Micronutrient deficiencies in infancy remain a hidden but preventable threat to growth, immunity, and neurodevelopment worldwide. Identifying these deficiencies early, particularly during the transition from exclusive breastfeeding to complementary feeding, is critical for shaping lifelong health. This cross-sectional study evaluated 500 healthy Turkish infants aged 4–12 months who attended routine pediatric visits. Complete blood count, ferritin, folic acid, vitamin B12, and 25(OH) vitamin D levels were retrospectively analyzed. Anemia was observed in 48.6% of infants, while ferritin, vitamin B12, and vitamin D deficiencies were detected in 28.6%, 20.4%, and 33.6% of cases, respectively. Vitamin B12 deficiency was most prevalent between 6 and 9 months (69.3%), coinciding with the onset of complementary feeding—a critical nutritional window. Despite national iron and vitamin D prophylaxis programs, subclinical deficiencies remain frequent, suggesting potential maternal and dietary gaps. These findings emphasize that maternal nutritional sufficiency, continuous infant supplementation, and tailored public health strategies are essential to protect neurodevelopmental outcomes and ensure optimal infant growth. Strengthening preventive policies could transform these silent deficiencies into an opportunity for healthier generations.
Populations with skin of colour (Fitzpatrick types IV–VI) have higher melanin levels, providing intrinsic photoprotection equivalent to SPF ~13.4 versus ~3.3 in lighter skin. Despite this advantage, darker skin remains susceptible to UV-related harm, including post-inflammatory hyperpigmentation (PIH), photoaging, and delayed skin cancer diagnosis. This review synthesizes evidence on sunscreen use in populations of colour, focusing on formulation efficacy, clinical outcomes, adoption barriers, and best-practice recommendations. Evidence consistently supports broad-spectrum sunscreens with SPF ≥30 for all skin types. Tinted sunscreens containing iron oxides are particularly effective against visible light–induced pigmentation, reducing blue light exposure by up to 86% and preventing PIH in 98–100% of cases. However, adoption is limited by higher costs (tinted products averaging $24.59/oz vs. $6.85/oz), restricted shade ranges, and cultural misconceptions about skin cancer risk. Only 15.79% of African American individuals report regular sunscreen use, and 76% perceive their risk as low or none. Emerging data also indicate increased photoaging risk in high–sun exposure coastal settings, including Jakarta. Optimal photoprotection for Fitzpatrick V–VI includes SPF 30 sunscreen, antioxidants, emollients, and iron oxide formulations. Effective interventions must address educational, cultural, and structural barriers while improving affordability and shade inclusivity.
Background: Graft selection is a key determinant of outcomes after anterior cruciate ligament reconstruction (ACLR). The anterior half peroneus longus tendon (PL) has emerged as an alternative autograft that may preserve hamstring–quadriceps balance while providing adequate graft size and strength, but its role relative to established grafts remains unclear. Methods: A narrative review of biomechanical studies, randomized controlled trials, cohort studies, and systematic reviews was conducted to compare ACLR using PL, hamstring tendon (HT), quadriceps tendon (QT), and bone–patellar tendon–bone (BPTB) autografts. Outcomes included graft mechanical properties, muscle strength balance, knee stability, clinical scores, donor-site morbidity, rehabilitation considerations, and harvesting techniques. Results: The anterior half PL autograft provides sufficient tensile strength and consistent graft diameter (≥8 mm), with knee stability and functional outcomes comparable to HT grafts. PL grafts demonstrate advantages in harvest time, graft size, and donor-site morbidity, while preserving hamstring strength and hamstring–quadriceps balance. Ankle function is largely maintained with appropriate tenodesis. QT grafts show greater early quadriceps weakness, and BPTB grafts are associated with higher anterior knee pain. Conclusion: The anterior half peroneus longus autograft is a viable alternative for ACL reconstruction.
Paracetamol is a leading cause of drug-induced liver injury (DILI) through the formation of the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI), which induces oxidative stress and hepatocellular damage. Natural antioxidants have potential as hepatoprotective agents. Pineapple peel (Ananas comosus), an agricultural by-product, contains bioactive compounds such as bromelain, flavonoids, and vitamin C with antioxidant and anti-inflammatory properties. This study aimed to evaluate the hepatoprotective effect of pineapple peel extract against paracetamol-induced liver injury in Wistar rats. This experimental study used a post-test only control group design with 30 male Wistar rats divided into six groups (n = 5): negative control, positive control (paracetamol 2.5 g/kg body weight), and four treatment groups receiving pineapple peel extract at doses of 250, 500, 750, and 1,000 mg/kg body weight prior to paracetamol induction. Liver tissues were examined histopathologically using Hematoxylin–Eosin staining and assessed with the Suzuki scoring system. Data were analyzed using Kruskal–Wallis and Mann–Whitney tests. There was a significant difference in liver damage scores among groups (p = 0.003). The 750 mg/kg dose showed the most effective hepatoprotective effect (p = 0.043). In conclusion, pineapple peel extract exhibits hepatoprotective potential against paracetamol-induced liver injury. Keywords: Ananas comosus, hepatoprotective, paracetamol, liver histopathology.
