Purple sweet potato (Ipomoea batatas L.) extract effects on levels of inflammatory markers and chondrocyte count in gout arthritis Wistar rat model.

BACKGROUND: Recently, herbal medicine has become alternative in management of gout. Our aim is to assess effectiveness of purple sweet potato extract in gout. METHOD: In vivo study with randomized posttest only control group design. Purple sweet potato extract administered to 16 Wistar rats with MSU-induced gout. Independent t-test for analyzing interleukin-1 ß (IL-1ß), matrix metalloproteinase-3 (MMP-3), cartilage oligomeric matrix protein (COMP), malondialdehyde (MDA), and number of chondrocytes results. RESULTS: Decreased level of IL-1ß (3.81 ± 1.54 ng/mL vs. 2.55 ± 0.59 ng/mL, p = 0.04), MDA (5.04 ± 1.02 ng/mL vs. 2.27 ± 0.57 ng/mL, p = 0.04), MMP-3 (5.66 ± 1.02 ng/mL vs. 3.84 ± 1.37 ng/mL, p = 0.01) COMP (21.01 ± 3.57 ng/mL vs. 17.27 ± 2.60 ng/mL, p = 0.03), and increasing chondrocytes (35.17 ± 12.35 lp vs. 48.56 ± 7.17 lp, p = 0.02). CONCLUSION: Purple sweet potato extract with anthocyanin inhibits inflammation and cartilage degeneration in gout. LEVEL OF EVIDENCE: Level 1.

A Peer-support Mini-counseling Model to Improve Treatment in HIV-positive Pregnant Women in Kupang City, East Nusa Tenggara, Indonesia.

OBJECTIVES: Low adherence to antiretroviral (ARV) therapy in pregnant women with human immunodeficiency virus (HIV) increases the risk of virus transmission from mother to newborn. Increasing mothers' knowledge and motivation to access treatment has been identified as a critical factor in prevention. Therefore, this research aimed to explore barriers and enablers in accessing HIV care and treatment services. METHODS: This research was the first phase of a mixed-method analysis conducted in Kupang, a remote city in East Nusa Tenggara Province, Indonesia. Samples were taken by purposive sampling of 17 people interviewed, consisting of 6 mothers with HIV, 5 peer facilitators, and 6 health workers. Data were collected through semi-structured interviews, focus group discussions, observations, and document review. Inductive thematic analysis was also performed. The existing data were grouped into several themes, then relationships and linkages were drawn from each group of informants. RESULTS: Barriers to accessing care and treatment were lack of knowledge about the benefits of ARV; stigma from within and the surrounding environment; difficulty in accessing services due to distance, time, and cost; completeness of administration; drugs' side effects; and the quality of health workers and HIV services. CONCLUSIONS: There was a need for a structured and integrated model of peer support to improve ARV uptake and treatment in pregnant women with HIV. This research identified needs including mini-counseling sessions designed to address psychosocial barriers as an integrated approach to support antenatal care that can effectively assist HIV-positive pregnant women in improving treatment adherence.

The Effects of Percutaneous Coronary Intervention on Biomarkers and Quality of Life in Patients With Chronic Total Coronary Artery Obstruction.

Background: Chronic total occlusion (CTO) is an angiographic picture of total occlusion without blood flow which is estimated to have lasted at least 3 months. This study attempted to provide an overview of the levels of matrix metalloproteinase-9 (MMP-9), soluble suppression tumorigenicity 2 (sST2), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as remodeling, inflammatory, and atherosclerotic markers, as well as changes in the angina severity in patients with CTO who underwent percutaneous coronary intervention (PCI) compared to those without PCI. Methods: This study is a preliminary report with quasi-experimental design study with a pre-test and post-test approach to compare PCI's effect in CTO patients towards changes in MMP-9, sST2, NT-pro-BNP levels, and changes in the angina severity. Twenty subjects underwent PCI and 20 subjects with optimal medical therapy, who were then assessed at baseline and 8 weeks after intervention. Results: The results of this preliminary report showed that decreased MMP-9 (pre-test: 12.07 ± 1.27 ng/mL vs. post-test: 9.91 ± 5.19 ng/mL, P = 0.049), sST2 (pre-test: 37.65 ± 20.00 ng/mL vs. post-test: 29.74 ± 15.17 ng/mL, P = 0.026) and NT-pro-BNP (pre-test: 0.63 ± 0.23 ng/mL vs. post-test: 0.24 ± 0.10 ng/mL, P < 0.001) levels were found after 8 weeks of PCI compared to those without such intervention. The levels of NT-pro-BNP were lower in the PCI group (0.24 ± 0.10 ng/mL) than in the non-PCI group (0.56 ± 0.23 ng/mL; P < 0.001). Moreover, there was an improvement of angina severity in PCI group than without PCI (P < 0.039). Conclusions: Although this preliminary report found a significant decrease in MMP-9, NT-pro-BNP, and sST2 levels in CTO patients who had undergone PCI compared to those without PCI, as well as improved angina severity in these patients, this study still has limitations. The number of samples was so small that similar studies with larger sample sizes or multicenter investigations are required to deliver more trustworthy and useful results. Nevertheless, we encourage this study as a preliminary baseline for further studies in the future.

