ROLE AND USEFULNESS OF BIOCHEMICAL MARKERS IN COVID-19 CASES: A SYSTEMATIC REVIEWS

Background: Coronavirus disease 2019 (COVID-19) is a highly contagious viral illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It has a catastrophic effect on the world resulting in more than 25 million deaths worldwide. In India on 30th January 2020 rst positive case in a student from Kerala of the SARS-CoV-2 infection. The SARS-CoV-2 can cause serious clinical complications, especially in elderly patients and in those with co-morbidities, especially diabetes obesity; cancer and digestive, endocrine, nervous and respiratory systems pathologies. The elevated biomarkers level was noticed in severe COVID 19 cases compared to non-covid 19 patients, revealing that D-dimer, CRP, ferritin, LDH, are signicantly correlated to COVID-19 severity. This review study aims to identify the most effective biomarker among C- reactive protein, IF6, D-dimer and ferritin to predict disease severity. This review intends to outline the biochemical laboratory tests that are useful in disease monitoring and assessment of severity in conrmed cases of COVID-19.

Is mental stress a risk factor of acute coronary syndrome? – A case–control study

Background: The burden of the cardiovascular disease is on rise throughout the world. Especially in India due to changing food habits, life style changes such as lack of physical activity, sedentary life style, and mental stress all add to the increase in the risk factors for acute coronary syndrome (ACS). Cardiovascular disease has become the leading cause of death. Our country, India has got highest number of deaths due to coronary artery disease in the world. Hence, the health burden is high in India with regard to coronary artery disease. Aims and Objectives: This study aimed to find out is mental stress a risk factor for ACS. Materials and Methods: This is a case–control study. Mental stress was assessed using perceived stress scale by Sheldon Cohen. Sample size of the study was 160 which include 80 cases and 80 controls. Results: Among cases, 73.8% had high stress and among controls, 35% had high stress. Odds ratio for high stress obtained in this study is 5.22 with 95% CI (2.65–10.27). Persons with high stress have 5.22 times more risk of developing ACS than the persons without high stress. Conclusion: In this study, it is proved that persons with high mental stress are a risk factor for ACS (as the persons with high mental stress have 5.5 times more risk of developing ACS). Hence, it is mandatory to focus on stress reduction measures to bring down the occurrence of ACS.

Efficacy comparison between rigid and foldable anterior iris-fixated phakic intraocular lens implantation for treating high myopia in Asian eyes / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare refractive and safety outcome of Artisan and Artiflex phakic intraocular lens(PIOL)for the correction of high myopia in Asian population.METHODS:Historical cohort study. A total of 81 high myopic eyes that underwent PIOL implantation from 2016 to 2020 at Yap Eye Hospital in Yogyakarta, Indonesia were reviewed. The patients were divided into two groups based on PIOL implanted, with 43 eyes using Artisan PIOL in Artisan group and 38 eyes using Artiflex PIOL in Artiflex group. Visual acuity, corneal biomicroscopy parameters, and intraocular pressure(IOP)were respectively recorded prior to the implantation and at 1d, 1 and 3mo after surgery. In addition, anterior chamber depth was documented before PIOL implantation.RESULTS:Mean follow-up period were 9.64±6.93mo and 8.96±4.28mo in Artisan an Artiflex group, respectively(P=0.736). The efficacy index was 1.03±0.47 in Artisan group, and 1.02±0.17 in the Artiflex group(P=0.119).The safety index was 1.10±0.45 and 1.05±0.21 in Artisan and Artiflex group, respectively(P<0.001). The mean spherical equivalent(SE)in Artisan group was -0.64±0.996D, and it was -0.22±0.58D in Artiflex group(P=0.076). In both groups, there was a significant loss of endothelial cell density(ECD)postoperatively compare to baseline(P<0.05), and the cumulative ECD loss was 7.44% and 5.79% in the Artisan and Artiflex groups, respectively(P=0.418).CONCLUSION:Artisan and Artiflex are comparable in terms of refractive outcome to correct high myopia in Asian eyes. Artisan had a slightly better safety index compare to Artiflex. However, the efficacy index and cumulative ECD loss was similar in both the Artisan and Artiflex groups.

