Serotonin norepinephrine reuptake inhibitors in managing neuropathic pain following spinal and non-spinal surgery: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: While serotonin norepinephrine reuptake inhibitors (SNRIs) offer promise in managing Post-surgical neuropathic pain (PSNP), uncertainties remain. This study aims to evaluate the effectiveness and adverse events of SNRIs in managing PSNP. METHODS: Systematic searches of PubMed, Embase, and Cochrane databases up to January 1st 2023 identified randomized controlled trials (RCTs) comparing SNRIs to placebo for PSNP. The primary outcome measures were pain at rest and adverse events post-surgery. Subgroup analyses were conducted based on surgical type and specific SNRIs. RESULTS: A total of 19 RCTs, encompassing 1440 participants (719 in the SNRI group vs 721 in the placebo group), met the inclusion criteria and were included. The pooled results demonstrated that pain scores were significantly lower in patients treated with SNRIs at 2 hours (MD:-0.26; 95%CI: -0.47 to -0.04; p=0.02), 6 hours (MD:-0.68; 95%CI: -1.01 to -0.34; p<0.0001), 24 hours (MD:-0.54; 95%CI: -0.99 to -0.09; p=0.02), and 48 hours (MD:-0.66; 95%CI: -1.23 to -0.10; p=0.02) post-surgery. In terms of adverse events, dizziness (OR:2.53; 95%CI: 1.34-4.78; p=0.004) and dry mouth (OR:2.21; 95%CI: 1.25-3.92; p=0.007) were significantly higher in the SNRIs group. Subgroup analysis showed that SNRI was found to significantly lower the 24-hour pain score after spinal surgery (MD:-0.45; 95%CI: -0.84 to -0.05; p=0.03). Duloxetine (MD:-0.63; 95%CI: -1.15 to -0.11; p=0.02) had a significant effect in lowering the 24-hour pain score at rest compared to placebo, whereas venlafaxine did not. CONCLUSIONS: SNRIs yielded considerable pain score reductions across multiple post-surgical intervals, although accompanied by an increased incidence of dizziness and dry mouth.

Risk of intracranial hemorrhage in brain arteriovenous malformations: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Brain arteriovenous malformations (bAVMs) carry a risk of hemorrhage. We aim to identify factors associated with subsequent hemorrhages. METHODS: Systematic searches were conducted across the ScienceDirect, Medline, and Cochrane databases. Assessed risk factors included bAVM size, bAVM volume, hemorrhage and seizure presentations, presence of deep venous drainage, deep-seated bAVMs, associated aneurysms, and Spetzler-Martin grade. Subgroup analyses were conducted on prior treatments, hemorrhage presentation, AVM size, and type of management. RESULTS: The meta-analysis included 8 cohort studies and 2 trials, with 4,240 participants. Initial hemorrhage presentation (HR 2.41; 95% CI 1.94-2.98; p < 0.001), any deep venous drainage (HR 1.52; 95% CI 1.09-2.13; p = 0.01), and associated aneurysms (HR 1.78; 95% CI 1.41-2.23; p < 0.001) increased secondary hemorrhage risk. Conversely, higher Spetzler-Martin grades (HR 0.77; 95% CI 0.68-0.87; p < 0.001) and larger malformation volumes (HR 0.87; 95% CI 0.76-0.99; p = 0.04) reduced risk. Subgroups showed any deep venous drainage in patients without prior treatment (HR 1.64; 95% CI 1.25-2.15; p < 0.001), bAVM > 3 cm (HR 1.79; 95% CI 1.15-2.78; p = 0.01), and multimodal interventions (HR 1.69; 95% CI 1.12-2.53; p = 0.01) increased risk. The reverse effect was found for patients initially presented without hemorrhage (HR 0.79; 95% CI 0.67-0.93; p = 0.01). Deep bAVM was a risk factor in > 3 cm cases (HR 2.72; 95% CI 1.61-4.59; p < 0.001) and multimodal management (HR 2.77; 95% CI 1.66-4.56; p < 0.001). Kaplan-Meier analysis revealed increased hemorrhage risk for initial hemorrhage presentation, while cumulative survival was higher in intervened patients over 72 months. CONCLUSION: Significant risk factors for bAVMs hemorrhage include initial hemorrhage, any deep venous drainage, and associated aneurysms. Deep venous drainage involvement is a risk factor in cases without prior treatment, those with bAVM > 3 cm, and cases managed with multimodal interventions. Deep bAVM involvement also emerges as a risk factor in cases > 3 cm and those managed with multimodal approaches.

