Introduction: Isolated hypothyroxinemia (IH) in pregnancy, characterized by low free thyroxine 4 (FT4) with normal thyroidstimulating hormone (TSH), has a reported prevalence of 1.3–8%. We present a diagnostically challenging case that initially mimicked central hypothyroidism before evolving into classic IH. Case: A 37-year-old G4P3 female at 22 + 3 weeks gestation with β-thalassemia trait presented with palpitations and tachycardia (150–184 bpm). A bedside echocardiogram showed volume depletion. Her heart rate improved to 108– 116 bpm following a 1.5 L normal saline bolus. Incidentally, thyroid function tests (TFTs) revealed both low FT4 6.04 pmol/L (7.86–14.41) and low TSH 0.009 mIU/L (0.38–5.33). Anti-thyroid peroxidase antibody was markedly elevated at 360 IU/mL (<35). At 24 + 4 weeks, TFTs showed persistently low FT4 (5.84 pmol/L) and TSH (0.022 mIU/L). Differential diagnoses included central hypothyroidism or assay interference. Tests were repeated using different platforms. Both the Beckman system (FT4: 5.73 pmol/L, TSH: 0.086 mIU/L) and Roche system (FT4: 8.83 pmol/L [12.0–22.0], TSH: 0.11 mIU/L [0.27–4.20]) confirmed low values, ruling out assay interference. Following endocrinology consultation and given her asymptomatic status, IH was considered most likely, and a plan for close monitoring was initiated. Serial follow-up demonstrated biochemical evolution. By 31 + 6 weeks, TFTs showed a low TSH (0.753 mIU/L) with an FT4 level (5.86 pmol/L) within the normal reference range, a pattern typical of IH in pregnancy. Repeat TFTs 6 weeks postpartum showed both TSH and FT4 within normal range. Conclusion This case illustrates a rare and unexpected biochemical progression of IH in pregnancy, initially presenting with a pattern indistinguishable from central hypothyroidism. It underscores that in an asymptomatic, fertile patient, IH can manifest with an atypical pattern early in gestation. The findings suggest that vigilant serial monitoring, rather than immediate extensive pituitary workup, may be a prudent initial approach in such scenarios, as the biochemical profile can normalize toward the classic IH pattern as pregnancy advances.
Female ; Pregnancy ; Thyrotropin

Introduction: Sinomenine, derived from Sinomenium acutum, has been reported as a potential treatment for morphine addiction but its mechanisms are poorly understood. Hence this study was conducted to investigate the potential mechanisms underlying sinomenine effects on morphine addiction. Materials and methods: Potential protein targets for sinomenine were predicted using SwissTarget Prediction and PharmMapper while morphine addiction targets were collected from DisGeNet and GeneCards databases. Protein-protein interaction was examined using GeneMANIA web server while Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were conducted using ShinyGO online tool. Topological network analysis was performed using Cytoscape to measure the degree centrality, betweenness centrality and closeness centrality values while molecular docking analysis was done using AutoDock Vina to determine the binding energies and interactions. Results: A total of 15 sinomenine targets were identified to be involved. Among the identified targets, 37.94% shared protein domains and 19.64% displayed physical interactions. Relevant biological processes, molecular functions, cellular components and signalling pathways were identified involving G-protein coupled opioid receptor signalling pathways and activities, integral component of presynaptic membrane and mitophagy. Molecular docking suggested that the substituted aromatic ring of sinomenine plays important roles in the binding to the protein targets. The top five most significant protein targets were identified based on the binding energies and degree centrality values, namely OPRD1, OPRK1, NOS1, OPRM1 and SRC. Conclusion: Sinomenine interacted with various protein targets and pathways which can potentially treat morphine addiction mainly via opioid receptors and their signalling pathways