Torsión uterina causada por miomatosis: reporte de un caso / Uterine torsion caused by myomatosis: A case report

Resumen ANTECEDENTES: La torsión uterina es una rotación del útero sobre su eje mayor de más de 45°; por lo general sucede en torno del istmo uterino. Los leiomiomas son el factor predisponente más frecuente en úteros no grávidos. OBJETIVO: Reportar el caso de una paciente con torsión uterina cervical y miomatosis de grandes elementos. CASO CLÍNICO: Paciente de 42 años, nuligesta, con antecedente de miomatosis uterina de grandes elementos de 27 x 27 cm. Los síntomas se iniciaron con síndrome doloroso abdominal intenso, tipo cólico, localizado en el hipogastrio y la fosa iliaca. En la exploración física el abdomen se percibió doloroso a la palpación superficial y profunda, con una tumoración cercana a la cicatriz umbilical (25 cm), móvil y dolorosa. En la laparotomía exploradora se encontró líquido peritoneal hemorrágico y se observó una torsión uterina (una vuelta) cerca del cuello del útero, además de un mioma subseroso en la cara posterior, de 27 x 27 cm. El útero, los anexos y las salpinges se advirtieron con datos francos de daño vascular, con áreas de isquemia. Por lo anterior se decidieron la histerectomía total abdominal y la salpingooforectomia bilateral. El informe histopatológico reportó: útero con cambio isquémico extenso panmural, sin evidencia de neoplasia maligna. CONCLUSIONES: El dolor abdominal es el síntoma más común de la torsión uterina que puede variar de leve a agudo. El diagnóstico preoperatorio rápido y preciso de torsión uterina es decisivo y se justifica la intervención quirúrgica de urgencia.

Abstract BACKGROUND: Uterine torsion is a rare entity that is defined as a rotation of the uterus on its major axis of more than 45°, generally occurring at the level of the uterine isthmus. Leiomyomas are the most frequent predisposing factor in non-gravid uterus. OBJECTIVE: Report of a case of a gynecological patient with uterine torsion at the cervical level in a uterus with uterine myomatosis of large elements. CLINICAL CASE: A 42-year-old patient, nulliparous, with a history of uterine myomatosis with large elements of 27 x 27 cm. The symptoms began with intense abdominal pain syndrome, colic type, located in the hypogastrium and the iliac fossa. On physical examination, the abdomen was perceived as painful on superficial and deep palpation, with a mobile and painful tumor close to the umbilical scar (25 cm). In the exploratory laparotomy, hemorrhagic peritoneal fluid was found and a uterine torsion (one turn) was observed near the cervix, as well as a subserous myoma on the posterior face, measuring 27 x 27 cm. The uterus, the annexes and the salpinges were noted with frank data of vascular damage, with areas of ischemia. Therefore, total abdominal hysterectomy and bilateral salpingo-oophorectomy were decided. The histopathological report reported: uterus with extensive panmural ischemic change, without evidence of malignancy. CONCLUSIONS: In uterine torsion, abdominal pain is the most common symptom and can range from mild to severe abdominal symptoms. Therefore, a prompt and accurate preoperative diagnosis of uterine torsion is crucial and urgent surgical intervention is warranted.

Superior vena cava syndrome management in limited source setting: a casereport

Superior vena cava syndrome (SVCS) is syndrome caused by mass compression, tumor invasion, and/or thrombosis of SVC. In the past, SVCS was mostly linked to infection. Nowadays, SVCS is mostly linked to malignant tumor and medical procedures. Most common malignant cause of SVCS is non small cell lung cancer.A 69-year-old man was presented with breathing difficulty. Symptom began 4 months before admission, with worsening of symptom since 2 weeks before admission. Symptom improved with sitting position, and worsened with supine position. Patient had been sleeping with 2 pillows. Patient had productive cough and hoarseness. Swelling of face and neck were present. Collateral vein distention was visible in the area of head, neck, and chest. Physical examination of lung revealed decreased vesicular breath sound at right side. Non pitting edemawas found at both sides of upper extremity.SVCS in this case can be categorized into grade 2, chronic SVCS case. CT showed center right lung mass, although malignant cells were not obtained from pleural puncture and CT guided needle biopsy. Staging of mass was T4N3M1a. Mass finding at the center of right lung is in accordance with the previous findings that SVCS generally arise from lung (not mediastinum), and that right sided masses are generally more likely to cause SVCS. Management in this case was done by giving corticosteroid and diuretic. Surgery, radiotherapy, and immunotherapy were not done since malignancy diagnosis hadn抰 been able to be concluded.

