Association between angiotensin-converting enzyme (ACE) gene I/D polymorphism with the risk of knee OA: A systematic review, meta-analysis, and meta-regression.

Background: Previous studies have linked genetics to knee osteoarthritis. Angiotensin-converting enzyme (ACE) gene I/D polymorphism may cause OA. However, evidence remains inconsistent. This study examines knee OA risk and ACE gene I/D polymorphism. Methods: We explored Europe PMC, Medline, Scopus, and Cochrane Library using keywords. Three assessment bias factors were assessed using the Newcastle-Ottawa Scale (NOS). Criteria for inclusion: (1) Split the study population into knee OA patients and healthy controls; (2) Analysed the ACE gene I/D polymorphism; (3) Case-control or cross-sectional surveys. Studies with non-knee OA, incomplete data, and no full-text were excluded. The odds ratio (OR) and 95% confidence intervals (95% CI) were calculated using random-effect models. Results: A total of 6 case-control studies consist of 1,226 patients with knee OA and 1,145 healthy subjects as controls were included. Our pooled analysis revealed that a significant association between ACE gene I/D polymorphism and risk of knee OA was only seen in the dominant (DD + ID vs. II) [OR 1.69 (95% CI 1.14 - 2.50), p = 0.009, I2 = 72%], and ID vs. II [OR 1.37 (95% CI 1.01- 1.86), p = 0.04, I2 = 43%] genotype models. Other genotype models, including recessive (DD vs. ID + II), alleles (D vs. I), DD vs. ID, and DD vs. II models did not show a significant association with knee OA risk. Further regression analysis revealed that ethnicity and sex may influence those relationships in several genotype models. Conclusions: Dominant and ID vs. II ACE gene I/D polymorphism models increased knee OA risk significantly. More research with larger samples and different ethnic groups is needed to confirm our findings. After ethnicity subgroup analysis, some genetic models in our study showed significant heterogeneities, and most studies are from Asian countries with Asian populations, with little evidence on Arabs.

Evaluation of Blended Learning in Terms of the Perceptions of Medical Students: A Mixed Method Study.

Introduction: The ongoing 4.0 industrial evolution, characterized by the rise of digital technology, has had a massive impact on human lifestyles worldwide. Faculty members in medical school are expected to respond to this industrial revolution by implementing teaching strategies, one of which is Blended learning as a suitable solution to overcome the limitations of space and time in the teaching process. For effective utilization of blended learning, it is important to conduct extensive studies on its implementation. The aim of this study was to assess the effectiveness and efficiency of implementing blended learning in the faculty of medicine in Hasanuddin University from the students' perspective. Methods: This study used a sequential explanatory mixed method approach, combining quantitative and qualitative methods. The quantitative part involved 782 undergraduate medical students from the first, second, and third years. Data were collected through a questionnaire survey distributed among the students. The qualitative part of the research was conducted through focus group discussions involving 13 students based on the questionnaire scores, representing both high and low scores. The results of the quantitative and qualitative research were collected and integrated. Results: Based on the results, the majority of students agreed that blended learning provided many advantages to their learning (Mean±SD: 3.79±0.78). Also, they reported e-learning platform significantly contributed to their learning process (Mean±SD: 3.88±0.67). The workload of blended learning method was still considered quite heavy by students, and good time management was highly needed (Mean±SD: 3.45±0.84). As for qualitative part, some positive results were obtained; they reported that it increased motivation for learning, enhanced the efficiency of learning and gaining adaptability, while the negative opinions were the network error in e-learning, erratic e-learning display, and video quality problem. Conclusion: Most of the students expressed positive opinions about the advantages of blended learning; according to them, learning was more efficient and effective, it enhanced learning motivation, and it provided comprehensive accessible learning materials.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study.

Introduction: Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital. Methods: This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. The questionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled "Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital" and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA. Results: Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (p<0.05) was found in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, p<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, p<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors. Conclusion: This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.

