Oral acute toxicity study and in vivo antimalarial activity of Strychnos lucida R. Br. tablet

ETHNOPHARMACOLOGICAL RELEVANCE

Malaria eradication has been a major goal of the Indonesian government since 2020. Medicinal plants, such as Strychnos lucida R. Br., are empirically used to treat malaria through traditional preparation methods. However, the safety and efficacy of these plants have not yet been confirmed. Therefore, further investigations are necessary to confirm the safety and efficacy of S. lucida as an antimalarial agent.

AIMS OF THE STUDY

To quantify the concentration of brucine in the S. lucida extract, determine the acute oral toxicity of the standardized extract, and evaluate the in vivo antimalarial potency of S. lucida tablet (SLT).

MATERIALS AND METHODS

Acute oral toxicity of S.lucida extract was determined using the Organization for Economic Co-operation and Development 420 procedure, and the analytical method for brucine quantification was validated using high-performance liquid chromatography. In addition, antimalarial activity was determined using the Peter's four-day suppressive method.

RESULTS

Acute toxicity analysis revealed S. lucida as a low-toxicity compound with a cut-off median lethal dose of 2000-5000 mg/kg body weight [BW], which was supported by the hematological and biochemical profiles of the kidneys, liver, and pancreas (p > 0.05). Extract standardization revealed that S. lucida contained 3.91 ± 0.074% w/w brucine, adhering to the limit specified in the Indonesian Herbal Pharmacopeia. Antimalarial test revealed that SLT inhibited the growth of Plasmodium berghei by 27.74-45.27%. Moreover, SLT improved the hemoglobin and hematocrit levels. White blood cell and lymphocyte counts were lower in the SLT-treated group than in the K (+) group (p < 0.05).

CONCLUSION

Histopathological and biochemical evaluations revealed that S. lucida extract was safe at a dose of 2000 mg/kg BW with low toxicity. SLT inhibited Plasmodium growth and improved the hemoglobin, hematocrit, and red blood cell profiles. Additionally, SLT reduced the lymphocyte and WBC counts and increased the monocyte and thrombocyte counts as part of the immune system response against Plasmodium infection.

Impact of randomised wmel Wolbachia deployments on notified dengue cases and insecticide fogging for dengue control in Yogyakarta City

BACKGROUND

Releases of Wolbachia (wMel)-infected Aedes aegypti mosquitoes significantly reduced the incidence of virologically confirmed dengue in a previous cluster randomised trial in Yogyakarta City, Indonesia. Following the trial, wMel releases were extended to the untreated control areas, to achieve city-wide coverage of Wolbachia.

OBJECTIVE

In this predefined analysis, we evaluated the impact of the wMel deployments in Yogyakarta on dengue hemorrhagic fever (DHF) case notifications and on the frequency of perifocal insecticide spraying by public health teams.

METHODS

Monthly counts of DHF cases notified to the Yogyakarta District Health Office between January 2006 and May 2022 were modelled as a function of time-varying local wMel treatment status (fully- and partially-treated vs untreated, and by quintile of wMel prevalence). The frequency of insecticide fogging in wMel-treated and untreated areas was analysed using negative binomial regression.

RESULTS

Notified DHF incidence was 83% lower in fully treated vs untreated periods (IRR 0.17 [95% CI 0.14, 0.20]), and 78% lower in areas with 80-100% wMel prevalence compared to areas with 0-20% wMel (IRR 0.23 [0.17, 0.30]). A similar intervention effect was observed at 60-80% wMel prevalence as at 80-100% prevalence (76% vs 78% efficacy, respectively). Pre-intervention, insecticide fogging occurred at similar frequencies in areas later randomised to wMel-treated and untreated arms of the trial. After wMel deployment, fogging occurred significantly less frequently in treated areas (IRR 0.17 [0.10, 0.30]).

