birth nutritional status shape the response towards BCG vaccination at 10 months of age. Infants born to low SES families have smaller BCG scar size compared to infants born from high SES families and total IgE contributed to the reduced scar size. On the other hand, infants born with better nutritional status were found to have bigger BCG scar size but this association was abolished by leptin levels at birth. CONCLUSION: This study provides new insights into the importance of SES and leptin levels at birth on the development of BCG scar in 10 months old infants.

OBJECTIF: Investiguer les facteurs qui déterminent la réponse à la vaccination par le BCG en milieu urbain en ce qui concerne le statut socioéconomique (SSE), l'exposition prénatale aux infections ou l'état nutritionnel du nouveau-né. MÉTHODES: L'étude a été menée dans une zone urbaine, à Makassar, en Indonésie. Au départ, 100 paires mère-nouveau-né issues de communautés à statut social élevé et faible ont été incluses. Les protozoaires intestinaux, les helminthes transmis par le sol, les IgE totales, les IgG anti-virus de l'hépatite A et anti- Toxoplasma ont été mesurés pour déterminer l'exposition aux infections. Des informations sur l'âge gestationnel, le poids/taille à la naissance et l'état d'accouchement ont été collectées. Le z-score poids-pour la taille, un indicateur indirect de l'adiposité du nouveau-né a été calculé. La leptine et l'adiponectine provenant de sérum des cordons ont également été mesurées. A l'âge de 10 mois, la taille des cicatrices de BCG a été mesurée chez 59 nourrissons. La modélisation statistique a été réalisée à l'aide d'une régression linéaire multiple. RÉSULTATS: Le statut socioéconomique et l'état nutritionnel à la naissance déterminent la réponse à la vaccination par le BCG à l'âge de 10 mois. La taille des cicatrices de BCG est plus petite chez les nourrissons nés de familles à statut socioéconomique faible comparée à celles chez ceux de familles à statut socioéconomique élevé et les IgE totales ont contribué à la réduction de la taille de ces cicatrices. En revanche, les bébés nés avec un meilleur état nutritionnel avaient une taille de cicatrice du BCG plus grande, mais cette association était supprimée par les niveaux de leptine à la naissance. CONCLUSION: Cette étude fournit de nouvelles informations sur l'importance du SSE et des niveaux de leptine à la naissance sur le développement d'une cicatrice du BCG chez des nourrissons âgés de 10 mois.

Community deworming alleviates geohelminth-induced immune hyporesponsiveness.

In cross-sectional studies, chronic helminth infections have been associated with immunological hyporesponsiveness that can affect responses to unrelated antigens. To study the immunological effects of deworming, we conducted a cluster-randomized, double-blind, placebo-controlled trial in Indonesia and assigned 954 households to receive albendazole or placebo once every 3 mo for 2 y. Helminth-specific and nonspecific whole-blood cytokine responses were assessed in 1,059 subjects of all ages, whereas phenotyping of regulatory molecules was undertaken in 121 school-aged children. All measurements were performed before and at 9 and 21 mo after initiation of treatment. Anthelmintic treatment resulted in significant increases in proinflammatory cytokine responses to Plasmodium falciparum-infected red blood cells (PfRBCs) and mitogen, with the largest effect on TNF responses to PfRBCs at 9 mo-estimate [95% confidence interval], 0.37 [0.21-0.53], P value over time (Ptime) < 0.0001. Although the frequency of regulatory T cells did not change after treatment, there was a significant decline in the expression of the inhibitory molecule cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) on CD4+ T cells of albendazole-treated individuals, -0.060 [-0.107 to -0.013] and -0.057 [-0.105 to -0.008] at 9 and 21 mo, respectively; Ptime = 0.017. This trial shows the capacity of helminths to up-regulate inhibitory molecules and to suppress proinflammatory immune responses in humans. This could help to explain the inferior immunological responses to vaccines and lower prevalence of inflammatory diseases in low- compared with high-income countries.

Competing for blood: the ecology of parasite resource competition in human malaria-helminth co-infections.

Ecological theory suggests that co-infecting parasite species can interact within hosts directly, via host immunity and/or via resource competition. In mice, competition for red blood cells (RBCs) between malaria and bloodsucking helminths can regulate malaria population dynamics, but the importance of RBC competition in human hosts was unknown. We analysed infection density (i.e. the concentration of parasites in infected hosts), from a 2-year deworming study of over 4000 human subjects. After accounting for resource-use differences among parasites, we find evidence of resource competition, priority effects and a competitive hierarchy within co-infected individuals. For example reducing competition via deworming increased Plasmodium vivax densities 2.8-fold, and this effect is limited to bloodsucking hookworms. Our ecological, resource-based perspective sheds new light into decades of conflicting outcomes of malaria-helminth co-infection studies with significant health and transmission consequences. Beyond blood, investigating within-human resource competition may bring new insights for improving human health.

