Finding a Link between Obesity and Senescence: A Systematic Review and Meta-Analysis.

Background: Cell aging is associated with changes in telomeres due to DNA damage arising from chronic inflammation in obese patients. The aim of the systematic review and meta-analysis was to find the relationship between obesity and aging or senescence. Methods: The systematic review was conducted through PRISMA guideline, beginning with literature search within 2012-2022 in several databases (PubMed, EBSCOHost, Science Direct, Scopus, and Cochrane) followed by screening process using predetermined PICO criteria. Original studies on the topic of obesity and senescence (aging), from preclinical studies to clinical research (cohort or cross-sectional studies) that were published within the last ten years. All studies were appraised using SYRCLE risk of bias tool for preclinical studies and Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort studies. The data extraction on the studies' characteristic and outcome on aging or senescence were followed by quantitative analysis using MetaXL process on prevalence ratio and hazard ratio of obesity to comorbidities and mortality. Results: Fifteen studies were enrolled. Obesity and white adipose tissue cause increased levels of pro-inflammatory and pro-senescence cytokine and macrophage whilst the aging process lowers metabolism with increased insulin resistance and linked to increased risk of obesity. Obesity occurs in 22% (95% CI 18%-26%) of elderly population with higher prevalence rate in the women population. Obesity is associated with significant increased risk of multimorbidity by 56% (OR = 1.58 [95% CI 1.48-1.96]). Conclusion: The obesity and aging or senescence has reciprocal relationship between each other.

Anti Inflammatory Action of Allium Sativum Ethanol Extract to Prevent Lung Damage in Smoker Rat Model.

Background: Smoking is the leading cause of death in worldwide and is known as one of the risk factors in the development and pathogenesis of several diseases and most are respiratory and cardiovascular diseases. Secondhand smoke (SHS) exposure is associated with negative health consequences including respiratory tract infection, asthma, and cancer. One of the pathogenesis that has known to cause these diseases is inflammation. Garlic (Allium sativum) is a medicinal herb that contains Allicin and other active constituents that are known to have anti-inflammatory ability by suppressing the expression and production of proinflammatory cytokines that will cause inflammation. Objective: The aim of this study is; to analyze the anti-inflammatory action of Allium sativum ethanol extract to prevent lung damage in the smoker rat model. Methods: This is a case-control study with five groups of rats each group contains of three rats. The five groups were negative control (KN), 10 days (10d) smoker (K1), 20 days (20d) smoker (K2), 20d smoker treated with Allium sativum for 10 days (K3) and 20d smoker treated with Allium sativum for 20 days (K4). After 20 days all animals were sacrificed and histological preparation of lung organs was observed under a microscope with 100 dan 400 times magnification and then captured by photomicrograph for analyzed. Results: There were improvements in lung structure both in group K3 and K4 . there was a decrease of leucocytes and inflammatory cells infiltration that covered almost all alveolar surface to 10-20% surface area and the dilated alveoli decrease from more than 50% to less than 30% area. The bronchus was clean in both two groups compared to the groups that were not treated with Allium sativum. Conclusion: This study shows that Allium sativum ethanol extract has the ability to prevent lung damage in the smoker rat model.

Effect of Garlic Ethanol Extract Administration on Gluthatione Levels to Prevent Oxidative Stress in Smoker Rat Model.