Mechanical thrombectomy in M1 and M2 segments of middle cerebral arteries: A meta-analysis of prospective cohort studies.

BACKGROUND: Recent studies indicate that endovascular therapy is superior to intravenous thrombolysis in treating M1 segment MCA occlusions, however, the effectiveness of mechanical thrombectomy in MI vs. M2 segment occlusions is unclear. METHODS: The meta-analysis was conducted by searching databases from January 2016 to January 2023, without language constraints. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Pooled data analysis of outcomes, pre-existing medical comorbidities, and baseline scores were performed. RESULTS: Six prospective cohort studies with 6356 patients were included (4405 vs. 1638). Patients with M2 occlusion had a significantly lower mean baseline NIHSS at admission (MD: -2.14; 95 %CI: -3.48 to -0.81; p = 0.002). Conversely, patients with M1 occlusion had a lower ASPECTS at admission score (MD: 0.29; 95 %CI: 0.00-0.59; p = 0.05). No significant difference was found between segments in terms of pre-existing medical comorbidities (OR: 0.96; 95 %CI: 0.87-1.05; p = 0.36), mortality rate at 90 days (OR: 0.88; 95 %CI: 0.76-1.02; p = 0.10), and hemorrhage occurrence within 24-hours (OR: 1.06; 95 %CI: 0.89-1.25; p = 0.53). Patients with M2 occlusion were more likely to have good outcomes after therapy (OR: 1.18; 95 %CI: 1.05-1.32; p = 0.006). Successful recanalization rates were comparatively higher among patients with an M1 occlusion (OR: 0.79; 95 %CI: 0.68-0.92; p = 0.003). Functional outcomes at 90 days are better in M2 occlusion patients, while successful recanalization rates are higher in M1 occlusion patients. No significant differences were found in mortality rates or hemorrhage incidence. CONCLUSIONS: These results suggest that mechanical thrombectomy is a safe and effective treatment for MCA occlusions in both M1 and M2 segments.

Modified ICH score was superior to original ICH score for assessment of 30-day mortality and good outcome of non-traumatic intracerebral hemorrhage.

INTRODUCTION: Intracerebral hemorrhage (ICH) score has been widely used as a consistent and reliable clinical grading scale for predicting mortality. However, ICH score had not been used to predict good outcome or significant disability for those who were alive. We intended to address whether any modifications would increase prediction accuracy for mortality as well as the extent of morbidity for those who survived. METHODS: We conducted a retrospective cohort study, involving all non-traumatic ICH patients admitted to our hospital between September 2018 and July 2020. All non-traumatic ICH patients who were admitted to the stroke unit and registered in our stroke database had their medical records, neuroimaging, and laboratory test results reviewed. Only patients with complete medical records and available CT imaging and laboratory test results were included in our study. Independent predictors of mortality (modified Rankin scale/mRS of 6) or good outcome vs. significant disability (mRS≤2 vs. mRS 3-5, respectively) were identified by logistic regression. A modified ICH (mICH) score was compared with the original ICH (oICH) score for its diagnostic performance (DP). Overall DPs were graded and ranked according to Youden Index (YI). RESULTS: As many as 311 patients were eligible with both 39.9% rate of 30-day mortality and good outcome. Factors independently associated with mortality were low GCS and high NIHSS on admission (P = 0.002, <0.001, respectively), and presence of respiratory failure (P < 0.001). Independent factors for good outcome were low NIHSS on admission and mass effect (midline shift > 5 mm) [both P < 0.001]. A modification of ICH score from the original was made by substituting GCS with NIHSS (0 -10 = 1; 11 - 20 = 2; >20 = 3), changing age cut-off point to > 55 years old (= 1), and adding respiratory failure (= 1), and mass effect (= 1). Overall, mICH scored better over oICH score with respect to sensitivity and had comparable specificity for both 30-day mortality and good outcome (sensitivity 80.6% vs. 50.8%; specificity 88.7% vs. 89.3%; YI 0.69 vs. 0.40, respectively) and good outcome (sensitivity 86.3% vs. 77.4%; specificity 74.6% vs. 77.8%; YI of 0.61 vs. 0.55, respectively). There was only one patient with oICH and none on mICH score of 0, who died and none survived with oICH and mICH score of ≥ 5 and ≥ 7, respectively. The proportion of 30-day mortality and good outcome increased in a more linear fashion with mICH score. CONCLUSIONS: The mICH score was proven to be reliable and consistent as a risk grading assessment for non-traumatic ICH patients. The mICH was statistically superior to oICH score in predicting 30-day mortality and good outcome.

