Microneedle-Mediated Transdermal Delivery of Genetic Materials, Stem Cells, and Secretome: An Update and Progression

Medical practitioners commonly use oral and parenteral dosage forms to administer drugs to patients. However, these forms have certain drawbacks, particularly concerning patients' comfort and compliance. Transdermal drug delivery presents a promising solution to address these issues. Nevertheless, the stratum corneum, as the outermost skin layer, can impede drug permeation, especially for macromolecules, genetic materials, stem cells, and secretome. Microneedles, a dosage form for transdermal delivery, offer an alternative approach, particularly for biopharmaceutical products. In this review, the authors will examine the latest research on microneedle formulations designed to deliver genetic materials, stem cells, and their derivatives. Numerous studies have explored different types of microneedles and evaluated their ability to deliver these products using preclinical models. Some of these investigations have compared microneedles with conventional dosage forms, demonstrating their significant potential for advancing the development of biotherapeutics in the future.

The Application of Polymers in Fabricating 3D Printing Tablets by Fused Deposition Modeling (FDM) and The Impact on Drug Release Profile

A new chapter in the pharmaceutical industry has been created by 3D printing, particularly in the manufacturing of solid preparations. This technology can support the modification of medicine in terms of drug dosage. Furthermore, it is achieved by adjusting the volume of tablets while being designed using the software to meet the required dose. The research aims to review several polymers used in 3D printing through the fused deposition modeling technique. The polymers in filament fabrication for 3D printed tablets should be thermoplastic and have the appropriate mechanical properties for further processing steps. This review focuses on studying the characteristics of polymers such as polylacticacid, polyvinyl alcohol, polycaprolactone, polyvinyl pyrrolidone, polyethylene oxide, ethylene vinyl acetate, ethyl cellulose, hydroxypropyl methyl cellulose, and hydroxypropyl cellulose. Additionally, it discusses the effect of these polymers on the drug release profile from the 3D printed tablets.

C75. Premature Coronary Artery Disease in Young Male Patient with Strong Family History

Background

Coronary artery disease (CAD) occurring in less than 45 years of age is termed as premature CAD (PCAD). Recent studies showed a prevalence of 4-10 % of PCAD. PCAD is associated with unfavorable outcomes for the patients and had a greater impact on the quality of life. Family History is the best method to explained complex interaction between shared risk factor.

Case Summary

A 37-years old male admitted to Saiful Anwar Hospital for further evaluation of anginal pain. The patient complains of recurrent chest pain since 5 months ago but still relieved by rest. The electrocardiogram showed Wellens Type B which is specific for critical stenosis of the left anterior descending artery (LAD). Then the patient undergoing DCA Ad Hoc. The implantation of a 46 mm DES at proximal until distal LAD was performed. The patient discharged after a day observation.

Discussion

The challenging point, in this case, was it happen at a young age with strong family history. There was positive family history of PCAD in 1st degree relative on her brother and mother, despite several risk factors were identified in this case consist of smoking, and dyslipidemia, which make CAD risk higher. Despite adequate control of risk factors, family screening is important to reveal subclinical atherosclerosis.

C75. Premature Coronary Artery Disease in Young Male Patient with Strong Family History

Background

Coronary artery disease (CAD) occurring in less than 45 years of age is termed as premature CAD (PCAD). Recent studies showed a prevalence of 4-10 % of PCAD. PCAD is associated with unfavorable outcomes for the patients and had a greater impact on the quality of life. Family History is the best method to explained complex interaction between shared risk factor.

Case Summary

A 37-years old male admitted to Saiful Anwar Hospital for further evaluation of anginal pain. The patient complains of recurrent chest pain since 5 months ago but still relieved by rest. The electrocardiogram showed Wellens Type B which is specific for critical stenosis of the left anterior descending artery (LAD). Then the patient undergoing DCA Ad Hoc. The implantation of a 46 mm DES at proximal until distal LAD was performed. The patient discharged after a day observation.

Discussion

The challenging point, in this case, was it happen at a young age with strong family history. There was positive family history of PCAD in 1st degree relative on her brother and mother, despite several risk factors were identified in this case consist of smoking, and dyslipidemia, which make CAD risk higher. Despite adequate control of risk factors, family screening is important to reveal subclinical atherosclerosis.

Prognostic value of myocardial injury biomarker in COVID-19: a systematic review and meta-analysis

Background

An accurate prognostic tool that can help with risk stratification at first admission is crucial in COVID-19 patients, as severe complications and mortality rate can be reduced with prompt treatment and close follow up. The myocardial injury biomarker, Troponin, is reported to be a potential predictor of mortality in COVID-19 cases.

Purpose

This study aims to investigate the utility of cardiac troponin level as a prognosis tool in COVID-19 patients.

Methods

On March 12th, 2021, data was collected from PMC, PubMed, Google Scholar, Science Direct, and Scopus, using combination of keywords associated with myocardial injury biomarker, Troponin, and its prognostic value for mortality in COVID-19 patients. Included publications are original clinical trials, limited to those with English manuscripts, and all were reviewed and evaluated by 5 authors to minimise bias. Inclusion criteria for studies are original clinical trials with a study population of adults (≥18 years old) patients with confirmed SARS-CoV-2 infection through PCR. The quality of each studies included was assessed using the Newcastle-Ottawa Scale (NOS) and data synthesis and statistical analysis were carried out using Review Manager software.

