Universa Medicina

Giant congenital melanocytic nevus of the back: a case report

Areta Idarto — 2024-04-17

Background
Giant congenital melanocytic nevus (GCMN) is a rare disease with an extremely low incidence, that is present from or develops at birth and typically affects the dermis but may also affect other skin layers. Its incidence is estimated at <1 in 20,000 newborns. Despite its rarity, this lesion is important because it may be associated with severe complications such as malignant melanoma. A thorough follow-up is crucial since the probability of malignancy can vary depending on the clinical course. As such, careful observation is necessary to support possible management plans.

Case Description
In this case report, we present a three-day-old newborn male with abrasions on a black patch on his back. He presented with fever, jaundice, and black patches on more than 50% of his trunk down to the sacral area. The black raised patches resembling nodules had wounds on the lower back near the gluteus. A histopathology examination of specimens taken from 3 nodules on the back revealed hypocellular tissues with lymphocytes, histiocytes, neutrophils, fat droplets, and mature fat cells interspersed with some erythrocytes. The lesion was, therefore, diagnosed as a giant congenital melanocytic nevus (GCMN). Parents were counseled regarding the possible future course and were asked to come for regular follow-ups.

Conclusions
In this instance, we document a rare occurrence of GCMN that warrants recognition and appropriate treatment. To accumulate evidence for improving disease prognosis and outcomes, children with congenital melanocytic nev

Embryology and developmental toxicity risk assessment: complexity, concerns, and implications for industrializing developing nations

Osaretin Godwin Igharo — 2024-01-30

Macrophage modulation in activation process induced immune thrombocytopenia

Mahdaleny Mahdaleny — 2024-02-16

The immune system operates like an orchestra that harmoniously maintains the homeostasis balance while protecting from external or internal pathogens attack. Inflammation is one of the key critical immune defenses to eradicate pathogens and encourage tissue repair and recovery by activating the host’s immune and non-immune cells. As a part of the immune response during inflammation, blood platelets serve various functions; however, their activation and involvement in inflammation can also contribute to pathological conditions, such as thrombosis, which results in myocardial infarction, stroke, and venous thromboembolism. Activated platelets can mobilize and release intracellular granules (alpha and dense granules), which include secondary mediators like chemokine PF4/CXCL4. In contrast to most other chemokines, PF4 participates in several long-term regulatory processes, such as cell differentiation, survival, and proliferation. However, recent findings suggest that PF4 is also responsible for modulating macrophage polarization, which can substantially impact the development of induced immune thrombotic thrombocytopenia. This review aims to explain how PF4 induced vascular problems by modulation of macrophage development during immunological thrombocytopenia. A literature search using the keywords PF4, CXCL4, macrophage M4, platelet macrophage M4, and induced immune thrombocytopenia was done using the following databases: Google Scholar, ProQuest, ScienceDirect, and Scopus for articles published from 2000 to 2023. The literature study was done to find the connection between platelet activation, macrophage modulation, and vascular problems such as atherosclerosis and thromboembolism in induced immune thrombotic thrombocytopenia. Several recent studies on PF4, macrophage modulation, and vaccine-induced thrombotic thrombocytopenia were carefully reviewed. This review concludes that macrophage polarization modulation is promising in managing vascular problems in patients with induced immune thrombotic thrombocytopenia.

Developing a conceptual framework for burnout intervention program in the workplace

Bala Murali Sundram — 2024-03-21

This review proposes a comprehensive conceptual framework for developing and implementing burnout intervention programs in the workplace. In recent years, job burnout has become a new and vigorous research hotspot in the field of psychology and human resources management at home and abroad. Job burnout has a serious impact on personal health and performance but also harms the work efficiency, organizational effectiveness, and even social stability of employees. With the escalating concern over employee burnout and its consequent negative impacts on both individual health and organizational productivity, there is a pressing need for effective strategies to mitigate this issue. The framework draws on extensive literature review and theoretical model analysis, integrating key theories such as the Job Strain Model, Effort-Reward Imbalance Model, Conservation of Resources Theory, and the Job Demands-Resources Theory to explore the multifaceted nature of burnout. It identifies critical components of burnout, including symptoms such as emotional exhaustion, depersonalization, and reduced personal accomplishment, and contributing factors such as high job demands, inadequate job resources, and personal traits. Intervention strategies such as exercise have been identified as beneficial in addressing burnout. A systematic review of six studies highlights that aerobic exercise effectively lowers burnout and stress levels among employees. The framework also examines mediating factors such as personality traits and external factors, evaluating outcomes such as improved mental and physical health, enhanced job performance, and better workplace environment. Moreover, this review discusses the sustainability of interventions and emphasizes the importance of tailoring approaches to fit specific organizational contexts. The proposed framework provides a structured approach to understanding and addressing workplace burnout, highlighting the necessity for ongoing research and adaptation of intervention programs to meet evolving workplace dynamics.

