Scoring System for Predicting No Hearing Recovery in Unilateral Idiopathic Sudden Sensorineural Hearing Loss.

BACKGROUND: The varying degrees of hearing recovery in idiopathic sudden sensory neural hearing loss (ISSHL) patients indicate the need of model to predict no hearing recovery. We aimed to aid in the counseling of ISSHL patients about their recovery chances by developing a simple clinical scoring system to predict no hearing recovery using clinical information available at first visit. METHODS: A retrospective cohort study, using medical records was conducted from January 2017-May 2019 in Cipto Mangunkusumo General Hospital and Proklamasi Ear, Nose, Throat, Head and Neck (ENT-HN) Surgery Specialized Hospital in Jakarta, Indonesia. The outcome measure is no hearing recovery and we built the prediction score developed based on multiple logistic regression analyses and tested for discriminative ability. There were 183 adults unilateral ISSHL patients included in the study. RESULTS: The proportion of no hearing recovery was 56%. The independent predictors were older age 30-60 years and >60 years old (Odds Ratio 4.0; 95% CI 1.4-11.8; p=0.012 and OR 5.3; 95% CI 1.5-18.4; p=0.008, respectively) as compared with 18-<30 years old, later onset (onset 15-60 days and >60 days had OR 5.4; 95% CI 1.7-16.9; p=0.004 and OR 12.6; 95% CI 2.9-54.6; p=0.001, respectively, as compared with onset < 3 days), and presence of vertigo (OR 2.3; 95% CI 1.1-4.6; p=0.026). Prediction scores ranged from 3 to 12, with three categories for age, four for onset, and two for the presence of vertigo. The predictions showed adequate calibration and good discriminative ability (AUC 0.77). CONCLUSION: Using information of age, onset and presence of vertigo at first visit, ISSHL patient with increased risk of no hearing recovery can be identified with moderate accuracy. This prediction model could help clinician in predicting patients' prognosis.

Adjuvant chemoradiotherapy versus chemotherapy or radiotherapy in advanced endometrial cancer: a systematic review and meta-analysis.

Background: Endometrial cancer is one of the most common gynecological cancer in the world. However, the available adjuvant therapies, chemotherapy (CT) and radiotherapy (RT), demonstrated several limitations when used alone. Therefore, we conducted a meta-analysis to investigate the clinical effectiveness of chemoradiotherapy (CRT) based on overall survival (OS) and disease-free survival (DFS). Methods: A literature search was performed on five databases and one clinical trial registry to obtain all relevant articles. Search for studies was completed on September 9, 2021. A meta-analysis was conducted to determine the overall hazard ratio with the 95% Confidence Interval. Results: A total of 17 articles with 23,975 patients in the CRT vs RT group and 50,502 patients in the CRT vs CT group were included. The OS Hazard Ratios (HR) of CRT compared to RT was 0.66 (95% CI [0.59-0.75]; P < 0.00001). Compared to CT, the OS HR was 0.70 (95% CI [0.64-0.78]; P < 0.00001). CRT also significantly improved the DFS compared to CT only (HR 0.79, 95% CI [0.64-0.97]; P = 0.02) However, CRT did not improve the DFS compared to RT only, with HR of 0.71 (95% CI [0.46-1.09]; P = 0.12). Conclusion: Adjuvant CRT can significantly improve OS compared to CT or RT alone and improve the DFS compared to CT alone in patients with advanced endometrial cancer. Further research is needed to identify the optimal CRT regimen, and to whom CRT will be most beneficial.

Optimization of Castor Oil-Based Ion Selective Electrode (ISE) with Active Agent 1,10-Phenanthroline for Aqueous Pb2+ Analysis.