Comparison between Neutralization Capacity of Antibodies Elicited by COVID-19 Natural Infection and Vaccination in Indonesia: A Prospective Cohort.

BACKGROUND: To fight the COVID-19 pandemic, immunity against SARS-CoV-2 should be achieved not only through natural infection but also by vaccination. The effect of COVID-19 vaccination on previously infected persons is debatable. METHODS: A prospective cohort was undergone to collect sera from unvaccinated survivors and vaccinated persons-with and without COVID-19 pre-infection. The sera were analyzed for the anti-receptor binding domain (RBD) titers by ELISA and for the capacity to neutralize the pseudovirus of the Wuhan-Hu-1 strain by luciferase assays. RESULTS: Neither the antibody titers nor the neutralization capacity was significantly different between the three groups. However, the correlation between the antibody titers and the percentage of viral neutralization derived from sera of unvaccinated survivors was higher than that from vaccinated persons with pre-infection and vaccinated naïve individuals (Spearman correlation coefficient (r) = -0.8558; 95% CI, -0.9259 to -0.7288), p < 0.0001 vs. -0.7855; 95% CI, -0.8877 to -0.6096, p < 0.0001 and -0.581; 95% CI, -0.7679 to -0.3028, p = 0.0002, respectively), indicating the capacity to neutralize the virus is most superior by infection alone. CONCLUSIONS: Vaccines induce anti-RBD titers as high as the natural infection with lower neutralization capacity, and it does not boost immunity in pre-infected persons.

Dynamic interaction of obesity, age, MCP-1 Level, and ACE-1 gene with the severity of knee osteoarthritis: a cross-sectional study.

The risk factors most strongly associated with knee osteoarthritis (OA) are old age and obesity. However, few studies have evaluated the interaction between aging and obesity in conjunction with inflammatory markers and knee OA severity as part of a complete assessment of knee OA management. Therefore, this study aims to evaluate the interaction between obesity, age, inflammation [including the I/D polymorphism of angiotensin converting enzyme-1 (ACE-1)], and the severity of knee OA. Methods: A total of 80 knee OA patients were included in this cross-sectional study. The severity of knee OA was determined based on the Kellgren-Lawrence system. All patients underwent physical and radiological examination; monocyte chemoattractant protein 1 (MCP-1) markers were measured. The parameters of the ACE-1 gene were examined with sequencing DNA. Results: There was a significant relationship between age and severity of knee OA (P=0.007), with subjects aged greater than or equal to 65 having a 3.56-fold higher risk of developing moderate to severe OA than subjects aged less than 65. There was a significant difference between body weight and knee OA severity (P=0.026), in which subjects weighing greater than or equal to 60 kg had 3.14 times the risk of experiencing severe knee OA. Multivariate regression analysis indicated that age was the strongest independent variable for knee OA severity compared with body weight. MCP-1 levels were significantly higher in mild knee OA than in moderate to severe knee OA. The DD genotype of the ACE-1 gene increases the risk of severe knee OA by four times in subjects aged greater than or equal to 65 compared to subjects aged less than 65. However, the DD genotype of the ACE-1 gene does not increase the risk of severe knee OA in subjects weighing greater than or equal to 60 kg. Conclusion: While obesity and age were found to be associated with the severity of knee OA, age emerged as the independent risk factor for knee OA severity. Furthermore, MCP-1 levels were significantly higher in cases of mild knee OA compared to severe knee OA. It was observed that the DD genotype of the ACE-1 gene increases the risk of severe knee OA in individuals aged 65 years or older.

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.

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.

Seroprevalence of Chikungunya in an Asymptomatic Adult Population in North and South Sulawesi, Indonesia.