Background: Sickle Garlic (Allium sativum L.) is known as a spice native to western Asia has a strong antioxidant effect and revealed it functions as an antioxidant by increasing ROS-capture activity, cellular antioxidants, SOD, CAT, and GSH levels in cells. Cigarette smoke is very dangerous because it can cause serious illness and death. Cigarette smoke is a major source of exogenous ROS because its particles are high in free radicals. Smoking is also related to a decrease in the body's natural antioxidant levels. Glutathione (GSH) synthesis and expression were found to increase initially and then decrease after being exposed to cigarette smoke. Objective: The aim of this study is; to analyze effect of garlic ethanol extract administration on gluthatione levels to prevent oxidative stress in smoker rat model. Methods: This was a case-control study with a control group design, with 15 healthy rats (Rattus norvegicus, sp.) divided into three groups, KN untreated animals (control), K1 animals exposed to cigarette smoke for 40 days (smoker), and K2 animals exposed to cigarette smoke for 40 days and treated with Allium sativum 0.1 g per day for 40 days (smoker and Allium sativum L.). After 40 days of treatment, all animals, including the control, were sacrificed with 30 mg/IP ketamine injections, and the blood plasma were taken for examination. Results: there were significant difference in glutathione levels between the treatment groups (K2) with the control group (KN) and the smokers group (K1) (p <0.05). Conclusion: garlic ethanol extract administration can increase gluthatione levels and prevent oxidative stress in smoker rat model.

The anti-obesity properties of Anredera cordifolia leaf extract in rats fed a high-fat diet through inhibition of adipogenesis.

Objective: Various disease complications are a risk of overweight or obesity, so losing weight can reduce the risk of diseases caused by obesity. Binahong leaf ethanol extract (Anredera cordifolia) is a weight-loss herbal preparation. Aim: This study aims to analyze whether A. cordifolia extract is effective in losing weight by affecting the mechanism of adipogenesis in an animal obesity model. Materials and Methods: Animals were grouped into six groups as follows: the normal diet (K1), the negative control group (K2), the positive control group with Orlistat at a dose of 20 mg/kg BW (K3), an ethanol extract of A. cordifolia leaves at doses of 50 mg/kg BW (P1), 100 mg/kg BW group (P2), and 150 mg/kg BW (P3). All rats were fed a diet that consisted of high fat for eight weeks, except K1. Afterward, the treatments were given based on group distribution. Then, the rats were treated based on their groups for 4 weeks, and the high-fat diet was still given during the treatment for the control groups (K2). Anthropometric examinations such as body weight, length, and the circumference of the abdomen were measured. Metabolic parameters, including blood glucose, cholesterol levels, triglyceride levels, and abdominal fat weight, were measured using molecular parameters that measured PI3K levels and Extracellular signal-regulated kinase (ERK) in abdominal fat tissue samples using the ELISA method. Results: ERK levels of abdominal fat were lowered in the treatment group using the extract of A. cordifolia (50 mg/kg BW (P1) and 100 mg/kg BW (P2)) compared to the control group that was given a high-fat diet without treatment. The control group, which was fed a high-fat diet without treatment, had an average ERK level of 10.17 ± 2.98 ng/ml, P1 (50 mg/kg BW). Furthermore, when ethanol extracts were used as opposed to the control group, which received a high-fat diet without treatment, there was an increase in phosphoinositide three-kinase (PI3K) levels (K2). The control group received 9.35 ± 2.87 ng/ml, the treatment group received 100 mg/kg BW (P2) 9.48 ± 1.54 ng/ml, and the treatment group received 150 mg/kg BW (P3) 7.87 ± 1.79 ng/ml. The weight of fat in the abdomen differed between the groups that received a high-fat diet without treatment (K2) and those that received a high-fat diet with treatment (P1, P2, P3; p < 0.05). Conclusion: Anredera cordifolia extract possesses anti-obesity activities by decreasing ERK and increasing PI3K levels, as well as reducing abdominal fat weight.

Risk of Cardiovascular Complication Among Type 2 Diabetes Mellitus Patients in Medan, Indonesia. A Cross-sectional Study.