Refractory hypokalemia: a case report

Hypokalemia is a common electrolyte disturbance in hospitalized patients, which prompts appropriate identification of hypokalemia symptoms and signs. As many as 20% of hospitalized patients are found to have hypokalemia. Many hypokalemia patients could also have systemic disease.A 55-year-old woman was presented with weakness, nausea, and vomiting for 2 days before admission. Vomit consisted of water; there was no bloodin the vomit. Defecation was normal; consistency and odor of feces were normal. Patient had diabetes and was already on insulin regiment. Insulin was discontinued during hospitalization since blood sugar was close to lower limit. Electrocardiography (ECG)was within normal limit.Symptoms and signs of hypokalemia may not be readily apparent, as seen in this case. Treatment of hypokalemia should intend not to only replenish potassium, but also to identify underlying cause. Causes include gastrointestinal losses, intracellular shift, renal potassium losses, and inadequate intake.

Women’s Empowerment Facilitates Complete Immunization in Indonesian Children: A Cross-sectional Study / 예방의학회지

Objectives@#The primary objective of this study was to examine the effect of women’s empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association. @*Methods@#We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12-23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women’s empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women’s empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group. @*Results@#The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women’s empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles. @*Conclusions@#To our knowledge, this study is the first to explore women’s empowerment as a determinant of child immunization in Indonesia. The results indicate that women’s empowerment must be considered in Indonesia’s child immunization program. Women’s empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women’s empowerment on health outcomes.

The antioxidant activity of lemongrass leaves extract against fibroblasts oxidative stress / Atividade antioxidante do extrato das folhas de capim-limão contra o estresse oxidativo em fibroblastos

Objective : The purpose of this research is to assess the antioxidant activity of lemongrass leaves extract in terms of lowering ROS generation and its effect on the viability and proliferation of fibroblasts under oxidative stress. Material and Methods: The antioxidant activity was measured using the DPPH method and the ROS assay was carried out by fluorescent H2DCFDA staining. Viability and proliferation assays were performed using the Cell Counting Kit-8 (CCK-8) and was read at 450 nm using microplate reader. The groups were divided into 8, namely fibroblasts without treatment (comparison group), fibroblast induced by H2O2 (negative control), fibroblast with H2O2 then treated with ascorbic acid (positive control), and fibroblast with H2O2 then treated with lemongrass leaves extract at various concentrations (10, 20, 30, 40, and 50 ppm). Results: The results showed that the antioxidant activity of lemongrass leaves extract had an IC value of 64.17 ppm. ROS production were reduced by the LgLE of all concentrations if compared with negative control (p=0.819). LgLE can maintained the fibroblast viability with 10 ppm of LgLE was the most optimum concentration (p<0.05). LgLE can induced the proliferation of fibroblast, with the most effective was at 24 h of observation (p<0.05). Conclusion: Lemongrass leaves extract has a strong antioxidant activity that can reduce oxidative stress and increase the viability and proliferation of fibroblasts with the optimum concentration is at 10 ppm. (AU)