Chikungunya (CHIK) is an emerging and reemerging infectious disease of public health importance in Indonesia. Information on the asymptomatic and true burden of CHIK virus (CHIKV) infections is limited. We assayed 1,092 healthy population samples, collected in North and South Sulawesi between 2019 and 2020, for antibodies against CHIKV. Blood samples were screened by IgM and IgG ELISAs and quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) assay. CHIKV IgG seroprevalence in North and South Sulawesi was 53.2% and 53.9%, respectively. The overall prevalence of anti-CHIKV IgM antibody was 12.9%. Molecular testing of blood donors revealed 0.66% (2/300) were positive for CHIKV qRT-PCR. Our study provides new insights into the CHIKV endemicity situation in the eastern part of Indonesia and warrants the need for further systematic surveillance considering there is no treatment or vaccine for CHIK infection.

Effectiveness of Prolotherapy Combined with Physical Therapy Versus Physical Therapy Only for Frozen Shoulder: A Case Report.

BACKGROUND Frozen shoulder (FS) is a common conditions that causes significant morbidity. It is characterized by restriction of both active and passive shoulder motion (ROM) of the glenohumeral joint. The etiology, pathology, and most efficacious treatments are unclear. The purpose of FS treatment is complete elimination of pain and recovery of shoulder joint function. Prolotherapy injects certain compounds into articular spaces, ligaments, and/or tendons to relieve pain and disability around joint spaces and to stimulate a proliferation cascade to enhance tissue repair and strength. This case report aims to describe functional outcome changes in 2 patients with FS, comparing prolotherapy combined with physical therapy vs physical therapy only. CASE REPORT We report the cases of 2 patients with confirmed FS. Patient A was 66-year-old man with chief concern of right shoulder pain and limited ROM in the past 3 months, which disrupted daily life, with a visual analog scale (VAS) of 6 out of 10. Patient B was 65-year-old man with chief concern of right shoulder pain and limited ROM in the past 2 months. The symptoms affected his general quality of life, with a VAS of 5 out of 10. Patient A underwent prolotherapy combined with physical therapy and had significantly improved ROM after 2 weeks, with relieved pain and improved shoulder function. Patient B underwent physical therapy only and showed similar ROM and no significant pain improvement. CONCLUSIONS Initial treatment with prolotherapy combined with physical therapy for patients with frozen shoulder achieved fast improvement of active and passive ROM, significantly decreased pain, and improved quality of life compared to physical therapy intervention only.

Correlation between innate and adaptive immunity response in TB children post BCG vaccination. Is it effective or not?: Cross-sectional study.

Background: How far the role of innate immunity and adaptive immunity do in children who have been BCG vaccinated in controlling the course and the severity of the TB disease has not been completely known. Mycobacterium tuberculosis entry to the body will be recognized by Toll-like receptors found on macrophages, neutrophils, and dendritic cells as part of the innate immune response, after which the dendritic cells will then present the antigen to lymphocyte T0 cells and initiate the adaptive immune response (of which CD4 T cells have an important role in). Was one or were both of these immune responses function well or not in a BCG Vaccinated Children with TB? Objective: This study aim to find a better understanding of the role of innate immune response assessed by TLR2/TLR4 mRNA gene expression and serum TLR2/TLR4 levels, while the role of adaptive immune response is assessed by analyzing serum CD4 level in children with TB who have had BCG vaccination. Methods: This cross-sectional study was conducted among children with TB at the outpatient and inpatient wards at Bhakti Medicare and Jakarta Islamic Hospital. Expression of mRNA gene was measured using the Boom method and protein serum levels were measured using the ELISA method. The results were analyzed by using the SPSS v.23 program. Results: Sixty-nine children were recruited as subjects. In this study, 68.1% of whom had BCG scars. TLR4 mRNA gene expression was found to be higher than TLR2 mRNA gene expression. Serum CD4 level was found to be highest out of TLR2 and TLR4 level, but serum TLR2 level was higher than TLR4 level. TLR2/TLR4 mRNA gene expression, serum TLR2/TLR4 levels, and CD4 levels in subjects with BCG scar were also found to be significantly higher than in subjects without BCG scar (p < 0.001). There was a significant positive correlation between TLR2/TLR4 mRNA gene expression and serum TLR2/TLR4 levels (r = 0.860; r = 0.864; p < 0.001) and between serum levels TLR2/TLR4 with serum CD4 levels (r = 0.822; r = 0.832 p < 0.001). Conclusion: As early as possible, BCG vaccine administration is needed in endemic countries, but it must be ensured that scars can be formed. It is also important to control Latent TB Infection (LTBI) to prevent transmission and relapse of disease.