This research has successfully fabricated ion selective electrode (ISE) for Pb2+ using castor oil (Ricinus communis L.)-based polyurethane (PU) membrane with 1,10-phenanthroline as the active agent. The sensitivity of the Pb2+ ISE obtained is 27.25 mV/decade with a linear range of [Pb(NO3)2] of 10−10−10−5 M and a coefficient of determination (R2) of 0.959. The system response reaches stability after 25 s of measurement. The Pb2+ has a detection limit of 10−10 M and gives a stable response at pH 7−8 with a 15-day lifetime. The investigation of the selectivity of the ISE was performed using the mixed solution method with log Kij values of <1. The selectivity order of Pb2+ ISE against the foreign ions is Ag2+ > Ca2+ > K+ > Mg2+ > Cu2+ > Fe3+ > Cr3+> Zn2+ > Cd2+. The Pb2+ ISE shows acceptable reproducibility and repeatability with standard deviation values of 0.065 and 0.0079, respectively. Fourier transform infrared (FT-IR) spectra confirmed that 1,10-phenanthroline was responsible for the formation of the Pb2+ ion entrapment via complexation. Other characterizations (crystallinity, micro-surface morphology, and mechanical strength) suggest the degradation of the membrane structure integrity after the application. The analysis results of Pb levels using the Pb2+ ISE in artificial and wastewater samples were not significantly different from the atomic absorption spectroscopy (AAS) measurement.

Green Synthesis and Antimicrobial Activities of Silver Nanoparticles Using Calotropis gigantea from Ie Seu-Um Geothermal Area, Aceh Province, Indonesia.

Herein, we report our success synthesizing silver nanoparticles (AgNPs) using aqueous extracts from the leaves and flowers of Calotropis gigantea growing in the geothermal manifestation Ie Seu-Um, Aceh Besar, Indonesia. C. gigantea aqueous extract can be used as a bio-reductant for Ag+→Ag0 conversion, obtained by 48h incubation of Ag+, and the extract mixture in a dark condition. UV-Vis characterization showed that the surface plasmon resonance (SPR) peaks of AgNPs-leaf C. gigantea (AgNPs-LCg) and AgNPs-flower C. gigantea (AgNPs-FCg) appeared in the wavelength range of 410-460 nm. Scanning electron microscopy energy-dispersive X-ray spectrometry (SEM-EDS) revealed the agglomeration and spherical shapes of AgNPs-LCg and AgNPs-FCg with diameters ranging from 87.85 to 256.7 nm. Zeta potentials were observed in the range of -41.8 to -25.1 mV. The Kirby-Bauer disc diffusion assay revealed AgNPs-FCg as the most potent antimicrobial agent with inhibition zones of 12.05 ± 0.58, 11.29 ± 0.45, and 9.02 ± 0.10 mm for Escherichia coli, Staphylococcus aureus, and Candida albicans, respectively. In conclusion, aqueous extract from the leaves or flowers of Calotropis gigantea may be used in the green synthesis of AgNPs with broad-spectrum antimicrobial activities.

Electrochemical DNA Biosensor Based on Mercaptopropionic Acid-Capped ZnS Quantum Dots for Determination of the Gender of Arowana Fish.

A new electrochemical DNA biosensor based on mercaptopropionic acid (MPA)-capped ZnS quantum dots (MPA-ZnS QDs) immobilization matrix for covalent binding with 20-base aminated oligonucleotide has been successfully developed. Prior to the modification, screen-printed carbon paste electrode (SPE) was self-assembled with multilayer gold nanoparticles (AuNPs) and cysteamine (Cys). The inclusion of MPA-ZnS QDs semiconducting material in modified electrodes has enhanced the electron transfer between the SPE transducer and DNA leading to improved bioanalytical assay of target biomolecules. Electrochemical studies performed by cyclic voltammetry (CV) and differential pulsed voltammetry (DPV) demonstrated that the MPA-ZnS QDs modified AuNPs electrode was able to produce a lower charge transfer resistance response and hence higher electrical current response. Under optimal conditions, the immobilized synthetic DNA probe exhibited high selectivity towards synthetic target DNA. Based on the DPV response of the reduction of anthraquinone monosulphonic acid (AQMS) redox probe, the MPA-ZnS QDs-based electrochemical DNA biosensor responded to target DNA concentration from 1 × 10-9 µM to 1 × 10-3 µM with a sensitivity 1.2884 ± 0.12 µA, linear correlation coefficient (R2) of 0.9848 and limit of detection (LOD) of 1 × 10-11 µM target DNA. The DNA biosensor exhibited satisfactory reproducibility with an average relative standard deviation (RSD) of 7.4%. The proposed electrochemical transducer substrate has been employed to immobilize the aminated Arowana fish (Scleropages formosus) DNA probe. The DNA biosensor showed linearity to target DNA from 1 × 10-11 to 1 × 10-6 µM (R2 = 0.9785) with sensitivity 1.1251 ± 0.243 µA and LOD of 1 × 10-11 µM. The biosensor has been successfully used to determine the gender of Arowana fish without incorporating toxic raw materials previously employed in the hazardous processing conditions of polypyrrole chemical conducting polymer, whereby the cleaning step becomes difficult with thicker films due to high levels of toxic residues from the decrease in polymerization efficacy as films grew.

