Universa Medicina

The danger of puff bars in adolescents

Selen OZAKAR AKCA — Tue, 17 Sep 2024 00:00:00 +0700

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Dysmenorrhea and recent treatment options in adolescents and young adults

Fri, 08 Nov 2024 00:00:00 +0700

Dysmenorrhea, or primary dysmenorrhea (PD), marked by menstrual cramps in the lower abdomen, is a common but often overlooked condition affecting a considerable number of women. The impact of dysmenorrhea extends beyond physical pain, often causing considerable disruption to daily activities, work, and social interactions. It significantly affects the quality of life, often causing absenteeism from school or work. Increased intrauterine prostaglandin secretion is linked to pelvic pain in PD. Diagnosis relies mainly on clinical assessment, considering symptoms and physical examination, with treatment aimed to enhance the quality of life. These menstrual cramps are frequently accompanied by other symptoms, such as headaches and nausea, which are believed to be due to prostaglandins released as the endometrium breaks down. A literature search using the keywords dysmenorrhea, menstrual pain, and hormonal contraceptives was done using the following databases: Google Scholar, ProQuest, ScienceDirect, Web of Science, Pubmed, and Scopus for articles published from 2015 to 2024. The literature study was done to find the connection of dysmenorrhea and menstrual pain with hormonal contraceptives. Common treatments include nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and non-pharmacological interventions. This review provides an in-depth analysis of recent treatment advancements for dysmenorrhea, focusing on its pathophysiology, clinical diagnosis, and impact on women's quality of life. It evaluates current and emerging treatments, including pharmacological interventions, non-pharmacological therapies, surgical approaches, hormonal treatments, and investigational drugs, aiming to identify improvements in efficacy and side effects.

Early radial band deflation after transradial access coronary catheterization reduces complications: a systematic review

Rico Maulana Nugroho, Agung Waluyo, Tuti Herawati — Tue, 10 Dec 2024 00:00:00 +0700

BACKGROUND
Transradial access (TRA) coronary catheterization is widely used for coronary artery disease (CAD) management. However, complications such as pain, hematoma, and radial artery occlusion (RAO) often occur due to prolonged use of radial compression bands. Early deflation protocols have been proposed to minimize these complications while maintaining effective hemostasis. This systematic review evaluates the impact of early radial band deflation protocols on reducing TRA-related complications.

METHODS
A systematic literature search was conducted in ProQuest, PubMed, ScienceDirect, Sage Journal, and Scopus databases, including studies published between 2018 and March 2024. Inclusion criteria focused on randomized controlled trials (RCTs), cohort studies, and quasi-experimental studies evaluating radial band deflation protocols in TRA coronary catheterization patients. Outcomes included pain, hematoma, and RAO. Twelve studies were critically appraised using the Joanna Briggs Institute (JBI) tools and synthesized using narrative and quantitative approaches.

RESULTS
The review included eight RCTs, three cohort studies, and one quasi-experimental study involving a total of 4,477 patients. Findings revealed that early radial band deflation (1.5–2 hours) reduced pain and hematoma incidence compared to prolonged durations (>4 hours). RAO rates were significantly lower with gradual and early deflation protocols. However, shorter durations (<1.5 hours) slightly increased bleeding risk. Evidence supported the TR Band® Light Protocol as an effective and safe deflation strategy.

CONCLUSION
Early radial band deflation protocols effectively reduce TRA-related complications, enhancing patient comfort and safety. Standardized deflation protocols and further research, including innovative technologies, are recommended to optimize post-TRA care.

Risk factors of tumor lysis syndrome in childhood acute lymphoblastic leukemia

Tue, 08 Oct 2024 00:00:00 +0700

Background
Acute lymphoblastic leukemia (ALL) is the most common childhood hematologic malignancy. Treatment failure in ALL can be caused by severe and life-threatening complications, including tumor lysis syndrome (TLS). Delay in identifying risk factors and establishing the diagnosis of TLS by clinicians can be fatal. This study aimed to determine the risk factors for TLS in children with ALL.