Effectiveness of Augmented Reality (AR) based learning media on increasing the physical examination system of pregnant women urinary system.

OBJECTIVE: This study aims to analyze the effectiveness of learning media based on Augmented Reality (AR) on improving the physical examination skills of the urinary system of pregnant women. METHOD: This type of research is an experimental study with a quasi-experimental non-equivalent control group design conducted in January-February 2020 at the Midwifery Polytechnic Laboratory of the Ministry of Health Gorontalo. A sample of 92 students was selected by purposive sampling and met the inclusion criteria. Then the sample was divided into two groups: a control group that was given material through lecture and demonstration methods totaling 30 respondents and an intervention group that was given material through AR learning media and a method of demonstration totaling 62 respondents. Data collection was performed using a checklist to assess student skills improvement. Data were analyzed using the Cochran test to determine differences in skills over time. RESULTS: There was an increase in skills in the control and intervention groups with a statistically significant P<0.001 (P<0.05). However, the results showed that the mean improvement in skills in the week I of the study in the intervention group who were given AR learning media was higher in the percentage of skill improvement (72.6%) when compared to the control group who were given the lecture method and the demonstration method (36.7%). Likewise, the mean increase in skills in week II of the study in the intervention group was higher in the percentage of skill improvement (91.9%) compared to the control group given the lecture and demonstration method (66.7%), although in the third week all respondents in the control group and group the intervention becomes skilled at carrying out a physical examination of the urinary system of pregnant women. CONCLUSION: AR media is more effective in improving student skills.

Mean arterial pressure and the endothelin-1 levels in preeclampsia.

OBJECTIVE: This study aims to determine the correlation between Endothelin-1 levels and mean arterial pressure (MAP) with preeclampsia so that their combination can be used as the predictor of PE in early pregnancy. METHOD: This study used a cross-sectional study with a case-control design carried out in February to June 2020 in several hospitals and health centers in Makassar city, namely Dr. Wahidin Soedirohusodo General Hospital, Hasanuddin University State University Hospital, health center Bara Baraya, health center Mamajang, and health center Antang. Respondents in this study were divided into 37 pregnant women with preeclampsia and 53 pregnant women with normotension. This study's criteria for respondents were 20-35 years old, single pregnancy with > 20 weeks gestational. Data collected included education, body mass index (BMI), parity, the interval of pregnancy, and gestational age. ET-1 levels were determined using th ET-1 Elisa Kit with the ELISA method, and MAP was collected by measuring blood pressure when pregnant women came to health facilities. RESULTS: The mean serum ET-1 levels in the preeclampsia were highest than normotensive with a significant p-value of 0.001 (p<0.05). The MAP in the preeclampsia was highest than normotensive too, with a significant value of p-value 0.001 (p<0.05), and there is a positive correlation between ET-1 and MAP with r=0.34 and p-value 0.001 (p<0.05). CONCLUSION: The combination of ET-1 and MAP can be considered as a prognostic factor to detect PE in early pregnancy.

The effectiveness of gentle prenatal yoga on the recovery of anxiety level in primigravid and multigravid pregnant women.