Objetivo: O intuito deste estudo foi determinar a ação antioxidante do extrato das folhas de capim-limão no que se refere a diminuição da produção de espécies reativas do oxigênio (EROS) e o seu efeito na viabilidade e proliferação de fibroblastos submetidos à estresse oxidativo. Material e Métodos: A atividade antioxidante foi medida utilizando o método de DPPH e o ensaio de EROS foi realizado pela coloração fluorescente de H2DCFDA. Os ensaios de proliferação e viabilidade foram realizados utilizando-se o kit de contagem de células CCK-8 em microplacas de leitura à 450nm. Os grupos foram divididos em 8: Fibroblastos sem tratamento (grupo controle), Fibroblastos tratados com H2O2 (controle negativo), Fibroblastos tratados com H2O2 e extrato da folha de capim-limão em concentrações variadas (10, 20, 30, 40 e 50 ppm). Resultados: Os resultados mostraram que a atividade antioxidante do extrato de capim-limão teve uma IC50 (com o numeroal subscrito) com valor de 64.17ppm. A produção de ROS foi reduzida pelo tratamento com o extrato em todas as concentrações testadas quando comparado ao grupo controle negativo (p=0.819). O extrato manteve a viabilidade dos fibroblastos, sendo 10ppm a concentração menos tóxica (p<0.05). LgLE pôde induzir a proliferação de fibroblastos, sendo que a melhor eficiencia foi após 24h de observação (p<0.05). Conclusão: O extrato das folhas de capim-limão apresentam forte atividade antioxidante reduzindo o estresse oxidativo e aumentando a viabilidade e proliferação de fibroblastos, sendo a concentração ótima de 10ppm. (AU)

Protective Effect of Quercetin Administration in Bacterialinduced Periodontitis on Rats

@#Introduction: Quercetin is a flavonoid found in a variety of plants, including guava, apples, onions, and tea. It’s been used as an anti-oxidant and anti-inflammatory substance for a long time. This study aims to investigate the effect of quercetin on periodontitis caused by Porphyromonas gingivalis-adhered ligatures. Methods: Eighteen male adult Sprague Dawley rats were divided into 3 groups, namely the control group (C, n=6) and the other two groups that received quercetin at 45mg/kg/day as a preventive (Qp, n=6) and a curative treatment (Qc, n=6), respectively. Under general anaesthesia, periodontitis was induced by placing a 3/0 non-resorbable sterile silk thread around the mandibular incisor teeth of eighteen male adult Sprague Dawley rats. The ligature placement caused severe irritation in the periodontal tissue. The animals were euthanized after 14 days of post-induction treatment, and samples of the mandibular portion were kept in formalin and prepared for histological processing to determine the grade of inflammation (GI). The periodontal pocket depth (PPD) was measured using the Michigan-O probe with Williams marks at the mesial and lingual sites of the rat’s incisors tooth to determine the clinical parameter. Results: Qp showed the best improvement, in both parameters, clinically (PPD score, p=0,0018 at the lingual site, and p=0,0264 at the mesial site) and histologically (GI, p=0,0002). Significant differences were found in preventing clinical attachment-loss statistically (p<0,05) on Qp, better than the Qc at an equal dose (p<0,05). Conclusion: This finding suggests that quercetin administered as a preventive measure (Qp) may promote the healing process of gingiva in periodontitis conditions better than the control group and curative group (Qc).

Molecular detection of bat coronaviruses in three bat species in Indonesia

Bats are an important reservoir of several zoonotic diseases. However, the circulation of bat coronaviruses (BatCoV) in live animal markets in Indonesia has not been reported. Genetic characterization of BatCoV was performed by sequencing partial RdRp genes. Real-time polymerase chain reaction based on nucleocapsid protein (N) gene and Enzyme-linked immunosorbent assay against the N protein were conducted to detect the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA and antibody, respectively. We identified the presence of BatCoV on Cynopterus brachyotis, Macroglossus minimus, and Rousettus amplexicaudatus. The results showed that the BatCoV included in this study are from an unclassified coronavirus group. Notably, SARS-CoV-2 viral RNA and antibodies were not detected in the sampled bats.