Methods
This was a retrospective cross-sectional study on 81 children aged 0 to 18 years with ALL. Tumor lysis syndrome comes in two forms: laboratory and clinical. Laboratory TLS occurs if uric acid levels >normal values, potassium >6mEq/L, phosphate >6.5mg/dl, and calcium <7mg/dl. Clinical TLS includes an increase in serum creatinine, the presence of heart attacks, sudden death, and seizures. Risk factors for TLS include age, nutritional status, leukocyte count, presence of organ infiltration, presence of mediastinal mass, uric acid level, renal function, and type of chemotherapy regimen. Risk factors were analyzed using simple and multiple logistic regression analyses. A value of p<0.05 indicates a significant risk factor.

Results
Twenty seven patients (33.3%) experienced TLS. Adjusted OR analysis showed that the presence of organ infiltration (aOR 5.42; 95% CI 1.45-20.27; p=0.012), leukocyte count (aOR 8.70; 95% CI 1.67-45.13; p=0.010), and decreased kidney function (aOR 12.21; 95% CI 1.09-136.89; p=0.042) were significant risk factors for TLS.

Conclusion
Decreased renal function, leukocyte count, and organ infiltration were significant risk factors for TLS. We suggest more vigilant assessment and monitoring to recognize and treat those patients who are at risk of TLS.

Ethanol extract of Abrus precatorius L. leaves diminishes inflammatory responses in nicotine-treated human gingival fibroblasts: an in vitro study

Raden Roro Widorini Kesumaningtias, Indra Kusuma, Yulia Suciati, Wening Sari — Thu, 17 Oct 2024 00:00:00 +0700

BACKGROUND
Nicotine induces oxidative stress in human gingival fibroblasts (HGF) and stimulates the production of cytokines that trigger inflammation. Abrus precatorius L. (AP) leaves contain antioxidants with anti-inflammatory properties that can prevent the formation of free radicals and reduce tissue damage due to inflammation. This study aimed to determine the effect of ethanolic extract of AP leaves (EAP) on interleukin (IL-6) levels and cyclooxygenase-2 (COX-2) gene expression in gingival fibroblasts exposed to nicotine.

METHODS
Cells were randomized into six treatment groups and clustered into the non-treatment control group (NTC), solvent control (SC), nicotine control (NC), and groups treated with nicotine and EAP at doses of 9.375 µg/mL, 18.75 µg/mL, and 37.5 µg/mL, respectively, for 24 hours. IL-6 levels were examined using the Elisa method, while COX-2 gene expression was assessed using PCR. Data were analyzed using Oneway ANOVA and the Kruskal Wallis test.

RESULTS
IL-6 levels and COX-2 expression were considerably higher in the nicotine control group. Conversely, the cell groups treated with nicotine and EAP had substantially decreased levels of both inflammatory markers IL-6 and COX-2 (p=0.029) across all EAP dose levels compared to the nicotine control group. The highest reduction in response was observed at the dose of 9.375 ìg/mL EAP.

CONCLUSION
These results highlight the potential of Abrus precatorius L. in relieving nicotine-induced inflammation in smokers. By suppressing the production of inflammatory mediators IL-6 and COX-2 in HGF, EAP presents a promising avenue for further in vitro research.

Stereoacuity test as a screening tool for amblyopia and binocular vision in children 6-12 years of age

Thu, 17 Oct 2024 00:00:00 +0700

Background
Stereoacuity is essential for depth perception and daily activities, complementing visual acuity. Assessing stereoacuity in children is vital for detecting binocular vision disorders and amblyopia. This study aimed to compare the Toegepast Natuurwetenschappelijk Onderzoek (TNO) test and the Titmus Fly test in school-based vision screening for children aged 6-12 years.