Background: Cardiovascular disease (CVD) is a disease associated with impaired heart and blood vessel function. The occurrence of Diabetes Mellitus (DM) is due to an imbalance in blood glucose that could cause damage to large and small blood vessels and increase platelet aggregation, contributing to atherosclerosis and cardiovascular disease. It could be attributed to high blood pressure, smoking, diabetes, lack of movement, obesity, high cholesterol, unbalanced diet. CVD can be prevented, especially in at-risk groups, with risk assessment utilizing the Framingham Risk Score (FRS). Objective: The study aimed to to analyze the risk of CVD according to the Framingham Risk Score (FRS) in type 2 DM patients in Medan. Methods: The data were collected with the Framingham Risk Score, which consisted of sub-variables of age, total cholesterol, HDL cholesterol, systolic blood pressure (SBM), history of DM, and history of smoking, which were assessed by gender. It was a cross-sectional analytic study with consecutive sampling on 252 respondents, namely DM patients who came for treatment or control to the health centers in Medan and fulfilled the inclusion and exclusion criteria. The data were then analyzed with SPSS. Results: The respondents consisted of 197 women (78.2%) and 55 men (21.8%). The results were predominated with high risk patients (139, 55.2%), followed by those with medium risks (80, 31.7%), and low risks (33, 13.1%). Chi-square test yielded a significant association between each sub-variable of CVD risk factors and the risks based on FRS in type 2 DM patients. Conclusion: Each sub-variable of CVD risk factors and the risks on FRS among type 2 DM patients. In future studies, it is recommended to include that a larger number of samples in the community with a balanced proportion of men and women.

The Assessment Metabolic Markers and Cardio Risk Index Among Controlled and Uncontrolled Type 2 Diabetic Patients in Primary Health Clinics in Medan City, North Sumatera, Indonesia: Cross-sectional Study.

Background: Diabetes mellitus is the most common metabolic disorder affecting people worldwide. Diabetes mellitus has been known to be associated with lipid metabolic disorders and macrovascular and microvascular complications. Objective: This study assesses the correlation between cardio risk index and metabolic markers in type 2 diabetes mellitus patients. Methods: This study was conducted on type 2 diabetes mellitus with the cross-sectional analytic method. The inclusion criteria of the samples were all the patients diagnosed with type 2 diabetes mellitus of both sexes. We recorded Body Mass Index, Blood Pressure, disease duration, and family history. The laboratory parameters, including Fasting Blood Sugar, Hba1c, HDL, LDL, TG, and Cholesterol, were examined by Paramita Laboratory Clinic. The data of the samples were processed using a computer with the SPSS program.. Results: There were significantly different mean of age, abdominal circumference, FBG, Hba1c, cardio risk index, and HDL controlled and uncontrolled type 2 diabetes groups, but the mean cholesterol and LDL levels were not different in the two groups.At uncontrolled type 2 diabetic we found that there was a significant correlation between the cardio risk index with Cholesterol (r= 0.3 p=0,004), triglycerides (r=0.5 p=0,001), and negative correlation cardio risk index with HDL (r= -0.5 p=0.012). There was no significant correlation between the cardio risk index with LDL (r=0.157 p=0.101). Conclusion: Hba1c and FBS are higher in uncontrolled type 2 diabetes accompanied by lipid profile and cardio risk index levels that are higher than expected values are the risk of complications in type 2 diabetes mellitus.

Exploring the Potential of Poguntano Extract on Diabetes Management: Systematic Review and Meta-Analysis.

Background: Poguntano (Picria fel-terrae Merr) is a traditional herb commonly used as a blood glucose lowering agent in Indonesia. However, the effectiveness of the herb has not yet been established. Objective: This systematic review and meta-analysis aim to review the hypoglycemic effect of Poguntano extract in lowering plasma glucose levels. Methods: We conducted a literature search using peer-reviewed databases for relevant articles on Poguntano extract in animal models of diabetes. The effect size was pooled using a random effect model. Results: Two animal studies were included in the systematic review and meta-analysis. There was a significant difference in plasma glucose levels between diabetic control and rats treated with Puguntano extract (MD: 28.77; 95%CI: 6.20-51.34; p=0.01). There was no significant difference between non-diabetic control and Poguntano extract. Conclusion: Poguntano extract lowers the blood glucose levels in diabetic rats compared to control.

Curcumin: Boosting the immunity of COVID-19-vaccinated populations.