Pigmented Villonodular Synovitis (PVNS) of the Knee mimicking Septic Arthritis in a Paediatric Patient: A Case Report

@#Pigmented villonodular synovitis (PVNS) is a benign but rare proliferative disorder of the synovium. It commonly occurs in the adult population and usually presents as a monoarticular disease. There are two types of PVNS, namely the localised and diffused type. The disease is often misdiagnosed due to its rarity especially in paediatric patients. Knee involvement in PVNS is the commonest form in children although other joints such as hip, foot, ankle, hip, sacroiliac joint and concurrent multiple joint involvements have also been reported. PVNS in paediatric patients is often misdiagnosed as septic arthritis, juvenile rheumatoid arthritis and bone sarcoma, and the diagnosis is usually often made late due to its vague presentation. The majority of PVNS cases are managed by surgery either via open or arthroscopic synovectomy except in a few paediatric patients as described in the literature. This case report of PVNS is of a knee in 11- year-old boy who was initially treated as septic arthritis. The synovium appearance mimicked the features of PVNS during a knee arthrotomy washout, and histopathological examination confirmed the diagnosis. The knee symptoms had significantly improved without additional surgery, and good functional knee motion was achieved, with no sign of recurrence, after two years of follow-up.

Comparison of Transforming Growth Factor 1 (TGF-β 1) Expression in Various Lysate Platelet-Rich Fibrin (L-PRF) Concentrations on Human Dental Pulp Stem Cell Differentiation

ABSTRACT Objective: To compare Transforming growth factor-β1 (TGF-β1) expression in various L-PRF concentrations on the hDPSC differentiation process. Material and Methods: hDPSC cell cultures were subjected to serum starvation by reducing FBS levels in the hDPSC culture media. Lysate PRF was obtained from the PRF gel, which was then incubated at 4°C for 24 h. The supernatant was dried, transferred to a 2-ml Eppendorf tube, and stored at −20°C. The evaluation of TGF-β1 expression in 1%, 5%, 10%, and 25% L-PRF samples and 10% FBS (control) during the process of hDPSC differentiation was quantified using an ELISA reader on day 7. The expression of TGF-β1 was subjected to a one-way ANOVA test, followed by Bonferroni's post hoc test with significant values (p<0.05). Results: Significant differences were noted in TGF-β1 expression between 1%, 5%, 10%, and 25% L-PRF and the control group (10% FBS). The highest TGF-β1 expression occurred with 25% L-PRF (0.645 ± 0.048), followed by 10% L-PRF (0.461 ± 0.035), 10% FBS (0.374 ± 0.013), 5% L-PRF (0.275 ± 0.045), and the lowest expression was with 1% L-PRF (0.160 ± 0.045). Conclusion: The best result of TGF-B1 expression in hDPSC differentiation was in the 25% L-PRF group.

Effectivity of Camellia sinensis Extract with Nano-chitosan to Fibroblast Amounts of Wistar Rats Gingival Wound Healing Process

ABSTRACT@#Green tea (Camellia sinensis) has high level of flavonoids which are proven to have anti-inflammatory activity. Effect of flavonoids can be enhanced by nano-chitosan capsulation as drug carrier. Chitosan is polysaccharide derived from crustacean shells that mostly used as matrix of various drugs and plant extracts. The aim of this study was to determine the effectivity of flavonoids in green tea extract in nanochitosan capsulation towards the number of fibroblasts on proliferative phase of gingival wound healing process. Green tea was extracted, encapsulated with nano-chitosan and then made into gel. Gingiva labial of 24 male white 3-month-old Wistar rats were wounded by punch biopsy (2 mm diameter), then were treated two times a day, and were divided randomly into four groups of topical gel applications: green tea extract gel encapsulated nano-chitosan, green tea extract gel, base gel as negative control, and NSAIDs gel as positive control, starting at 0 day until 7th day. At 5th and 7th day, three rats from each group were decapitated and the mandibular gingiva was taken in order to make histology slides with hematoxylin eosin staining. Under microscope, the number of fibroblasts were examined. The data were analysed using ANOVA test with 95% confidence level. The results showed that the number of fibroblasts on proliferative phase was significantly higher than control negative (p < 0.05) and has no significant differences (p > 0.05) with control positive. In conclusion, topical application of green tea extract gel encapsulated nano-chitosan was effective to accelerate rats gingival wound healing process by increasing the fibroblasts.