Emerging and reemerging human fungal pathogens that affect people with weakened immune systems: a systematic review

Amere Genet — 2024-04-01

BACKGROUND
Emerging and reemerging human fungal pathogens are becoming more closely associated with morbidity and mortality, with 13 million infections and 1.5 million deaths per year. They are most often associated with critically ill and immunosuppressed patients. Therefore, this systematic review focused on emerging and reemerging human fungal pathogens that affect immunosuppressed individuals.

METHODS
A systematic literature search was performed using PubMed, ScienceDirect, Web of Science, Google Scholar, and other sources (Google engine and manual search using a reference list). The data were extracted in a structured format prepared using Microsoft Excel.

RESULTS
Cryptococcus neoformans, Candida auris, Aspergillus fumigatus, Candida albicans, Nakaseomyces glabrata (Candida glabrata), Histoplasma spp., Mucorales (Rhizopus spp., Mucor spp., Lichtheimia spp., and others), Fusarium spp., Candida tropicalis, Candida parapsilosis, Pichia kudriavzevii (Candida krusei), Talaromyces marneffei and Pneumocystis jirovecii were emerging and reemerging fungal pathogens reported among critically ill and immunocompromised patients including but not limited to HIV patients and patients with infectious diseases such as influenza, COVID-19, and tuberculosis as well as chronic conditions or co-morbidities such as asthma, hepatic cirrhosis, cancer, diabetes, cystic fibrosis (CF), transplant recipients, and chronic obstructive pulmonary disease (COPD). Climate change, agricultural activities, occupational hazards, deforestation, migratory trends of people, soil dispersion, decreased immunity of patients, biofilm development, medication tolerance, and resistance to antifungal therapies are all factors that contribute to the emergence of fungal diseases.

CONCLUSION
This review makes recommendations for policymakers, public health experts, and other stakeholders to improve the response to these fungal infections, including laboratory capacity and surveillance, fostering sustainable research and innovation, implementing public health initiatives, and limiting the development of antifungal drug resistance.

Trends in iron deficiency anemia research 2010 – 2023: a bibliometric analysis

Budi Santosa — 2024-04-22

Anemia is a health disorder marked by a reduction in hemoglobin concentration (Hb), hematocrit (Ht), and erythrocyte count. Iron deficiency anemia is marked by a reduction in hemoglobin synthesis, resulting in the production of hypochromic microcytic erythrocytes. The interest over time in the topic of iron deficiency anemia throughout the world is increasing. Many studies associated with iron deficiency anemia have been conducted by various authors and are increasing from year to year. The aim of the present review was to evaluate the literature on iron deficiency published between 2010 and 2023, with a focus on the trend in number of publications and citations, the trend of the link strength on the topic of iron deficiency anemia, and the low density of articles published from 2010 to 2023, to determine the trend and novelty of the topic of iron deficiency anemia. This review was a systematic study with the stages conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. The data on scientific publications on the topic of iron deficiency anemia were collected using dimensions.ai from 2010 to 2023. The data were subsequently analyzed with the Vosviewer program. This review resulted in the following findings. First, the number of publications and citations on the topic of iron deficiency anemia increased exponentially from year to year. Second, there were 139 items, 3 clusters, and 5579 links, with a link strength of 18253 for the topic of iron deficiency anemia. Third, the recommended study topics connected with iron deficiency anemia are topics of low density, namely clinician, pathogenesis, and biofortification. The study findings may assist the interested researchers to know the trends and novelties of studies on iron deficiency anemia, and may recommend suggestions for further research.

Assessing patient safety implementation and its associate factors in a pediatric inpatient ward

Rukmini Rukmini — 2024-02-06

Background
Patient safety is an emerging healthcare discipline with the ultimate goal of reducing errors and harm to patients by implementing quality health services. The provision of patient safety is complex and difficult to achieve. The purpose of this research was to assess patient safety in hospital pediatric inpatient care and factors affecting nurses implementing pediatric patient safety.

Methods
This cross-sectional study involved 80 nurses (male and female) at several private and public hospitals in Surabaya City. The research instruments used were secondary data on patient safety in hospital pediatric inpatient wards, hospital medical records, as well as questionnaires, and observations of the implementation of pediatric patient safety goals. Data were analyzed using multiple logistic regression.