Comprehensive Travel Health Education for Tour Guides: Protocol for an Exploratory Sequential Mixed Methods Research.

BACKGROUND: Tourists are at risk of experiencing health problems during their travel. However, even though tour guides have the potential to become travel health promoters, their participation has not been optimal. OBJECTIVE: This study aims to develop a comprehensive travel health education model to help tour guides improve health information delivery to tourists. METHODS: This is an exploratory sequential mixed methods research. The first phase consisted of a qualitative study with an informed grounded theory design. In-depth interviews were carried out with tour guides from all language divisions and policymakers of the Indonesian Tour Guide Association Bali Branch or Himpunan Pramuwisata Indonesia Daerah Bali (HPI Bali). The interview guidelines were developed based on the theory of planned behavior and identity theory. Qualitative data were analyzed thematically. In the interim phase, a travel health education model and questionnaire were developed based on the qualitative findings. The initial model and its instruments were finetuned after consultation with travel medicine and health promotion experts. Furthermore, the validity and reliability of the questionnaire were tested on 30 tour guides. The second phase consisted of a quantitative study with a randomized pretest-posttest control group design. A total of 76 tour guides in the intervention group received comprehensive travel health education, while 76 in the control group received no specific intervention. Outcome variables (ie, attitudes, subjective norms, perceived behavioral control, actual behavioral control, role identity, and behavioral intention) were measured at baseline (T0), after the online training (T1), before information sharing via WhatsApp (T2), a month after the start of the WhatsApp intervention (T3), and at the end of the WhatsApp intervention (T4). The mean difference of each outcome variable before and after the intervention will be compared between the intervention and control groups. Thereafter, the quantitative and qualitative findings will be integrated into a joint display. RESULTS: The qualitative phase was conducted through in-depth interviews with 21 informants who included tour guides and policymakers from HPI Bali from May to June 2021. The education model, educational materials, and questionnaire were developed based on the qualitative findings and consultation with experts. The education model consists of online training and information sharing through WhatsApp and was trialed with tour guides from November 2021 to February 2022. As of April 2022, this study is in the quantitative data analysis stage. CONCLUSIONS: A travel health education model was developed based on qualitative findings and consultation with experts. The model was tested with tour guides, and a series of self-administered questionnaires were completed. This study is in the quantitative data analysis stage and will continue by integrating qualitative and quantitative findings into a joint display. TRIAL REGISTRATION: ClinicalTrials.gov NCT04961983; https://clinicaltrials.gov/ct2/show/NCT04961983.

A Health Belief Model-Based Motivational Interviewing for Medication Adherence and Treatment Success in Pulmonary Tuberculosis Patients.

Medication adherence behavior plays a central role in the success of tuberculosis (TB) treatment. Conventional motivation is not optimal in strengthening long-term medication adherence. A motivational interviewing (MI) communication motivation model based on the Health Belief Model (HBM) was designed with the main objective of improving medication adherence and treatment success. This study used an experimental design with a randomized posttest-only control group design. The intervention and control groups consisted of 107 TB patients each, who were selected by random cluster sampling. The study was conducted from November 2020 to June 2021 at 38 public health centers in Bali Province. The HBM-based MI model intervention was given in seven counseling sessions, pill count percentages were used to measure medication adherence, and treatment success was based on sputum examination results. Logistic regression was used to assess the effect of the intervention on medication adherence and treatment success. Logistic regression analysis showed that MI-based HBM and knowledge were the most influential variables for increasing medication adherence and treatment success. Medication adherence was 4.5 times greater (ARR = 4.51, p = 0.018) and treatment success was 3.8 times greater (ARR = 3.81, p < 0.038) in the intervention group compared to the control group, while the secondary outcome of knowledge of other factors together influenced medication adherence and treatment success. The conclusion is that the HBM-based MI communication motivation model creates a patient-centered relationship by overcoming the triggers of treatment barriers originating from the HBM construct, effectively increasing medication adherence and treatment success for TB patients, and it needs further development by involving families in counseling for consistent self-efficacy of patients in long-term treatment.