CONCLUSIONS

Deployments of wMel-infected Aedes aegypti mosquitoes resulted in an 83% reduction in the application of perifocal insecticide spraying, consistent with lower dengue case notifications in wMel-treated areas. These results show that the Wolbachia intervention effect demonstrated previously in a cluster randomised trial was also measurable from routine surveillance data.

Skin properties of itching without symptoms and associated factors among older adults in long-term care facilities

Since itching without rash frequently among older adults' population, study about skin properties of itching without rash is important to develop prevention methods. Therefore, this study explored the skin properties related to itching without rash and the factors associated with them. A correlation, predictive designs study was conducted at Indonesian Long-term Care (LTC) facilities. Skin properties including skin barrier function and skin inflammation were examined by photographs (macroscopic and microscopic), stratum corneum (SC) hydration, skin Potential of Hydrogen (pH), and skin blotting. Itching experience and skincare behavior were obtained by questionnaire. The itching-related skin properties and associated factors were analyzed. A total of 405 residents participated in this study, with mean age was 74 years. The prevalence of itching on the whole body was 69.1%, and 50.3% of those manifesting itching on the left forearm involved itching without macroscopic abnormalities (itching without rash). SC hydration, skin pH, albumin and nerve growth factor β (NGFβ) were associated with itching without rash (p = 0.007, 0.012, < 0.001, and < 0.001, respectively). Additionally, factors associated with skin properties were age, sex, sun exposure experience, skincare, and hygiene care in the linear regression analysis. Measurement of skin biomarkers using skin blotting was a possible objective measurement of itching skin properties without rash regardless of the environmental condition.

Healthcare-seeking behavior for children aged 0-59 months: Evidence from 2002-2017 Indonesia Demographic and Health Surveys

BACKGROUND AND OBJECTIVE

Healthcare-seeking behavior for children is crucial for reducing disease severity. Such behavior can improve child health outcomes and prevent child morbidity and mortality. The present study sought to analyze the determinants of mothers' engagement in healthcare-seeking behavior for children with common childhood diseases, focusing on mothers of children aged 0-59 months in Indonesia.

METHODS

This cross-sectional study comprised a secondary data analysis using the 2002-2017 Indonesia Demographic and Health Survey (IDHS) databases. We included all women surveyed aged 15-49 years old who had children under five years of age. We weighted the univariate, bivariate, and multivariate logistic regression analysis of healthcare-seeking behavior for children aged 0-59 months.

RESULTS

We analyzed data for 24,529 women whose children were under five years of age at the time of survey. Common diseases, such as diarrhea, fever, and acute respiratory infection (ARI) were the most frequently cited reasons for healthcare-seeking behavior. During 2002-2017, the proportion of mothers seeking healthcare for their children with diarrhea increased from 67.70% to 69.88%, that with fever increased from 61.48% to 71.64% and that ARI increased from 64.01% to 76.75%. Multivariate analysis revealed that child's age, child's birth order, mother's education, ability to meet expenses, distance to nearest healthcare facility, wealth index, place of residence, and region of residence, were significantly associated with healthcare-seeking behavior.

CONCLUSION

Various individual and environmental-level factors influence healthcare-seeking behavior for childhood diseases. Available, accessible, and affordable health service facilities are recommended to assist socio-economically and geographically disadvantaged families.