Prognostic factors and models to predict pediatric sepsis mortality: A scoping review.

Introduction: Several scoring systems are available to assess the severity of sepsis in pediatric patients in diverse settings worldwide. This study investigates the quality and applicability of predictive models for determining pediatric sepsis mortality, especially in acute care and limited-resource settings. Data sources: Mortality prediction factors and models were searched in four databases using the following criteria: developed for pediatric health care, especially in acute settings, and with mortality as an outcome. Study selection: Two or more reviewers performed the study selection to ensure no bias occurred. Any disagreements were solved by consensus or by the decision of a third reviewer. Data extraction: The authors extracted the results and mapped the selected studies qualitatively to describe the prognostic properties of the risk factors and models proposed in the study. Data synthesis: The final analysis included 28 mortality prediction models. Their characteristics, analysis, and performance measures were summarized. Performance was described in terms of calibration and discrimination, including assessing for risk of bias and applicability. A modified version of the PRISM-III score based on physiologic criteria (PRISM-III-APS) increased its predictive value to 0.85-0.95. The vasoactive-inotropic score at 12 h had a strong independent association with death. Albumin had an excellent predictive value when combined with other variables. Lactate, a biomarker widely measured in patients with sepsis, was highly associated with mortality. The bioimpedance phase angle was not considered applicable in our setting. Measurement using more straightforward methods, such as mid-upper arm circumference, was feasible in numerous health care facilities. Conclusion: Leveraging prognostic models to predict mortality among pediatric patients with sepsis remains an important and well-recognized area of study. While much validation and development work remains to be done, available prognostic models could aid clinicians at the bedside of children with sepsis. Furthermore, mortality prediction models are essential and valuable tools for assessing the quality of care provided to critically ill pediatric patients.

The Effect of Vitamin D Supplementation on Symptoms of Depression in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The effect of vitamin D supplementation on depressive  symptoms in people with type 2 diabetes is still up for debate. The aim of this paper was to investigate the effect of vitamin D supplementation on symptoms of depression in type 2 diabetic patients. METHODS: The protocol for this review has been registered in PROSPERO:CRD42021231713. Searching for literature was conducted using Pubmed, EBSCOhost, and EMBASE. Randomised controlled trials (RCTs) regarding vitamin D supplementation in type 2 diabetic patients with depression were retrieved through a systematic search. The outcome measured was a change in depressive symptoms evaluated with any validated rating scale. Independent data extraction was conducted, and the study quality was assessed. A meta-analysis was carried out to calculate the improvement in depressive symptoms in the group receiving vitamin D and the control group. The available evidence in RCTs was analysed using the PRISMA approach, and clinical significance was determined using the GRADE system. Risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS: Four RCTs were reviewed and three RCTs were meta-analysed. In two studies, vitamin D was statistically effective in improving depressive symptoms in type 2 diabetic patients. Three randomised controlled trials  were included in the meta-analysis with 161 subjects using depression score as an outcome assessment. Vitamin D is significantly more effective than placebo (95% CI: -0.70 to - 0.08, p = 0.01). CONCLUSION: Vitamin D supplementation is effective in improving depressive symptoms in type 2 diabetic patients. Future research with different geographical areas and larger samples should be done to further assess the benefits.

A simple optical pH sensor based on pectin and Ruellia tuberosa L-derived anthocyanin for fish freshness monitoring.

A simple optical pH sensor using the active compound anthocyanin (ACN), derived Ruellia tuberosa L. flower immobilized in a pectin membrane matrix, was been fabricated and employed to monitor the freshness of tilapia fish at room temperature and 4 oC storage. The optimum pectin weight and ACN concentrations were 0.1% and 0.025 mg/L. The sensor showed good sensitivity at 0.03 M phosphate buffer solution. The sensor's reproducibility was evaluated using 10 replicate sensors where a standard deviation of 0.045 or relative standard deviation of 9.15 was achieved. The sensor displayed an excellent response after 10 minutes of exposure, possessing a response stability for 10 consecutive days. The decrease in pH value of the Tilapia fish from 7.3 to 5 was observed in a 48 hour test, which can be used as the parameter when monitoring fish freshness.

