Enhancing vitamin D levels in care homes: the role of healthy building design in preventing respiratory infections.

The recent article by Willcox et al. in the Journal of Public Health highlights the effectiveness of antiviral prophylaxis and high-dose vitamin D supplementation in reducing acute respiratory infections (ARIs) in care homes. This correspondence extends the discussion by emphasizing the critical role of healthy building design in enhancing vitamin D levels, which is vital for immune function and ARI prevention. Many care home residents suffer from vitamin D deficiency due to limited sunlight exposure. Incorporating architectural elements such as large windows, skylights, and outdoor spaces can significantly increase natural light exposure, thereby boosting vitamin D levels and potentially reducing ARI susceptibility. Despite the benefits of supplementation, addressing environmental factors through healthy building design offers a sustainable, long-term strategy that aligns with public health goals of preventive care and environmental sustainability. Prioritizing such design principles in care home planning and renovation can enhance residents' health and resilience against infections like influenza and COVID-19.

Role of CD44 and CD24 Expression on 2-years Disease Free Survival in Patients with Advanced Epithelial Ovarian Carcinoma.

OBJECTIVE: Ovarian cancer is one of the most common cancers with a high mortality rate worldwide. Despite optimal surgical therapy and chemotherapy, recurrence is still common. Cancer stem cells expressing CD44 and CD24 are thought to be contributing factors in recurrence. METHODS: A cohort retrospective study with survival analysis was carried out on advanced ovarian cancer patients who underwent optimal debulking surgery followed by 6 cycles of chemotherapy at Cipto Mangunkusumo General Hospital and Fatmawati General Hospital from January 2019 to March 2023. Immunohistochemical examination was performed on tumor tissue with CD44 and CD24 expression were assessed using the H-Score method then determined the cut off-point expression level using the ROC curve. Furthermore, the relationship between these expression levels with the disease-free survival was assessed using the survival curve. RESULTS: There were 48 subjects who were included in the study. There were high expression levels of CD44 in 47.9% and CD24 in 50% of cases. High CD44 expression had mean and median survival of 13.2 ± 1.8 and 11 months (HR 5.05, 95% CI 1.84- 13.85). High CD24 expression had mean and median survival of 13.5 ± 2.4 and 7 months (HR 7.73, 95% CI 2.58 - 23.15). The combination of the two high expressions had mean and median survival of 10.44 ± 1.88 and 7 months. CONCLUSION: High expression of CD44 and CD24 will shorten the disease-free survival of patients with advanced ovarian cancer.

Is there any difference in insulin resistance status between cases of benign and malignant ovarian neoplasms? A study on surrogate markers of insulin resistance in Indonesian non-diabetic women.

The association between insulin resistance (IR) and ovarian neoplasm is little known. The present study attempted to investigate the difference in clinicopathological characteristics, metabolic parameters, and IR prevalence between benign and malignant ovarian neoplasms. The cross-sectional study involved 52 non-diabetic women with benign (n=27) and malignant (n=25) diagnoses in a tertiary hospital in Indonesia. Fasting insulin level (FIL), homeostatic model assessment of IR and ß-cell dysfunction (HOMA-IR and HOMA-ß), fasting IR index (FIRI), and quantitative insulin sensitivity check index (QUICKI) were used as surrogate markers to evaluate IR. Parametric and nonparametric statistical tests were employed to analyze the different parameters between the two groups. Pearson or Spearman's rank test assessed the correlation between markers and clinical variables. Results revealed that patients with benign neoplasms were younger than those with malignant neoplasms (38.63 vs. 47.40 years; P=0.003) and had a higher median body mass index (BMI) than their counterparts (22.98 vs. 18.61 kg/m2; P=0.014). Different characteristics between benign and malignant neoplasm cases were found in menopausal status, ovary side affected, systolic blood pressure, and BMI classes. Endometrial cysts and mucinous carcinoma were the most often diagnosed benign and malignant neoplasms. Malignant neoplasms had a lower median HOMA-ß score than benign neoplasms (49.33 vs. 75.79; P=0.011), indicating more severe ß-cell dysfunction. No significant difference was observed in the prevalence of IR between benign and malignant ovarian neoplasms for the following values of each marker: FIL (25.9% vs. 12.0%), HOMA-IR (37.0% vs. 28.0%), FIRI (51.9% vs. 48.0%) and QUICKI (81.5% vs. 92.0%). The indicators of FIL, HOMA-IR, HOMA-ß, FIRI, and QUICKI correlated with each other and confirmed the reliability of these surrogate markers for measuring IR status in ovarian neoplasms. In brief, benign ovarian neoplasms tended to have more IR when compared with malignant ovarian neoplasms. However, this difference was not statistically significant.