Why Counseling Intervention Fails to Improve Compliance towards Antiretroviral Therapy: Findings from a Mixed-Methods Study among People Living with HIV in Bali Province, Indonesia.

This study explores the contribution of counseling to improving acceptance of and adherence to anti-retroviral therapy (ART) among people living with HIV (PLHIV) and identifies key issues associated with its implementation. We conducted a longitudinal mixed-methods study in Bali Province between 2015 and 2017. The study participants were 170 newly diagnosed PLHIV and 17 outreach-counselor workers (OWs). We interviewed PLHIV for their experiences in receiving counseling, and acceptance of and adherence to ART. We surveyed four counseling domains (privacy, contents, frequency, and duration) and explored the key findings through in-depth interviews. In addition, 24 exit interviews and record reviews were performed. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Out of 170 PLHIV who received the counseling program, 139 (81.76%) accepted ART, and 52 (37.4%) discontinued ART in six months of follow up. Although counselors covered most of the content (16/17 components), the median time and frequency of counseling were insufficient. Despite a high score of HIV counseling provided to PLHIV in our study location, the overall acceptance of and adherence to ART remains fair or moderate. Our study suggests that counseling before ART initiation is inadequate for improving acceptance and adherence to ART in Bali Province. This reduced effectiveness is influenced by internal issues (interpersonal skills, limited technical capacity) and external factors both from PLHIV and society (stigma, disclosure, discrimination).

Association between Lactate Dehydrogenase Levels to the Response of Non-Hodgkin Lymphoma in Elderly Patients Who Treated with First-Line Chemotherapy in Sanglah General Hospital.

BACKGROUND: Non-Hodgkin Lymphoma (NHL) is a malignant haematological disease originates in the lymphocytes, caused by an abnormality in lymphocytes development which forms a tumour and may become cancer. Chemotherapy is the main treatment modality for aggressive lymphoma, but only a few patients achieve remission. Several factors such as age, clinical stadium, number of extranodal regions, and Lactate Dehydrogenase (LDH) level played a role in determining response to chemotherapy. AIM: To measure the association between LDH levels to prognosis of NHL in elderly patients who treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy in Sanglah General Hospital. METHODS: This study used a retrospective descriptive study on elderly NHL patients in Sanglah General Hospital from January until December 2014. The evaluation was measured using the IPI score to determine the prognosis of patients. Demographic data, the stadium, extranodal region, LDH level, and response to chemotherapy were recorded. RESULTS: Twenty-five patients were included in the study. The age ranged was between 61-76 years old (Mean 65,68 ± 4,7 years; Median 65 years). The number of male patients was 19 (76%). Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histopathological structure observed on the patients (68%). LDH levels were normal in 51.6% of the patients and considered high in the rests (48.4%). Results of the chemotherapy were a good response in 72.2%. Compared to the patients who showed complete response to chemotherapy, patients with no response (partial response and progression) had significantly higher levels of LDH (OR: 13,1; 95% CI: 1,36-126,30; p = 0,001). CONCLUSION: Non-Hodgkin Lymphoma in elderly patients with no response to chemotherapy had significantly higher levels of LDH than patients with complete response.

High levels of serum IL-6 and serum hepcidin and low CD4 cell count were risk factors of anemia of chronic disease in HIV patients on the combination of antiretroviral therapy.