Factores pronósticos de mortalidad en pacientes graves con enfermedades neurológicas agudas no traumáticas / Prognostic factors of mortality in seriously ill patients with acute non-traumatic neurological diseases

RESUMEN Fundamento: las enfermedades neurológicas son una de las principales causas de muerte e invalidez en todo el mundo. Objetivo: identificar los factores pronósticos relacionados con la mortalidad por enfermedades neurológicas agudas no traumáticas en pacientes graves. Métodos: se realizó un estudio retrospectivo, transversal, del 1ro de enero al 31 de diciembre 2019. El universo estuvo representado por 130 pacientes y la muestra fue de 114. Se empleó el porcentaje, suma, el chi cuadrado y el Odd Radio para identificar los factores de riesgo, con un IC de 95 %. Resultados: predominó el grupo etario de 50-59 años del sexo masculino con enfermedad cerebrovascular isquémica, aunque el mayor porcentaje de fallecidos fue por enfermedad cerebrovascular hemorrágica. Los pacientes con tratamiento quirúrgico tuvieron relación con la mortalidad, con discreto predominio de la cirugía urgente. Alrededor de la mitad de los pacientes requirieron ventilación mecánica y fue un factor pronóstico de mortalidad. Predominó la desnutrición y la obesidad. Las arritmias cardíacas, necesidad de apoyo de aminas vasoactivas, estadía promedio mayor de 14 días y las complicaciones fueron factores de pronóstico de mortalidad. Igual, el índice leucoglicémico mayor de 0,75 y APACHE II inicial mayor de 15 puntos. Predominó la puntuación Glasgow por encima de ocho puntos. Conclusiones: los factores pronósticos relacionados con la mortalidad por enfermedades neurológicas agudas no traumáticas en pacientes graves fueron la presencia de arritmias cardíacas, necesidad de ventilación mecánica y de apoyo de aminas vasoactivas tratamiento quirúrgico, índice leucoglicémico mayor de 0,75 puntos, puntuación APACHE II inicial mayor de 15 puntos y la presencia de complicaciones.

ABSTRACT Background: neurological diseases are one of the main causes of death and disability worldwide. Objective: to identify prognostic factors related to mortality from acute non-traumatic neurological diseases in seriously ill patients. Methods: a retrospective, cross-sectional study was carried out from January 1st to December 31st, 2019. Universe was constituted of 130 patients and the sample was 114. Percentage, sum, chi-square and Odd Radio were used to identify risk factors, with an IC of 95 %. Results: the age group of 50-59 years prevailed, male with ischemic cerebrovascular disease, although the highest percentage of deaths was due to hemorrhagic cerebrovascular disease. Patients with surgical treatment were related to mortality, with a slight predominance of urgent surgery. About half of the patients required mechanical ventilation and it was a prognostic factor for mortality. Malnutrition and obesity predominated. Cardiac arrhythmias, need for vasoactive amine support, average length of stay greater than 14 days and complications were prognostic factors for mortality. Likewise, the leukoglycemic index greater than 0.75 and the initial APACHE II was greater than 15 points. The Glasgow score was above 8 points. Conclusions: the prognostic factors related to mortality from acute non-traumatic neurological diseases in severe patients were the presence of cardiac arrhythmias, need for mechanical ventilation and support for vasoactive amines, surgical treatment, leukoglycemic index greater than 0.75 points, initial APACHE II score greater than 15 points and the presence of complications.

Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16±8 weeks in both groups. There is no complication such as non-union, avascular necrosis of femoral head and/or broken fibular graft in both the groups occurrences. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost effective and technically less demanding and associated with good outcomes. There is no added advantage of non-vascularized fibular grafting with multiple hip screw fixation in fresh femoral neck fractures in young adults over multiple hip screw fixation alone.

A rare case of unruptured live second trimester ovarian ectopic pregnancy

Ovarian ectopic pregnancy is an extreme rare entity in all the cases of ectopic pregnancies. Before, the end of first trimester, it usually ends with rupture. It is such a unique and rare presentation that only 3% of all ectopic pregnancies are reported due to an ovarian cause. In this case report, authors have presented a patient with ovarian ectopic pregnancy which was found unruptured, live at the second trimester. The patient presented with abdominal pain and after routine check-up and ultrasound abdomen, patient was taken for an emergency explorative laparotomy and the ovarian pregnancy was excised and sent for histopathological examination, the histopathological examination further confirmed the diagnosis of the same. In some researches it has been seen that ovarian pregnancies are rising, considering that, the findings of the report may help frame future diagnostic and treatment guidelines.