Optical pH Sensor Based on Immobilization Anthocyanin from Dioscorea alata L. onto Polyelectrolyte Complex Pectin-Chitosan Membrane for a Determination Method of Salivary pH.

A simple optical pH sensor based on immobilization, Dioscorea alata L. anthocyanin methanol extract, onto a pectin-chitosan polyelectrolyte complex (pectin-chitosan PEC), has been successfully fabricated. The optical pH sensor was manufactured as a membrane made of pectin-chitosan PEC and the extracted anthocyanin. This sensor has the highest sensitivity of anthocyanin content at 0.025 mg/L in phosphate buffer and 0.0375 mg/L in citrate buffer. It also has good reproducibility with a relative standard deviation (%RSD) of 7.7%, and gives a stable response at time values greater than 5 min from exposure in a buffer solution, and the sensor can be utilized within five days from its synthesis. This optical pH sensor has been employed to determine saliva pH of people of different ages and showed no significant difference when compared to a potentiometric method.

Prognostic Scoring System for Mortality of Hospitalized COVID-19 Patients in Resource-Limited Settings: A Multicenter Study from COVID-19 Referral Hospitals.

BACKGROUND: Many studies identified the risk factors and prognostic factors related to in-hospital COVID-19 mortality using sophisticated laboratory tests. Cost and the availability of supporting blood tests may be problematic in resource-limited settings. This multicenter cohort study was conducted to assess the factors associated with mortality of COVID-19 patients aged 18 years and older, based on history taking, physical examination, and simple blood tests to be used in resource-limited settings. METHODS: The study was conducted between July 2020 and January 2021 in five COVID-19 referral hospitals in Indonesia. Among 1048 confirmed cases of COVID-19, 160 (15%) died during hospitalization. RESULTS: Multivariate analysis showed eight predictors of in-hospital mortality, namely increased age, chronic kidney disease, chronic obstructive pulmonary disease, fatigue, dyspnea, altered mental status, neutrophil-lymphocyte ratio (NLR) ≥ 5.8, and severe-critical condition. This scoring system had an Area-under-the-curve (AUC) of 84.7%. With cut-off score of 6, the sensitivity was 76.3% and the specificity was 78.2%. CONCLUSION: The result of this practical prognostic scoring system may be a guide to decision making of physicians and help in the education of family members related to the possible outcome.

Clinical Profile of Elderly Patients with COVID-19 hospitalised in Indonesia's National General Hospital.