Neurologic manifestations of COVID-19 infection in Asia: a systematic review.

BACKGROUND: COVID-19 infection can show various manifestation, including neurologic manifestations, such as anosmia, ageusia, or dysgeusia, and causes the neurologic disorder such as stroke, Guillain-Barre syndrome, encephalopathy, and many more. AIM: To briefly review neurologic manifestation in COVID-19 infection in the Asia region (South East Asia and the Western Pacific Region). MATERIAL AND METHODS: This review uses the PRISMA statement and checklist. The source for reviewed article was performed in PubMed that were published between December 2019 to September 2020 with the latest 1 year of publication. Study titles were first screened, then reviewed by title and abstract and then the last review, we tested full text and applied eligibility criteria. RESULTS: We found a total of 9 retrieved articles from the electronic database. Among these 9 articles, 5 of them are case report, 1 case series, 1 prospective multi-center cohort study, 1 retrospective multi-center study, and 1 retrospective observational study. All articles reported confirmed COVID-19, confirmation by positive swab test using the real-time RT-PCR method, with neurologic manifestations, disorder, or syndrome on presentation or found during hospital stay. In case of neurologic disorder or syndrome, the studies reported encephalitis and ADEM, acute cerebrovascular disease, acute symptomatic seizure, and Guillain-Barré syndrome with acute cerebrovascular disease as the most common neurologic disorder associated with COVID-19 infection, followed by encephalitis. CONCLUSION: COVID-19 also affects the brain, which may result in a global or focal neurologic manifestation. Healthcare provider treating patient with COVID-19 infection should also be aware of neurologic manifestation associated with COVID-19 infection to improve patient's outcome.Guillain-Barre syndrome, encephalopathy, and many more. This review will briefly review neurologic manifestation in COVID-19 infection in the Asian region (South East Asia and the Western Pacific Region. A total of 9 retrieved articles from the electronic database reported confirmed COVID-19, confirmation by RT-PCR method, with neurologic manifestation, disorder, or syndrome on presentation or found during hospital stay. Healthcare provider treating patient with COVID-19 infection should also be aware of neurologic manifestation associated with COVID-19 infection to improve patient's outcome.

Pain related viral infections: a literature review.

Pain is a common health problem all around the world. The pain symptoms are various depending on the underlying disease or the direct cause of pain itself. Viral infection could cause arthralgia or acute-onset arthritis, moreover in pandemic era of SARS-CoV-2 infection. The patients might experience arthritis, arthralgia, joint pain, or musculoskeletal pain. Viral infection including parvovirus B19, hepatitis virus, human immunodeficiency virus, arthropod-borne virus, and coronavirus could cause various types of pain. The pathogenesis of these symptoms is similar to each other despite of different causative organism. This review will discuss about pain caused by various causative organisms.

Pain as clinical manifestations of COVID-19 infection and its management in the pandemic era: a literature review.

Coronavirus disease 2019 (COVID-19) is a current global pandemic. The case number has increased since December 31, 2019. It has been reported that COVID-19 patients have been giving pain complaints, one of which is muscular pain. Other types of pain that have also been reported by COVID-19 patients are joint pain, stomach pain, and testicular pain. Neuropathic pain is the rarest case among others. COVID-19 mechanisms in the nerve and musculoskeletal damage are believed to be caused by the expression and distribution of angiotensin-converting enzyme 2 (ACE-2). Patients with pain, especially neuropathic pain, normally do not respond well to various therapies, and experience psychiatric disorders such as depression, which leads to a decrease in the patient's quality of life. Important considerations for health professionals in terms of pain management during this pandemic include ensuring treatment continuity, painkillers, utilization of telemedicine, biopsychosocial management approach, and modifying therapy needs to reduce the risks of COVID-19 complications.