OBJECTIVE: This study aimed to analyze the effectiveness of gentle prenatal yoga on the anxiety problem in primigravida and multigravida pregnant women. METHOD: This study was conducted at Bara-Baraya Health Center, Antang Health Center, Kapasa Health Center, and Mamajang Health Center. The applied research design in this study was a quasi-experiment with a non-equivalent control group design approach. Samples were selected using a purposive sample technique. Furthermore, the instrument used was the Hamilton Anxiety Rating Scale (HARS) questionnaire. The number of samples in this study was 24 respondents divided into two groups, 12 in the intervention group and 12 in the control group. Meanwhile, the criteria of samples in this study were pregnant women in the first to fifth pregnancy, having been in trimester II-III with the gestational age of ≥20-30 weeks, and not having complications in pregnancy. RESULTS: the HARS scores in the intervention group showed that the mean rank of the pre-test was 23.75, In the mid-test, it was 20.00, and in the post-test, it was 16.00. Meanwhile, in the control group, its mean rank was 23.50, mid-test it was 21.58, and the post-test it was 20.41 showed that the intervention group experienced a significant decrease in anxiety levels. From the results of the Mann Whitney test, the intervention group p=0.001<(α 0.05) showed that there were significant changes. CONCLUSION: There were differences in HARS (Hamilton Anxiety Rating Scale) scores between the intervention and control groups before and after a gentle prenatal yoga treatment.

Antenatal care parameters that are the risk factors in the event of preeclampsia in primigravida.

OBJECTIVE: This study aimed to analyze the parameters of antenatal care, which becomes a risk factor against the incidence of preeclampsia in primigravidae in Kolaka. METHODS: The study uses case-control studies (case-control), which use a retrospective approach. The population in this study were all primigravida pregnant women recorded in the medical records at the BLUD Hospital. HM Djafar Harun as many as 5796 women and BLUD Benyamin Guluh Hospital as many as 5065 women. The sample in this case group is the primary mother Gravida, who suffered from preeclampsia from January 2014 to September 2018, and the control group was primigravida mothers who did not suffer from preeclampsia in the same period. RESULTS: The results showed that the age of primigravida mothers 14-28 years had a risk of 1.581 times more significant for having preeclampsia than the age group 29-49 years with CI (1.186-2.108), the incidence of hypertension in trimester 1 in primigravida mothers had a risk of 3.405 times greater for preeclampsia than mothers without a history of hypertension in trimester 1 with CI (2.164-5.358), irregular antenatal visits are 1.095 times more likely to develop preeclampsia than regular antenatal visits with CI (0.799-1.539), weight gain primigravida maternal body 1-10kg 1.540 times greater risk of developing preeclampsia than 10-20kg of weight gain with CI (1.074-2.207), pregnancy checks according to Antenatal Care non-compliant care standards are 1.333 times more likely to develop preeclampsia than primigravida mothers who obediently do the inspection antenatal care with CI (0.970-1.831). CONCLUSION: Variables that are very risky with preeclampsia in primigravida mothers based on multivariate analysis are the hypertension incidence in the first trimester with an OR: 3.363 with a CI value of 2.126 and a lower value of 5.318.

Learning media based on augmented reality (AR) increased the skill of physical examination of the integumentary system of pregnant women in midwifery students.

OBJECTIVE: This research was to analyze the correlation of AR-based Learning Media to improving the physical examination of the integumentary system of pregnant women in midwifery students. METHOD: The research method used Quasi-experimental with Non-Equivalent Control Group Design. The sample of 92 students was selected by a purposive sample, divided into two intervention and control groups. The intervention group was 62 students, and the control group was 30 students. Data collection was performed using a checklist to assess the skill of the physical examination of the integumentary system of pregnant women. To test the differences of skill before and after treatment in control and intervention groups used the Mcnemar test, whereas to know the differences in skill from time to time Cochran test was used. RESULT: The results showed differences in the measurement of skills improvement in the control and intervention groups before and after the intervention was given. A more significant increase in skills occurred in the intervention group with a p-value <0.001 contributing after 1week of giving a demonstration, and application-based (AR) skills increased by 66.1%. After two weeks it increased by 93.5%, and after two weeks it increased by 100%. So it could be concluded statistically that AR-based learning media was significant in improving the physical examination skills integumentary systems in pregnant women.

