The alpha-fetoprotein serum is still reliable as a biomarker for the surveillance of hepatocellular carcinoma in Indonesia.

BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC), the most common type of liver cancer, is one of the leading causes of cancer-related death worldwide with an inferior prognosis. In Indonesia, the average life expectancy is less than 5 months, with most patients being in an advanced stage wherein the survival rate is very low. Early detection through surveillance program is very crucial. HCC guidelines worldwide have provided surveillance recommendation through the examination of α-fetoprotein (AFP) and ultrasound for patients at risk in developing HCC. However, there have been some controversies regarding the usage of AFP concerning its low sensitivity and specificity in detecting HCC. Therefore, the effectiveness of AFP in the surveillance of HCC patients and identifying the parameters most associated with the increase of AFP ≥ 10 ng/ml in Indonesia should be evaluated. METHODS: We analyzed medical records of HCC patients and those at high risk of developing HCC through cross-sectional study, including patients with cirrhosis and hepatitis B and C, from 2015 to 2017 who underwent treatment at the Cipto Mangunkusumo National General Hospital and Dharmais National Cancer Hospital, Indonesia. RESULTS: The sensitivity and specificity of AFP in the surveillance of HCC in Indonesia with a cut-off of 10 ng/ml were 82.6 and 71.2%, respectively. The parameters most associated with the increase of AFP ≥10 ng/ml according to multivariate analysis were the etiology of hepatitis B, the stage of Barcelona Clinic Liver Cancer (BCLC) B and C, and the presence of cirrhosis, respectively. CONCLUSION: AFP can still be used in the surveillance of HCC in Indonesia for its high sensitivity value.

Is Higher BMI Associated with Worse Overall Mortality in Hepatocellular Carcinoma Patients? An Evidence Based Case Report.

BACKGROUND: liver cancer is currently the second deadliest cancer in the world with hepatocelullar carcinoma (HCC) being the commonest form-accounting 90% of all its cases. With the current global alarming increase of obesity, there is hence an increase of fatty liver disease cases, which is one of the major non-viral etiology of cirrhosis in the world. The objective of this study is to evaluate whether obese HCC patients have worse survival outcome. METHODS: PubMed, Cochrane, Scopus, ProQuest, and EBSCOhost were comprehensively searched for systematic review and cohort prognostic researches studying overall survival of HCC patients who are underweight and obesity according to their BMI. Three studies were selected and critically appraised. Data were then summarized descriptively. RESULTS: the three studies included consist of one meta-analysis and two cohort studies. Meta-analysis study stated no association between overweight and obesity status with higher mortality rate in Asian race HCC patients (aHR, 1.10; 95% CI, 0.63-1.92). A cohort study from Japan reported while there was a significant difference of mortality rate in obese HCC patients in bivariate analysis, adjustment with other important prognostic factors with multivariate analysis found no significant correlation between obesity and HCC-related mortality rate (aHR, 1.00; 95% CI, 0.83-1.22). Another cohort study from China reported that HCC-related mortality rate in patients with higher BMI was lower than in patients with lower BMI (aHR, 0.347; 95% CI, 0.239-0.302). CONCLUSION: there is no association between higher BMI with HCC-related mortality in Asian race patients.

Adipose-derived stem cell conditioned medium for hair regeneration therapy in alopecia: a review of literature.

To date, therapeutic choices for alopecia have shown limited effectiveness and safety, making the discovery of new therapeutic choices challenging. Adipose-derived stem cells conditioned-medium (ADSC-CM) contain various growth factors released by ADSCs that may support hair regrowth. This literature review aims to discover the effect and clinical impact of ADSC-CM in the treatment of alopecia. A comprehensive literature search was performed through four databases (Pubmed, ScienceDirect, Cochrane, and Scopus) in September 2021. A combination of search terms including "adipose-derived stem cells" and "alopecia" was used. Studies published in English that included ADSC-CM interventions on alopecia of all types were selected and summarized. A total of five studies were selected for review, all of which were case series. All studies showed a positive outcome for intervention. Outcomes measured in the studies include hair count or hair density, hair thickness, anagen, and telogen hair count. No adverse effects were reported from all studies. Limitations lie in the differences in intervention method, application, and length of treatment. ADSC-CM hair regeneration therapy is an effective and safe treatment for alopecia that may be combined with other types of therapy to improve outcomes.

Low-Dose versus Conventional-dose Oral Isotretinoin Regimens: A Systematic Review on Randomized Controlled Comparative Studies of Different Regimens.

BACKGROUND: The effectiveness of Isotretinoin is superior compared to other acne therapies, particularly in reducing acne lesion counts. Concerns, however, arise relating to the most optimal dosage regimen with the best efficacy and lesser side effect. OBJECTIVE: We intend to review existing randomized controlled comparative studies of isotretinoin in different regimens. METHODS: PubMed, Cochrane, Scopus, and ScienceDirect were searched. The inclusion criteria is the RCT article. Full-text reading excluded articles that did not use GAGS as the method of measurement. Out of 921 articles that were electronically searched, 6 RCTs were extracted and summarized descriptively. After full-text reading, 4 RCTs were included. We then conducted risk of bias assessments for the selected studies using The Cochrane Risk of Bias Tool. RESULTS: Across all trials, low-dose regimens were preferable in all types of acne-owing to its similar efficacy to conventional dose but with fewer occurrence of side effects as well as better patients' satisfaction and compliance. Furthermore, a continuous low-dose regimen had the best efficacy in comparison to other regimens of low-dose treatment. DISCUSSION: The limitations of our study include a slight difference in dosage between selected studies. Other limitations are that some studies did not explain the side effects and relapse rate thoroughly and did not state the compliance scoring method used. CONCLUSION: This review recommends continuous low-dose treatment as the chosen regimen for acne vulgaris. However, further evaluation regarding relapse rate compared to the conventional dose is needed.