Alveolar Bone Osteoclast Profile in the Periodontitis Wistar Rats Model with the Snail Slime (Achatina Fulica) Application.

BACKGROUND: Bone damage is a result of periodontal disease that occurs due to changes in osteoclast and osteoblast activity in response to local inflammation. The bacteria Aggregatibacter actinomycetemcomitans produces Lipopolysaccharide (LPS), which can increase osteoclast activity. AIM: This study aimed to analyse the decrease in alveolar bone osteoclasts in periodontitis rats' model with the application of snail slime. METHODS: Wistar rats (27) with periodontitis divided into three groups, namely the control group (debridement), P1 group (debridement and application of oral snail slime) 300 Mg/Kg Body weight, P2 group (debridement, application of topical snail slime) 0.1 Mg. Osteoclast profile analysis was carried out by HE staining procedure to determine the histological feature of osteoclasts. The statistical significance was determined using the Shapiro-Wilk Test, One Way ANOVA, and Post Hoc test (p < 0.05). RESULTS: Osteoclast profile in rats with periodontitis applied with snail slime significantly decreased the number of osteoclasts with both oral and topical administration, there were significant differences in the number of osteoclasts between groups (one way ANOVA, p < 0.05) and there were no significant differences between groups P1 and P2 (Post Hoc, p > 0.05). CONCLUSION: In this study, there was a decrease in the number of osteoclasts which were slipped by snail slime in Wistar rats with periodontitis; this indicates a periodontitis healing process.

Cerebellar Cryptococcal Abscess in HIV-Negative Patient: A Case Report and Literature Review.

BACKGROUND: Cryptococcus is a common cause of opportunistic infection in HIV-positive patients. While the incidence of this disease has decreased in AIDS-associated cases, cryptococcal infection in immune-competent person has been increased. CASE PRESENTATION: We report a case of cryptococcosis and literature review of pathogenesis and clinical aspects of cryptococcal central nervous system infection. A 64-year-old man, from Flores, complaining of severe headache since a few days before admitted to hospital. Head MRI showed multiple hypointense lesions in the left cerebellar hemisphere, suspected abscess or metastatic process. HIV testing was non-reactive. Surgery was performed, and microscopic evaluation revealed multiple abscesses containing PAS-positive budding yeasts consistent with cryptococcal abscesses. CONCLUSION: Cryptococcosis rarely occur in immunocompetent patients. The clinical manifestation depends on pathogenic factors of pathogen and host factor. Treatment is with the administration of antifungal drugs, and the prognosis mostly depends on the underlying disease.

Antibacterial Activity of Lumbricus Rubellus Earthworm Extract Against Porphyromonas Gingivalis as the Bacterial Cause of Periodontitis.

AIM: The purpose of this study was to determine the antibacterial activity of Lumbricus rubellus earthworms through inhibitory zone diameter to the growth of the bacterium Phorphyromonas gingivalis as the cause of periodontitis. METHODS: This was an experimental study with randomised posttest-only control group design. The study was conducted at the Microbiology Research Center laboratory at the Faculty of Dentistry, Airlangga University, Indonesia. The study was conducted in vitro, the sample size was calculated using the Federer formula as many as four agar plates containing bacteria Phorphyromonas gingivalis, with each plate given five different treatments: control (ethanol), Lumbricus rubellus earthworm extract (ECT) with concentrations of 50%, 25%, 12.5%, and 6.25% respectively. The data in the form of inhibition zone diameter (measured in millimetres) obtained were tested using One-Way ANOVA. RESULTS: The mean diameter of the inhibitory zone extract of Lumbricus rubellus earthworm on the growth of Phorphyromonas gingivalis bacteria in the treatment group had significant differences (p < 0.05). The mean inhibition zones between controls and the ECT treatment group (ECT 50%, ECT 25%, ECT 12.5%) were statistically different (p < 0.05), in contrast with ECT 6.25% (p > 0.05) which did not show significant difference with the control group (p > 0.05). CONCLUSION: Lumbricus rubellus earthworm extract with a concentration of 50% has the largest diameter of the inhibitory zone on the growth of the Phorphyromonas gingivalis bacteria. The 6.25% earthworm extract showed no antibacterial activity against the growth of Phorphyromonas gingivalis bacteria.

