Objectives: Catastrophic health expenditures (CHE) is a well-established indicator of financial risk protection. This study aimed to examine the contribution of medication expenditure to CHE and the associated socioeconomic inequalities. Methods: Data were drawn from 6 nationally representative income and expenditure surveys covering the period 2019–2024. Using the budget share method, CHE was defined as out-of-pocket (OOP) health payments exceeding 25% of a household’s total consumption expenditure. The contribution of medication expenditures to CHE was then calculated as the difference in the proportion of households experiencing CHE with and without medication payments. Socioeconomic inequalities were quantified using the Concentration Index (CI), and decomposition analysis was conducted to identify the primary drivers of overall socioeconomic inequality in the contribution of medication expenditures to CHE. Results: During the study period, medications represented a substantial share of household health expenditures and contributed to CHE. In 2024, OOP spending on medications accounted for 31.2% of total health expenditures, while the contribution of medication expenditures to CHE was 1.28%. The CI indicated that the contribution of medication expenditures to CHE was concentrated among poorer households. Decomposition analysis further identified medium-sized households, male-headed households, households with employed heads, insured households, and urban households as the main contributors to this socioeconomic inequality. Conclusions In Iran, OOP payments for medications constitute a substantial share of household healthcare expenditures and contribute to CHE. Because the roots of inequality extend beyond the healthcare system, addressing this issue requires a comprehensive, cross-sectoral strategy that integrates broader social and economic policies.

Purpose: This study evaluated the feasibility and effectiveness of autologous adipose-derived mesenchymal stem cell (ASC) transplantation into the lacrimal gland for treating aqueous-deficient dry eye disease (DED) associated with Sjögren syndrome. Methods: Patients with Sjögren syndrome–related DED underwent autologous adipose tissue harvest via liposuction. ASCs were isolated, cultured, and injected into the lacrimal gland (volume ≤50% of estimated gland volume). Clinical evaluations— including Ocular Surface Disease Index (OSDI), tear osmolarity, tear film breakup time (TBUT), Oxford corneal staining, and Schirmer test I—were conducted at 1-, 4-, 16-, and 24-weeks after injection. Visual quality assessments included contrast sensitivity and higher-order aberrations (HOAs). Results: Six patients (mean age 56.1 ± 7.2 years) completed the study. Mean OSDI scores significantly decreased from 48.6 ± 8.4 to 28 ± 2.1. TBUT improved in both eyes (right, 3.3 ± 1.0 to 5.6 ± 1.2 seconds; left, 3.6 ± 1.0 to 6.1 ± 1.6 seconds). Schirmer test I values increased (right, 4.1 ± 0.7 to 7.8 ± 0.7 mm; left, 4.0 ± 0.6 to 7.6 ± 0.5 mm). Oxford staining scores decreased (right, 1.6 ± 0.5 to 0.67 ± 0.2; left, 1.3 ± 0.5 to 0.67 ± 0.2). Tear osmolarity also improved (right, 311.6 ± 6.1 to 299.1 ± 5.8 mOsm/L; left, 309 ± 7.6 to 298.3 ± 7 mOsm/L). HOAs were reduced in one eye. No significant change in contrast sensitivity or visual acuity was observed. No adverse events were reported. Conclusions Autologous ASC transplantation into the lacrimal gland appears to be a safe and promising therapeutic option for aqueous-deficient DED in Sjögren syndrome, offering significant improvement in both objective measures and patient-reported symptoms over a 6-month period.

