Evidence of Placental Villous Inflammation and Apoptosis in Third-Trimester Symptomatic SARS-CoV-2 Maternal Infection

Purpose@#In view of conflicting reports on the ability of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to infect placental tissue, this study aimed to further evaluate the impact of inflammation and placental damage from symptomatic thirdtrimester maternal COVID-19 infection. @*Materials and Methods@#This case-control study included 32 placenta samples each from symptomatic COVID-19 pregnancy and normal non-COVID-19 pregnancy. The villous placental area’s inflammatory expression [angiotensin converting enzyme-2 (ACE-2), transmembrane protease serine-2 (TMPRSS2), interferon-γ (IFN-γ), interleukin-6 (IL-6), and SARS-CoV-2 spike protein] and apoptotic rate were examined using immunohistochemistry and Terminal deoxynucleotidyl transferase dUTP Nick- End Labeling (TUNEL) assay. Comparison and correlation analysis were used based on COVID-19 infection, placental SARS-CoV-2 spike protein evidence, and maternal severity status. @*Results@#Higher expressions of TMPRSS2, IFN-γ, and trophoblast apoptotic rate were observed in the COVID-19 group (p0.05). Additionally, SARS-CoV-2 spike protein was detected in 8 (25%) placental samples of COVID-19 pregnancy. COVID-19 subgroup analysis revealed increased IFN-γ, trophoblast, and stromal apoptosis (p<0.01). Moreover, the results of the current study revealed no correlation between maternal COVID-19 severity and placental inflammation as well as the apoptotic process. @*Conclusion@#The presence of SARS-CoV-2 spike protein as well as altered inflammatory and apoptotic processes may indicate the presence of placental disturbance in third-trimester maternal COVID-19 infection. The lack of correlation between placental disruption and maternal severity status suggests the need for more research to understand the infection process and any potential long-term impacts on all offsprings born to COVID-19-infected pregnant women.

Non-extraction camouflage treatment of skeletal class III malocclusion

@#Class III malocclusion can be defined as a skeletal facial deformity that is characterized by a forward mandibular position with respect to the cranial base and or the maxilla. We present a case of a 15-year-old man with skeletal Class III malocclusion who was treated with non-extraction orthodontic camouflage treatment using an orthodontic conventional technique. A fixed appliance, straight wire appliance (SWA) technique was used with a non-extraction treatment plan. Treatment was accompanied by intermaxillary Class III elastics. The total duration of active treatment was 23 months. There was a significant improvement in his occlusion, smile esthetics, and soft tissue profile pattern. Orthodontic camouflage can be considered an effective therapy for correcting milder cases of skeletal Class III malocclusion.

Strong Linkage Disequilibrium and Haplotype Association of Neovascular Age-related Macular Degeneration in Indonesian Patients

@#Introduction: The aim of this study was to investigate the linkage disequilibrium (LD) and haplotype of three most associated SNP with nAMD of 80 patients in Indonesia. Methods: All patients underwent standard ophthalmic tests including fundoscopy and optical coherence tomography. Genomic DNA was extracted using commercially available DNA isolation kits. Genotyping of rs11200638, rs1061170 and del443ins54 used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. The acquired genotype data were analyzed using Haploview and R package software. Results: Linkage Disequilibrium analyses showed high LD value in the 10q26 region of 80 patients with AMD and 85 controls. The PCR-RFLP showed TTA was the most frequent haplotype while GTG was the most associated haplotype in the study sample. Conclusion: There was a high LD in the 10q26 region and strong association in GTG haplotype of Indonesian patients with AMD.

Anti-SARS-CoV-2 receptor binding domain antibodies after the second dose of Sinovac and AstraZeneca vaccination

Purpose@#The Sinovac and AstraZeneca vaccines are the primary coronavirus disease 2019 vaccines in Indonesia. Antibody levels in vaccine-injected individuals will decline substantially over time, but data supporting the duration of such responses are limited. Therefore, this study aims to quantitatively evaluate antibody responses resulting from the completion of Sinovac and AstraZeneca administration in Indonesian adults. @*Materials and Methods@#Participants were divided into two groups based on their vaccine type. Both groups were then assessed on the anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor binding domain (anti-SRBD) concentrations. The anti-SRBD level was measured using Elecsys anti-SARS-CoV-2 S assay and analyzed every month until 3 months after the second vaccination. @*Results@#The results presented significant differences (p=0.000) in immunoglobulin G (IgG) titers among the vaccines’ measurement duration, where all samples observed a decrease in IgG titers over time. The mean titer levels of anti-SRBD IgG in the group given Sinovac were high in the first month after vaccination and decreased by 55.7% in 3 months. AstraZeneca showed lesser immune response with a slower decline rate. Adverse effects following immunization (AEFI) showed that systemic reactions are the most reported in both vaccines, with a higher percentage in the second dose of AstraZeneca type vaccines. @*Conclusion@#Sinovac induced more significant titers of anti-SRBD IgG 1 month after the second dose but generated fewer AEFIs. In contrast, AstraZeneca generated more AEFIs, in mild to moderate severity, but provided lower levels of anti-SRBD IgG.