Comparison of Mean VEGF-A Expression Between Acute Ischemic Stroke Patients and Non-Ischemic Stroke Subjects.

BACKGROUND: Glucose and oxygen supply to neurons are disrupted during acute ischemic stroke, resulting in hypoxia. This event, in turn, activates the transcription of hypoxia-inducible factor (HIF-1), which is responsible for activating genes responsible for angiogenesis, including vascular endothelial growth factor (VEGF). VEGF and their receptor systems exert complex mechanisms of angiogenesis, including the stimulator, inhibitors, angiogenic and modulator. VEGF-A is the primary regulator of angiogenesis, both during physiological and pathological conditions. Nevertheless, the role of VEGF on the prognosis of hypoxia remains controversial. AIM: The purpose of this study was to address if there is any difference between the mean expression of VEGF-A between acute ischemic patients and non-ischemic stroke subjects. METHODS: This was an observational study with a cross-sectional design, the population in this research is the acute ischemic stroke patients and non-ischemic stroke subjects, which were admitted on Emergency Room and later treated in the Stroke Unit, Dr Sardjito General Hospital, Yogyakarta, Indonesia. Subjects were recruited using the purposive method, yielding a total of 64 subjects on both groups. Diagnosis of acute ischemic stroke was established using a head CT scan. Patients who meet the inclusion criteria and willing to participate in the study were asked to provide informed consent. Laboratory analysis was conducted during the first 24 hours after being treated at Stroke Unit, Dr Sardjito General Hospital, Yogyakarta, Indonesia, with venous blood was withdrawn VEGF-A levels between acute ischemic stroke and non-ischemic stroke subjects were subsequently compared. Categorical variables (including gender) were tested using either chi-square or Fisher exact test. Interval data was examined using student t-test if data distribution was normal. RESULTS: As many as 35 acute ischemic stroke and 35 non-ischemic stroke patients were included in the study, among whom were 18 men (51.43%) and 17 women (48.57%) among stroke patients and 21 (60%) men and 14 (40%) women among subjects without stroke. The average of the subject's age on stroke and non-ischemic stroke group was 58.51 and 48.57 years old. VEGF-A levels were significantly higher in the non-stroke group (561.77 ± 377.92) compared with stroke group (397.78 ± 181.53) with p = 0.02. CONCLUSION: expression of VEGF-A in acute ischemic stroke group was lower when compared with the non-stroke group.

Instrumental Balinese Flute Music Therapy Improves Cognitive Function and Serum Dopamine Level in the Elderly Population of West Denpasar Primary Health Care Center.

BACKGROUND: Musical artwork using Balinese flutes made from bamboo (timing buluh) by Agus Teja Sentosa, S.Sn is a combination of music played with flute as the main instrument which contains certain components resembling music therapy such as in western classical music by Antonio Lucio Vivaldi. AIM: This study aims to determine the improvement of cognitive function and increase in serum dopamine in the elderly after listening to music with Balinese flute as the main instrument. METHOD: The current study allocated 18 subjects in the control group listened to western classical music by Antonio Lucio Vivaldi, while 18 subjects in the intervention group listened to western classical music and music from Balinese flute as the main instrument by Agus Teja Sentosa, S.Sn. MoCA-Ina assessment and examination of serum dopamine levels were carried out initially and 21 days after listening to music intervention. RESULTS: The mean increase in cognitive function score was higher in the intervention group (5.22; p < 0.001) than in the control group (4.67; p < 0.001), this increase was not statistically significant with a value of p = 0.562 (p > 0.005). The mean increase in dopamine levels in the control group (3.60) was greater than in the treatment group (3.56), but the mean increase was not statistically significant (p = 0.085). CONCLUSION: There was a significant relationship between listening to the main instrumental Balinese flute music and the improvement of cognitive function, especially in the memory domain in all study subjects, but the mean increase in cognitive function and serum dopamine level did not reach statistical significance.