THE EFFECT OF SENSITIVE INTERVENTIONS ON STUNTING REDUCTION EFFORTS

Background: Stunting occurs when a toddler's growth is not age-appropriate, characterized by a child's body length or height being less than age-appropriate. Reducing stunting requires integrated interventions, including both nutrition-specific and nutrition-sensitive interventions. Efforts to address the indirect causes of stunting are summarised in nutrition-sensitive interventions, which account for 70% of stunting interventions. Purpose: This study aims to analyze the effect of sensitive interventions on efforts to reduce stunting among children under five years of age at Puskesmas (Community Health Centre) in Bangkalan Regency. Methods: The study was conducted in March-September 2020 with an analytical cross-sectional design. The population in this study were all children aged 1 to 5 years who were in the working area of Bangkalan District in January - December 2019, totaling 430. A sample of 207 was taken by random cluster sampling. The independent variables in this study were clean and healthy living behaviour (PHBS), access to family planning services, and insurance ownership (only BPJS because this insurance is the most commonly owned by the community). In comparison, the independent variable was stunting in toddlers. The data used were primary and secondary data using closed question questionnaires, Maternal and Child Health books, and cohorts of pregnant women/toddlers. Data were analyzed using logistic regression. Results: It was found that sensitive interventions that affect the incidence of stunting were PHBS with a p-value = 0.03 and BPJS ownership variables with a p-value = 0.04, which means that PHBS and BPJS affect the incidence of stunting in children under five. Meanwhile, the variable access to family planning does not affect stunting. Conclusion: Sensitive interventions affecting stunting incidence are PHBS and BPJS ownership.

Statin and mortality in COVID-19: a systematic review and meta-analysis of pooled adjusted effect estimates from propensity-matched cohorts

PURPOSE

Statin potentially improved outcome in patients with COVID-19. Patients who receive statin generally have a higher proportion of comorbidities than those who did not, which may introduce bias. In this meta-analysis, we aimed to investigate the association between statin use and mortality in patients with COVID-19 by pooling the adjusted effect estimates from propensity-score matching (PSM) matched studies or randomised controlled trials to reduce bias.

METHODS

A systematic literature search using the PubMed, Scopus and Embase databases were performed up until 1 March 2021. Studies that were designed the study to assess statin and mortality using PSM with the addition of Inverse Probability Treatment Weighting or multivariable regression analysis on top of PSM-matched cohorts were included. The effect estimate was reported in term of relative risk (RR).

RESULTS

14 446 patients were included in the eight PSM-matched studies. Statin was associated with decreased mortality in patients with COVID-19 (RR 0.72 (0.55, 0.95), p=0.018; I2: 84.3%, p<0.001). Subgroup analysis in patients receiving statin in-hospital showed that it was associated with lower mortality (RR 0.71 (0.54, 0.94), p=0.030; I2: 64.1%, p<0.025). The association of statin and mortality was not significantly affected by age (coefficient: -0.04, p=0.382), male gender (RR 0.96 (0.95, 1.02), p=0.456), diabetes (RR 1.02 (0.99, 1.04), p=0.271) and hypertension (RR 1.01 (0.97, 1.04), p=0.732) in this pooled analysis.

CONCLUSION

In this meta-analysis of PSM-matched cohorts with adjusted analysis, statin was shown to decrease the risk of mortality in patients with COVID-19.

PROSPERO REGISTRATION NUMBER

CRD42021240137.

Behavior of Users Personal Protective Equipment based on Health Belief Model and Social Capital

Background: Developing a health belief model using social capital in social groups that have the same social characteristics has never been done. Methods: This study was conducted on employees of the weaving division in one of the largest textile industries in Indonesia located in Sukoharjo Regency, Central Java, Indonesia. In this case, 178 respondents were selected randomly to be assessed for the health belief model through the construct of perception: vulnerability, severity, benefit, threat, self-efficacy, barriers to readiness for action, and social capital through the construction of social networks, norms, trust, and reciprocity. In order to get a suitable model, the data were analyzed using path analysis with the assistance of Stata 13. Results: The results of the development of the health belief model using social capital for behavioral changes in weaving employees obtained the following results. First, the health belief model consists of the constructs of perception of vulnerability, perception of severity, perception of benefits, and perception of barriers that indirectly affect the perception of threats to behavioral changes using personal protective equipment. (b= -1.07; 95% CI = -1.88 to -0.26; p=0.010). Second, social capital has a direct effect on behavioral changes in the use of personal protective equipment. (b= 0.85; 95% CI = 0.18 to 1.53; p=0.013). Furthermore, cues to action has a direct effect on behavioral changes in the use of personal protective equipment (b= 1.35; 95% CI = 0.49 to 2.21; p=0.02). Conclusion: Behavioral changes to use personal protective equipment for weaving employees who are exposed to high intensity noise are directly affected by cues to action and social capital. In addition, it is also indirectly affected by the variable of Health Belief Model.