Methods
A cross-sectional study was conducted in social service settings with 122 elementary school children aged 6-12 years. Examinations included visual acuity, refraction, Ishihara color vision, and stereoacuity using both the TNO and Titmus Fly tests. Statistical comparisons were made using the Wilcoxon Signed-Ranks Test, and stereoacuity differences based on demographic factors and visual acuity were assessed using the Mann-Whitney U Test. The level of agreement between the two tests was determined using Bland-Altman analyses.

Results
Visual acuity significantly influenced stereoacuity results in the Titmus Fly test (p=0.001), with children having abnormal visual acuity performing worse. Approximately 68% of children reported that the Titmus Fly test was easier to perform. The mean difference between TNO and Titmus Fly measurements was 79.52 ± 63.75 (95% CI = 68.14–90.90; p=0.001), demonstrating a consistent bias between the two tests.

Conclusion
The Titmus Fly test is easier for children (6–12 years) to perform, but it tends to overestimate stereoacuity values compared to the TNO test, making the two methods non-interchangeable and not reliable. Stereoacuity assessment remains essential in school-based vision screening for evaluating binocular vision and amblyopia, especially in children with refractive errors.

Acute effect of five different stretching strategies on speed and agility parameters in recreationally active women

Harun GENÇ, Ali Erdem CİĞERCİ, İbrahim AYDINLI — Fri, 25 Oct 2024 00:00:00 +0700

Background
Stretching includes movements that provide joint range of motion, increase the flexibility of muscles, joints, ligaments, and the speed of musculoskeletal communication, which are applied to increase performance in the main part of the training. Anaerobic properties are among the most important determinants of performance in athletes. Therefore, the objective of this study was to investigate the effects of five different stretching exercises on anaerobic performance (speed and agility parameters) in recreationally active women.

Methods
A study of within-subject experimental design was conducted involving 30 recreationally active females aged 23.76 ± 1.50 years. Five different protocols (NS: no stretching; SS: static stretching; DS: dynamic stretching; SDS: static + dynamic stretching; DSS: dynamic + static stretching) were used to measure performance parameters after stretching exercises. After each stretching exercise, the 10 and 20 m sprint, Illinois agility test, and reactive agility test were used to determine anaerobic performance. Repeated measures analysis of variance (ANOVA) was employed for the analysis.

Results
A notable difference was observed in the 10 m and 20 m performance of recreationally active women after five different stretching protocols (p<0.05). When looking at the agility test values, it was found that a significant difference existed (p<0.05). DS showed the best performance in all tests.

Conclusion
According to these results, in recreationally active women, only SS should be avoided before high or explosive exercises, or the warm-up period should include only DS, or if a combined application is to be made, DS should be applied after SS.

Risk factors of doxorubicin-induced cardiomyopathy in non-muscle- invasive bladder cancer

I Made Nugraha Gunamanta Sabudi, Ahmad Zulfan Hendri — Fri, 15 Nov 2024 00:00:00 +0700

Background
Doxorubicin is an anthracycline antibiotic widely used as a chemotherapeutic agent to treat solid tumors and hematologic malignancies. Bladder cancer is the second most common genitourinary malignancy and can be classified into muscle-invasive bladder cancer and non-muscle-invasive bladder cancer (NMIBC). In Indonesia, NMIBC is treated by doxorubicin instillation. Several risk factors have been suggested to be associated with doxorubicin-induced cardiomyopathy, but on their quantitative effects no consensus has as yet been reached. This study aimed to determine the risk factors of doxorubicin-induced cardiomyopathy in NMIBC patients with intravesical doxorubicin instillation.

Methods
A cross-sectional study was conducted involving 74 NMIBC patients who received local treatment by doxorubicin instillation after transurethral resection of bladder tumor (TURBT). Data were collected on the risk factors that may be favorable to doxorubicin-induced cardiomyopathy, namely age, sex, hypertension, type 2 diabetes mellitus, smoking, and NMIBC risk classification. The dependent variable was cardiomyopathy with decreasing left ventricular ejection fraction (LVEF) below 50 %. Multiple logistic regression was used to analyze the data.