Type 2 diabetes mellitus (T2DM) is a common chronic metabolic disease among Indonesian Hajj pilgrims, particularly in older adults. The strenuous physical activities and environmental stress during the pilgrimage may exacerbate glycemic instability and increase metabolic complications. This study aimed to analyze random blood glucose (RBG) levels and their association with age, gender, and number of comorbidities among hospitalized Indonesian Hajj pilgrims with T2DM in Saudi Arabia in 2023. A descriptive-analytic cross-sectional design was applied using secondary data from the Integrated Hajj Health Information System (Siskohatkes). A total of 292 hospitalized Indonesian Hajj pilgrims diagnosed with T2DM (ICD-10 E11) and available RBG results were included. Chi-square analysis with a significance level of p≤0.05 was used. Most participants were aged ≥60 years (75.3%), male (54.8%), and had fewer than two comorbidities (57.2%). Uncontrolled RBG levels (≥200 mg/dL) were found in 58.9% of participants. While gender and comorbidities were not significantly associated with glycemic control, age showed a near-significant relationship (p=0.050). These findings highlight the need for targeted pre-departure screening and enhanced diabetes management for elderly Hajj pilgrims to prevent complications during the pilgrimage.
Indonesia is currently facing a sexual violence emergency, with sexual violence being the most frequently reported form of violence against women. One form of Online Gender-Based Violence (OGBV) that remains underreported is the Non-Consensual Dissemination of Intimate Images (NCII), which refers to the distribution of intimate images without the victim’s consent. In Bali, NCII cases reflect an iceberg phenomenon in which only a small proportion of incidents are reported, while rapid tourism development and the expansion of digital communication are believed to increase the risk of such cases. This study aims to describe the NCII situation and to develop a peer support–based assistance model for vulnerable adolescents. A mixed-method approach was used by integrating quantitative and qualitative data. Quantitative data were obtained through pre-test and post-test questionnaires during peer support training, while qualitative data were collected through observations during peer-led socialization activities in schools. The intervention consisted of two stages: researcher-led peer support training followed by peer-led dissemination. Statistical analysis at a significance level of α = 0.05 showed a significant increase in participants’ knowledge after the intervention (p < 0.001). These findings indicate that a peer support–based assistance model can improve adolescents’ awareness and readiness to support NCII victims.
Malignant pleural effusion (MPE) is a frequent complication of advanced adenocarcinoma, leading to dyspnea and impaired quality of life. Pleurodesis is the standard palliative approach, but outcomes vary. This study evaluated the association of sex, smoking exposure (Brinkman Index), and pleural glucose with pleurodesis success. An observational analytic study was conducted at RSUD Jenderal Ahmad Yani Metro, Lampung, from July 2023 to July 2024. Thirty-eight patients with adenocarcinoma-related MPE were recruited; six were excluded, leaving 32 eligible subjects who underwent bleomycin pleurodesis. Outcomes were categorized as complete response (CR), partial response (PR), or failure. Associations between predictive factors and pleurodesis outcomes were analyzed using the Chi-Square test. Pleurodesis success correlated significantly with sex (p = 0.042), Brinkman Index (p = 0.027), and pleural glucose (p < 0.001). Females achieved higher CR rates (53.8%) than males (15.8%). Lower Brinkman Index values were linked to better outcomes, while pleural glucose >60 mg/dL strongly predicted success. Conclusion: Sex, smoking exposure, and pleural glucose may predict pleurodesis outcomes in adenocarcinoma-related MPE. Female sex, lower smoking burden, and higher pleural glucose were associated with improved pleural adhesion, supporting their role in guiding treatment.