Results
Most participants were female (71.3%), were over 45 years old (18%), and had more than 5 years of work experience in pediatric wards (76%). There were reportedly 145 patient safety incidents, consisting of 46% unexpected events (Kejadian Tidak Diharapkan), 48% nearly injurious events (Kejadian Nyaris Cedera), 6% potential injurious events (Kejadian Potensial Cedera), and 0% sentinel events. Multiple logistic regression analysis showed that nurses who work in less positive working settings are at higher risk of negative implementation of pediatric patient safety than those who work in positive working settings [AOR= 1.85 (95% CI 1.62-4.92)].

Conclusion
This study demonstrated that work setting and frequency of reported events were significantly associated with negative implementation of pediatric patient safety. Therefore, intervention is recommended to minimize unnecessary pediatric patient harm.

Effect of cognitive stimulation therapy in combination with other intervention modalities on cognitive ability in elderly with cognitive impairment: a quasi-experimental study

Yuda Turana — 2024-02-21

Background
Cognitive stimulation therapy (CST) has been proven to be beneficial in improving cognition and quality of life in people with mild cognitive impairment (MCI) and mild dementia (MD). This study investigates the benefit of more frequent exclusively CST intervention compared to less-frequent CST-exercise combination on cognitive ability among elderly people with cognitive impairment.

Methods
A quasi-experimental controlled study involving 22 subjects aged = 60 years with cognitive impairment. They were divided into three groups: group A (6 months, weekly CST + exercise sessions, n=13), Group B (3 months, twice-weekly CST-only sessions, n=5), group C (3 months, no intervention, n=4) as control. The Modified Mini Mental State Examination Indonesian Version was used for evaluating the cognitive ability of the elderly subjects. Data were analyzed using one-way Anova and Kruskal-Wallis tests

Results
All participants completed the study, the majority being female with mean age of 70.43 ± 6.97 years and differences in education level distribution across the three groups. The scores before and after the intervention showed a significant difference in the registration and construction domains (p<0.005). However, there was a greater improvement of the mean difference in cognitive scores in groups A and B compared to the control group, although the difference was not statistically significant (p >0.05).

Conclusion
A twice-weekly CST-only intervention and a once-a-week CST-exercise combination provide better cognitive improvement than no intervention (control). Therefore, elderly people with cognitive impairment should be encouraged to engage in physical activities, brain training, and group activities for promoting the brain’s ability.

Nicotine reduces cell viability and induces oxidative stress in human gingival fibroblasts

Sabrina Azmi — 2024-03-04

Background
Nicotine, as the main component of cigarettes, is known to interfere with the proliferation of human gingival fibroblasts (HGFs) and can trigger oxidative stress. This study aimed to analyze the impact of nicotine on viability, expression of the antioxidant Nrf2, levels of the product of oxidative stress malondialdehyde (MDA), and the migration capacity of HGFs.

Methods
An experimental laboratory study used fibroblasts isolated from healthy human gingiva. The cells were grouped into the non-treatment control group (NTC), the solvent control (SC), and the treatment groups, exposed to nicotine at various concentrations for twenty-four hours. Cell viability was assesed using the cell counting kit-8 (CCK-8), Nrf2 expression was examined using ELISA, MDA level was measured using an MDA kit, and migration capacity was assessed using a scratch assay. Statistical analysis used one-way Anova or Kruskal-Wallis test. A p-value of <0.05 was expressed statistically significant.

Results
The Cell viability was substantially reduced in the nicotine group compared to the untreated group, accompanied by changes in cell morphology. In contrast, Nrf2 expression increased significantly (p=0.010) in the 5 mM nicotine group compared with the control group. The MDA levels were not significantly distinct across groups (p=0.056). Cell migration was delayed significantly in the 5 mM nicotine group at 72 hours after scratching compared to the control group.

Conclusion
Nicotine decreased HGFs viability and increased Nrf2 expression significantly in a dose-dependent manner. Nicotine at 5 mM concentration did not alter MDA levels but delayed cell migration.

Evaluation of risk factors of postpartum urinary retention after vaginal delivery

Suskhan Djusad — 2024-03-07

Background
Urinary retention is a condition where a person is unable to urinate even after making sufficient efforts. It can be classified as either acute or chronic, as well as overt or covert. Urinary retention can be caused by various factors such as poor detrusor muscle contraction, a decrease in bladder contractility, anatomical anomalies, impaired neurological coordination while urinating, and disruption of outlet relaxation. The objective of this study was to identify the risk factors of postpartum urinary retention (PPUR) after vaginal delivery.