Ethnobotanical study of plants used as food and for maternal health care by the Malays communities in Kampar Kiri Hulu, Riau, Indonesia

Abstract. Susandarini R, Khasanah U, Rosalia N. 2021. Ethnobotanical study of plants used as food and for maternal health care by the Malays communities in Kampar Kiri Hulu, Riau, Indonesia. Biodiversitas 22: 3111-3120. Studies to reveal the diversity of food plants on communities living in remote areas with limited access to the market are important as an effort in documenting the traditional knowledge. The same applies to the diversity of medicinal plants used in maternal health care for communities that have limited access to public health facilities. The documentation of ethnobotanical knowledge is not only for the purpose of developing the potential of these plants, but also could have an impact on their conservation in nature. This study aims to document the traditional knowledge on the diversity of food plants and medicinal plants used in maternal health care by Malays tribes living within the Bukit Rimbang Bukit Baling Wildlife Reserve, Kampar Kiri Hulu Subdistrict, Kampar District, Riau Province, Indonesia. The research was conducted in three villages by collecting data through interviews and followed by fieldwork to collect plant specimens for identification. Data on food plant diversity data were obtained from 20 informants, while data on the diversity and use of medicinal plants for maternal health care were obtained from 73 informants. The results showed that there were 76 species of food plants from 35 families. These food plants were used as secondary food ingredients, vegetables, fruit and spices with most of these plants were obtained from the yard of the house. Plants used for maternal health care identified from this study were 34 species from 26 families. These plants were used for various purposes during pregnancy, child delivery, postpartum recovery, and infant health care. The diversity of food plants and medicinal plants for maternal health care documented in this study showed the valuable role of plant resources in supporting daily needs and health care of the communities living in the fringe of forest area.

Clinical Gastroenterology and Gastrointestinal Endoscopy Practices during the Coronavirus Disease 2019 Pandemic in Indonesia: An Online Nationwide Survey

BACKGROUND/AIMS

The coronavirus disease 2019 (COVID-19) pandemic has necessitated modifications to allow the safe practice of clinical gastroenterology and gastrointestinal endoscopy. This study aimed to investigate the characteristics of clinical gastroenterology and gastrointestinal endoscopy practices during the COVID-19 pandemic in Indonesia.

METHODS

This cross-sectional study enrolled physician members of the Indonesian Society for Digestive Endoscopy. We used an online self-administered questionnaire disseminated via social media. The 32-item survey determined the baseline characteristics of the participants, characteristics of clinical gastroenterology and gastrointestinal endoscopy practices, involvement of the physicians in the management of COVID-19, and overall impact of the pandemic on practice. All collected data were analyzed using descriptive statistics.

RESULTS

The 200 participants in this study had a median age of 50 (34-76) years. Modifications in clinical gastroenterology practice were frequently reported in the outpatient (95.5%) and inpatient (100%) settings. All participants reported changes in the gastrointestinal endoscopy practice patterns. Of the participants, 86.0% were working in high-risk zones, and several of them reported inadequate protective personal equipment (34.0%). The median overall impact score of the pandemic on practice was 9 (2-10).

CONCLUSION

Physicians practicing clinical gastroenterology and gastrointestinal endoscopy in Indonesia work in high-risk settings. Modifications in clinical gastroenterology and gastrointestinal endoscopy practices are prevalent during the COVID-19 pandemic.

