HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) vs. ADIPOSE-TISSUE-BASED THERAPY AS A THERAPEUTIC OPTION IN SYSTEMIC SCLEROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS Introduction: Systemic sclerosis (SSc) is a multisystem autoimmune disease. Currently, there is no cure for this disease. One of the emerging therapies for SSc includes hematopoietic stem cell transplantation (HSCT) and adipose-tissue-based therapy. A study that compares the usage of HSCT with adipose-tissue-based therapy in SSc has not been made. The objective of this study was to conduct a systematic review and meta-analysis that compared the efficacy of HSCT and adipose-tissue-based therapy in SSc. Methods: A comprehensive literature search was conducted from inception to 14th June 2023 in PubMed, CENTRAL, EBSCOhost, ProQuest, SAGE, and JSTOR. The inclusion criteria are: (1) Investigated the effects of HSCT or adipose-tissue-based therapy in SSc; (2) Study design is RCT; (3) Is a human study; (4) Written in English; (5) Full-text is available. The quality of evidence was assessed using Cochrane risk of bias 2 (RoB 2). Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). The outcomes are mean change in modified Rodnan skin score (mRSS), visual analog scale (VAS), quality of life (QoL), activities of daily living (ADL), and adverse events (AEs). Results: A total of 1011 articles were obtained after duplicate removal with 32 retrieved for a second screening and nine assessed for eligibility. Five articles were included in the systematic review and four in the meta-analysis. Overall, our study found 170 patients in the intervention group and 158 controls. There was a more significant change in the mean mRSS in those who received HSCT compared to adipose-tissue-based therapy (P < 0.00001). HSCT had significantly more SAEs compared to adipose-tissue-based therapy (P = 0.04). Two out of three HSCT studies reported two deaths in the HSCT group compared to no deaths in control. In contrast, there was no event of death in both the adipose-tissue-based therapy and control groups. There was a moderate risk of bias for our study and a moderate level of confidence. Conclusion: In conclusion, this meta-analysis suggested that HSCT might be superior to adipose-tissue-based therapy as therapy in SSc patients. Some of the limitations of our studies are the small number of studies, exclusion of non-English studies, and lack of studies that directly compared HSCT against adipose-tissue-based therapy. Thus, we strongly suggest more research regarding HSCT and adipose-tissue-based therapy in SSc patients to be conducted.

FOE OR FRIEND? SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS AND COVID-19 VACCINATION: A SYSTEMATIC REVIEW Background: In the early year of 2020, SARS-CoV-2 was first diagnosed in Indonesia after an outbreak in Wuhan, China. Later, this disease became a worldwide pandemic. Systemic lupus erythematosus (SLE) patients are more vulnerable to COVID-19. They are also prone to relapse and have lower efficacy for COVID-19 immunization. Objective: This study aimed to evaluate the antibody seroconversion and disease status after COVID-19 vaccination in SLE patients. Method: We followed the PRISMA guidelines to systematically search and collect literature in the following databases: ProQuest, PubMed, EBSCOhost, SAGE, JSTOR, and ScienceDirect from 1st January 2019 to 24th April 2023. Titles and abstracts were reviewed for relevance. The inclusion criteria are original articles, written in English, investigated the effects of COVID-19 vaccination in SLE patients. The quality of evidence was evaluated using the Newcastle-Ottawa Scale. Results and Discussion: From 1,088 studies, we retrieved nine studies for this review. There were cohort studies (n = 5), case-control studies (n = 2), and observational studies (n = 2) published between 2021 and 2022. Vaccines against SARS-CoV-2 are currently widely available and SLE patients should receive vaccination. In a large study involving healthy individuals and healthcare professionals, nearly all of the individuals who received two doses of BNT162b2 developed antibodies to the vaccine. Seroconversion after a first COVID-19 vaccination is delayed in older patients on specific immunosuppressive drugs. Conclusion: This systematic review found that the overall immunogenicity and safety of COVID-19 vaccines were satisfactory in patients with SLE.