The ongoing, highly infectious COVID-19 pandemic has prompted various drugs, vaccines, and phytochemical research to control the disease. The accelerated development of vaccines showed the importance of immune boosters against the virus. This study aims to elucidate the role of curcumin, a phytochemical with an immunoediting profile potentially able to boost immunity after vaccination. Eighty participants were enrolled to receive curcumin supplementation (n = 40) and without (n = 40) after the first vaccination until 4 weeks after the second vaccination. Total antibody formation for SARS-CoV-2 was measured using an enzyme-linked immunosorbent assay 4 weeks after the second vaccination. The average antibody formed in groups treated with curcumin supplementation showed a statistically significant increase compared to the control group (262.6 ± 324.2 vs. 42.8 ± 53.5, P < 0.01). Age, sex, and comorbidities did not affect the production of antibodies within groups. Curcumin showed potential as a complementary supplementation during the period of vaccination as it can increase antibodies produced post vaccinations. Further investigation should be conducted on more subjects and a longer period in concordance to vaccine boosters and emerging new variants.

The Effect of Hypoxia Inducible Factor -1 Alpha and Vascular Endothelial Growth Factor Level in Type 2 Diabetes Microvascular Complications and Development.

Background: Angiogenesis in diabetic patients is often caused by hyperglycemia induced by hypoxia. Objective: The aim of this study was to analyze the serum level of Hypoxia Inducible Factor -1α (HIF-1α) and Vascular Endothelial Growth Factor (VEGF) between March until Desember 2020. Methods: This is a cross-sectional analytic methods, 135 patients with Type 2 Diabetes 48 samples with Microvascular complication and 87 samples with non-microvascular complication were recruited from the various primary health care centers in Medan city and surrounding areas in North Sumatera. VEGF levels and HIF-1α tested were done with ELISA methods in the laboratory of Medical Faculty, Universitas Sumatera Utara. Statistical analysis was performed using the IBM SPSS Statistics version 24. The significance level was set up to 0.005. Results: The median HIF-1 levels in patients with microvascular complications were lower than those without microvascular complications, with a range of HIF-1α values in non-complicated samples (0.02-13.96) ng/ml and a range of HIF-1α values in vascular complications (0.52- 8.87) mg/dL. There was a significant difference in HIF-1α levels in patients with Type-2 DM with complications compared to those without complications (p<0.05). Median VEGF levels were higher in complicated Type-2 DM. There was no difference in VEGF levels in patients with Type-2 DM with complications compared to those without complications (p > 0.005). Conclusion: HIF-1α and VEGF levels showed the development in vascularity. With the higher level of HIF-1α, an increase in VEGF levels were found, indicating the angiogenesis is occurring. Although complications have not yet occurred, it is predicted that high VEGF values will cause vascular complications in the future.

What Contributes to Palliative Care Practice in Cancer Patients in Indonesia.

Background: Palliative care has an important role in cancer treatment. It has been established in Indonesia for years, however, palliative care does not give significant improvements which may due to the numerous components of palliative care. Objective: This research aims to identify factors affecting palliative care in Indonesia. Methods: This article is a literature review which was conducted through a systematic search from four online databases: Cochrane, Pubmed, Embase, EbscoHOST. The search revealed 45 studies then selected using PRISMA 2020 algoritm, leaving 8 studies to be analyzed. The factors affecting palliative care in Indonesia were then grouped into three points of view: the patients and caregiver; healthcare provider, further divided into healthcare personnel and system; as well as healthcare system. By knowing these factors it is expected that we can achieve optimal implementation palliative care in Indonesia, especially in cancer patient. Results: The factors influencing palliative care in Indonesia can be grouped into patients, healthcare provider and healthcare system. Conclusion: Palliative care improvement in Indonesia can be enhanced to achieve optimal implementation in cancer treatment.