Purpose: This study aimed to determine whether high levels of serum IL-6 and serum hepcidin and CD4<350 cells/ul were risk factors for the anemia of chronic disease (ACD) in HIV-infected patients on the combination of antiretroviral (cARV) therapy with successful clinically and immunological responses. Patients and Methods: A matched case-control study was conducted in the VCT clinic of Sanglah General Hospital, Indonesia, between January 1 and September 1, 2016. The case group was HIV patients with ACD, while the control group was HIV patients without ACD. Purposive consecutive sampling was employed in HIV patients aged 15-65 years who have received cARV therapy for >6 months, had >95% adherence of cARV within 6 months, did not have any clinical failure, did not have any immunological failure and did not receive switch therapy within 6 months. Chi-square test and logistic regression analysis were performed. Results: A total of 42 cases and 42 controls were included in this study. Significant differences were found between case and control, which included serum IL-6, serum hepcidin, smoking, creatinine clearance, anemia at the initiation of cARV, CD4 at the initiation of cARV and actual CD4 (cell/µL). High levels of serum IL-6, high levels of serum hepcidin and CD4< 350 cells/µl were risk factors for ACD. After adjusted with anemia at cARV initiation and BMI, we found that high levels of serum IL-6 (adjusted OR: 17.682; 95% CI: 3.442-90.826), high levels of serum hepcidin (adjusted OR: 10.562; 95% CI: 2.531-44.076) and CD4 <350 cells/µl (adjusted OR: 4.181; 95% CI: 5.6-12.381) remain as risk factors for ACD. Conclusion: High levels of serum IL-6, high levels of serum hepcidin and CD4 count <350 cells/µL were risk factors for ACD in HIV patients with cARV therapy.

Interleukin-6 and ratio of plasma interleukin-6/interleukin-10 as risk factors of symptomatic lumbar osteoarthritis.

AIM: To determine the role of cartilage oligomeric matrix protein (COMP), interleukin (IL)-6, IL-10 and ratio of IL-6/IL-10 as risk factors of symptomatic lumbar osteoarthritis (OA) in postmenopausal women with estrogen deficiency. METHODS: Case-control study had been conducted in Sanglah General Hospital from October 2015 until March 2016. The blood samples were obtained and analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: From 44 pairs of samples which divided into 44 samples as case group and 44 samples as control group showed that high level of COMP in estrogen deficiency postmenopausal women were not at risk (OR = 0.7; 95%CI: 0.261-1.751; P = 0.393) for symptomatic lumbar OA (cut-off point 0.946). Estrogen deficiency in postmenopausal women with the high level of IL-6 had 2.7 times risk (OR = 2.7; 95%CI: 0.991-8.320; P = 0.033) for symptomatic lumbar OA from the low level of IL-6 (cut-off point 2.264). At lower level of IL-10, there was no risk for symptomatic lumbar OA (OR = 0.6; 95%CI: 0.209-1.798; P = 0.345) than with the higher level of IL-10 (cut-off point 6.049). While the high ratio of IL-6/IL-10 level in estrogen deficiency postmenopausal women gave 3.4 times risk (OR = 3.4; 95%CI: 1.204-11.787; P = 0.011) for symptomatic lumbar OA than the low ratio of IL-6/IL-10 level (cut-off point 0.364). CONCLUSION: High ratio of IL-6/IL-10 plasma level was the highest risk factor for causing symptomatic lumbar OA in postmenopausal women with estrogen deficiency.

CRF01_AE dominates the HIV-1 epidemic in Indonesia.

BACKGROUND: The HIV epidemic in Indonesia remains concentrated in vulnerable populations, namely injecting drug users (IDUs), commercial sex workers (CSWs) and men who have sex with men (MSM). We aimed to determine the HIV-1 subtypes present in Indonesia and to establish the extent of the viral overlap between individuals with different risk factors. METHODS: Venous blood samples were collected from HIV-positive individuals primarily from sexually transmissible infection clinics and drug rehabilitation centres in Bali and Jakarta, and applied to filter paper. A polymerase chain reaction-based assay designed to amplify a 330-bp region of the HIV-1 envelope was used to determine HIV-1 subtype result and to perform phylogenetic analysis. RESULTS: Of the 175 individuals recruited to the study, a subtype result was obtained for 108 (62%). Four subtypes were found to exist in the population, CRF01_AE (n=96, 88.9%), B (n=10, 9.3%), C (n=1, 0.9%) and G (n=1, 0.9%). Of these 108 individuals, 65 (60%) were IDUs, and the remaining 40% were CSWs, MSM, transgender individuals, people with multiple sexual partners or those with no obvious risk factor. CRF01_AE was found to be more common among IDUs with 100% of individuals infected with this subtype. Subtype B was more common among MSM and CSWs (P=<0.001). Phylogenetic analysis revealed a lack of viral segregation between risk groups. CONCLUSIONS: In Indonesia, CRF01_AE continues to dominate the HIV epidemic, although HIV subtype B is responsible for a significant number of sexually acquired infections.

Correlation between clinical stage of solid tumor and D dimer as a marker of coagulation activation.