Possible different genotypes for human papillomavirus vaccination in lower middle-income countries towards cervical cancer elimination in 2030: a cross-sectional study.

Purpose: Human papillomavirus (HPV) genotype and age distribution of HPV infection were crucial for the national vaccination and screening program planning. However, there was a limited study providing these data in the normal cervix population. This study aimed to explore the HPV genotypes profile of women with clinically normal cervix based on Visual Inspection of Acetic Acid (VIA) test. Materials and Methods: A 7-year cross-sectional study was conducted from 2012 to 2018 in private and public health care centers in Jakarta. Subjects were recruited consecutively. Data were collected by anamnesis, VIA, and HPV DNA test using the polymerase chain reaction (PCR; SPF10-DEIA-LiPA25) method. HPV genotyping procedures include DNA extraction, PCR (SPF10-DEIA-LiPA25) using the HPV XpressMatrix kit (PT KalGen DNA, East Jakarta, Indonesia), and hybridization. The IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) were used to analyze the data. Results: A total of 1,397 subjects were collected. Positive HPV-DNA tests were found in 52 subjects (3.7%); 67% were single and 33% were multiple HPV infections. HPV 52 was the most frequently detected HPV genotype, followed by HPV 39, 16, 18 74, 44, 31, 54, and 66, respectively. The highest HPV infections in this population were in the 31-40 and 41-50 years old group. Conclusion: This study suggested beneficial screening for women aged 31-50 years old. Instead of "original" nonavalent (HPV 16, 18, 6, 11, 31, 33, 45, 52, 58), the different "nonavalent" formula for HPV vaccines protecting against HPV 16, 18, 6, 11, 31, 39, 44, 52, 74 might be useful for Indonesian population. However, further multicenter studies with a huge sample size are still needed.

Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue.

Background: Early detection and treatment of cervical intraepithelial neoplasia (CIN) through a "see and treat" approach is a pillar of cervical cancer prevention programs in developing countries such as Indonesia. One of the major challenges faced is the limited N2O or CO2 gas supply for cryotherapy. Thus, an alternative therapeutic method such as trichloroacetic acid (TCA) topical application is needed as an alternative solution. The effectiveness of this therapy will depend on its destructive effect on eliminating the whole lesion in CIN. Objective: To estimate the extent of damage in the normal cervical tissue after a single topical application of 85% TCA solution. Design and Methods: This research was an intervention study carried out by applying ±5 ml of 85% TCA solution into the cervix of 40 patients scheduled for total hysterectomy for indications other than cervical pathology 24 h before surgery. The extent of tissue destruction was determined microscopically using histopathological specimens. The study protocol is registered at www.clinicaltrial.gov (ID NCT04911075). Results: In the final analysis, 39 subjects were included. The necrotic area was detected at the superficial layer, accompanied by the full epithelial erosion thickness. In addition, there were also fibrotic areas resembling burned tissue in the stroma. The mean depth of destruction was 1.16 ± 0.01 mm in the anterior lip and 1.01 ± 0.06 mm in the posterior lip. There was no significant depth difference between the anterior and posterior lips (p ≥0.05). Moreover, the 85% TCA topical application was tolerable, as represented by the fact that the vast majority (82.1%) of participants experienced pain with a visual analog scale score of <4. Conclusion: Single dose of TCA 85% in topical solution was able to destroy the normal cervical tissue with a deeper mean depth than the mean depth of CIN III in squamous epithelium.