High Serum Lead Levels Increase the Incidence of Cognitive Impairment of Public Fueling Station Operators.

BACKGROUND: Air pollution due to lead contained in motor vehicle fuel is inhaled for a long period causing cognitive impairment. Cognitive disorders in general fuel station operators are found in developing countries as a negative impact of environmental pollution. AIM: This study aims to find out that high levels of lead in the blood increase the risk of cognitive impairment in operators of Public Fuel Filling Stations. METHODS: This was a case-control study design to determine high lead levels in the blood increasing the risk of cognitive impairment in operators of General Fuel Filling Stations. There were 76 study subjects consisting of 38 case groups and 38 control groups. RESULTS: Obtained lead levels of all research subjects in normal criteria (1.1-5.58 µg/dL). We used MoCA-Ina (a validated Indonesian version of MoCA questionnaire) to evaluate the cognitive function. High lead levels in the blood in the case group were 28 subjects (66.7%) and 14 subjects (33.7%) in the control group. Factors that significantly affected the occurrence of cognitive disorders are work periods of more than 3 years, which are 4 times higher risk of experiencing cognitive impairment (p = 0.021). CONCLUSION: High lead levels in the blood have a 6 times greater risk of cognitive impairment than subjects with not high blood lead levels and work periods of more than 3 years have a risk of 6 times greater cognitive impairment.

Single - Door Cervical Laminoplasty Using Basket Laminoplasty Device: A Case Report.

BACKGROUND: The management of the cervical canal stenosis as a result of ossification of the posterior longitudinal ligament (OPLL) is still evolving. Anterior and posterior approaches are still much in demand by the surgeons. In Japan, a posterior approach is more well-known to be used as the case OPLL is often on the populace. Single-door laminoplasty technique or "Hirabayashi" often used with either autograft or allograft, with or without an additional miniplate. CASE PRESENTATION: In this case report, we would like to report the treatment of tetraparesis patients with "basket laminoplasty" using a special device with some advantages, not only providing stability of the lamina but also at the same time providing bone-graft container/basket for the benefit of the patient's bone fusion. CONCLUSION: Basket laminoplasty device is an excellent choice for cervical OPLL. We believe the use of this device is very favourable for long-term patient outcome.

Chronic Osteomyelitis after Seven Years Neglected Bone Exposed in 12-Year-Old Boy: A Case Report.

BACKGROUND: Access to modern medicine is still limited in some rural areas in Indonesia. This is mostly due to lack of people's knowledge and concern for their health, especially in orthopaedic cases. Osteomyelitis is generally described as infection and inflammation of the bone, which results in local bone destruction, necrosis, and apposition of new bone. Chronic post-traumatic osteomyelitis (CPTO) is a complex condition and one of the most challenging problems in orthopaedic surgery that cause considerable morbidity. CASE PRESENTATION: We present a case of chronic post-traumatic osteomyelitis with radial nerve injury, in which radical surgical debridement and broad-spectrum antibiotic administration were done. A 12-year-old boy with a history of falling from the three-meter-high tree had swollen, deformed, and neglected humerus bone exposed. After stabilisation in the emergency room, surgical limb amputation was scheduled, yet the family refused this medical care and chose debridement instead. CONCLUSION: This case is an important addition to the literature about chronic post-traumatic osteomyelitis with neglected bone exposed and the lacking of society's concern in regards to orthopaedic cases.

The Comparison of Simple Anthropometric and Biochemical Parameters for Predicting Liver Steatosis in Obese Balinese Young Women.

BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing globally. Early identification of liver steatosis (LS) status is critical to prevent the development of NAFLD into non-alcoholic steatohepatitis (NASH) fibrosis. AIM: This study aimed at exploring the validity of simple anthropometric and biochemical parameters to predict LS in young obese women. MATERIALS AND METHODS: This is a cross-sectional study involving 132 young obese women. We collected the data of measured waist circumference (WC), body mass index (BMI), serum triglyceride (TG), and gamma-glutamyltransferase (GGT). The lipid accumulation product (LAP) was designed from TG and WC variables. Fatty liver index (FLI) was calculated from TG, BMI, WC, and GGT variables. LS status was measured using ultrasonography assay. Statistical significance was set at p < 0.05. RESULTS: A positive correlation was found between BMI, WC, TG, GGT, LAP, FLI, and LS (p = 0.001). We found that BMI is a better predictor for LS to WC. Our multiple linear regression analysis revealed that BMI, GGT, and TG could predict 41.4% of LS. The validity (specificity, sensitivity, and odds ratio) of simple body fat parameters in predicting LS were as follows: BMI ≥ 30 kg/m2 (69.6%, 74.4%, and 6.21), WC ≥ 90 cm (67.4%, 70.0%, and 4.28), TG ≥ 100 mg/dL (70.6%, 70.0%, and 5.62) and GGT ≥ 20 µg/L (69.6%, 77.5%, and 7.87), as well as LAP ≥ 30 (82.6%, 70.0%, and 11.1), and FLI ≥ 2.5 (79.3%, 72.5%, and 10.1), significantly. CONCLUSION: Simple anthropometric and biochemical parameters (BMI, WC, and TG, GGT), are appropriately predicting LS as well as LAP, and FLI among obese Balinese young women.

Association between Increased Matrix Metalloproteinase-9 (MMP-9) Levels with Hyperglycaemia Incidence in Acute Ischemic Stroke Patients.

BACKGROUND: Hyperglycemia is common in acute stroke patients. Hyperglycemia can induce the production of reactive oxygen species, causing increased activity of matrix metalloproteinase-9 (MMP-9). AIM: This study aimed to determine an association between the increased levels of MMP-9 and the incidence of hyperglycemia in acute ischemic stroke patients. METHODS: This is a case-control study. Acute ischemic stroke patients admitted to the Stroke Unit of a reference hospital in Yogyakarta, Indonesia was divided into the hyperglycemic and non-hyperglycemic group. Demographic and clinical characteristics of each subject were recorded, and blood levels of MMP-9 were measured. Seventy-one patients were recruited, 40 subjects in the hyperglycemic group and 31 subjects in the non-hyperglycemic group. RESULTS: The median levels of blood MMP-9 level in the hyperglycemic and non-hyperglycemic group were 974.37 and 748.48 ng/mL, respectively, and the difference was statistically not significant (95% CI, 191.24-2849.53; p = 0.07). When the calculated cut-off point of 600.99 ng/mL was used, the proportion of patients with higher MMP-9 levels was significantly more in the hyperglycemic group compared with the ones in the non-hyperglycemic group (82.5% and 54.8%, respectively; OR = 3.88; p = 0.011). CONCLUSION: We concluded that the proportion of patients with MMP-9 level >600.99 ng/mL was significantly higher in acute ischemic stroke patients with hyperglycemia.

Elevated High-Sensitivity C-Reactive Protein And Interleukin-6 Plasma As Risk Factors For Symptomatic Lumbar Osteoarthritis In Postmenopausal Women.

AIM: To determine whether elevated high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR), as risk factors of symptomatic lumbar osteoarthritis (OA) in estrogen deficiency postmenopausal women. METHODS: A case-control study was conducted between January and June 2017. The inclusion criteria include post-menopausal women with estrogen deficiency with low back pain. Exclusion criteria were: patients with a history of undergoing bilateral oophorectomy, taking hormonal replacement therapy or corticosteroid, malignancies, and lumbosacral spine trauma. The blood examinations were taken to measure IL-6 level by ELISA, hs-CRP level by spectrophotometry and ESR by modified Westergren method. RESULTS: A group of 44 pairs of subjects were divided equally into case and control groups showed that in estrogen deficiency postmenopausal women, an increased level of hs-CRP increased the risk for symptomatic lumbar OA (OR = 2.83, CI95% = 1.065-8.776, p = 0.034). Also, a high level of IL-6 increased the risk of symptomatic lumbar OA (OR = 2.7, CI95% = 0.991-8.320, p = 0.033). No such significant findings were found for an increased ESR level. CONCLUSION: Elevated level of plasma hs-CRP and IL-6 were concluded as risk factors for symptomatic lumbar OA in post-menopausal women.

S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis.

BACKGROUND: The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury. AIM: This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies. METHODS: We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark). RESULTS: The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively). CONCLUSION: S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.

Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016.

BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33-77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year's survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.