Results

A total of 19 studies consisting of 13,789 COVID-19 patients were included. All 19 studies were good quality according to the NOS. Studies found that myocardial injury, indicated by the elevation of its biomarker, Troponin, is a strong predictor of in-hospital mortality. Furthermore, elevated troponin level itself is an independent marker of mortality, regardless of its concomitant cardiac disease. Meta-analysis of 9 included studies revealed a significant association between elevated cardiac troponin levels and mortality (HR 4.13; 95% CI 3.42 - 5.00; P<0.001). Based on GRADE, the result of this systematic review and meta-analysis proved to be moderate in quality as there are no inconsistency and variability in results and there are no publication biases.

Conclusion

Cardiac troponin level is found to be a strong predictor of mortality in COVID-19 patients and therefore should be treated both as an evaluation for cardiac involvement and as an important prognostic marker. Patients with elevated troponin levels within admission should be closely monitored and given prompt treatment to decrease mortality.

Funding Acknowledgement

Type of funding sources: None. Forest plot figure

Does elective orthopaedic surgery in pandemic era increase risk of developing COVID-19? A combined analysis of retrospective and prospective study at Cipto Mangunkusumo Hospital, Jakarta, Indonesia

BACKGROUND

To date, no recommendations have been published on when and how to start again carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak has been reached in a given country or region and the pressure on healthcare facilities, healthcare workers and resources has been released by so far that elective surgery procedures can be safely and ethically programmed again. This study aims to investigate whether elective orthopaedic surgery will increase the risk of developing COVID-19.

MATERIALS AND METHODS

This was a combined retrospective and prospective studies performed at a national tertiary hospital in Jakarta, Indonesia. Subjects were patients who underwent elective orthopaedic surgeries at our institution from April to May 2020. Those who were previously infected with COVID-19 from polymerase chain reaction (PCR) reverse transcriptase (RT) examination obtained via nasopharynx and oropharynx swab, as well as those who were reluctant to participate were excluded from the study.

RESULTS

A total of 35 subjects (mean age 32.89 ± 17.42) were recruited. Fifteen (42.9%) subjects were male, and 20 subjects (57.1%) were female. Mean duration of surgery was 240 min with the longest and shortest duration of 690 and 40 min, respectively. General anaesthesia was performed in the majority of cases in 18 surgeries (51.4%) with local anaesthesia as the least in 2 surgeries (5.7%). Length of stay of our study was 6 days of average. None of the patients developed symptoms suggestive of COVID-19 infection.

CONCLUSION

We found that elective orthopaedic surgery may not be associated with increased cases of COVID-19 cases. However, our study was limited by short duration of follow-up. Further studies are required in order to investigate the affect of undergoing elective surgery and the number of COVID-19 cases.

Breast Cancer Education and Screening in Indonesian Rural Community: A Programme Trial

Background and context: Breast cancer has the highest incidence and prevalence among cancers in Indonesia. Indonesian rural society has low level of breast cancer knowledge and self examination practice. Difficulty for accessing breast cancer primary health care screening also caused negligence. Furthermore, ignorance and economy situation made patients chose alternative treatments. Hence, most cases are detected at late stages, in which late diagnosis and treatment resulted in high mortality. Aim: Decrease breast cancer mortality by increasing breast cancer knowledge level, monthly self-examination practice awareness, and mass screening for early detection of breast cancer. Strategy/Tactics: In conjunction with National Cancer Control Committee event at 2017, we did a one day social occasion of education and early detection screening for breast cancer in Indonesia rural communities. Participants were gathered with mass announcement from primary health care workers. An expert brought an education class, then parallel screening rooms were provided for all participants. Program/Policy process: Phase one (2017) consists of establishing a good basic education and screening system. We gave free invitation to district health office to be distributed to a local primary health care and participate in a small education class brought by breast cancer specialist. Materials consist of basic knowledge and risk factors, self-examination awareness, diagnostic and treatment procedure, and referral process. Afterward, participants got breast physical exam screening by general clinicians. In phase two (2018), we added questionnaires to assess the effectiveness of education class in increasing knowledge level and self-practice awareness. An ultrasonography examination was added to narrow the diagnosis. Participants with higher risk factor or positive findings were given extra consultation. All participants were referred to our secondary referral General Hospital at Karawaci district, Tangerang, Banten, Indonesia. Outcomes: In 2017, 10% of participants had positive results and referred for further tests. In 2018, education class significantly increase knowledge and breast self-exam practice awareness. Moreover, ultrasonography examination narrowed positive diagnosis from 13% to 7%. What was learned: Education and early detection screening to primary health cares across Indonesia are needed to gather breast cancer cases at earliest stadium, hopefully could decrease breast cancer mortality. Feedbacks from participants showed that feeling of importance played important role and can only be developed internally after the disease became personal. Mobile mammography examination will help establishing breast cancer diagnosis. Budget is an issue, participants must be filtered beforehand based on risk factors for positive diagnostic results. A follow up and reminder system is needed to ensure participants follows proper management steps.

Wave energy absorption by a submerged air bag connected to a rigid float

A new wave energy device features a submerged ballasted air bag connected at the top to a rigid float. Under wave action, the bag expands and contracts, creating a reciprocating air flow through a turbine between the bag and another volume housed within the float. Laboratory measurements are generally in good agreement with numerical predictions. Both show that the trajectory of possible combinations of pressure and elevation at which the device is in static equilibrium takes the shape of an S. This means that statically the device can have three different draughts, and correspondingly three different bag shapes, for the same pressure. The behaviour in waves depends on where the mean pressure-elevation condition is on the static trajectory. The captured power is highest for a mean condition on the middle section.