Impact of COVID-19 Pandemic on Routine Childhood Immunization Programs in Indonesia: Taking Rural and Urban Area into Account

Background

To date, the primary global concern has revolved around addressing the COVID-19 pandemic. However, there is a growing awareness of the pandemic's secondary impacts on critical aspects of healthcare, such as childhood immunization programs.

Objective

This study aims to assess the impact of the COVID-19 pandemic on childhood immunization programs in Indonesia, with a specific focus on performance disparities between rural and urban areas. It considers factors like access, utilization, and program workload.

Methods

Data were collected from primary health cares (PHCs) in two regions in West Java Province, Indonesia, representing rural and urban areas. A descriptive analysis was conducted to compare vaccination coverage, drop-out rates, and the ratio of vaccinators per dose from 2019 to 2021 in 40 and 22 PHCs for rural and urban areas, respectively. A general linear model was employed to evaluate the differences in these parameters over the three consecutive years.

Results

The results indicate fluctuations in vaccine coverage over the three years, with the most significant impact observed in 2020, particularly in rural areas. Statistical analysis revealed a significant difference in routine immunization coverage, drop-out rates, and vaccinator ratios between rural and urban areas from 2019 to 2021 (p<0.05). In 2021, both rural and urban areas displayed significant differences in performance parameters for routine immunization and COVID-19 vaccination (p<0.05), except in terms of coverage for IPV and COVID-19 vaccination.

Conclusion

The study highlights a reduction in routine immunization coverage during the pandemic, a concerning issue that increases the risk of vaccine-preventable diseases, particularly in rural areas.

Roselle (Hibiscus sabdariffa L.) calyces tea improves physical fitness of healthy adults

Roselle calyces (Hibiscus sabdariffa L.) is a plant that contains anthocyanin and flavonoids, which function as exogenous antioxidants for the human body to counteract excess oxidative stress. Roselle has anti-hypertensive, anti-cancer and anti-diabetic effects. The present study evaluated roselle to see whether it affects physical fitness. The components of physical fitness include strength, balance, right and left hand grip, vertical jump and VO2max (maximum oxygen consumption). A total of 30 subjects received 200 ml rosella tea for 30 days every morning and evening. Every week, subjects were assessed for physical fitness. Data analysis used paired t and Wilcoxon test according to the normality test results. The results showed significant improvements in strength (from 24.9 to 27.3 kg; P=0.025), balance (from 23.3 to 42.2 sec; P=0.004), right (from 31.8 to 35.1 kg; P<0.0001) and left hand grip (from 29.8 to 31.6 kg; P=0.020), vertical jump (from 38.6 to 41.1 m/sec; P=0.008) and VO2max (from 31.1 to 34.3 ml/kg/min; P=0.014). This demonstrated that roselle significantly improved six parameters of physical fitness and may be used as a supplement to improve physical fitness without severe side effects.

Immunomodulatory Role of Plants and Their Constituents on the Management of Metabolic Disorders: An Evidence-Based Review

The relationship between the immune system and metabolic diseases is complex and increasingly recognized as critical to understanding conditions like obesity, diabetes, and cardiovascular diseases. Modulation of the immune system in patients with metabolic disorders can offer several potential benefits. While the salutary impact of plant-derived bioactive compounds on metabolic and immune functions is acknowledged, there is a paucity of comprehensive reviews on the multifaceted and synergistic mechanisms through which these effects are mediated. This review elucidates the therapeutic potential of phytochemical formulations in ameliorating metabolic disorders and delineates their mechanistic implications on relevant biomarkers and immune modulation. Our analysis reveals a predominance of plant species, including Boswellia serrata, Cinnamomum cassia, Citrus bergamia, Coffea arabica, Ficus racemosa, Momordica charantia, Morus Alba, and Trigonella foenum-graecum, that have undergone clinical evaluation and have been substantiated to confer both metabolic and immunological benefits. The phytoconstituents contained in these plants exert their effects through a range of mechanisms, such as improving glucose regulation, reducing inflammatory responses, and modulating immune system. As such, these findings hold considerable promise for clinical and therapeutic translation and necessitate further empirical validation through randomized controlled trials and mechanistic elucidations to affirm the safety and efficacy of herbal formulations.