Placental-related disorders impact over 33% of pregnancies. Several of these syndromes lead to higher rates of maternal and fetal death and morbidity and can have long-term health consequences. Several RCTs have found that pravastatin is associated with a significant reduction in the incidence of preterm preeclampsia and preterm birth. However, alternatives require substantial evidence. On the methods, two writers assessed the risk of bias. The Cochran test was used to assess heterogeneity among studies. The Mantel-Haenszel technique was used to obtain the results. The study's results were described using forest plots. The study used six randomized controlled trials. Findings showed a reduced risk of preeclampsia, preterm birth, and NICU admission in pregnant women taking pravastatin. There was no significant reduction in the risk of neonatal respiratory distress, congenital disorders, and adverse events of headache, heartburn, and musculoskeletal pain. Our conclusion, this study suggests that pravastatin use may have beneficial effects in reducing the risk of placental-related disorders in patients.
Introduction: Colorectal adenocarcinoma is a common malignancy with high mortality. Carcinoembryonic Antigen (CEA) is widely used as a tumor marker, while contrast-enhanced CT scans provide tumor size parameters. The correlation between these parameters and CEA remains unclear. Objective: To analyze the relationship between tumor area and thickness on contrast-enhanced CT scan and CEA levels in colorectal adenocarcinoma. Methods: A retrospective cross-sectional study was conducted at RSUP Prof. Dr. I.G.N.G. Ngoerah (2018–2023) involving patients with available CT scan and CEA data. Pearson correlation and multivariate regression were applied. Results: Tumor area showed a significant positive correlation with CEA (r = 0.513; p = 0.001), independent of age and sex. Tumor thickness was not significantly correlated (r = 0.196; p = 0.224). Conclusion: Tumor area correlates significantly with CEA levels, whereas tumor thickness does not. Tumor area may serve as an additional indicator in colorectal cancer evaluation.
Drug-induced liver injury is the most common cause of acute liver failure in the United States. Hepatocyte injury can be caused by the consumption of high doses of aspirin, leading to the formation of free radicals. Golden sea cucumber (Stichopus hermanii) can play a role in prevention of free radicals through antioxidant. The study used a post test only control group design involving 32 wistar male rats divided into 4 groups : negative control (K-), positive control (K+), and two groups treated with Stichopus hermanii extract at doses of 486 mg/kg BB (KP1) and 972 mg/kg BB (KP2) for 23 days. The results of the study with Man-Whitney test showed that neither the groups treated with Stichopus hermanii extract at both doses of 486 mg/kg BB nor 972 mg/kg BB doses of Stichopus hermanii extract led to a significant reduction in ALT levels when compared to positive control. There was no significant difference in ALT levels between the two extract doses. The conclusion of this study is the administration of Stichopus hermanii extract at doses of 486 mg/kg BB dan 972 mg/kg BB for 23 days can not reduce ALT levels in aspirin-induced experimental animal.
Biofilm formation is a virulence factor contributing to the pathogenicity and antibiotic resistance of Klebsiella pneumoniae. This process occurs due to biofilm genes in clinical isolates, especially the mrkA, mrkD, and fimH genes. These three genes are related the quality of biofilms formed, which lead to chronic and prolonged infections. This study was conducted to determine the presence of mrkA, mrkD, and fimH genes as biofilm formers in Klebsiella pneumoniaeclinical isolates. The study used a descriptive in vitro laboratory study, with total of 24 Klebsiella pneumoniae clinical isolates from the collection of the Department of Microbiology, Faculty of Medicine, Universitas Tanjungpura. Isolates were subculture in MacConkey Agar, Gram staining, followed by DNA extraction and gene detection using PCR. The results showed the presence of the mrkA gene in 91.6% of the isolates, while the mrkD and fimH genes were each in 87.5% of the isolates. The high percentage of biofilm gene detected, should increase health workers and stakeholder awarness about the impact.
Online games are a type of game that can be played on various devices and connected to the Internet network so that it can be used to play online games, if played continuously with a long intensity can cause a person to be addicted to online games and have an impact on mind disorders and emotional and mental health. Faculty of Medicine students have a busy schedule, so they play online games to overcome the boredom. This study is to determine the relationship between online game addiction and changes in emotional regulation of Maranatha Christian University Medical students. This study used an analytical method with a cross sectional research design with a total research sample of 132 students. The results of the spearman correlation test where the p value = 0.001 is obtained, meaning that there is a very significant correlation between online game addiction and emotional regulation. The r value is 0.688, which means that there is a strong relationship between online game addiction and emotional regulation and has a positive pattern. There is a strong relationship between online game addiction and emotional regulation in Maranatha Christian University Medical faculty students class of 2021 and 2022.