Latar BelakangSebanyak 38.6% kasus kematian pasien COVID-19 di Indonesia terjadi di populasi lansia. Data mengenai profil klinis pasien rawat inap lansia dengan COVID-19 masih tidak ada. Padahal kelompok pasien ini adalah pasien risiko tinggi selama pandemi ini yang memerlukan perhatian lebih.MetodeStudi deskriptif ini menggunakan data lengkap pasien lansia dengan COVID-19 yang dirawat inap di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN Cipto Mangunkusumo) dari April hingga akhir Agustus 2020. Data termasuk karakteristik klinis, gejala, komorbiditas, multimorbiditas dan luaran mortalitas pasien.HasilDi populasi pasien lansia (n=44), mayoritas berusia di antara 60-69 tahun (68%), berjenis kelamin laki-laki (66%), dan tidak memiliki riwayat kontak erat dengan pasien COVID-19 sebelumnya (86%). Gejala tersering ialah demam, batuk, dan sesak yang merupakan gejala khas COVID-19, sedangkan penyakit kronis tersering adalah diabetes melitus, hipertensi, dan keganasan. Multimorbiditas ditemukan hanya di 14% pasien lansia, dan para pasien tersebut bertahan hidup pasca infeksi virus SARS-CoV-2. Angka kematian pasien lansia rawat inap dengan COVID-19 di studi ini adalah 23%, dan 90% dari kasus kematian berjenis kelamin laki-laki.KesimpulanPasien laki-laki mendominasi kasus terkonfirmasi dan kasus kematian lansia dengan COVID-19. Gejala khas COVID-19 hanya ditemukan di sekitar setengah pasien penelitian. Pasien yang meninggal dunia memiliki persentase gejala khas lebih tinggi. Gejala tidak khas pun mungkin ditemukan di pasien lansia. Immunosenescence dan fungsi imunoregulasi jenis kelamin tertentu dihipotesiskan memiliki peran penting dalam menyebabkan kematian lansia di studi ini.Kata Kunci: Profil Klinis, Lansia, Pasien Geriatri, COVID-19, Indonesia  ABSTRACTBackgroundOlder people contributed to 38.6% of death cases related to COVID-19 in Indonesia. Data regarding clinical profile of hospitalised elderly with COVID-19 in Indonesia were still lacking. Older people are at-risk population in the pandemic, whom we should pay attention to.MethodsThis single centre descriptive study utilised complete data of elderly inpatients with COVID-19 in Indonesia's national general hospital from April to late August 2020. The data consisted of clinical characteristics, symptoms, comorbidities, multimorbidity, and mortality outcome.ResultsAmong elderly patients (n=44), a majority of patients were aged 60-69 years (68%), were male (66%), and had no history of close contact with COVID-19 patient (86%). The most common symptoms were fever, cough and shortness of breath (classic symptoms of COVID-19), whereas the most common chronic diseases were diabetes mellitus, hypertension, and malignancy. Multimorbidity was only found in 14% of patients, all of whom remained alive following SARS-CoV-2 infection. The death rate among elderly inpatients with COVID-19 in this study was 23%, and male older adults contributed to 90% of death cases.ConclusionMale patients dominated both confirmed cases and death cases among elderly with COVID-19. Classic symptoms of COVID-19 were only found in about half of the study patients. Non-survivors had higher percentage of the classic symptoms of COVID-19 than survivors. Atypical COVID-19 presentations are possible in older adults. We postulated that immunosenescence and sex-specific immunoregulatory function play an important role in causing death in this study cohort. Keywords: Clinical Profile, Elderly, Geriatric Patient, COVID-19, Indonesia.

Risk factors and laboratory test results associated with severe illness and mortality in COVID-19 patients: A systematic review.

BackgroundWe aimed to systematically review all relevant studies related to the risk factors and laboratory test results associated with severe illness and mortality in COVID-19 patients.MethodsWe utilised PubMed, Scopus, ProQuest, Wiley Online Library, ScienceDirect and MedRxiv to search for studies, with additional hand-searched journals. We included systematic reviews/meta-analyses, cohort and case control studies of suspected and/or confirmed COVID-19 cases with severe illness and/or mortality as outcomes. We included laboratory test results and risk factors. We assessed risk of bias using ROBIS-I and Newcastle-Ottawa Scale assessment tool. Type of study, risk of bias, and precision of results determined evidence sufficiency.ResultsOf 26 records included, sufficient evidence suggested the association between age >60 years, hypertension, coronary heart disease, DM, serum LDH 250-500 U/L, LDH >500 U/L, and lymphopenia (lymphocyte count ≤1.0 x 109 /L) and severe illness of COVID-19. CD3+CD8+ cell count ≤ 75 cell/µl, D-dimer > 1 mg/L, AKI stage 2 and 3, proteinuria ≥1+, hematuria ≥1+, and peak serum creatinine > 13.26 µmol/L are associated with mortality.ConclusionAge >60 years, hypertension, DM, and coronary heart disease are the risk factors for severe illness of COVID-19. Laboratory test results associated with severe illness are serum LDH 250-500 U/L, LDH >500 U/L, and lymphopenia, whereas test results associated with mortality are CD3+CD8+ cell count ≤ 75 cell/µl, AKI stage 2 and 3, proteinuria ≥1+, hematuria ≥1+, D-dimer > 1 mg/L, peak serum creatinine > 13.26 µmol/L.

Oral prednisolone for acute otitis media in children: a pilot, pragmatic, randomised, open-label, controlled study (OPAL study).