Comparison of nitric oxide levels, roll over test value, and body mass index in preeclampsia and normotension.

OBJECTIVE: The study aims to compare levels NO, the ROT, and BMI values in preeclampsia and normotension. METHOD: This study was an observational analytical study that combined the draft case-control study and a cross-sectional study (hybrid method) conducted in February-June 2020. This study was conducted in the Hospital Dr. Wahidin Sudirohusodo Makasar, Antang Health Center, Barabaraya Health Center, and Mamajang Health Center. Respondents in this study were pregnant women divided into two groups, 108 mothers with normal pregnancies and 42 mothers with preeclampsia. The criteria of the study respondents were single pregnancies, pregnancy of more than 20 weeks, and the gestational age of 20-35 years old. Data collected includes age, parity, gestational age, pregnancy interval, body mass index (BMI), and education. In addition, Nitric oxide levels are determined using Elisa Kit, and roll over test is collected by performing blood pressure measurements at two different positions. RESULTS: The mean serum NO levels in the preeclampsia 176.43±50.8 and 152.75±51.3 in normotension, and there is a meaningful relationship p=0.012. Mean value of ROT in preeclampsia 23.21±8.54 and 19.63±8.85 in normotension p=0.026. There is a meaningful difference in IMT with preeclampsia p=0.003. CONCLUSION: NO, ROT and BMI are significantly higher in pregnant mothers with preeclampsia than in normal pregnancies.

The effectiveness of gentle prenatal yoga on the recovery of depression level in pregnant women aged.

OBJECTIVE: This study aimed to analyze the effectiveness of gentle prenatal yoga toward depression and abnormal serotonin hormone levels in pregnant women aged <20 and >35 years old. METHOD: This study was conducted at Bara Baraya Health Center, Antang Health Center, Kapasa Health Center, and Mamajang Health Center. The applied research design in this study was a quasi-experiment with a non-equivalent control group design approach. Samples were selected using a purposive sample technique. The instrument used was the Beck Depression Inventory (BDI) questionnaire. The number of samples in this study was 24 respondents divided into 2, 12 in the intervention group and 12 in the control group. Sample criteria in this study were pregnant women aged <20 and >35 years old, having been in trimester II-III with the gestational age of ≥20 to <31 weeks, and not having complications in pregnancy. RESULTS: The mean values for the intervention group were 6.50 in the pre-test to the mid-test and 6.50 in the mid-test to the post-test. Meanwhile, the mean values for the control group were 5.61 in the pre-test to the mid-test and 4.50 in the mid-test to the post-test. This indicated that the intervention group experienced a significantly reduced level of depression based on the BD-II (Beck Depression Inventory-II) scores when compared to the control group. Furthermore, based on the comparison of the post-test data between the intervention group and the control group, it was obtained the p-value of 0.005 (α<0.05). CONCLUSION: There were differences in BDI-II (Beck Depression Inventory-II) scores between the intervention group and the control group after receiving prenatal gentle yoga treatment.

Exercise adaptations and TGF-ß1 levels in recreational cyclists.

