[No abstract available]
Editorial

BACKGROUND : Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that impacts several organ systems. Regulatory T cells (Tregs) are essential for maintaining immunological tolerance, and their dysregulation has been found linked to the pathogenesis of SLE. This study aimed to evaluate the correlation between CD4⁺CD25⁺FOXP3⁺ Treg levels and disease activity, as measured by the MEX-SLEDAI score, in patients with SLE. METHODS : A cross-sectional study was conducted involving 40 SLE patients treated in the Allergy and Immunology outpatient clinic and inpatient ward of Mohammad Hoesin Hospital from June 1, 2024 to August 31, 2024. Inclusion criteria were adults (≥18 years) diagnosed with SLE who provided informed consent. Exclusion criteria included other history autoimmune or immunocompromised conditions, pregnancy or lactation, hormonal contraceptive use, and active severe infection. CD4⁺CD25⁺FOXP3⁺ Treg cell levels were measured by flow cytometry. Disease activity was assessed using the MEX-SLEDAI score. Spearman’s correlation test was used to analyze the association between Treg levels and disease activity. RESULTS : Of 40 enrolled subjects (39 women, 1 man), 75% were aged 20–44 years. Mucocutaneous manifestations were the most common clinical feature (95%). Nephritis and hematologic involvement were most frequently observed in patients with severe disease activity. A strong negative correlation was identified between CD4⁺CD25⁺FOXP3⁺ Treg cell levels and MEX-SLEDAI scores (R = –0.72, p<0.001), indicating that lower Treg levels were associated with higher disease activity. CONCLUSIONS CD4⁺CD25⁺FOXP3⁺ Treg levels show a significant negative correlation with MEX-SLEDAI disease activity in SLE. Lower Treg cell levels reflect more severe disease activity.
disease progression ; flow cytometry ; systemic lupus erythematosus ; Treg cells

BACKGROUND : Heart disease in children is frequently diagnosed late in life. This study aimed to establish and validate a scoring system to screen for heart disease in children, based on clinical examinations to accelerate referral. METHODS : This 2-phase cross-sectional study was conducted in pediatric cardiology outpatients and emergency room Ngoerah Hospital, Bali, Indonesia, from January to May 2024 and July to October 2024. Children aged 0–18 who were suspected of having heart disease and willing to be research participants were included in this study. Patients who had already been diagnosed with heart disease and acute lower respiratory tract infection were excluded from the study. The chi-square, multivariate logistic regression, and ROC analysis were performed to identify and validate variables eligible for the scoring system. Phase 1 for generating the score, continued to phase 2 to validate the developed score. RESULTS : Of 310 patients enrolled, 15 were excluded from the study. Congenital heart disease was the dominant condition in this study. The first model of the scoring system, named VEKARD score, consisted of a significant murmur, exercise intolerance, difficulty in breathing, and SpO2 <95%. The second model replaced SpO2 <95% with cyanosis, which can be used if pulse oximetry is not available. Using a sensitivity-first threshold suitable for screening purposes, a cutoff ≥1 for model 1 and cutoff ≥2 for model 2 yielded sensitivities of 85% and 81.8%, respectively. Both models underwent validation in a sample of 241 patients. The results demonstrated good discriminative performance, with AUC values of 0.859 for model 1 and 0.853 for model 2. CONCLUSIONS The VEKARD score can be used to enhance pediatric heart disease screening and accelerate referral to tertiary healthcare facilities, thereby preventing delays in treatment.
children ; heart disease ; heart murmur ; prediction ; score

BACKGROUND : Exergames have been proven to effectively improve physical function, particularly in the elderly. Although, older adults were once considered a low-tech population, tailored exergame interventions have proven beneficial. However, utilizing virtual reality (VR) in group presents challenges related to both cognitive acceptance and cardiovascular tolerance. This study aimed to evaluate cardiovascular responses, safety, and exercise intensity or VR-based exergaming in an acute care setting and to explore what to consider when giving exergames to subjects with high comorbidity. METHODS : This pre-post study used the Oculus Meta Quest 2® platform in 32 elderly participants. Each completed a single exergame session. Pre- and post-session assessments included measurements of heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Cardiopulmonary sentinel signs were monitored thoroughly. RESULTS : Post-exergame HR was significantly higher than baseline (82 [18] beats per minute [bpm] versus 79 [17] bpm; p = 0.004; mean difference: 4 [8] bpm). Blood pressure decreased slightly, but not significantly (SBP: −1 [14] mmHg, p = 0.837; DBP: 0 [12] mmHg, p = 0.829). Most participants experienced light-intensity activities (n = 26, 81%). No sentinel events occurred. CONCLUSIONS A single session of VR exergaming safely increased HR above baseline in elderly participants, with activity predominantly classified as light intensity. Further studies should explore the determinants of exergame intensity to optimize prescriptions and tailoring.
elderly ; exergames ; heart rate ; virtual reality

BACKGROUND : The incremental shuttle walk test (ISWT) and six-minute walk test (6MWT) assess cardiorespiratory endurance in sedentary populations, with the ISWT being externally paced and the 6MWT self-paced. This study aimed to evaluate whether both tests produce comparable cardiorespiratory responses. METHODS : 100 healthy sedentary adults (18–59 years) from Cipto Mangunkusumo Hospital completed both tests. Outcomes measured included distance traveled, maximal heart rate (HRmax), and Borg scale scores (rating of perceived exertion [RPE], dyspnea, and leg fatigue). RESULTS : Of 100 sedentary adults (25 men, 75 women), the ISWT resulted in significantly longer walking distances (p<0.001), higher post-test Borg dyspnea scores (median [interquartile range]: 2 [1–3]) versus 1 [0–2]; p = 0.024), and the higher HRmax (70.9 [9.2%] bpm versus 67.9 [10.9%] bpm; p = 0.004) compared to the 6MWT. No significant differences were observed in other parameters, and Bland–Altman analysis revealed no proportional bias for Borg leg fatigue scores (p = 0.561). CONCLUSIONS In healthy sedentary adults, the 6MWT and ISWT showed no agreement in distance traveled, Borg dyspnea scale scores, or HRmax, but they agreed on Borg leg fatigue scores.
exercise test ; exercise tolerance ; incremental shuttle walk test ; physical fitness ; six-minute walk test