The Correlation of Age, Gender, Heredity, Smoking Habit, Obesity, and Salt Consumption with Hypertension Grade in Cirebon, Indonesia

Background: Hypertension is one of the most global killer diseases that causes death. The World Health Or- ganiza on es mated around 1.5 billion people in the world will be diagnosed with hypertension every year. The increasing incidences of hypertension in the world may be affected by several predictors including age, sex-linked, heredity, smoking habit, obesity, and salt consump on. This study has objec ve to examine those predictors to hypertension grade. Methods: This research was used observa onal analy c method with cross-sec onal study. This study involved 136 respondents who came to Kalijaga Permai Public Health Center, Cirebon City. The variables were measured by microtoise, sphygmomanometer, stethoscope, scales, and ques onnaires. Spearman correla on test and lo- gis c regression test was analyzed for this study. Results: 59.9% of respondents were in hypertension grade 1 and 54% of respondents were in high risk age. The bivariate results revealed that age, sex-linked, heredity, and salt consump on were sta s cally correlated with hypertension grade (p=0.001). However, smoking habit and obesity were not sta s cally correlated. Mul vari- ate analysis found that those who add extra salt were 3.3 mes more likely to have hypertension grade 2 and those in high risk age were 3.1 more likely to have hypertension grade 2 as well. Compared with female and those who have nega ve heredity, male and posi ve heredity were 2.7 mes more likely to have hypertension grade 2. Conclusion: Salt consump on, age, sex-linked, heredity was significantly correlated with hypertension grade. Salt consump on was a risk factors which has the highest impact. Public health center should educate people about the recommenda on of daily salt intake to prevent the excessive intake that may affect hypertension.

Hubungan Antara Kadar Hemoglobin dan Status Gizi dengan Produktivitas Pekerja Wanita di Bagian Percetakan dan Pengemasan di UD X Sidoarjo

Background : Work produvtivity is the top priority demanded of every workforce to produce the product. Many factors can affect work produktivity such as nutritional status and anemia. Anemia is a nutritional problem that can cause fatigue, weakness, loss of work capacity and produktivity.Objective: The purpose of this research was to analyze the relation between hemoglobin levels and nutritional status with women employee’s produktivity in stamping and packaging section at UD X Sidoarjo.Methods: This reserch was an observational analytic study designed with cross sectional. The population was all women employees in production of 130 people and the sample of 54 respondents selected by random sampling. Data collection used height and weight measurement, measurement of hemoglobin levels, and questionnaires. Data were analyzed using chi square test.Results: The result showed that there was a correlation between the nutritional status and productivity (p=0.014), but there was no correlation between Hb concentration and productivity (p=0.836).Conclusion: The better the nutritional status were, the higher the productivity would be. It is recommended that the women employees of this company to aware on their nutritional status.ABSTRAKLatar Belakang: Produktivitas kerja menjadi hal utama yang harus dimiliki setiap tenaga kerja untuk menghasilkan produk. Banyak faktor yang dapat mempengaruhi produktivitas kerja seperti status gizi dan anemia. Anemia merupakan masalah gizi yang dapat menyebabkan kelelahan dan penurunan kapasitas kerja serta produktifitas pada tenaga kerja.Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan antara status gizi dan kadar hemoglobin dengan produktivitas pekerja wanita bagian percetakan dan pengemasan di UD X Sidoarjo.Metode: Jenis penelitian yang dilakukan merupakan observasional analitik dengan menggunakan pendekatan cross sectional. Populasi pada penelitian ini merupakan semua pekerja wanita di bagian produksi sebanyak 130 orang dan didapatkan besar sampel sebanyak 54 responden yang dipilih secara random sampling. Teknik pengumpulan data menggunakan pengukuran tinggi dan berat badan, pengukuran kadar hemoglobin, dan kuesioner. Analisis data menggunakan uji chi square.Hasil: Penelitian menunjukkan bahwa responden cenderung memiliki produktivitas diatas rata-rata. Terdapat hubungan antara status gizi dengan produktivitas (p=0,014), namun tidak terdapat hubungan antara kadar hemoglobin dengan produktivitas (p=0,836).Kesimpulan: Semakin baik status gizi semakin meningkat produktivitasnya. Tidak ada hubungan antara kadar Hb dengan produktivitas. Dianjurkan agar pegawai wanita perusahaan menyadari status gizi mereka.