Extracranial carotid artery aneurysms (ECAAs) are rare, and the optimal therapeutic modality for these lesions remains controversial. Surgical resection and covered stents may be limited to selected cases. While the concept of using flow diversion is appealing for large aneurysms, the application of flow diverters in extracranial carotid lesions may face restrictions due to off-label use, reimbursement challenges, and factors related to the devices themselves. We report our experience with multiple overlapping Low-profile Visualized Intraluminal Support (LVIS) stents as a reconstructive option for selected ECAAs. Five patients with large ECAAs were treated with multiple overlapping LVIS stents. The primary goal was parent-artery reconstruction and reduction of intra-aneurysmal flow reduction by increasing local metal coverage across the neck of the aneurysm. Double overlapping LVIS stents were used in 3 cases, whereas triple or more extensive overlapping constructs were used in 2 cases. During a mean radiologic follow-up of 24 months, complete occlusion in 2 cases, partial occlusion in 3 cases, and adjunctive procedures in 3 cases were required, and no major thromboembolic or hemorrhagic complications were documented. Adjunctive or staged treatment was required in 3 cases, including balloon angioplasty, additional LVIS stenting, flow-diverter placement, stent-graft placement, or coil embolization. Multiple overlapping LVIS stenting is a feasible and relatively safe reconstructive option for selected large or clinically significant ECAAs, particularly when primary flow-diverter treatment is constrained by off-label indication or reimbursement issues. However, they have limited standalone efficacy, particularly in large or complex aneurysms, often requiring adjunctive or staged treatment.

Introduction: Obstructive sleep apnoea (OSA) is characterised by recurrent pharyngeal collapses that occur five or more times per hour of sleep or more and reduce or completely block airflow for at least 10 seconds. Obesity predis-poses individuals to and potentiates OSA. Materials and methods: As a pre- and post-training activity measure, 30 obese people between the ages of 25 and 45 were asked to complete the STOP-BANG questionnaire and a 6-minute walk test. After that, they engaged in aerobic activity. Results: The scores for the six-minute walk test and the stop-bang questionnaire were 0.0005 and 0.0003, respectively with a “p” value- ≤0.001 (significant). In our investigation, the effects of aerobic exercise on exercise tolerance and obstructive sleep apnoea were significantly different. Con-clusion: Aerobic exercise is a better intervention for increasing exercise tolerance and obstructive sleep apnoea in obese patients. This intervention may be a significant contributor to cardiorespiratory fitness and can be considered a useful tool for enhancing quality of life.

Abstract Hyperkalemia (serum potassium >5.0 mEq/l) is a significant complication in patients with heart failure, chronic kidney disease, and diabetes mellitus, particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Both hyperkalemia and RAASi interruption are associated with increased cardiovascular events, hospitalizations, and mortality. This expert opinion document, developed between January and December 2024 through a systematic process, aims to establish guidance for hyperkalemia treatment in Indonesian patients with cardiorenal diseases receiving RAASi therapy, addressing the unique challenges within the Indonesian healthcare context. A comprehensive literature review of international guidelines and regional studies was conducted by a panel of 11 expert specialists (3 cardiologists, 6 internist-nephrologists, and 2 internist-cardiologists), who evaluated 29 statements covering diagnosis, monitoring, prevention, and treatment of hyperkalemia. Of the 29 statements, 26 reached consensus: 17 statements achieved very high agreement (≥90%) and 9 attained high agreement (≥67% – <90%). The agreed statements covered key areas, including potassium monitoring frequency, RAASi dose optimization strategies, dietary modifications, and treatment thresholds. Three statements regarding alternative therapeutic approaches did not receive agreement (<67%) due to limited local availability and cost considerations. Key recommendations include structured monitoring protocols for high-risk patients, strategies for RAASi dose optimization while managing hyperkalemia risk, and specific interventions adapted to local resources. This document provides a practical approach for managing hyperkalemia in Indonesian patients with cardiorenal diseases while maintaining optimal RAASi therapy, considering local Indonesian healthcare resources and constraints.
Hyperkalemia ; Cardio-Renal Syndrome ; Renin-Angiotensin System ; Indonesia

We report a case of a previously healthy 9-year-old boy who presented to the emergency department following accidental ingestion of 35% hydrogen peroxide. He developed emesis and mild abdominal pain and was found to have extensive portal venous gas, severe gastric pneumatosis, and free intraperitoneal air on a computed tomography scan. He was transferred to an outside hospital for hyperbaric oxygen therapy, with no emergency surgical intervention indicated. This case highlights the dangers of ingesting even a small amount of concentrated hydrogen peroxide in children and underscores the safe storage practices at home.