BACKGROUND: Acute otitis media (AOM) is associated with high antibiotic prescribing rates. Antibiotics are somewhat effective in improving pain and middle ear effusion (MEE); however, they have unfavourable effects. Alternative treatments, such as corticosteroids as anti-inflammatory agents, are needed. Evidence for the efficacy of these remains inconclusive. We conducted a pilot study to test feasibility of a proposed large-scale randomised controlled trial (RCT) to assess the efficacy of corticosteroids for AOM. METHODS: We conducted a pilot, pragmatic, parallel, open-label RCT of oral corticosteroids for paediatric AOM in primary and secondary/tertiary care centres in Indonesia. Children aged 6 months-12 years with AOM were randomised to either prednisolone or control (1:1). Physicians were blinded to allocation. Our objectives were to test the feasibility of our full RCT procedures and design, and assess the mechanistic effect of corticosteroids, using tympanometry, in suppressing middle ear inflammation by reducing MEE. RESULTS: We screened 512 children; 62 (38%) of 161 eligible children were randomised and 60 were analysed for the primary clinical outcome. All study procedures were completed successfully by healthcare personnel and parents/caregivers, despite time constraints and high workload. All eligible, consenting children were appropriately randomised. One child did not take the medication and four received additional oral corticosteroids. Our revised sample size calculation verified 444 children are needed for the full RCT. Oral corticosteroids did not have any discernible effects on MEE resolution and duration. There was no correlation between pain or other symptoms and MEE change. However, prednisolone may reduce pain intensity at day 3 (Visual Analogue Scale mean difference - 7.4 mm, 95% confidence interval (CI) - 13.4 to - 1.3, p = 0.018), but cause drowsiness (relative risk (RR) 1.8, 95% CI 1.1 to 2.8, p = 0.016). Tympanometry curves at day 7 may be improved (RR 1.8, 95% CI 1.0 to 2.9). We cannot yet confirm these as effects of corticosteroids due to insufficient sample size in this pilot study. CONCLUSIONS: It is feasible to conduct a large, pragmatic RCT of corticosteroids for paediatric AOM in Indonesia. Although oral corticosteroids may reduce pain and improve tympanometry curves, it requires an adequately powered clinical trial to confirm this. TRIAL REGISTRATION: Study registry number: ACTRN12618000049279. Name of registry: the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of registration: 16 January 2018.

Construction of a Hydrogel Pectin-Based Triglyceride Optical Biosensor with Immobilized Lipase Enzymes.

A novel and simple optical biosensor to detect triglycerides (TGs) has been successfully constructed by using pectin hydrogel membrane as the indicator pH and chromoionophore ETH 5294 (CI), with lipase as the catalyst. The enzymatic working system against TGs releasing H+ ions will affect the color absorbance of CI. The characterization results show that a TG biosensor has the optimum condition and sensitivity at the phosphate buffer concentration of 50 mM, pH 7, and enzyme loading of 60 µg. The biosensor works at the tripalmitin (TP) concentration range of 100-400 mg/dL. With the sensitivity of 0.001 (∆A/(mg/dL)), the biosensor response reaches stability after five minutes, and the limit of detection (LOD) of the TG optical biosensor is 15 mg/dL. Relative standard deviation (RSD) in a reproducibility test was 2.5%, with a 15-day lifespan.

Preparation and Characterization of a Pectin Membrane-Based Optical pH Sensor for Fish Freshness Monitoring.

In a simple and instant procedure for detecting fish freshness, a hydrogel and hydrophilic pectin matrix membrane was used successfully as an optical pH sensor by immobilizing the chromoionophore ETH 5294 (CI), which is very selective and sensitive for the membrane. The Pe/CI optical pH sensor exhibited excellent linearity between pH 5 and pH 9, with a sensor response time of 5 min and reproducibility of 1.49% relative standard deviation (RSD). The sensor showed response stability for 15 days and a response reduction of 8.6%. The sensor's capability was demonstrated by the detection of fish freshness for 17 days at 4 °C.

Oral prednisolone for acute otitis media in children: protocol of a pilot randomised, open-label, controlled study (OPAL study).

