Folia Medica Indonesiana

The Differences between Pre- and Post-Therapy Levels of Platelet Count and Platelet Indices in Children with Immune Thrombocytopenia Purpura

Regina Rania Cahya Kusumaningrum - — 2024-12-11

Highlights:
1. This study was the first to analyze the therapeutic response in children with ITP at Dr. Soetomo General Academic Hospital, Surabaya.
2. This study analyzed the response of platelet count and indices, including MPV, PDW, P-LCR, and PCT to therapy, which provides a more comprehensive perspective on therapy response in children with ITP.
3. This study explored the effectiveness of various therapeutic approaches based on ITP categories, offering new insights into the most effective treatment options for children with ITP.

Abstract
Immune Thrombocytopenia Purpura (ITP) is an autoimmune disorder triggered by antiplatelet autoantibodies. Clinically, ITP is classified into three phases including Newly-Diagnosed ITP, Persistent ITP, and Chronic ITP, each with distinct durations and therapy implications. Patients with ITP who do not receive appropriate or optimal treatment are at a heightened risk of morbidity and mortality related to bleeding complications, the condition could worsen, potentially resulting in fatal consequences. In ITP patients, platelet counts decrease, accompanied by abnormal shifts in platelet indices, including Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Large Cell Ratio (P-LCR), and Plateletcrit (PCT). Thus, therapeutic response in ITP patients can be evaluated through increased platelet counts and normalization of platelet indices. This study aimed to assess the therapeutic response of platelet counts and platelet indices in pediatric ITP patients by comparing pre- and post- therapy levels overall by category, across all medication types administered, and according to the specific medication used within each category. The result of this study are expected to provide an overview of the most effective treatments across all ITP categories in order to prevent severe complications and reduce the risk of mortality. This retrospective study included ITP patients under 18 years old at Dr. Soetomo General Academic Hospital, Surabaya, conducted from September 2023 to March 2024. Platelet count and platelet indices pre- and post-therapy levels were analyzed using the Paired T-test for normally distributed data and the Wilcoxon test for non-normally distributed data, with significance set at p < 0.05. In summary, there were notable changes in the pre- and post-therapy levels of platelet, MPV, PDW, P-LCR, and PCT in each ITP category and for all therapies. Platelet count and PCT increased, while MPV, PDW, and P-LCR decreased. Patients treated with prednisone exhibited the best therapeutic response. Among the categories, Newly Diagnosed ITP demonstrated the most optimal therapeutic response. Overall, ITP therapy led to significant differences between pre- and post-therapy levels, marked by an increase in platelet counts and normalization of platelet indices.

The Tubarial Glands: Key Anatomical Features and Clinical Significance

Dwi Martha Nur Aditya — 2024-12-11

Medical technological advancements have revealed previously unknown anatomical features in the nasal cavity known as tubarial glands. However, many questions remain unanswered concerning these glands. Through this systematic review, we sought to analyze the tubarial glands, including their major discovery, anatomical and histological features, and clinical significance. Articles were identified according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, with data collected from Scopus, ScienceDirect, SpringerLink, and PubMed until September 2024. Medical Subject Headings (MeSH) were utilized with various terminology: "tubarial gland*", "tubarial salivary gland*", and "radiotherapy”. The inclusion criteria were: (1) resources categorized as original research reports, case reports, case studies, letters to the editor, brief communications, commentaries, editorials, and news; (2) publications with accessible full text; and (3) articles providing information on the tubarial glands. The exclusion criteria were: (1) papers categorized as systematic reviews, meta-analyses, or bibliometric analyses; and (2) articles not published in English. The identification yielded 37 resources from around the world, including 19 original research reports (51.3%), 3 case reports (8.1%), 6 letters to the editor (16.2%), 2 brief communications (5.4%), 7 commentaries (18.9%), 1 editorial (2.7%), and 1 news article (2.7%). The research subjects comprised 1 healthy patient (2.7%) out of 26 subjects, 12 prostate cancer patients (32.4%) out of 612 subjects, 3 head and neck cancer patients (8.1%) out of 38 subjects, 1 nasopharyngeal carcinoma patient (2.7%) out of 240 subjects, 1 Sjögren's syndrome patient (2.7%) out of 29 subjects, 1 patient with oncocytic papillary cystadenoma (2.7%), and 20 patients with other conditions (54.0%). This systematic review suggests that the newly discovered glands exhibit similar morphological, histological, and physiological properties to salivary glands and may have a function in the lubrication and maintenance of the upper airway.