Helminth-induced IgE and protection against allergic disorders.

The immune response against helminths and allergens is generally characterized by high levels of IgE and increased numbers of Th2 cells, eosinophils, and mast cells, yet the clinical outcome with respect to immediate hypersensitivity and inflammation is clearly not the same. High levels of IgE are seen to allergens during helminth infections; however, these IgE responses do not translate into allergy symptoms. This chapter summarizes the evidence of the association between helminth infections and allergic disorders. It discusses how helminth infection can lead to IgE cross-reactivity with allergens and how this IgE has poor biological activity. This information is important for developing new diagnostic methods and treatments for allergic disorders in low-to-middle-income countries.

Asymptomatic plasmodial infection is associated with increased tumor necrosis factor receptor II-expressing regulatory T cells and suppressed type 2 immune responses.

BACKGROUND: In malaria-endemic areas, a proportion of individuals becomes chronic carriers of parasites with few or no clinical signs. There is little information on cellular immune responses in asymptomatic parasite carriers. METHODS: In 80 schoolchildren residing in a malaria-endemic area of Flores Island, Indonesia, T-helper subsets, regulatory T-cell (Treg) frequencies, tumor necrosis factor receptor type II (TNFRII) expression on Tregs, and cytokine responses induced by Plasmodium falciparum-infected red blood cells (RBCs) were measured, and values for asymptomatic infected subjects were compared to those for uninfected controls. To ascertain that alterations found were due to the presence of malaria parasites, the immune responses were analyzed in 16 children before and 1 month after antimalarial treatment. RESULTS: TNFRII expression, a marker of activation on Tregs, was higher during infection but decreased upon treatment. GATA3-positive cells and the level of interleukin 13 secretion in response to P. falciparum-infected RBCs appeared to be suppressed by plasmodial infection, as both increased after antimalarial treatment. TNFRII expression on Tregs correlated positively with TNF in response to P. falciparum-infected RBCs, but this association disappeared following treatment. CONCLUSIONS: Malaria parasites associated with asymptomatic infections seem to result in increased TNFRII expression on Tregs, as well as suppressed Th2 cytokine responses, features that might be important for survival of the parasites in asymptomatic carriers.

The relationship of changes in molecular subtypes with metastases and progression-free survival in breast cancer.

BACKGROUND: Molecular subtyping of breast cancer cells is increasingly being developed as an initial step in selecting therapy and predicting the prognosis of breast cancer patients. During breast cancer, the molecular subtype of cancer cells can change. This study aimed to analyze the relationship between changes in the intrinsic subtype of breast cancer with metastasis and progression-free survival in breast cancer patients. METHODS: This was a retrospective cohort study of patients diagnosed with breast cancer from 2016 to 2021. The molecular subtypes from the immunohistochemical examination results were recorded twice, and metastasis and progression-free survival (PFS) were recorded. The data were analyzed using the chi-square test and SPSS 26. RESULTS: Of the 44 patients, 19 (43.2%) experienced a change in molecular subtype, and 25 (56.8%) did not. No significant relationship existed between changes in molecular subtype and metastasis (p = 0.405). No significant relationship existed between changes in molecular subtype and PFS (p = 0.900). A significant relationship was found between changes in the molecular subtype and PFS in the patients with changes in the molecular subtype (p = 0.022). CONCLUSIONS: Changes in the intrinsic subtype were associated with PFS in breast cancer patients. Patients with an intrinsic subtype that changed to triple-negative showed worse PFS.

Serotonin Levels in Newly-Infected HIV-Positive: A Preliminary Study.

Background: HIV is still a global health concern worldwide and in 2021, a total of 27,000 newly infected cases were detected in the Indonesian population, specifically among adults. However, there is no available data found about serotonin levels in newly infected cases of HIV. Objective: This study aimed to preliminary investigate serotonin levels in newly-infected HIV-positive cases in the Indonesian population. Methods: A quantitative cross-sectional analytic design was used with a total of 54 newly-infected HIV-positive participants who were enrolled using the purposive sampling technique. The questionnaire, blood sampling, and ELISA methods for measuring serotonin were applied. Furthermore, the serotonin distribution was compared based on participants' characteristics using the Mann-Whitney U test. The main effect of characteristics was also tested by the generalized linear model. Results: The mean serotonin level was low and did not differ based on participants' characteristics. Conclusion: Low serotonin level is characteristic of people newly infected with HIV in Indonesia. This might be a manifestation of the depression stage, a consequence of infection, or the involvement in provoking HIV infection progression.