AIM: to examine the relationship between clinical stage of solid cancers and plasma D dimer value. METHODS: patients with solid cancer treated in Sanglah hospital who met study ctiteria were consecutively recruited and studied in order to examine the relationship between clinical stage of solid cancers and plasma D dimer value. Plasma D dimer was measured by ELISA (Nycocard) and TNM system to assign each patient into stage I,II,III and IV according to American Joint Committee on Cancer. Rank Spearman analysis was used to determine the relationship and one way Anova to compare the mean difference of D dimer between group of clinical stages. RESULTS: there were 79 patients included, mostly female (72,2%) and 57% was in age group of 40-59 years old. Level of D dimer >500 ng/ml were found in 60 patients and 19 patients with D dimer <500 ng/ml. The most frequent cancer was cervix (32.9%) then followed by nasopharyng cancer (16.5%). Clinical stage I,II,III, and IV were 6.3%, 16.5%, 53.2% and 24.1% respectively. Thrombocytosis (>400.103/uL) was found 50.6% as well as leukocytosis 62%. Although the differences of mean D dimer in each type of solid cancers were big enough but it was not statistically significant (p = 0.156). Plasma D dimer was positively correlated with clinical stage of solid cancers (r = 0.367; p = 0.001). CONCLUSION: plasma D dimer level was positively correlated with clinical stage of solid cancers. High plasma D dimer could be a marker for advanced stage of a patient with solid cancer.

Influence of iron on plasma interleukin-2 and gamma interferon level in iron deficiency anemia.

AIM: to find out the the influence of iron on the levels of plasma IL-2 and IFNgamma in iron deficiency anemia patient. METHODS: the study subjects were patients with IDA (intended samples) selected from the accessible population that met the inclusion and exclusion criteria using consecutive sampling technique and by signing an informed consent. Blood samples were taken for measurement of IL-2 and IFNgamma concentrations as well as list of questionnaires for obtaining data on age, gender, body weight, infections suffered, use of immunosuppressive medicines, malnutrition, malignancy and genetic disorder, and IDA diagnosis. The levels of IL-2 and IFNgamma were measured before and after 8 weeks of iron tablet adminitration using immunoassay solid phase ELISA. Descriptive statistics was used to illustrate patient's characteristics and frequency distribution of various variables. The average difference of IL-2 and IFNgamma concentrations was also examined pre and post administration of iron tablets for 8 weeks using Wilkoxon sign rank test. RESULTS: in the study, 26 IDA patients were eligible, chosen from 64 IDA patients who were then given iron tablets for 8 weeks. By the end of the treatment, they were tested for complete blood analysis, serum ferritin, and cytokines of plasma. Sign rank test of Wilcoxon was used to find out direction and degree of difference between the two paired groups which showed a significant difference between pre and post iron tablet administration of hemoglobin (Z= -4.561; p<0.001), MCV (Z= -4.276; p<0.001), MCH (Z= -3.616; p<0.001) and feritin (Z= -3.556; p<0.001). After 8 weeks of iron tablets, the study also noted, increasing of plasma IL-2 and IFNgamma. Before treatment level of plasma IL-2 was 7.65 pg/l then became 29.3 pg/l after treatment (Z=- 3.508, p<0.001) and plasma IFNg before treatment was 10.15 pg/l became 46.7 pg/l after treatment (Z= -4.241, p<0.001). CONCLUSION: concentration of IL2 dan IFNgamma in plasma significantly increased after administration of iron tablets for 8 weeks as compared to that before iron treatment.

Iron-deficiency anemia in pregnant women in Bali, Indonesia: a profile of risk factors and epidemiology.

Iron-deficiency anemia in pregnant women is a serious public health problem especially in tropical countries. The aim of this study was to assess the prevalence of iron-deficiency anemia in pregnant women in Bali and determine the risk factors for anemia. A cross-sectional study was conducted among 1,684 pregnant women in 42 villages in Bali that were selected by probabilistic/proportional-to-size sampling technique. Two ml of venous blood were collected for hemoglobin estimation using an automatic hematology analyzer (Technician H-I), and serum ferritin examination using immunolescent technique. The WHO criterion for anemia in pregnancy was applied and serum ferritin < 20 microg/l as cut-off point for iron deficiency. Data regarding risk factors were gathered using pre-designed questionnaires. The prevalence of iron-deficiency anemia in pregnant women was 46.2%; most of the cases of anemia were mild. The risk factors for anemia identified in this study were: length of gestation; level of education; antenatal intake of iron pills. Given the high prevalence of iron-deficiency anemia in pregnant women in Bali, preventive measures, eg iron supplementation, the iron fortification of food, and health education, should be encouraged.