Potential Benefits of Aloe vera and Raphanus sativus var. longipinnatus Gel for Prevention of Radiation-Induced Dermatitis in Head and Neck Cancer Patients.

Background: The main therapy for head and neck cancer is radiation, and one of the toxic effects of radiation is radiation dermatitis. Aloe vera is a species of succulent plant of the genus Aloe, widely used in cosmetic and skin care products, as well as daikon (Raphanus sativus var. longipinnatus), which is high in antioxidants. Objectives: The present study aims to evaluate the potential benefits of Aloe vera and daikon gel combination in head and neck cancer patients to prevent radiation-induced dermatitis. Methods: A cohort study was conducted with eligible subjects, all head and neck cancer patients receiving radiation therapy selected in consecutive sampling. Samples were divided into two groups; either received Aloe vera and daikon combination gel (study group) or baby oil (control induced dermatitis (RID) were observed. Results: A total of 44 patients were grouped into intervention (Aloe vera-daikon gel) and control (baby oil) groups. After ten radiotherapies (RT) sessions, the intervention group had a lower percentage of grade 1 RID (35% vs. 91.7%, control: 65% grade 2 RID, P < 0.001). After 20 RT sessions, 40% had no dermatitis, while all patients had RID in the control group (P = 0.061). After 30 RT sessions, the intervention group had a lower RID grade overall (gr 0: 5%, gr 1: 85%, gr 2: 10%) compared to the control group (gr 1: 33.3%, gr 2: 54.3%, gr 3: 8.3%, P = 0.002). After 35 RT sessions, the intervention group also had a lower RID grade overall (gr 0: 5%, gr 1: 65%, gr 2: 20%, gr 3: 10%) compared to the control group (gr 1: 8.3%, gr 2: 37.5%, gr 3: 45.8%, gr 4: 8.3%, P < 0.001). Conclusions: The combination of Aloe vera and daikon gel showed promising results in reducing the severity of radiation-induced dermatitis for head and neck cancer patients.

Enhanced cytotoxic effects of Clinacanthus nutans and doxorubicin in combination toward breast cancer cell lines.

Breast cancer is one of the most common cancers with a relatively high mortality rate. Despite the advancement of its medical treatments, many patients are still seeking complementary alternative medicines, namely Clinacanthus nutans which is found mainly in South-East Asian countries. We aim to find the antioxidant properties and cytotoxic activity of the plant extract toward breast cancer cell lines Michigan Cancer Foundation-7 (MCF7) and T47D individually and in combination with doxorubicin. Extractions of C. nutans with ethanol, n-hexane, and ethyl acetate were done using rotatory vacuum evaporators with the reflux method. Screening of biochemical properties was conducted. Antioxidant activity was measured toward α, α-diphenyl-ß-picrylhydrazyl (DPPH) with IC50 scores were shown to be highest in ethyl acetate extract. Cytotoxic effects of all three extracts were shown to be low in both MCF7 and T47D cells. However, combinations of 125 µg/ml n-hexane extract of C. nutans, and 0.1 µg/ml doxorubicin in T47D cancer cells showed further proliferation reduction compared to the single administration. The results suggested possible synergisms of the treatment combination.

Glucose Lowering Effect of Basil Leaves in Diabetic Rats.

BACKGROUND: The incidence of diabetes and its complications has risen since the last decades, and it has been predicted that the prevalence of diabetes will be double in the coming year. Chronic hyperglycemia marked as elevated advanced glycation end products plays an important role in complications of diabetes. Basil leaves (Ocimum basilicum) originating from India and commonly found in Southeast Asia, is widely used empirically to decrease the blood sugar in diabetic patients. AIM: The purpose of the study was to investigate the effect of extract ethanol of Basil leaves in diabetic rats. METHODS: This is an experimental study; Streptozotocin was used to induce type 2 diabetic rats. Thirty Wistar male rats were divided into six groups (normal group, group treated with metformin 45 mg/kg body weight, group treated with Basil leaves 100 mg/kg body weight, 200 mg/kg body weight, 400 mg/kg body weight, control diabetic group). The blood glucose level was measured before induction and after treatment at week 1 and 4. Advanced glycation end products were measured in all groups at week 4. RESULTS: Extract ethanol of basil leaves 100, 200, 400 mg/body weight all showed significant lowering blood glucose level (p < 0.001) compared to diabetic group without treatment, but did not show superior to metformin group (p = 0.17), advanced glycation end products did not show statistical significance between group with normal rats and group of diabetic rats treated with basil leaves 100 mg/kg, 200 mg/kg, 400 mg/kg (p = 0.12, p = 0.33, p = 0.26). CONCLUSION: Extract ethanol of basil leaves showed good results in lowering blood glucose and advanced glycation end products in diabetic rats.