Clinical manifestations and pregnancy outcomes of COVID-19 in indonesian referral hospital in central pandemic area

Objectives@#Data on the clinical manifestations and pregnancy outcomes of pregnant women with COVID-19 are limited, particularly in developing countries. The aim of this study was to analyze the clinical manifestations and pregnancy outcomes in COVID-19 maternal cases in a large referral hospital in Indonesia. @*Methods@#This study used a prospective cohort design and included all pregnant women with suspected COVID-19. Subjects were divided into COVID-19 and non-COVID-19 groups based on the results of real-time polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2. Clinical characteristics, laboratory results, and pregnancy outcomes were compared between the two groups. @*Results@#Of the 141 suspected maternal cases, 62 cases were COVID-19-confirmed (43.9%), while 79 suspected cases were negative (56.1%). The clinical manifestations and laboratory findings between the two groups were not significantly different (P>0.05). However, the maternal mortality directly caused by COVID-19 was significantly higher than that in the non-COVID-19 group (8.3% vs. 1.3%; P=0.044; odd ratio, 6.91; 95% confidence interval, 0.79-60.81). @*Conclusion@#The clinical manifestations and laboratory results of suspected pregnant women with positive and negative RT-PCR COVID-19 results were similar. However, within the Indonesian setting, COVID-19 significantly increases the risk of maternal death through both direct and indirect factors.

Correlation of Plasma Level of Insulin-Like Growth Factor-1 (IGF-1) with Bacterial Index on Leprosy Patients in Bali

Background@#Leprosy is an infection by Mycobacterium leprae, which influenced by cellular immunity. Leprosy tends to occur in low socio-economic and nutrition groups. Researchers try to prove the role of nutrition in the pathogenesis of leprosy. Insulin-like growth factor-1 (IGF-1) as a marker of nutritional status shown to play a role in cellular immunity. @*Objective@#To evaluate the correlation between IGF-1 with bacterial index (BI) on leprosy patients in Bali. @*Methods@#Cross-sectional study in Sanglah Public General Hospital, Denpasar of patients with paucibacillary (PB) and multibacillary (MB) leprosy were assessed for BI using slit-skin smear. All patients were tested for plasma IGF-1 using chemiluminescent immunometric assay Immulite. All data were analyzed using IBM SPSS ver. 24.0. The study has been approved by local Institutional Review Board with ethical clearance number 2017.02.1.0356. @*Results@#Our study involved 44 MB and 2 PB leprosy. The common age group affected was between 31∼40 years old (23.9%), male (60.9%), and normal body mass index (BMI) (65.2%). Mean plasma IGF-1 level in PB leprosy was higher (91.07±0.74 ng/ml) than MB (82.74±6.44 ng/ml). The mean IGF-1 level decreases as BI increases in both groups (CI 95%=81.16∼85.04; p＜ 0.001). Pearson correlation test shows strong negative correlation (Pearson r=−0.976; p＜0.001) with determinant coefficient (R2) showing 95.2% (p＜0.001). @*Conclusion@#In Balinese leprosy patients, severity of disease status measured by BI were found to be strongly correlated with the plasma IGF-1 level which may help preventing transmission in household contacts by improving nutritional status.

Psychopharmacology in myasthenia gravis patients with focus on depression

Myasthenia gravis is an autoimmune disease with a potential to disrupt brain function and cause depression as a result of the disease itself or treatment side effect. Some biological and psychological mechanisms have been proposed for the correlations between myasthenia gravis and depression. Depression might present in patients myasthenia gravis, and it might complicate the course of the disease. Adequate treatment might not only improve the depression but might also impact the myasthenia gravis in general.

Lactobacillus reuteri DSM 17938 Improves Feeding Intolerance in Preterm Infants / 대한소아소화기영양학회지

PURPOSE: Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality. METHODS: This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28–34 weeks and birth weight of 1,000–1,800 g. RESULTS: Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12–0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99–1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36). CONCLUSION: The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.

Unusual presentation of Sheehan's syndrome with severe hyponatremia and recurrent symptomatic hypoglycemia: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;">Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. The onset in most cases is several months or even years after the inciting delivery, so it is often unrecognized and not adequately treated. Because SS often evolves slowly, it is usually diagnosed late. We report a 47-year old woman with loss of consciousness. Fourteen years ago, she had postpartum hemorrhage with subsequent amenorrhea and failure to lactate. Laboratory investigation showed low blood sugar and serum sodium levels, amid normal cortisol and thyroid function tests. Magnetic resonance imaging (MRI) of the pituitary revealed an empty sella consistent with SS. The presentation of hypoglycemia and hyponatremia are less known complications of Sheehan's syndrome with only a few documented in case reports.</p>

Plasma CRH Level Difference Between Wistar Rats Exposed To Acute Stress Due To Predator And To The Psychological Stress Device

Objective: Stress triggers and causes psychiatric disorders. This study compared stress generated by different stressors: a cat as the predator of rats and a Psychological Stress Device (PSD) which was developed and modified by the researchers based on the model by Xu and Rocher. Methods: Twenty-eight Wistar rats were simple randomly divided into one control group and six treatment groups, each consisting of 4 rats. Each treatment group was individually exposed to stressor for 30, 60, and 90 minutes. The first three treatment groups were treated using the PSD while the other three treatment groups were treated exposed to the cat. Plasma CRH level was measured using the ELISA (Cusabio) method. Result: Plasma CRH levels in the rat exposed to stressor using the PSD ranged from 9.89 to 50.22 ng/mL, higher than plasma CRH level in the groups exposed to cat ranged from 0.22 to 23.44 ng/mL with significance level (p0.05). Conclusion: Plasma CRH level of the rats exposed to stressor using the PSD was higher and positively correlate with the length of exposure compared to those exposed to cat.