Efficacy and Safety of Ozoralizumab versus Moxibustion for Rheumatoid Arthritis

Luthfiana Rofhani Susanti — 2024-12-11

Rheumatoid arthritis (RA) is a chronic inflammatory disease that symmetrically damages the synovial membrane, affecting approximately thirteen percent of the global population. Systemic complications and substantial declines in quality of life may ensue from untreated RA. This study investigates the safety and efficacy of moxibustion and ozoralizumab in reducing disease activity scores in RA patients. Between July and November 2023, we performed an extensive search across four online databases (PubMed, Cochrane, Scopus, and ProQuest) utilizing keywords, reference searches, and other methodologies in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The obtained randomized controlled trials (RCTs) have been assessed using the Cochrane Risk of Bias 2 Risk of Bias Tools (ROB2). MetaInsight version 5.2.1 was employed to conduct this indirect network meta-analysis, which employed mean difference (MD) as summary statistics. This study demonstrated that ozoralizumab had a more significant effect on rheumatoid arthritis than placebo, as measured by DAS28 (MD=-1.88; 95% CI -2.24-(-1.52)) and moxibustion (MD=-0.69; 95% CI=-1.07-0.31). Ozoralizumab exhibited mild, moderate, and severe side effects, whereas moxibustion exhibited modest side effects compared to the placebo. In summary, ozoralizumab and moxibustion decreased DAS28 scores in rheumatoid arthritis patients, with ozoralizumab being the more effective treatment. Nevertheless, the adverse effects of ozoralizumab were more diverse than those of moxibustion.

Urine Periostin Level and Renal Function in Malignancy Patients Treated with High-Dose Cisplatine

Harry Yusuf — 2024-12-11

Cisplatin has been used extensively as a cancer treatment. Nephrotoxicity, which is assessed by blood urea levels, blood creatinine, and estimated glomerular filtration rate (eGFR), is caused by cisplatin metabolites that build up in the kidneys. Because of these indicators' numerous flaws, optimal biological markers are required. One of the key mediators of inflammatory processes, such as kidney fibrosis and inflammation, is periostin. In cancer patients undergoing high-dose cisplatin therapy, the purpose of this study is to ascertain how urine periostin changes and how it relates to kidney function. This cross-sectional study was carried out at the National Center General Hospital of Cipto Mangunkusumo's medical hematology-oncology outer clinic and medical hematology-oncology ward on the eighth floor starting in November 2019 and ending when the minimum sample was obtained through consecutive sampling. Data was analyzed by IBM SPSS Statistics for Windows version 23.0 based on the research objective. Of the 37 responders, 70.3% were men, 29.7% were between the ages of 41 and 50, 78.4% were married, 59.5% had completed high school, 37.8% were employed, 59.5% had NPC, and 64.9% had a Karnofsky score of 80. Between before and one week following chemotherapy II, the respondents' blood creatinine and urea levels rose. The eGFR value has also decreased. Periostin levels, on the other hand, tended to rise one week following treatment III after declining during chemotherapy I and II (p value>0.05). Urine periostin levels and other kidney function indicators did not significantly correlate (p>0.05), according to the correlation test, and several domains had negative directions. The correlation coefficient values were modest (r = 0.017-0.254). There is a changing of urine periostin level of malignant patients receiving high dose cisplatin therapy which increase after the third chemotherapy. No significant correlation was found between periostin levels and kidney function in malignant patients with high-dose cisplatin therapy.

Hypnopressure as a Non-Invasive Method for Anxiety and Pain Management in Primigravidae during Active Labor

Yeni Fitrianingsih — 2024-12-11

Highlights:
1. This study applied hypnopressure, an innovative method that combines auditory hypnosis with acupressure on effective uterine points, namely the Hegu (LI4) and Sanyinjiao (Sp6) points.
2. This innovation offers an effective method for managing labor pain in primigravidae during the active phase of the first labor stage compared to hypnotherapy and acupressure administered separately.

Abstract
Psychological factors, such as fear and anxiety, are often responsible for prolonged labor. Anxiety affects 58% of primigravidae, while 2–4% experience pain with scores ranging from 30 to 40 out of 50. Hypnopressure is an innovative combination of hypnotherapy and acupressure applied on the Sanyinjiao (SP6) and Hegu (LI4) points for 3–5 seconds in 20 repetitions during the first stage of labor contractions. This study aimed to determine the effect of hypnopressure on the LI4 and Sp6 points in reducing primigravidae's anxiety levels and pain degrees during the active phase of the first labor stage. This research used a double-blind randomized controlled trial methodology with a pretest-posttest design. Eighty subjects were divided into four groups to compare the effects of different interventions and determine which one demonstrated the most effectiveness. Each of the hypnopressure, hypnotherapy, acupressure, and control groups comprised 20 subjects. The treatment interventions were administered during the active phase of the first labor stage, which was subsequently analyzed using the Wilcoxon and Kruskal-Wallis statistical tests (p<0.05). The hypnopressure (p=0.000), hypnotherapy (p=0.000), and acupressure (p=0.002) groups experienced decreasing anxiety levels. The Kruskal-Wallis post-test indicated a significant difference (p=0.000) after treatment, revealing that hypnotherapy resulted in the lowest decrease in anxiety compared to the other three groups. Additionally, the degree of labor pain (p=0.000) was lower in the hypnopressure group (4.00±1.496) than in the other three groups. There was a significant difference across the four groups (p=0.000), with subjects in the hypnopressure group reporting lower pain degrees compared to those in the hypnotherapy (p=0.000), acupressure (0.000), and control (p=0.000) groups. In conclusion, this study suggests that hypnopressure treatment can decrease anxiety levels and pain in primigravidae during active labor.