Assessment of childhood immunization services at private healthcare facilities in Indonesia: a case study in a highly-populated city

Introduction

The need to enhance the utilization of the private sector for immunization programs in Indonesia while maintaining the high quality of services provided is evident. This study aimed to rapidly assess immunization services at private healthcare facilities in Indonesia by using Bandung, the most densely populated city, as the reference case.

Methods

Initially, a situation analysis was conducted by collecting data from selected healthcare facilities (n = 9). Furthermore, a qualitative study was taken into account by developing framework approaches and conducting interviews with different layers, such as mid-level managers at healthcare facilities (n = 9), professional organizations (n = 4), and public stakeholders (n = 7).

Results

The situation analysis showed that private healthcare facilities had provided sufficient time for essential childhood immunization services with adequate staff. Nevertheless, the number of limited staff the Ministry of Health (MoH) has trained remains a programmatic problem. Furthermore, private healthcare facilities have used the MoH guidelines and additional internal guidelines for immunization services as the primary reference, including in the efforts to provide complete and reliable equipment. Vaccine availability at private healthcare facilities is manageable with an acceptable out-of-stock level. The results of our interviews highlighted three key findings: the lack of coordination across public and private sectors, the need for immunization service delivery improvement at private healthcare facilities, and the urgency to strengthen institutional capacity for advocacy and immunization systems support.

Conclusion

Even though private healthcare facilities have been shown to make a modest contribution to childhood immunization services in Indonesia, efforts should be made to expand the role of private healthcare facilities in improving the performance of routine immunization programs.

Clinical Toxicology of Vitamin D in Pediatrics: A Review and Case Reports

Intoxication of vitamin D is not a common case in pediatrics. Vitamin D supplements are sold as OTC drugs; however, there is a lack of public education about the permissible limits of vitamin D intake which may lead to vitamin D toxicity (VDT). This review aims to give insights to readers or practitioners about the clinical toxicology of vitamin D in pediatrics, which includes the mechanism of VDT, case reports, and the management of vitamin D poisoning. VDT refers to serum 25(OH)D levels, particularly when the level exceeds 100 ng/mL (250 nmol/L) or is defined as hypervitaminosis D. Hypercalcemia is a common condition of vitamin D toxicity. Vitamin D and its metabolites in moderate levels can induce hypercalcemia, as indicated by the elevation of osteoclastic bone resorption, the presence of calcium in renal tubules, intestinal calcium intake (through increased production of calcium-binding protein in enterocytes), and the decrease of parathyroid hormone synthesis. VDT in pediatrics can be managed by discontinuing vitamin D intake; using activated charcoal, furosemide, prednisone, and calcitonin; rehydration using intravenous sodium chloride 0.9%; and dextrose fluid therapy. It is important for parents to be more careful when providing vitamin D to their children.

Nanoparticle-Based Antioxidants in Stress Signaling and Programmed Cell Death in Breast Cancer Treatment

Breast cancer (BC) is a complex and heterogeneous disease, and oxidative stress is a hallmark of BC. Oxidative stress is characterized by an imbalance between the production of reactive oxygen species (ROS) and antioxidant defense mechanisms. ROS has been implicated in BC development and progression by inducing DNA damage, inflammation, and angiogenesis. Antioxidants have been shown to scavenge ROS and protect cells from oxidative damage, thereby regulating signaling pathways involved in cell growth, survival, and death. Plants contain antioxidants like ascorbic acid, tocopherols, carotenoids, and flavonoids, which have been found to regulate stress signaling and PCD in BC. Combining different antioxidants has shown promise in enhancing the effectiveness of BC treatment. Antioxidant nanoparticles, when loaded with antioxidants, can effectively target breast cancer cells and enhance their cellular uptake. Notably, these nanoparticles have shown promising results in inducing PCD and sensitizing breast cancer cells to chemotherapy, even in cases where resistance is observed. This review aims to explore how nanotechnology can modulate stress signaling and PCD in breast cancer. By summarizing current research, it underscores the potential of nanotechnology in enhancing antioxidant properties for the treatment of breast cancer.