Methods
A cross-sectional study was conducted involving 500 female subjects who were in labor. All data obtained including variables such as age, parity, perineal rupture, episiotomy, history of using assisted vaginal birth during labor, and newborn weight, were compared between female subjects with and without postpartum urinary retention. The data were was analyzed using chi square test and multiple logistic regression analyses as a means to identify risk factors for PPUR.

Results
Among the 500 patients recruited to our study, 68 (13.6%) had PPUR. Episiotomy and parity were found to be potential risk factors for PPUR (OR=1.84;95% CI = 1.06-3.18 and OR=2.19;95% CI = 1.16-4.12, respectively). Severe perineal rupture was not a risk factor of PPUR (OR= 0.82;95% CI =0.82-5.89).

Conclusion
The prevalence of PPUR was quite high. Risk factors identified for PPUR were parity and episiotomy. In clinical practice, healthcare providers should pay more attention to women with these risk factors to prevent PPUR.

HIV-1 drug resistance-associated mutations in relation to viral load among HIV/AIDS patients at Dr. M. Djamil-Hospital Padang

Rizka Nadia — 2024-03-18

Background
According to the WHO, 38 million people suffer from HIV worldwide and according to the HIV Drug Resistance Report, the prevalence of antiretroviral therapy (ART) resistance is 3-29%. Drug resistance-associated mutations (DRAMs) are the presence of one or more HIV mutations that reduce the ability of certain drugs to inhibit viral replication and that will increase viral replication and HIV RNA, which can lead to therapeutic failure. The objective of this study was to determine the prevalence of HIV-1 DRAMs among patients with chronic HIV-1 infections and to compare HIV RNA viral load between M184V and K103N mutations.

Methods
A cross-sectional was conducted involving 80 patients with HIV who met the inclusion criteria. The study subjects were examined for genotype and HIV RNA viral load, both using the polymerase chain reaction (PCR). Data were analyzed with the Kruskal-Wallis test.

Results
The overall drug resistance mutation prevalence was 10.0%. The most common mutations were M184V and K103N. There was a significant difference between the median HIV RNA viral load counts in patients with either M184V or K103N, and with both M184V and K103N mutations, the values being 45.420, 13.207, and 97.517 copies/mL, respectively (p<0.001).

Conclusion
The HIV RNA viral load count was higher in the mutation group than in the group without mutation. Long-term and ongoing surveillance of HIV DRAMs among these patients is necessary, which will help us to adjust the treatment regimen.

Factors that influence refractive errors in premature infants

Ni Made Ayu Surasmiati — 2024-03-26

Background
The prevalence of refractive errors is reported to be higher in children born preterm. Factors such as gestational age, birth weight, and retinopathy of prematurity status, have a significant impact on the refractive development in preterm infants. Prematurity and low birth weight affect the development of organ systems in infants, including the eyes. In addition to immature retinas, other eye conditions, such as refractive status, are also observed. This study aimed to determine the risk factors of refractive status, specifically refractive errors (spherical equivalent, astigmatism, and anisometropia) in premature infants at a tertiary hospital in Bali.

Methods
A cross-sectional study was conducted involving 53 premature infants. This study collected samples from January to August 2023 at the Neonatal Intensive Care Unit of Prof. dr. IGNG Ngoerah General Hospital. Data regarding gender, gestational age, birth weight, retinal condition, spherical equivalent, and refractive disorders were collected. The relationship between risk factors and spherical equivalent, astigmatism, and anisometropia were analyzed using multiple regression analysis with statistical significance set at p<0.05.

Results
Hypermetropia is the most common finding in premature infants, followed by myopia and astigmatism. The prevalence of myopia (9.4%) and astigmatism (5.7%) is also more common among newborns of gestational age ≤30 weeks (p=0.024). Chronological age was significantly associated with spherical equivalent (β=0.424; p=0.019).

Conclusion
In premature infants, chronological age was the risk factor of spherical equivalent. Other risk factors were not associated with the prevalence of refractive errors among premature infants.

Exposure assessment and micronuclei induction in populations exposed to electronic waste in South-West Nigeria

Osaretin Godwin Igharo — 2024-04-22

BACKGROUND
Informal electronic waste (e-waste) reprocessing in Nigeria is reportedly substantial in Africa, putting the growing exposed population at high risk of metal toxicity. This study aimed to investigate the existence of chromosomal aberration in the growing e-waste exposed populations in Nigeria, using induction of micronuclei (MN) expression in peripheral blood as an indicator.