BACKGROUND: Acute otitis media (AOM) is an acute inflammation of the middle ear commonly found in children, for which antibiotics are frequently prescribed. However, antibiotics are beneficial for only one third of AOM cases, and then, with only modest benefit. Since antibiotic use leads to risk of side effects and resistance, effective alternative treatments are required. Corticosteroids are a candidate because of their anti-inflammatory effects, although evidence of their efficacy and harms is insufficient. Accordingly, we plan a large, rigorous clinical trial to test this. Initially, we will test pre-specified methods and procedures (including the overall process, resources, management, and scientific components) in a pilot study of corticosteroids for AOM, which will inform a future, definitive trial. METHODS: This is a pilot pragmatic, randomised, open-label, single-blind, controlled study of corticosteroids as either monotherapy or an addition to antibiotics in 60 children aged 6 months to 12 years with AOM in two cities (Jakarta and Bekasi) in Indonesia. We will randomise eligible children to prednisolone or control. We will also stratify by disease severity and randomise those with mild AOM to expectant observation plus prednisolone or observation alone and those with severe AOM to prednisolone plus antibiotic or antibiotic alone. Our outcomes are to determine (1) recruitment rates, (2) the success of the study procedures, (3) the ability to measure planned outcomes of the proposed main study, (4) the compliance to study visits and study medication, and (5) verification of the sample size calculation for the main study. We will also assess middle ear effusion using tympanometry as part of a mechanistic sub-study. DISCUSSION: This study will test all procedures in preparation for the main study, including several potential obstacles and challenges from the perspective of participating physicians, nurses, pharmacists, and the parents of eligible children. This information will be useful for developing strategies to overcome practical and procedural issues. This study may also provide information about the effects of corticosteroids on middle ear effusion in AOM. TRIAL REGISTRATION: Study registry number: ACTRN12618000049279. Name of registry: the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of registration: 16 January 2018.

Systemic corticosteroids for acute otitis media in children.

BACKGROUND: Acute otitis media (AOM) is a common acute infection in children. Pain is its most prominent and distressing symptom. Antibiotics are commonly prescribed for AOM, although they have only a modest effect in reducing pain at two to three days. There is insufficient evidence for benefits of other treatment options, including systemic corticosteroids. However, systemic corticosteroids are potent anti-inflammatory drugs, and so theoretically could be effective, either alone or as an addition to antibiotics. OBJECTIVES: To assess the effects of systemic corticosteroids (oral or parenteral), with or without antibiotics, for AOM in children. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) which contains the Cochrane ARI Group's Specialised Register, MEDLINE (Ovid), Embase (Elsevier), CINAHL (EBSCO), Web of Science (Thomson Reuters), and LILACS (BIREME) for published studies, and ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for completed and ongoing studies, to 20 February 2018. We checked the reference lists of all primary studies and review articles for additional references and contacted experts in the field to identify additional unpublished materials. SELECTION CRITERIA: We included randomised controlled trials of children with AOM that compared any systemic corticosteroid (oral or parenteral) with placebo, either with antibiotics (corticosteroid plus antibiotic versus placebo plus antibiotic) or without antibiotics (corticosteroid versus placebo). DATA COLLECTION AND ANALYSIS: Three review authors (EDS, RR, YP) independently screened the titles and abstracts and retrieved the full texts of potentially relevant studies. We independently extracted study characteristics and outcome data from the included studies, and assessed the risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We assessed study quality using the GRADE method. MAIN RESULTS: We included two studies involving 252 children with AOM aged from three months to six years receiving hospital ambulatory care who were treated with intramuscular ceftriaxone, and who were then randomised to the corticosteroid group (corticosteroid and corticosteroid plus antihistamine) or the placebo group (antihistamine and double placebo). In one study, children also had a needle aspiration of middle ear fluid. Both studies were at unclear risk of bias for allocation concealment, and unclear to high risk of bias for selective reporting.One study (N = 179) included pain as an outcome, but we were unable to derive the proportion of children with persistent pain at Day 5 and Day 14. Reduction of overall or specific symptoms was presented as improvement in clinical symptoms and resolution of inflamed tympanic membranes without the need for additional antibiotic treatment: at Day 5 (94% of children in the treatment group (N = 89) versus 89% in the placebo group (N = 90); risk ratio (RR) 1.06, 95% confidence interval (CI) 0.97 to 1.16) and Day 14 (91% versus 87%; RR 1.05, 95% CI 0.95 to 1.17). Low-quality evidence meant that we are uncertain of the effectiveness of corticosteroids for this outcome.The second study (N = 73) reported a reduction of overall or specific symptoms without additional antibiotic treatment during the first two weeks as a favourable outcome. Children in the treatment group had more favourable outcomes (adjusted odds ratio 65.9, 95% CI 1.28 to 1000; P = 0.037), although the numbers were small. We were unable to pool the results with the other study because it did not report the proportion of children with this outcome by treatment group. Only one study reported adverse effects of corticosteroids (e.g. drowsiness, nappy rash), but did not quantify incidence, so we were unable to draw conclusions about adverse effects. Neither study reported a reduction in overall or specific symptom duration. AUTHORS' CONCLUSIONS: The evidence for the effect of systemic corticosteroids on AOM is of low to very low quality, meaning the effect of systemic corticosteroids on important clinical outcomes in AOM remains uncertain. Large, high-quality studies are required to resolve the question.