Vertebral destruction in tuberculous spondylitis correlates with Toll-like Receptor 4 (TLR-4) levels: a cross-sectional study.

Background: Tuberculous (TB) spondylitis is a hazardous infectious disease causing significant spinal deformity. Increased toll-like receptor-4 (TLR-4) activity promotes more extensive infections in patients with TB spondylitis, so it has the potential to be used as a biomarker to predict the severity. This study aims to determine the relationship between TLR-4 levels and the degree of vertebral destruction in TB spondylitis patients. Materials and methods: A cross-sectional study was conducted from May to October 2023. A total of 27 TB spondylitis samples were then measured for TLR-4 serum levels. Vertebral destruction is assessed based on the Spine At Risk Signs (SARS) criteria on X-ray and MRI examinations. Moreover, the degree of sensory and motor impairment was also assessed in this study. The Spearman correlation test assessed the correlation between TLR-4 levels and vertebral destruction. Results: Most of the samples in this study were less than 30 years old (10 people, 37%), female (14 people, 51.9%), had spinal destruction at 1 level (11 people, 40.7%), had paraplegia (8 people, 29.6%), and had hypoesthesia (11 people, 40.7%). TLR-4 levels had a mean value of 8254.1±1076.1 ng/ml. TLR-4 levels were positively correlated with the degree of vertebral destruction (r=0.599, P=0.001), motor disorders (r=0.632.x, P=0.000), and sensory disorders (r=0.574, P=0.002). Conclusion: TLR-4 levels are associated with the severity of vertebral destruction in TB spondylitis, so it has the potential to be used as a prognostic biomarker.

Epidemiology of Plasmodium infections in Flores Island, Indonesia using real-time PCR.

BACKGROUND: DNA-based diagnostic methods have been shown to be highly sensitive and specific for the detection of malaria. An 18S-rRNA-based, real-time polymerase chain reaction (PCR) was used to determine the prevalence and intensity of Plasmodium infections on Flores Island, Indonesia. METHODS: Microscopy and real-time multiplex PCR for the detection of Plasmodium species was performed on blood samples collected in a population-based study in Nangapanda Flores Island, Indonesia. RESULTS: A total 1,509 blood samples were analysed. Real-time PCR revealed prevalence for Plasmodium falciparum, Plasmodium vivax, and Plasmodium malariae to be 14.5%, 13.2%, and 1.9% respectively. Sub-microscopic parasitaemia were found in more than 80% of all positive cases. The prevalence of P. falciparum and P. vivax was significantly higher in subjects younger than 20 years (p ≤ 0.01). In the present study, among non-symptomatic healthy individuals, anaemia was strongly correlated with the prevalence and load of P. falciparum infections (p ≤ 0.01; p = 0.02) and with the load of P. vivax infections (p = 0.01) as detected with real-time PCR. Subjects with AB blood group tend to have a higher risk of being infected with P. falciparum and P. vivax when compared to other blood groups. CONCLUSION: The present study has shown that real-time PCR provides more insight in the epidemiology of Plasmodium infections and can be used as a monitoring tool in the battle against malaria. The unsurpassed sensitivity of real-time PCR reveals that sub microscopic infections are common in this area, which are likely to play an important role in transmission and control. TRIAL REGISTRATION: Trials number ISRCTN83830814.

Pre-treatment inflammatory and immune system parameters predicting cervical cancer metastasis.

Objective: This study aimed to evaluate the relationship between mannose-binding lectin-associated serine protease-2 as an immune system parameter and neutrophil lymphocyte ratio (NLR) as an inflammatory parameter to predict cervical cancer metastasis. Materials and Methods: This cross-sectional study included 70 patients diagnosed with cervical cancer between January 2022 and February 2023 at Dr. Wahidin Sudirohusodo Hospital, Hasanuddin University Hospital, and Ibnu Sina Hospital, Makassar, Indonesia. Blood samples taken before therapy as well as clinical and histological data were gathered and examined. MASP-2 levels and NLR were measured by ELISA and flow cytometry respectively. Results: The median age of the patients was 46 years (range, 24-72 years), with the majority of patients aged between 41 and 52 years. Statistical analysis showed that MASP-2 was associated with cervical cancer stage (p≤0.000), organ metastasis (p=0.011), and lymphovascular invasion (p=0.036). In addition, NLR was associated with cervical cancer stage (p=0.004), histopathology type (p=0.031), tumor size (p=0.019), and organ metastasis (p=0.013). Conclusion: Pretreatment with MASP-2 as an immune system parameter and NLR as an inflammatory parameter is associated with cervical cancer metastasis. The NLR indicator can be applied in clinical practice because it is simple and reasonably priced.