Ultrasound Features and Diagnostic Workup of Uterine Leiomyosarcomas.

Uterine leiomyosarcoma is a rare malignancy and is difficult to diagnose preoperatively. In this case series, we retrospectively reassessed ultrasound findings of 18 leiomyosarcoma cases and proposed the diagnostic workup. We are select seven ultrasound features and found irregular tumor border in 100%, loss of normal myometrium >25% in 61.11% (12 cases), loss of typical benign leiomyoma feature >50% in 77.78%, necrosis in 85.7% (16 cases), and cystic degeneration in 83.3% (15 cases). Circumferential vascularity was absent or minimal in 66.7% of cases, whereas intralesional vascularity with minimal or moderate intralesional vascularity was seen in 12 (66.7%) cases. Diagnosis of suspected uterine leiomyosarcoma requires five out of these seven features present, four gray-scale and one color Doppler ultrasound.

Spatial analysis of COVID-19 outbreak to assess the effectiveness of social restriction policy in dealing with the pandemic in Jakarta.

Coronavirus disease 2019 (COVID-19) has been spread globally and brought health and socioeconomic issues. Jakarta tried to accommodate health and economic interests through the Large-Scale Social Restriction (LSSR) policy that should be assessed. This study aims to (1) visualize the spatial patterns of confirmed Covid-19 cases and the locations of potential risk of transmission, and (2) determine the spatial processes underlying the spatial patterns of Covid-19 cases. The emerging hot spot analysis and space-time scan statistic were employed to analyze the dynamic of infected cases and transmission risk. A Geographical Weighted Regression (GWR) model was developed to define factors that influence the spatial transmission. The result shows that spatial transmission keeps continuing, despite a decline in the aggregate pandemic curve during LSSR implementation. This was likely affected by settlements types and population density distribution, and transportation networks. Spatial analysis supports the aggregate pandemic curve to increase the pandemic surveillance effectiveness.

Peritoneal tuberculosis mimicking advanced ovarian cancer case report: Laparoscopy as diagnostic modality.

INTRODUCTION AND IMPORTANCE: Peritoneal Tuberculosis is one of extrapulmonary tuberculosis that occurs in 1-2% of patients, its incidence is higher in developing countries. It is very difficult to diagnosed and can mimic advanced ovarian cases. Making an accurate diagnosis is vital, laparoscopy is a great modality for this purpose. CASE PRESENTATION: A 36 years-old woman got referred with abdominal distention and weight loss from an internist and digestive surgeon. The abdominal computed tomography said thickening of the stomach wall with ascites. Ultrasound concluded the uterus, ovary, and endometrium within normal. The CA 125 levels elevated to 1200 U/mL and the complete blood count was normal. We were making diagnosis of peritoneal tuberculosis, peritoneal carcinomatosis, and advanced ovarian cancer. We did the diagnostic laparoscopic and taking a biopsy sample, ascites with peritoneal carcinomatosis and omental cake were found, the peritoneal cavity was covered by miliary nodules. Histopathology results concluded peritoneal tuberculosis without malignancy signs. The patient was treated with tuberculosis drugs. The follow-up evaluations show significant clinical improvement. CLINICAL DISCUSSION: When facing patients with massive ascites and elevated CA 125 without any ovary enlargement, a gynecologist should think that it may be a peritoneal TB case with peritoneal carcinomatosis and advance ovarian cancer possibility as differential diagnosis especially in developing countries. An exact diagnosis can be made using laparoscopy and histopathology examination. CONCLUSION: Laparoscopy is the best modality to differentiate between peritoneal tuberculosis, peritoneal carcinomatosis, and advance ovarian cancer. The benefits are direct visualization and could take a biopsy for histology examination.