Fenugreek (Trigonella foenum-graceum) increases postmenopausal fibroblast-associated COL1A1 and COL3A1 production dominantly through its binding to estrogen receptor beta

In postmenopausal women, oral or topical administration of estradiol increases skin thickness and collagen synthesis,such as collagen type 1 alpha 1 (COL1A1) and collagen type 3 alpha 1 (COL3A1). Due to undesirable side effectsof estradiol, such as risks of breast and endometrium pathology, topical phytoestrogens are alternative treatments foraging-related skin changes. Phytoestrogen is a nonsteroidal substance derived from plants, like fenugreek (Trigonellafoenum-graceum L.), which has an estrogen like composition that appears to mimic estradiol. The mechanism ofaction remains unknown, especially in fibroblast-associated COL1A1 and COL3A1 production. In vitro experimentswere conducted using postmenopausal women's fibroblasts with estrogen receptor (ER) antagonists. Cell isolationused explant and enzymatic techniques with ELISA kit (MyBioSource, California) for COL1A1 and COL3A1. Pairedstudent t-tests compared results between control (no treatment), fenugreek extract 2 µg/ml alone, fenugreek extract 2µg/ml with receptor antagonists for ERα, ERβ, and both receptors. Greater suppresion of COL1A1 and COL3A1 wereshown by both antagonists ERα / ERβ group and antagonist ERβ group compared to antagonist ERα group. Theseresults indicate that the fenugreek increases secretion of COL1A1 and COL3A1 through ERα, ERβ, and is mainlymediated by ERβ in post menopausal women’s fibroblasts.

Depression, Anxiety, and Stress among Students in Newly Established Remote University Campus in Indonesia

@#Introduction: Studies show that many university students experience common mental health problems, such as depression, anxiety, and stress. In severe cases, these problems can cause disability that may hinder youths from achieving their potential academic or career development. This study aims to measure the occurrence and levels of depression, anxiety, and stress and their determinants among undergraduate students of a recently established remote campus in Indonesia. Methods: This cross-sectional study was conducted in Banyuwangi, East Java from September- December 2017. Exactly 229 students were randomly selected using cluster sampling. Mental health status was measured using Depression, Anxiety, and Stress Scale. We used multivariable logistic regression to determine factors related to depression, anxiety, and stress. Results: The prevalence of depression, anxiety, and stress were 25.0%, 51.1%, and 38.9% respectively among these students. Level of education was associated with depression and stress, but not with anxiety. The fifth semester students had significantly greater odds of depression (AOR = 2.27; 95% CI: 1.04-4.93; p value = 0.04) and stress (AOR =2.18; 95% CI: 1.10-4.37; p value = 0.03) compared to the seventh semester students. No variables were significantly associated with the occurrence of anxiety. Conclusion: Fifth semester students had a greater risk for depression, anxiety, and stress compared to students at a higher level of education. The present study highlights the need for policies in new universities to provide a routine psychological support and counseling for students undergoing semesters that place greater mental burden.

Benign neonatal sleep myoclonus in a child

Benign neonatal sleep myoclonus (BNSM), is a disorder generally mistaken for seizures during the newborn period. Benign neonatal sleep myoclonus is featured by myoclonic "lightninglike" jerks of the extremities that exclusively occur during sleep; it is not associated with epilepsy that occur only during sleep and cease abruptly when the child is agitated. This case reported was a 50 days-old baby boy with a history suggestive of abnormal movements for limbs noted over the preceding 7 days. Diagnosis of BNSM in infant based on history taking, clinical manifestation, and with no electroencephalographic changes. BNSM is usually not associated with any other neurologic impairment and spontaneously subsides within the first year of life. Its importance lies in the differential diagnosis with the epileptic, especially myoclonic, seizures of infancy. BNSM can be misinterpreting for neonatal seizures or even neonatal status epilepticus, the recognition of benign sleep myoclonus of infancy is imperative to elude unnecessary diagnostic studies and treatments.