Visual impairment in children still becomes a burden globally. It can affect children’s learning process, career options, and psychosocial development eventually. This study aims to determine the prevalence of visual impairment among schoolchildren in Lengkong Subdistrict, Bandung. This was a retrospective descriptive study using secondary data from visual impairment screening program of schoolchildren aged 6-14 years, which was conducted by Health Promotion Unit of Bandung Eye Center Hospital from August to November 2023. The sample for this study was collected using a total sampling technique. A total of 907 data consisting of Uncorrected Visual Acuity (UCVA), Presenting Visual Acuity (PVA), age, and gender were collected and analysed using Microsoft Excel 2019. The prevalence of visual impairment in schoolchildren was 16.2% with UCVA and 11.1% with PVA, moderate visual impairment was the major classification. Female students were more likely to have visual impairment compared to male students. The highest number of visual impairments with UCVA and PVA compared to age distribution was 12 years old. These results need to become school and government’s concern to create further policy regarding children’s eye health to support an optimal learning process.
Migraine is a common neurological disorder affecting approximately 15% of adults worldwide, characterized by recurrent pulsating headaches. Conventional treatments often provide insufficient relief and may cause medication-overuse headaches. Calcitonin Gene-Related Peptide (CGRP) inhibitors have emerged as a novel preventive therapy by targeting the underlying migraine pathophysiology. This meta-analysis aimed to evaluate the efficacy and safety of CGRP inhibitors in reducing monthly migraine days (MMD) among patients with episodic and chronic migraine. A systematic search was conducted in ScienceDirect, PubMed, CENTRAL, and Wiley up to January 29, 2023, including randomized controlled trials with MMD as the primary outcome. Forty-two studies were analyzed qualitatively, and 32 studies were included in quantitative synthesis using random-effects models. Among 22,295 patients from studies published between 2013 and 2022, CGRP inhibitors significantly reduced MMD compared to placebo (Mean Difference -2.12; 95% CI -2.41 to -1.84; p=0.02), with galcanezumab showing the largest effect. Safety profiles were comparable to placebo, supporting their role in migraine prevention and guideline recommendations.
Patellofemoral maltracking remains a major cause of pain, instability, poor function, and dissatisfaction after total knee arthroplasty (TKA). Despite advances in implant design and surgical technique, patellofemoral complications continue to contribute to revision surgery and inferior outcomes. This review summarizes the etiology, diagnosis, prevention, and management of patellofemoral tracking abnormalities after TKA, including a comparison between conventional and robotic-assisted techniques. The most common causes of maltracking include internal rotation of the femoral or tibial component, excessive valgus alignment, soft-tissue imbalance, patella baja, anterior overstuffing, and implant design mismatch. Internal femoral malrotation is consistently identified as the leading factor causing lateral patellar tilt, subluxation, and instability. Clinical evaluation includes anterior knee pain, crepitus, apprehension, and extensor lag, while radiographs and computed tomography are important for assessing patellar tilt, shift, and component rotation. Treatment depends on the underlying cause. Revision of malrotated components, lateral release, tibial tubercle transfer, medial patellofemoral ligament reconstruction, and secondary patellar resurfacing may be required. Robotic-assisted TKA improves component alignment and intra-operative assessment, but current evidence has not shown superior functional outcomes compared with conventional TKA.
Vernal keratoconjunctivitis is an ophthalmological condition that presents significant challenges, especially in children and adolescents, due to chronic inflammation of the conjunctiva and cornea. This inflammation leads to distressing symptoms such as itching, irritation, and photophobia, which severely impact the quality of life. Traditional treatments for this condition often involve antiallergic medications like dexamethasone, prednisolone, and quercetin. However, understanding the precise mechanisms and comparative effectiveness of these treatments is crucial for improving therapeutic outcomes. In this study, protein structure data for dexamethasone (4UDA), prednisolone (8CC1), and quercetin (1JUH) were sourced from the Protein Data Bank (PDB). The crystal structure of the Histamine H1 Receptor (8X5X) was also retrieved from PDB. In silico modeling was carried out using the Cluspro web server to simulate the interactions between these drugs and the receptor. The analysis revealed that quercetin exhibited the lowest Weighted Score of -1810 in cluster 2, outperforming dexamethasone (-1223) and prednisolone (-1372.4), indicating a higher binding potency to the Histamine H1 Receptor. These findings suggest that quercetin has superior potential compared to dexamethasone and prednisolone for binding to Histamine H1 Receptors in the context of vernal keratoconjunctivitis.