Antiplasmodial Activity of Isolated Polyphenols from Alectryon serratus Leaves Against 3D7 Plasmodium falciparum

Background:

Alectryon serratus was selected from a screening program devoted to search naturally occurring antimalarial compound from plants in Alas Purwo National Park, Banyuwangi, East Java, Indonesia. The previous studies showed that ethanol extract of A. serratus leaves contains some polyphenol compounds.

Objective:

This study was designed to isolate and investigate antiplasmodial activity of polyphenol compounds.

Material and Methods:

The ethanol extract of A. serratus leaves was fractioned using liquid–liquid fractionation and column chromatography. Isolated compounds were identified using High-performance liquid chromatography, ultraviolet-visible, nuclear magnetic resonance, and compared with references. The isolates were tested in vitro for antiplasmodial activity against chloroquine-sensitive 3D7 strain of Plasmodium falciparum. Thin blood smears were used to assess the levels of parasitemia and growth inhibition of the isolates.

Result:

Half maximal Inhibitory concentration of Gallic acid (1), methyl gallate (2), and kempferol-3-O-rhamnoside (3) were 0.0722 μM, 0.0128 μM, and 3.4595 μM, respectively.

Conclusion:

The results suggest that gallic acid, methyl gallate, and kempferol-3-O-rhamnoside isolated from A. serratus leaves have antiplasmodial activity and are potential to be developed as antimalarial drugs.

SUMMARY

The ethanol extract of Alectryon serratus leaves was successively fractionated in CH₂Cl₂, EtOAc, and n-butanol. EtOAc fraction was fractionated using column chromatography and purified using preparative thin-layer chromatography (TLC). Isolates were studied for their antiplasmodial activity on parasites culture of chloroquine-sensitive 3D7 strain of Plasmodium falciparum. Parasitemia percentages, growth percentages, and inhibition percentages of each group were calculated. The half maximal inhibitory concentration (IC₅₀) values that represent the concentration required to inhibit 50% of Plasmodium growth were calculated from a calibration curve using linear regression. The results suggest that isolates have antiplasmodial activity and are responsible in the antimalarial activity of Alectryon serratus leaves.

Abbreviations Used: S.F: Subfraction, EGCG: Epigallocatechingallate, EGC: Epigallocatechin

An Action Error of Nursing Procedures: Types and Cause Factor Ners Profession Student

Introduction: An error could be danger for the safety of patients. Ners students because of its lack clinical experiences are at risk to make an error in medication or procedure to the patient. The purposes of this study are to identify types and causes error events conducted by ners students.Method: This is a qualitative study. The participants are 29 students for answering the open questionnaire and 5 students for in-depth interview. The instruments are open questionnaire and interview guideline. Data analysis is used content analysis.Result: This study revealed that the error is classified into 2 types: error related to medication and nursing procedures. The natures of error are from mild to severe error. The factors of error are classified into 3 categories: student  factor, environment and preceptor factor. The student factors: lack of confidence, nervous, first time experience, and lack of practice. Environment factor: lack of facilities, emergency condition, lack of supervision, and lack of patient safety habit in the hospital. Preceptor factors: lack of guidance, unclear instruction.Discussion:The students feeling when doing an error is classified into 2: negative and positive feeling. Negative feelings are fear, feeling guilty. Positive feeling: motivated to learn. The student actions after doing an error are keep silent, inform to other students, or inform the preceptor or hospital nurses. The suggestion from this research is improving the skills lab education during academic phase and developing procedure for manage and prevent the error.