Background: Thermal traumas impose a huge burden on healthcare systems. This merits the need for advanced but cost-effective remedies with clinical prospects. In this context, we prepared a regenerative 3D-construct comprising of Cassia angustifolia extract (SM) primed adipose-derived stem cells (ASCs) laden amniotic membrane for faster burn wound repair. Methods: ASCs were preconditioned with SM (30 µg/ml for 24 h), and subsequently exposed to in-vitro thermal injury (51 °C,10 min). In-vivo thermal injury was induced by placing pre-heated copper-disc (2 cm diameter) on dorsum of the Wistar rats. ASCs (2.0 × 105) pre-treated with SM (SM-ASCs), cultured on stromal side of amniotic membrane (AM) were transplanted in rat heat-injury model. Non-transplanted heat-injured rats and non-heat-injured rats were kept as controls. Results: The significantly upregulated expression of IGF1, SDF1A, TGFβ1, VEGF, GSS, GSR, IL4, BCL2 genes and downregulation of BAX, IL6, TNFα, and NFkB1 in SM-ASCs in in-vitro and in-vivo settings confirmed its potential in promoting cell-proliferation, migration, angiogenesis, antioxidant, cell-survival, anti-inflammatory, and wound healing activity. Moreover, SM-ASCs induced early wound closure, better architecture, normal epidermal thickness, orderly-arranged collagen fibers, and well-developed skin appendages in healed rat-skin transplanted with AM+SM-ASCs, additionally confirmed by increased expression of structural genes (Krt1, Krt8, Krt19, Desmin, Vimentin, α-Sma) in comparison to untreated-ASCs laden-AM transplanted in heat injured rats. Conclusion SM priming effectively enabled ASCs to counter thermal injury by significantly enhancing cell survival and reducing inflammation upon transplantation. This study provides bases for development of effective combinational therapies (natural scaffold, medicine, and stem cells) with clinical prospects for treating burn wounds.

In 2015, Indonesia was ranked as the second-highest, with a percentage of 12.9%. Open Defecation Free (ODF) in Indonesia is still a problem, 33 out of 34 provinces in Indonesia are still not 100% verified as ODF. The purpose of this study is to make a management control of OD behaviour in Indonesia. This study’s literature was collected using Google Scholar and Pubmed search engines by entering keywords open defecation Indonesia, and buang air besar sembarangan. From review of published literature, it is found that several factors cause people to practice OD, namely environmental, socio-cultural, and economic factors. These factors become the basis for making OD model control with a logic model. The program was made with a button-up approach carried out through several activities, namely approaches to community leaders, youth, and local communities, monitoring potential areas for OD practice and cross-sector coordination, and making regional regulations.

Coronavirus 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). To date, the disease has spread globally and caused 4 million deaths worldwide. SARS-CoV-2 spreads rapidly, leading to significant impacts on healthcare systems, social disruption and economic loss. To date, real time reverse transcription polymerase chain reaction remains the gold standard for diagnosis. However, it is costly and time consuming which result in delayed treatment and isolation of infected individuals. Hence, reliable and rapid diagnostic method is required for rapid detection of SARS-CoV-2. There have been a number of COVID-19 rapid diagnostic tests developed and evaluated widely for COVID-19 diagnosis, but a number of concerns related to these products have arisen. In this review, we provide an update on the available COVID-19 rapid diagnostic tests and discuss the feasibility and acceptability of these rapid tests for COVID-19 diagnosis. Continuous global improvement in diagnostic test is crucial for rapid detection of the infection to optimize patient management and prevent the spread of disease.
Rapid Diagnostic Test

Organochlorine organic pesticides used on a large scale still pose a great health hazard to humans and animals. Organochlorine pesticides contribute to reduced disease, higher yields and increased production. This research was to review various articles on management of organochlorine exposure and health risks. This research used multiple search engines (Scholar, PubMed). A few significant keywords were chosen to discover considers that fit this theme. Organochlorine as Persistent Organic Pollutants are difficult to remove from the environment. There are several health-causing effects of organochlorine most of which are chronic diseases (i.e., pulmonary function, cancer, reproductive issue). Organochlorine control in the environment is needed to reduce health effects, especially in farming communities, personal protective equipment including masks and gloves is also necessary. Local government may also promote and doing a prevention program from the danger of the use of pesticides in agriculture.