BACKGROUND: Cycling is a physical exercise that is widely performed to improve physical fitness. Regular physical exercise will lead to adaptations to exercise. This adaptation is useful in suppressing the production of reactive oxygen stress (ROS) generated in response to cellular metabolism that uses oxygen. Transforming growth factor beta-1 (TGF-ß1) plays a role in increasing the production of ROS, thus, when the concentration is low, it would lead to an improvement in physical fitness. This study aims to compare levels of TGF-ß1 between recreational cyclists and sedentary groups. In addition, this research also compares several other parameters, which are fasting blood sugar levels and lipid profiles (triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol) between cyclists and sedentaries. METHODS: This was an observational analytical study with a cross-sectional design. The research subjects consisted of 2 groups, each consisting of 21 participants, namely the recreational cyclist and the sedentary group. Anthropometric examinations were carried out, including body weight, height, body mass index, waist circumference, and body fat percentage. Fasting blood glucose concentration and lipid profile (Triglyceride - TG, Total Cholesterol - Total C, HDL Cholesterol - HDL-C, and LDL Cholesterol - LDL-C) were determined by the enzymatic colorimetric methods, and TGF-ß1 levels were determined using the fluorescence of specific antibodies for TGF-ß1 (pg/ml) using ELISA method. Statistical analysis was performed using IBM SPSS v. 25. RESULTS: The anthropometric variables, other than body height, did not differ significantly between the two groups, so did the fasting blood glucose concentration. Nevertheless, the lipid profile (TG, Total C, HDL-C and LDL-C) were found to be significantly better in the cyclist group (p < 0.05).The mean level of TGF-ß1 in recreational cyclists was 8, 908.48 pg/ml, lower than the control group, 10, 229.28 pg/ml. The results of the unpaired t-test showed significant mean differences between the two groups, (p = 0.001; p < 0.05). CONCLUSION: The levels of TGF-ß1 in the recreational cyclist group were lower than the sedentary group. Regular physical exercise will trigger exercise adaptations that can suppress latent TGF-ß1 activation.

Comparison TLR2 and TLR4 serum levels in children with pulmonary and extrapulmonary tuberculosis with and without a Bacillus Calmette-Guérin (BCG) scar.

The formation of a scar after Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination influences the effectiveness of protection against Mycobacterium tuberculosis (MTB) infection. The innate immunity plays a critical role both in the pathophysiology of tuberculosis (TB) and BCG vaccination protection mechanism. Parts of innate immunity: macrophages, dendritic cells, and neutrophils, have microbial recognition surface receptors called Toll-like receptors (TLR) 2 and 4. The objective of this study is to compare the serum levels of TLR2 and TLR4 in BCG-vaccinated pediatric patients with pulmonary and extrapulmonary TB. This cross-sectional study included children aged less than 18 years old with contracted TB disease and had received BCG vaccination. The subjects were recruited by convenience sampling from both outpatient and inpatient care at Bhakti Medicare and Jakarta Islamic Hospital, from November 2018 to December 2019. Serum TLR2 and TLR4 levels measured using ELISA of the two groups of subjects: children with pulmonary TB (PTB) and extrapulmonary TB (EPTB), were then compared. The presence of BCG scars was included in the analysis. Independent T-test, ANOVA test, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. Serum TLR2 and TLR4 levels were higher in EPTB group, but the difference was not significant (TLR2 p = 0.758 and TLR4 p = 0.646, respectively). Subjects with BCG scars in both groups have significantly higher serum TLR2 and TLR4 levels than those without BCG scars in the EPTB group (EPTB p = 0.001 and p = 0.004, respectively); (PTB p < 0.001 and p < 0.001, respectively). BCG vaccination and MTB infection stimulate better innate immune response in EPTB than in PTB and serum TLR2 and TLR4 levels in those with BCG scars were higher when compared to those without BCG scars.

Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial.

OBJECTIVE: To assess the effects of dextrose prolotherapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen, and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain. METHODS: A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dextrose prolotherapy. The hyaluronic acid group received 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injections, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Universities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conducted using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups. RESULTS: A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose prolotherapy) completed the protocol. Both interventions resulted in significant improvements in numerical rating scale scores for pain, total Western Ontario McMaster Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperformed hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p = 0.042) and 0.34 (p = 0.048), respectively. No significant changes in level of serum cartilage oligomeric proteinase were found in either group. CONCLUSION: Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither injection method resulted in reduced serum cartilage oligomeric proteinase.