Skin metastases originated from cervical cancer: A rare case report.

INTRODUCTION: Metastases in cervical cancer could be spread through direct local invasion, lymphatic dissemination, or hematogenous dissemination. The most common sites of distant metastases are lungs, bone, and liver. Skin metastases from cervical cancer are categorized as a rare occurrence of metastases. This rarity of the cases has led us to report it. CASE DESCRIPTION: A 66-year-old multiparous woman diagnosed with stage IIA cervical cancer seven years ago, then she came into our outpatient clinic complained about a brownish white color mass on the left side of the neck that keeps getting bigger over time came from a skin lesion. The lesion was first treated with topical steroid but there was no improvement. Biopsy was done and the result showed a carcinoma metastasis that led to adenosquamous carcinoma or cervical adenocarcinoma. The patient went through chemoradiation with biosensitizer paclitaxel 120 mg/m2 for six cycles, which began in August 2019 until October 2019. The treatment progress showed a promising result. We observed the patient during treatment until two months after finishing the treatment. At the last visit, the patient came to our outpatient clinic, the mass size decreased significantly, and the skin showed an excellent regeneration sign. CONCLUSION: The physicians should always consider the patient's history and pay more attention to skin lesions in patients with a history of cervical cancer. The physicians should also perform a thorough physical examination and biopsy to confirm the diagnosis.

Assistive technology for ultrasound-guided central venous catheter placement.

This study evaluated the existing technology used to improve the safety and ease of ultrasound-guided central venous catheterization. Electronic database searches were conducted in Scopus, IEEE, Google Patents, and relevant conference databases (SPIE, MICCAI, and IEEE conferences) for related articles on assistive technology for ultrasound-guided central venous catheterization. A total of 89 articles were examined and pointed to several fields that are currently the focus of improvements to ultrasound-guided procedures. These include improving needle visualization, needle guides and localization technology, image processing algorithms to enhance and segment important features within the ultrasound image, robotic assistance using probe-mounted manipulators, and improving procedure ergonomics through in situ projections of important information. Probe-mounted robotic manipulators provide a promising avenue for assistive technology developed for freehand ultrasound-guided percutaneous procedures. However, there is currently a lack of clinical trials to validate the effectiveness of these devices.

Automatic identification of blood vessel cross-section for central venous catheter placement using a cascading classifier.

This paper presents a system that is able to automatically identify, segment, and track the cross-section of the internal jugular vein (IJV) and the common carotid artery (CCA) in an ultrasound image feed during a central venous catheter (CVC) placement procedure. The goal is to provide assistance to the practitioner in order to decrease the probability of complications stemming from inadvertent punctures of the CCA during the procedure. In the system, a modified Star algorithm is implemented to segment and track the blood vessel throughout an ultrasound video feed. A novel algorithm based on a cascading classifier is used to identify the location of the IJV and the CCA for two main tasks: (1) selecting the initial seed point at the start of tracking and (2) validating the segmentation results at each subsequent frame. The classifier uses shape features (vessel area, ellipse fitting error, vessel depth, vessel eccentricity) and pixel-based features (pixel intensity and the histogram of oriented gradients descriptor) to differentiate between vessel and non-vessel structures and also differentiate between the IJV and the CCA. Evaluated on a database of 800 ultrasound images containing the cross-section of both vessels, the cascading classifier was able to identify the IJV and the CCA in 92.25% and 85.13% of the images respectively without any initialization from the user at a maximum processing rate of 40.65 frames per second. This allows identification to be conducted in real-time with existing ultrasound machines.

Microdispensing system via the contacting method.

This paper presents the development of a microdispensing system based on a contacting method, with an aim to lowering production and maintenance cost. The liquid, to be dispensed, is brought into contact with the work piece, thus dispensing a droplet by making use of the adhesion force between the liquid and the work piece. A piezoelectric actuator is employed as the drive for the system to achieve high precision. The control of the system is accomplished with a PID controller; controlling the dispensing process and trajectory tracking.