Cigarette smoke exposure is the major risk of chronic obstructive pulmonary disease, the third cause of death worldwide. Inhaled smoke triggers oxidative stress resulting in airway epithelium thickening and cilia shortening. Shallot (Allium cepa L.) peel contains flavonoid which can neutralize oxidative stress. This study aims to determine correlation between shallot peel infusion (SPI), bronchus epithelium thickness, and cilia length in cigarette smoke-induced rats; and establish maximum effective dose of SPI. Rats were divided into normal; cigarette; SPI 125, 250, 500, 1,000, 2,000 mg/kgBW groups. Two hours after administration, rats were exposed to cigarette smoke 2 cigarettes/day for 28 days. Hematoxylin-eosin-stained bronchus was observed and variable measurements were carried out. Comparation tests of epithelium thickness and cilia length between normal and cigarette group showed significant difference (p<0.05); Pearson coefficient between SPI dose and epithelium thickening was -0.614, Spearman coefficient between SPI dose and cilia length was 0.860; and maximum effective dose to prevent bronchus epithelium thickening and cilia shortening are 1,275.4 mg/kgBW and 1,325.8 mg/kgBW. In conclusion, the higher the SPI dose, the lower epithelium thickness, the higher cilia length. Maximum effective dose of SPI to prevent bronchus epithelium thickening and cilia shortening are 1,275.4 mg/kgBW and 1,325.8 mg/kgBW.
One in four girls and one in 13 boys globally experience child sexual abuse (CSA), a public health crisis. Snakes and ladders-based reproductive health education to combat CSA. This study examined the impact of snakes and ladders game modification on CSA anticipation knowledge. The study was quasi-experimental with pre- and post-test control groups. Sample size was 118. The experimental group received a modified snakes and ladders game comprising 59 students, whereas the control group received a brochure. The sampling method is sequential. This study included grade 4-6 primary pupils. The snakes and ladders modification group averaged pretest 68.3 SD 16.4 and posttest 82.0 SD 12.5. The leaflet group averaged 67.8 SD 11.4 pre-test and 76.4 SD 14.1 post-test. The snake and ladder modification group increased 13.6 and the leaflet group 8.5. An average difference of 5.1 was found between the snakes and ladders modification group and the leaflet, with a p-value of 0.037 < It can be concluded that snake modification increases female students' average knowledge.
Whether exaggerated cardiovascular response to postural changes among normotensive subjects with family history of hypertension does exist is not reported yet. Male and female normotensive subjects with (n=16) and without (n=14) hypertensive parents did postural changes from supine to standing. Systolic blood pressure, diastolic blood pressure and pulse rate were measured during supine and immediately after standing. The median value of the delta systolic blood pressure, diastolic blood pressure and pulse rate from all samples were used to classified exaggerated cardiovascular responses. The differences in the proportion of subjects with exaggerated cardiovascular responses were analysed with Chi square. P value <0.05 was considered significant. Proportion of normotensive subjects who had exaggerated systolic (≥3.5 mm Hg) or diastolic (≥2 mm Hg) blood pressure responses to postural changes were significantly higher in those with parental history of hypertension as compared to those without parental history of hypertension. Proportion of subjects who had exaggerated pulse rate (≥12 bpm) response to postural changes was not significantly different between the two groups. Normotensive young adults with family history of hypertension demonstrated heightened blood pressure, but not pulse rate, responses to orthostatic challenge from supine to standing.
Introduction: Infertility is the inability to achieve pregnancy after 12 months of regular unprotected intercourse, affecting millions globally. In Indonesia, it affects 10-15% of reproductive-aged couples. Infertility can be classified as primary (no prior pregnancies) or secondary (previous pregnancies). HSG is commonly used to assess uterine and tubal abnormalities, key contributors to infertility. Methodes: Descriptive qualitative study are done to examine correlation of age, uterine abnormalities, and fallopian tube abnormalities from HSG findings with the prevalence of infertility from patients in Radiology Department from Prof. Dr. I.G.N.G. Ngoerah Central General Hospital, covering the period from January 2021 to June 2024.Results: 66 patients were collected as samples. 47 patients (71.21%) have primary infertility, while 19 patients (28.79%) have secondary infertility. 9 patients (13.63%) have uterus abnormalities, while 21 patients (31.81%) have fallopian tube abnormalities.Discussion: Hysterosalpingography (HSG) is a key diagnostic tool in evaluating infertile patients, providing insights into uterine and fallopian tube morphology and patency. It detects structural abnormalities like retroflexed uterus, didelphys, or blocked tubes, which can hinder sperm-egg interaction, embryo implantation, or cause recurrent miscarriages, affecting fertility. Keywords: Abnormalities, Fallopian tube, Hysterosalphyngography, Infertiliy, uterus