An Amperometric Biosensor for the Determination of Bacterial Sepsis Biomarker, Secretory Phospholipase Group 2-IIA Using a Tri-Enzyme System.

A tri-enzyme system consisting of choline kinase/choline oxidase/horseradish peroxidase was used in the rapid and specific determination of the biomarker for bacterial sepsis infection, secretory phospholipase Group 2-IIA (sPLA2-IIA). These enzymes were individually immobilized onto the acrylic microspheres via succinimide groups for the preparation of an electrochemical biosensor. The reaction of sPLA2-IIA with its substrate initiated a cascading enzymatic reaction in the tri-enzyme system that led to the final production of hydrogen peroxide, which presence was indicated by the redox characteristics of potassium ferricyanide, K3Fe(CN)6. An amperometric biosensor based on enzyme conjugated acrylic microspheres and gold nanoparticles composite coated onto a carbon-paste screen printed electrode (SPE) was fabricated and the current measurement was performed at a low potential of 0.20 V. This enzymatic biosensor gave a linear range 0.01-100 ng/mL (R² = 0.98304) with a detection limit recorded at 5 × 10-3 ng/mL towards sPLA2-IIA. Moreover, the biosensor showed good reproducibility (relative standard deviation (RSD) of 3.04% (n = 5). The biosensor response was reliable up to 25 days of storage at 4 °C. Analysis of human serum samples for sPLA2-IIA indicated that the biosensor has potential for rapid bacterial sepsis diagnosis in hospital emergency department.

Exercise Intervention for Chronic Pain Management, Muscle Strengthening, and Functional Score in Obese Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis.

BACKGROUND: obesity and osteoarthritis have strong inter-relationship with multi-factorial mechanism that caused pain and leads to decreased quality of life. Exercise has been identified as prevention and management against obesity and joint pain. This systematic review aims to assess the effect between exercises compared to diet group for chronic pain management, physical and mental function in obese patients with chronic musculoskeletal problem. METHODS: we performed a systematic search of Randomized Control Trial studies from Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EBSCO; SCIENCEDIRECT (Elsevier); SCOPUS, grey literature, trial registry, ongoing study for published studies, and from the ClinicalTrial.gov, thesis of rehabilitation medicine in RSCM, and proceeding books for unpublished studies that was last updated on November 2016. Risk of bias was assessed using Cochrane risk-of-bias tool and data were analyzed using Review Manager 2014. RESULTS: one study showed no difference in pain reduction (assessed using VAS) between two groups. Two studies showed improvement in physical function measured using 6MWT in exercise group at 6 and 18 months with mean difference 28.12 [11.20, 45.04] and 26.21 [9.01, 43.41]. There was no significant effects observed for Mental and Physical Function based on SF-36 after 6 months (1 study) and 18 months (2 studies) observation, with mean difference 1.10 [-0.79, 2.99] and 0.08 [-1.53, 1.70] respectively for Mental Function score and -0.30 [-2.54, 1.94]  and -0.36 [-2.30, 1.57] respectively for Physical Function score. CONCLUSION: exercise can improve physical function objectively, but could not reduce pain in obese patients with chronic musculoskeletal problem subjectively.

Relationship Between Salted Fish Consumption and Nasopharyngeal Carcinoma: An Evidence-based Case Report.

AIM: to know the relationship between salted fish consumption and nasopharyngeal carcinoma (NPC). METHODS: we searched for the articles from PubMed® and ScienceDirect® based on our clinical question. After filtered with our in- and exclusion criteria, we had six articles about this topic, all of them were case-control studies. All articles were then critically appraised for their validity, importance, and applicability. RESULTS: there was no consistent relationship between salted fish consumption and NPC. Worth to note that those studies wo showed the firm relationship were conducted in Southern China, where the incidence of NPC was extremely high and related to specific Chineese-style salted fish consumption. CONCLUSION: there was an inconsistent relationship between salted fish consumption and NPC.