Hypercoagulable State and Glycemic Control in Diabetic Patients with Malignancy.

BACKGROUND: Diabetes and malignancy are two chronic diseases that have a major impact on the healthy population in developing countries, both contribute to the increase of morbidity and mortality of the patients. Diabetes presented with hyperglycemia due to insufficiency or resistance of insulin has been associated with an increased risk of thrombosis. Malignancy or cancer is number two killer in the developing countries after infectious diseases, one of the most common cause of death in cancer despite the disease itself is thrombosis, which occurred frequently as cancer cause changes in tumor biology, abnormal vascularisation, endothelial dysfunction, activation of coagulation and inflammation. Poor glucose control reflects by HbA1C has a significant correlation with a hypercoagulable state. AIM: This study was to evaluate the relation between hypercoagulable state and glycemic control in diabetic patients with malignancy. METHODS: This is a case control study, eighty samples of diabetes (40 samples were diabetes with malignancy) were collected from private hospitals and clinics. HbA1c, blood glucose level and Ddimer were measured. RESULTS: The forty five percent of the blood glucose level of the samples was not well controlled. Sixty five percent of the samples in this group were norm weight, overweight 20% and obese 10%. The Ddimer levels were elevated in both groups and there was a significant correlation between HbA1C and Ddimer (p-0.046), blood glucose and age (p = 0.017). CONCLUSION: Chronic hyperglycemia will increase the risk of hypercoagulable state, that will also increase the morbidity and mortality rate in diabetes with malignancy patients.

CD4 and Its Relevance to Advanced Glycation End Products in Tuberculosis Patients with Co-morbidity Diabetes.

BACKGROUND: Tuberculosis (TB) is one of the most common infectious diseases found in developing countries. One of the risk factors for TB is diabetes, a chronic metabolic disorder characterised by hyperglycemia. The altered in glucose metabolism will cause dysfunction of phagocyte and antibacterial that furthermore impaired activation of natural killer cells, dendritic cells. These together will alter the balance of T-cell immunity. Under hyperglycemic conditions, AGEs (advanced glycation end products) was increasingly formed and was believed to play a role in cell dysfunctions and diabetic complications. The CD4 deficiency will alter the immunity status in diabetes and TB with co-morbidity diabetes. AIM: This aim of this study was to evaluate CD4, and it's relevant to Advanced Glycation End Products (AGEs) in TB with co-morbidity diabetes. METHODS: This is a case-control study with a total of 80 patients (40 diabetes and 40 TB with co-morbidity diabetes were recruited from Murni Teguh memorial Hospital Medan after ethical approval from Health Research Ethical Committee. The CD4, AGEs, Blood glucose and HbA1C were measured. RESULTS: There was no statistical difference of CD4, HbA1C and blood glucose within diabetes and TB with co-morbidity diabetes but BMI (p = 0.009) and AGEs (p = 0.001) did. The CD4 below 500 were seen in 15% diabetes and 25% in TB with co-morbidity diabetes but did not show statistical significance difference (p = 0.07). No correlation was found between CD4 and AGEs in TB with co-morbidity diabetes (p = 0.44). CONCLUSION: The CD4 was not correlated significantly with AGEs.