Comparison of tumor size, histopathological grade, and molecular subtype of breast cancer at a single center study.

BACKGROUND: Breast cancer (BC) is the second most frequent cancer-related death among women worldwide. Factors influencing BC patients' survival include histopathological grade, histopathological type, stage, hormonal receptors, and number of mitotic images. OBJECTIVE: To compare the tumor size, histopathological grade, and molecular type of BC patients. METHODS: This was an observational analytic retrospective study. The population was BC patients at Dr. Wahidin Sudirohusodo Hospital from 2017 to 2021. The Kruskal-Wallis test was used to compare statistically between tumor size, histopathological grade, and molecular subtype. Significance was set at p < 0.05. RESULTS: The study included 784 patients. Most were aged 50-59 years (34.8%), with tumor size 4c (37.0%) and moderate grade (66.1%), and the most common molecular subtype was luminal A (34.2%). Bivariate analysis using the Kruskal-Wallis test found no significant difference in molecular subtypes based on tumor size (p = 0.079), but significant differences existed in molecular subtype by histopathological grade (p = 0.005) and tumor size by histopathological grade (p < 0.001). CONCLUSIONS: Significant differences existed between histopathological grade by tumor size and molecular subtype. Early diagnosis and prompt treatment of BC patients are important to prevent morbidity and mortality.

A Case Series: Effect of Comorbidities on the Outcomes of Prolotherapy Injection for Frozen Shoulder Patients.

Frozen shoulder (FS) is a disease caused by an inflammatory condition that causes severe pain and decreased range of motion by loss of glenohumeral mobility. Frozen Shoulder restricts daily life's functional aspect, increasing morbidity. Hypertension and diabetes mellitus are risk factors that make an FS poor prognosis during treatment because of the diabetes glycation process and hypertension-enhanced vascularization. Prolotherapy injects an irritant solution into the tendon, joints, ligaments, and joint spaces to release growth factors and collagen deposition, reducing pain, restoring joint stability, and increasing the quality of life. We report 3 cases of patients with confirmed FS. Patient A with no comorbidity, patient B with diabetes mellitus, and patient C with hypertension, with all patient's chief complaints of shoulder pain and limited ROM, and symptoms affected the general quality of daily life. This patient was provided injection with Prolotherapy treatment combined with physical therapy intervention. Patient A had significantly improved ROM to maximum after 6 weeks with relieved pain and improved shoulder function. Patients B and C showed increased ROM, still tiny, decreased pain, and improved shoulder function. In conclusion, prolotherapy demonstrated a beneficial effect in a patient with FS with comorbidities, although not to the maximum extent in patients without comorbidity.

The Association of "First 1000 Days of Life" Training Program on Communication Skill and Empathy of Undergraduate Medical Students: A Cross-Sectional Study.

Introduction: 1000 First Days of Life (1000FDL) training program is carried out for 2 years from the 3rd to 6th semester; in this program, students are asked to accompany pregnant women until their children are 2 years old. This study aimed to analyse undergraduate medical students' communication skills and empathy levels and determine the association between communication skills and empathy after the training program. Methods: This is a cross-sectional study in which 176 undergraduate medical students in Hasanuddin University participated; they were enrolled in 1000FDL training program and selected using purposive sampling. Data were collected using Modified Arabic Version of the ABIM's Patient Assessment (MAV-ABIM) and Jefferson Scale of Empathy - Student Version (JSE-S) questionnaires to assess their level of communication skills and empathy. In this study, demographic data were obtained using a semi-open-ended questionnaire. Data were analysed using descriptive statistics, Chi-Square, and Spearman tests. Results: Communication skill was very good (83.5%), good (15.9%), and inadequate (0.6%), while the empathy level was high (9.1%), medium (25%), and low (65.9%). There was no significant difference between the level of communication skills (p-value 0.168) and empathy (p=0.145) based on gender, but there was a significant difference between <12 or >12 times interaction with the empathy level (p<0.001). The association between the level of communication showed that the level of empathy was significant (p<0.001, r=0.399). Conclusion: Undergraduate medical students had very good communication skills but low empathy levels. There was a positive association between communication skills and empathy level after the training program. The students' empathy level can be improved by increasing the frequency of interaction with patients in experiential learning through training programs.

The level of ratio between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) after prolotherapy intervention and the functional outcome in patient with frozen shoulder: A randomized controlled trial.