Thioacetamide (TAA)-induced liver fibrosis, triggered by inflammation and oxidative stress, is prompted by hepatic stellate cells (HSCs) activation via several pathways. This study explores the hepatoprotective effect of aloe vera gel (AVG) extract and bone marrow mesenchymal stem cells (BM-MSCs) transplantation on regulating long intergenic noncoding RNA (lincRNA-p21) and microRNA (miR-17-5p) expressions and their impact on TGF-β1/Smad-3 and Wnt-10a/ β-Catenin cascades in TAA-induced liver damage. The study involved 48 adult male albino rats divided into four groups:control, TAA, TAA treated with BM-MSCs, and TAA treated with BM-MSCs+AVG extract. After 8 weeks, liver enzymes and hepatic oxidative parameters were evaluated alongside lincRNA-p21, miR-17-5p, TGF-β1, Smad-3, Wnt-10a, and β-Catenin expressions. Liver tissue sections were examined by light and electron microscopes and analyzed morphometrically. Group II showed increased aspartate aminotransferase, alanine aminotransferase, malondialdehyde, reduced glutathione levels, and deteriorated hepatocytes with distorted mitochondria and dilated rough endoplasmic reticulum. Group IV restored lincRNA-p21 expression, which downregulated miR-17-5p and suppressed activated HSCs by inhibiting TGF-β1/Smad-3 and Wnt-10a/β-Catenin pathways, and improved hepatic tissue architecture. Additionally, immunohistochemically, alpha-smooth muscle actin and cyclin D1 expressions were markedly decreased in group IV compared to group II. We concluded that AVG suppresses fibrotic pathways, boosts BM-MSCs differentiation, and reduces HSCs activation in liver fibrosis caused by TAA.

Background: The Ascertain Dementia 8-item Questionnaire (AD8) is a validated informant-based interview for early dementia detection. Research suggests the utility of self-rated AD8 to identify milder dementia forms in research settings. This study compares the factor structure, reliability, and diagnostic performance between AD8-Self and AD8-Informant for early cognitive impairment (ECI) in a clinical setting. Methods: Five hundreds fifteen patient-informant dyads (43 cognitively intact and 472 ECI) from a tertiary memory clinic completed both self-reported and informant AD8. We conducted exploratory factor analysis to determine the factor structure, Cronbach’s alpha for internal consistency, and receiver operating characteristic (ROC) curve analysis for ECI, including a subgroup analysis for mild cognitive impairment (MCI). Results: The mean age and education of ECI participants were 75.61 years (range, 51–95) and 5.6 years (range, 0–20), respectively, and 72.6 years (range, 51–89) and 6.8 years (range, 0–16) in the MCI subgroup. Unlike AD8-Informant’s one-factor structure, AD8-Self had a two-factor structure corresponding to memory and non-memory domains. AD8-Self demonstrated lower reliability (Cronbach’s alpha: ECI 0.666 vs. 0.764; MCI 0.663 vs. 0.709). In ECI, AD8-Informant (cutoff score ≥3) showed better diagnostic performance (sensitivity 89%, specificity 79%) than AD8-Self (cutoff score ≥4; sensitivity 27.1%, specificity 95.3%) (AUC 0.915 vs. 0.593; p<0.001). Similar results were found in MCI (sensitivity 64.7% vs. 26.5%; specificity 79.1% vs. 95.3%; AUC 0.745 vs. 0.600; p=0.002). Conclusion AD8-Self has a distinct factor structure, lower reliability, and inferior diagnostic performance compared to AD8-Informant for ECI/MCI detection. Our result do not support AD8-Self as a standalone tool for detecting ECI or MCI.