Results
The prevalence of cardiomyopathy was 6.75% (5/74). Type 2 diabetes mellitus was a significant risk factor for doxorubicin-induced cardiomyopathy among our subjects (aOR=34.30;95% C.I.:1.36-865-86;p=0.032). In contrast, age, sex, risk classification, hypertension, and smoking were nonsignificant predictors for doxorubicin-induced cardiomyopathy (p>0.05).

Conclusion
This study demonstrated that type 2 diabetes mellitus increased the risk of cardiomyopathy in doxorubicin users among patients with NMIBC. More research is necessary regarding the mechanisms underlying type 2 diabetes mellitus as a risk factor for doxorubicin-induced cardiomyopathy.

Comparison of natural versus artificial cycles for endometrial preparation prior to frozen embryo transfer

Mon, 25 Nov 2024 00:00:00 +0700

Background
The endometrial preparation phase preceding embryo transfer assumes pivotal significance in achieving optimal endometrial receptivity and ensuring the success of pregnancy. The natural cycle (NC) and artificial cycle (AC) are the preferred methods for many in vitro fertilization (IVF) specialists. The objective of this study was to compare the difference between NC and AC in women undergoing frozen-thawed embryo transfer (FET) after IVF.

Methods
A cross-sectional study was conducted involving 150 adult women who underwent FET with a single autologous blastocyst stage embryo in a 5-year period (2014-2019). Bivariate analysis was conducted to discern implantation and pregnancy rates associated with NC and AC for endometrial preparation. Multiple logistic regression was used to assess the association between endometrial preparation and clinical outcomes while adjusting for potential confounders.

Results
Of the 150 subjects meeting study criteria, 19 underwent NC, while 131 underwent AC for endometrial preparation. Natural cycle exhibited a higher biochemical pregnancy rates compared to AC (89.5% vs. 53.4%; p=0.003). Artificial cycle is a significant determinant for biochemical pregnancy rates compared to NC (aOR: 0.132;95% CI: 0.028 – 0.623; p=0.010)

Conclusion
In women undergoing FET, NC resulted in higher biochemical pregnancy rates compared to AC. However, clinical pregnancy rates and ongoing pregnancies rates did not exhibit significant disparities between NC and AC. Future studies will hopefully further illuminate which protocol is most suitable for the individual patient. Further multi-center randomized clinical trials are needed to confirm the relationship between biochemical pregnancy rates and NC.

Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis

Tue, 26 Nov 2024 00:00:00 +0700

Background
Despite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis.

Methods
This retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis.

Results
A low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR <2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131).

Conclusion
The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.

Relationship between presenting symptoms and tumor location in colorectal cancer patients

Mon, 09 Dec 2024 00:00:00 +0700

Background
Colorectal cancer (CRC) often shows symptoms at an advanced stage, causing delayed diagnosis and poorer prognosis. Initial symptoms, or chief complaints, are usually identified through patient history and can vary based on tumor location. This can help in establishing a diagnosis. This study aimed to determine the relationship between presenting symptoms and tumor location in CRC patients at Zainoel Abidin Regional General Hospital, Banda Aceh.

Methods
This cross-sectional study was conducted using secondary data from medical records (2019–2022) for 163 CRC patients. Information on symptoms of patients were collected from patient files: anemia, anorexia, diarrhea, constipation, abdominal pain, rectal bleeding, and palpable abdominal mass. Tumor locations were classified as right colon, left colon, rectum, and left colon plus rectum. Bivariate analysis was used to analyze the data.

Results
Of the 163 patients, 98 (58%) were aged e”50 years, 82 (50.3%) were male, and 99 (60.7%) had rectal tumors. The percentage of patients presenting with rectal bleeding was significantly higher in rectal cancers (47.47%) as compared with cancers in the left colon (28.57%) and left colon and rectal (33.33%) cancers (p=0.000). The percentage of patients presenting a palpable abdominal mass was significantly higher in right colon (31.58%) compared with left colon (4.76%) and rectal cancer (1.01%) (p=0.000).