A 22-YEAR-OLD MAN WITH LYMPH NODE TUBERCULOSIS AND ADULT ONSET STILL’S DISEASE: A RARE CASE REPORT Adult-onset Still's disease (AOSD) is a rare systemic inflammatory sickness with an unknown cause that is marked by a spiking fever that frequently exceeds 39o Celsius, evanescent skin symptoms, arthralgia or arthritis, and multiorgan involvement. Many diseases, such as infections, neoplasia, or immune diseases, can mimic AOSD. We found a rare condition lymph node tuberculosis (TB) with AOSD reported from Indonesia. A 22-year-old man had a prolonged fever, joint pain, reddish rash on extremities, and yellow eye membranes one week after taking a fixed combination anti-tuberculosis drug. The patient had a history of TB cervical lymphadenitis. Clinical examination disclosed salmon-colored rash, arthritis on wrists and shoulder, icterus, and hepatosplenomegaly. Laboratory results also revealed elevated leukocyte, bilirubin, c-reactive protein (CRP), and ferritin levels. Abdominal ultrasound found no cholestasis or obstruction. Immunological examinations showed negative antinuclear antibody (ANA), antibody streptolysin O (ASTO), rheumatoid factor, and hepatitis infection. According to Yamaguchi criteria, this patient fits the diagnosis of AOSD. Oral colchicine was also given with corticosteroids and cyclosporine. The treatment improved the patient’s conditions, with normalization of leukocyte, ferritin, and CRP count. The dose of prednisolone was successfully tapered, and remission was achieved in 2 months after oral administration of colchicine. This case highlights the importance of consideration of AOSD as a potential diagnosis in the presence of abnormal liver function tests and that one should not be misled into a diagnosis of drug-induced liver injury (DILI). Colchicine treatment silenced the disease activity of AOSD.

REV-ERBα MITIGATES HEART FAILURE BY EXERTING TRANSCRIPTIONAL REPRESSION: A LITERATURE REVIEW Heart failure (HF) is a major cause of mortality, affecting millions of people in the United States. Current treatments focus on minimizing stress and improving hemodynamics, but there is still a need for an effective strategy that can selectively inhibit the abnormal gene program associated with HF. Rev-erb, a member of the nuclear receptor superfamily, has been identified as a potential therapeutic target for HF due to its role in regulating circadian rhythm, glucose and lipid metabolism, and inflammation. Synthetic Rev-erb agonists have shown promise in preclinical studies, improving metabolic and inflammatory pathways while also enhancing mitochondrial function. Long-term therapy with these agonists has also been shown to reduce atherosclerotic plaque. While more research is needed to fully understand Rev-erb’s functions in HF development, it represents a potentially exciting new avenue for treatment. This literature review explores the potential use of Rev-erb agonists as a therapeutic target for HF patients.

Background: Heart failure (HF) is a complex clinical syndrome with signs and symptoms resulting from any structural dysfunction of ventricular filling or blood ejection. miRNAs were known as essential regulators and tissue-specifically expressed. MicroRNA-155 (miR-155) expression in macrophages is already well known to promote hypertrophy, cardiac inflammation, and failure due to pressure overload. In this study, we aim to identify the role of expression miR-155 as a potential biomarker for HF. Method: We incorporated search engines from Google Scholar, PubMed, EBSCO Host, and ProQuest to search the articles. Newcastle Ottawa Scale (NOS) was used to evaluate the bias risk in the case-control research. A systematic database search reveals 6 relevant studies. Results: This research found that miR-155 levels were significantly higher in heart failure patients than in the MI and control groups. MiR-155's plasma levels in heart failure are higher than the control group, with a cut-off value of 0.8591, a sensitivity value of 98.5%, and a specificity value of 64.6%. However, miRNA expression patterns do not appear to differ significantly between pf and cf LVAD. Most cardiac changes and clinical outcomes specific to each device are independent of differences in miRNA expression levels. According to one study, miR-155, a diagnostic biomarker for heart failure, had a specificity of 92.14% and a cutoff value of 1.77%. Conclusion Our systematic review showed that miR-155 could be a potential new diagnostic biomarker in HF patients.
MicroRNAs

Introduction: Coronavirus disease 2019 (COVID-19) is a condition brought on by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) where this virus is highly contagious. In several studies, acute kidney injury was associated with the cause of death. This study aimed to analyze what factors played a role as predictors of mortality in COVID-19 patients who experienced acute kidney injury. Method: This study used a one-center retrospective cohort method where the study was conducted at Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia. Statistical analysis of multivariate logistic regression was performed, and the results were presented in the form of an odds ratio (OR), with a p-value considered significant < 0.05 and a 95% confidence interval. Results: A total of 498 COVID-19 patients with acute kidney injury were included in this study. Our research found that 153 subjects (30.7%) died. The results of multivariate logistic regression analysis showed that the largest OR value was the D-dimer value variable, namely 2.102 (95% CI: 1.361-3.247), which means that COVID-19 patients with acute kidney injury who have a D-dimer value of ≥ 1.2 mg/L have the possibility of experiencing mortality within 30 days was 2.1 times greater than in patients with D-dimer values < 1.2 mg/L. The next variables were albumin value < 3.5 g/dL (OR 2.015, 95% CI: 0.992-4.091), history of hypertension (OR 2.003, 95% CI: 1.343-2.988). Conclusion Our study found that a history of hypertension, higher than normal D-dimer levels, and hypoalbuminemia were predictors of mortality in patients with acute kidney injury who were infected with COVID-19.
Medicine