Hyperinflammation and cytokine storm has been noted as a poor prognostic factor in patients with severe pneumonia related to coronavirus disease 2019 (COVID-19). In COVID-19, pathogenic myeloid cell overactivation is found to be a vital mediator of damage to tissues, hypercoagulability, and the cytokine storm. These cytokines unselectively infiltrate various tissues, such as the lungs and heart, and nervous system. This cytokine storm can hence cause multi-organ dysfunction and life-threatening complications. Mavrilimumab is a monoclonal antibody (mAb) that may be helpful in some cases with COVID-19. During an inflammation, Granulocyte-macrophage colony-stimulating factor (GM-CSF) release is crucial to driving both innate and adaptive immune responses. The GM-CSF immune response is triggered when an antigen attaches to the host cell and induces the signaling pathway. Mavrilimumab antagonizes the action of GM-CSF and decreases the hyperinflammation associated with pneumonia in COVID-19, therefore strengthening the rationale that mavrilimumab when added to the standard protocol of treatment could improve the clinical outcomes in COVID-19 patients, specifically those patients with pneumonia. With this review paper, we aim to demonstrate the inhibitory effect of mavrilimumab on cytokine storms in patients with COVID-19 by reviewing published clinical trials and emphasize the importance of extensive future trials.

Hyperinflammation and cytokine storm has been noted as a poor prognostic factor in patients with severe pneumonia related to coronavirus disease 2019 (COVID-19). In COVID-19, pathogenic myeloid cell overactivation is found to be a vital mediator of damage to tissues, hypercoagulability, and the cytokine storm. These cytokines unselectively infiltrate various tissues, such as the lungs and heart, and nervous system. This cytokine storm can hence cause multi-organ dysfunction and life-threatening complications. Mavrilimumab is a monoclonal antibody (mAb) that may be helpful in some cases with COVID-19. During an inflammation, Granulocyte-macrophage colony-stimulating factor (GM-CSF) release is crucial to driving both innate and adaptive immune responses. The GM-CSF immune response is triggered when an antigen attaches to the host cell and induces the signaling pathway. Mavrilimumab antagonizes the action of GM-CSF and decreases the hyperinflammation associated with pneumonia in COVID-19, therefore strengthening the rationale that mavrilimumab when added to the standard protocol of treatment could improve the clinical outcomes in COVID-19 patients, specifically those patients with pneumonia. With this review paper, we aim to demonstrate the inhibitory effect of mavrilimumab on cytokine storms in patients with COVID-19 by reviewing published clinical trials and emphasize the importance of extensive future trials.

This paper presents a design process of workstation with ergonomic features for University Kuala Lumpur MIDI Classroom. The workstation is expected to support body posture, with the aim to increase comfortability of a user usage for long periods in a class. Besides that, the workstation will ensure a conducive and responsive learning environment. Discomfort and an improper position can negatively affect overall health and productivity. A new design of workstation, which allows user to sit in ideal sitting position suggested by ergonomist and easy transition from one teaching mode to the next. The researcher has designed and developed a new workstation which has ideal ergonomic sitting working position and capable accommodate 50th percentile human size. These positions were used to evaluate the comfort of the workstation. Subjective evaluations, including comparison of the prototype and standard workstation setup, were carried out using human subjects and ergonomic principles. Result showed that the new workstation is much more comfortable, supporting the body in a balanced way. Users have the freedom to stretch and relax in different working positions before they feel any noticeable discomfort. As a result, it lets user sit for a longer period without strain, thus resulting in higher productivity and concentration in classroom.

BACKGROUND: Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery. METHODS: This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene. RESULTS: In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ²=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05). CONCLUSIONS Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.