Conclusions
Tumor location in the right colon is associated with palpable abdominal mass, while rectal location is associated with rectal bleeding in CRC patients. Familiarity with clinical symptoms of CRC could make patients more sensitive to undergo more frequent screening for cancer.

The effect of saffron serum on collagen density, inflammatory gene expression, and autophagy in UVB-exposed Wistar rats

Thu, 05 Dec 2024 00:00:00 +0700

Background
Skin aging is a complex biological phenomenon influenced by intrinsic and extrinsic factors. Photoaging can be prevented by applying phytochemicals that have sun-protective properties. This study aimed to evaluate the effect of saffron serum to restore collagen density and autophagy processes and reduce inflammatory gene expression in UVB-exposed Wistar rats.

Methods
An experimental laboratory study was conducted involving 20 male Wistar rats that were divided into 4 groups: control, UVB, UVB + base serum, UVB + saffron serum exposed to UVB radiation for 5 weeks with a total dose of 3100 mJ/cm2. The skin was extracted then underwent Masson Trichrome staining and real-time PCR to obtain collagen density and gene expression.

Results
The gene expression of MMP1, IL6, TNFá, LC3, and p62 was significantly increased in the UVB group compared to the control group. Topical administration of saffron serum significantly increased collagen density (p=0.001). Induction by UVB significantly increased LC3 (p=0.020) and p62 (p=0.030) gene expression, indicating an inhibition of autophagy. The saffron serum might modulate autophagy by increasing LC3, but not significant (p=0.495) and significantly decreasing p62 gene expression (p=0.001). As for MMP1, IL6, and TNFá, no significant decrease in gene expression was found in the UVB + saffron serum group compared to the UVB group.

Conclusion
Saffron serum increases collagen density and modulates autophagy in the skin of UVB-exposed Wistar rats. Inflammatory markers were increased after UVB induction, but no differences were found after saffron serum topical administration.

Evaluating sarcopenia prevalence and relationship with disease activity of primary Sjögren syndrome in females

Pınar Özge Başaran, Dilek Eker Büyükşireci — Thu, 12 Dec 2024 00:00:00 +0700

Background
Primary Sjögren’s syndrome (pSS) leads to impaired muscle function and mass as well as pain and fatigue. Sarcopenia is the pathological reduction of skeletal muscle mass and strength. We aimed to investigate the prevalence of sarcopenia and determine its relationship with disease activity levels in females with primary Sjögren syndrome.

Methods
This cross-sectional study was performed on 62 female patients diagnosed with pSS and 62 female age matched healthy controls. Disease activity was evaluated with the EULAR Sjögren’s syndrome patient reported index (ESSPRI) and EULAR Sjögren’s syndrome disease activity index (ESSDAI), fatigue severity scale (FSS), hospital anxiety and depression scale (HADS), and numerical rating scale (NRS). A simple questionnaire to rapidly diagnose sarcopenia (SARC-F) was used to screen for sarcopenia. Degree of sarcopenia was evaluated by handgrip strength, anterior thigh muscle thickness by USG, the 6-meter walk test (6MWT), and the five times sit-to-stand test (FTSST).

Results
The prevalence of sarcopenia was found to be 36/62 (58.1%) in pSS and 6/62 (9.7%) in healthy controls (p<0.001). HADS anxiety and depression scores and SARC-F scores were significantly higher in pSS (p<0.001). There were significant differences in 6MWT, FTSST, and hand grip strength results in pSS (p<0.001). Anterior thigh muscle thickness was similar in both groups (p=0.298). A positive correlation was found between SARC-F on the one hand and ESSPRI and NRS on the other (r=0.595, p=0.009; r=0.569, p=0.014).

Conclusion
Sarcopenia prevalence was increased in female patients with pSS and there was a relationship of SARC-F scores with pain and disease activity levels.