OBJECTIVE: To determine the effect of prolotherapy on functional outcome changes, along with ratio of matrix metalloproteinase-1 (MMP-1)/tissue inhibitor matrix metalloproteinase-1 (TIMP-1) as an indicator of tissue repair in the glenohumeral joint in frozen shoulder patients. DESIGN: Single-blinded randomized controlled trial. SUBJECTS/PATIENTS: Participants with frozen shoulder. METHODS: The prolotherapy group is the study group, and the normal saline (NS) group is the control group. Each group was given injections at weeks 0, 2, 4, and 6. Level of biomarker levels was measured at week 6 and week 12 after there. Functional outcomes were measured at weeks 0, 6, and 12. RESULTS: A significant difference in week 6 and week 12 was demonstrated in the ratio of MMP-1/TIMP-1 level between the prolotherapy group and the normal saline group (P value = .002). Both groups performed well regarding the Numerical Rating Scale score and functional outcome. Compared to the normal saline group, prolotherapy changed the mean range of motion in flexion and internal rotation. CONCLUSION: Prolotherapy is considered to play a role in repairing cartilage based on biomarker assessment, particularly the ratio of MMP-1/TIMP-1-prolotherapy effectiveness in improving functional outcome and Numerical Rating Scale score.

Anti-inflammatory effects of banana (Musa balbisiana) peel extract on acne vulgaris: In vivo and in silico study.

Objective: Acne vulgaris (AV) is a common problem with a relatively high incidence rate among Asian people. The potential antimicrobial and anti-inflammatory properties of banana peels have been demonstrated in previous studies but have not been studied in cases of AV. Therefore, this study was aimed at investigating the protective effects of banana (Musa balbisiana) peel extract (MBPE) against AV. Methods: Thirty rats were divided into five groups (n = 6 rats per group): an AV group, AV group treated with 0.15% MBPE, AV group administered 0.30% MBPE, AV group administered 0.60% MBPE, and AV group administered clindamycin (the standard drug treatment). We assessed nodule size, bacterial count, histopathology, and cytokine levels (IL-1α, IFN-γ, tumor necrosis factor (TNF)-α, and IL-8). Enzyme linked immunoassays were used to measure the cytokine levels. In addition, we performed molecular docking studies to determine the interactions between phytochemicals (trigonelline, vanillin, ferulic acid, isovanillic acid, rutin, and salsolinol) via the Toll-like receptor 2 (TLR2) and nuclear factor-kappa B (NF-κB) pathways. Results: All MBPE treatment groups, compared with the AV group, showed suppression of both bacterial growth and proinflammatory cytokine production, as well as resolved tissue inflammation. The nodule size was significantly suppressed in the groups receiving the two highest doses of MBPE, compared with the AV group. However, the pharmacological action of MBPE remained inferior to that of clindamycin. Docking studies demonstrated that rutin was the phytocompound with the most negative interaction energy with TLR2 or NF-κB. Conclusions: Our results indicated that MBPE has anti-inflammatory effects against AV, by suppressing nodule formation, inhibiting bacterial growth, and decreasing proinflammatory cytokine production.

Molecular identification of mycobacterial infections in nonsputum specimens.

Background: Mycobacterial infections can manifest in various anatomical sites, necessitating the analysis of nonsputum specimens for accurate diagnosis. The aim of this study was to identify the molecular cases of mycobacterial infections in nonsputum specimens using polymerase chain reaction based assays and gene sequencing methods. Methods: This observational study examined 161 nonsputum samples that have been stored in the Clinical Microbiology Laboratory at Hasanuddin University Hospital. Samples were analyzed by microscopy and molecular detection methods according to the standard methods at the Clinical Microbiology Laboratory of Hasanuddin University. Descriptive statistics were utilized to summarize patient demographics, infection characteristics, and outcomes. Results: The samples were collected from patients with an average age of 39.82 years. The anatomical sites of specimen collection varied, with musculoskeletal organs and eyes being the most common. Microbiological analysis revealed a predominance of Gram positive bacteria, with polymicrobial morphology observed. Methicillin susceptible Staphylococcus aureus were the most frequently isolated organisms. Acid fast bacilli were detected in 8.1% of samples. Phylogenetic analysis, based on 16S rRNA gene sequencing, revealed similarities between the samples and known mycobacterial species, including Mycobacterium parmense, Mycobacterium lacus, and Mycobacterium dioxanotrophicus. Conclusions: The findings highlight the microbial diversity observed in these infections. The study advocates for comprehensive diagnostic evaluations and targeted testing strategies based on both clinical and laboratory findings. This knowledge can contribute to improved diagnostic accuracy and optimized treatment strategies for mycobacterial infections.