METHODS
In this cross-sectional study, 632 consenting participants were recruited from South-West Nigeria, consisting of 381 e-waste workers (EWW), 120 environmental e-waste exposed participants (EEP) and 131 age-matched unexposed participants (UP) serving as controls. A validated structured questionnaire was used to assess exposure pattern while frequency of micronucleated polychromatic erythrocytes (MNPCE)/1000PCE in peripheral blood film was determined by modified micronucleus assay.

RESULTS
A duration of exposure of ³5 years and exposure frequency ³6 hours/day; 6 days/week (9360 hours in any 5-year duration) was observed in both EWW and EEP. Routes of exposure observed in EWW entailed eyes, oral cavity, nasal cavity and skin. EWW that used personal protective equipment (PPE) while working was barely 10.24% while non-PPE users constituted the majority (89.76%) of the studied population. Frequency of MNPCE)/1000PCE in EWW (22.70 ± 0.15) was significantly higher than in EEP (4.17 ± 0.28), which in turn was significantly higher than the lowest frequency (0.99 ± 0.76) observed in UP (p<0.001).

CONCLUSION
The observed exposure pattern and the comparatively higher MN induction in the e-waste populations may suggest risk of significant cytogenetic damage and aberrant chromosomal changes associated with occupational e-waste reprocessing in Nigeria.

The effect of listening to Holy Quran recitation on stress among healthy adults: a non-blinded randomized controlled trial

Muchtar Hanafi — 2024-04-22

Background
Stress is the body’s inability to reach a balance between physical or psychological demands and the ability to meet them. Failure to meet these demands has a crucial impact which includes physical, emotional, and behavioral disorders. Recitation of the Quran is believed to cause relaxation by lowering adrenocorticotropic and cortisol hormonal levels. This study aimed to assess the effects of Quran recitation on stress levels using the biofeedback indicators electromyogram, skin conductance, and heart rate among healthy adults.

Methods
This study used a pre- and post-test group design involving 40 males between 19 and 23 years of age, randomized into two groups, i.e. control group (n=20) and Quran recitation listeners (n=20). The subjects were conditioned in a quiet room for 30 minutes before the stress level measurements were taken. The stress level measurements by means of electromyogram, skin conductance, and heart rate were performed with biofeedback before and after giving the stressor tests’ protocol. Statistical analysis using independent t-test was then performed.

Results
The baseline comparative measurement using biofeedback between control and treatment groups revealed nonsignificant between-group differences in electromyogram, skin conductance, and heart rate (p=0.150; p= 0.389; and p=0.985 respectively). After applying the stress protocol followed by the intervention, the independent t-test revealed significant between-group differences in electromyogram and skin conductance (p= 0.042 and p=0.030), but not in heart rate (p=0.741).

Conclusions
Our study demonstrated that Quran recitation has a significant effect in relieving stress levels assessed using biofeedback parameters (electromyogram and skin conductance) among healthy adults.

Self-esteem as a risk factor of anxiety in senior high school students

Yoga Rizky Pratama — 2024-04-24

Background
Adolescence is a dynamic period of significant physical, emotional, and cognitive development, where individuals shape their identities and influence their mental health. Being vulnerable to various risk factors, including anxiety, adolescents often face mental disorders that can affect their overall well-being. With anxiety being a major concern in the global context as well as in Indonesia, this study aimed to determine self-esteem as a risk factor of developing anxiety among senior high school students.

Methods
A cross-sectional study was conducted involving 162 senior high school students, using proportionate stratified cluster simple random sampling. Data were collected through the Rosenberg Self Esteem Scale and the Hamilton Anxiety Rating Scale questionnaires to measure self-esteem and anxiety levels, respectively. The full score for self-esteem was 10–40 points. The higher the score, the greater the self-esteem. Data was analyzed using multiple logistic regression.

Results
The research findings indicate that adolescents experiencing anxiety amount to 51.9% and most of them indicated high self-esteem (61.1%). Multiple logistic regression test showed that low self-esteem (OR=2.21; 95% CI: 1.15-4.24) was the most influential risk factor of anxiety. However, there were no significant associations between anxiety and demographic factors such as gender, grade level, major of study, and parental income.

Conclusion
Most senior high school students experience anxiety, and lower self-esteem was the most influential risk factor of anxiety. The findings highlight the need for targeted interventions to boost self-esteem as a preventive measure against anxiety among senior high school students.