Efficacy and Safety of Add-On Plant-Based Drugs for COVID-19 Patients: A Review of the Randomized Control Trials

COVID-19 caused by the infection of SARS-CoV-2 is still a global concern. WHO reported that from 13 March to 9 April 2023, there were 3 million new cases and approximately 23,000 deaths, mostly occurring in the South-East Asia and Eastern Mediterranean regions, which is predicted due to the new Omicron variant, Arcturus XBB.1.16. Many studies have reported the potency of medicinal plants in enhancing the function of the immune system to combat virus infection. The literature review aimed to describe the efficacy and safety of add-on plant-based drugs for COVID-19 patients. The articles were explored on the PubMed and Cochrane Library databases, and published during 2020-2023. Twenty-two varieties of plants were used as add-on therapy for COVID-19 patients. These plants were Andrographis paniculata, Viola odorata, Withania somnifera, Zingiber officinale, Curcuma longa, Ferula foetida, Centella asiatica, Thymus vulgaris, Citrus sinensis, Eugenia caryophyllus, Boswellia carterii, Elettaria cardamomum, Salvia rosmarinus, Piper nigrum, Alstonia scholaris, Picrorhiza kurroa, Swertia chirata, Caesalpinia crista, Cucurbita maxima, Tinospora cordifolia, Ocimum sanctum, and Allium sativum. The best efficacy of an add-on therapy for COVID-19 patients was found in A. paniculata herbs as a single component in pharmaceutical dosage form or in combination with other plants. The safety of the plant has been confirmed. A. paniculata does not show interaction with remdesivir or favipiravir, however, caution and therapy drug monitoring is needed if A. paniculata is used in combination with lopinavir or ritonavir because a strong noncompetitive inhibition of CYP3A4 may occur.

Practical Models of Pharmaceutical Care for Improving Tuberculosis Patient Detection and Treatment Outcomes: A Systematic Scoping Review

Decreasing global tuberculosis (TB) notifications indicate problems related to TB patient detection and treatment outcomes. Pharmaceutical care (PC) has potential roles in managing these issues. However, PC practices have not yet become widespread in the real world. This systematic scoping review aimed to identify and analyze the current literature on practical models of pharmaceutical care for improving tuberculosis patient detection and treatment outcomes. We then discussed the present challenges and future considerations for the successful implementation of PC services in TB. A systematic scoping review was performed to identify the practice models of PC in TB. Systematic searches and screening were used to identify relevant articles in the PubMed and Cochrane databases. We then discussed the challenges and recommendations for successful implementation using a framework to improve professional healthcare practice. Our analysis included 14 of 201 eligible articles. We identified that the focuses in the PC of TB are on increasing patient detection (four articles) and improving TB treatment outcomes (ten articles). Practices cover services in the community and hospital settings, such as screening and referring people with presumptive TB, tuberculin test services, collaborative practices for treatment completion, directly observed treatment, the solution of drug-related problems, reporting and managing adverse drug reactions, and medication adherence programs. Although PC services positively increase TB patient detection and treatment outcomes, hidden challenges in the actual practice are analyzed. Several factors should be comprehensively considered in successful implementation, such as guidelines, individual pharmacy personnel, patient, professional interaction, organizational capacity, regulation, incentive, and resource factors. Hence, a collaborative PC program that involves all related stakeholders should be considered to create successful and sustainable PC services in TB.

Student Self-Medication Behavior in Stress Handling

Changing learning patterns from senior high school student to college student status is difficult, and each individual's response varies, some of which cause stress. Factors that cause stress are internal and external, and external factors consist of physical, conflict, emotional, and behavioral conditions. In comparison, the external factors consist of the physical environment, work environment, community environment, family environment, economic and legal problems. The burden of life stress is heavy and impacts the physical, such as feeling dizzy, nauseous, ulcers, and difficulty sleeping. Sometimes causes a person to take self-medication to overcome these uncomfortable symptoms. This study aims to determine the characteristics of early-level students and the stress level of early-level students at one of the State Universities of East Kalimantan Province. This study used a qualitative descriptive design on 121 students. Using a questionnaire through a cross-sectional approach with a purposive sampling technique. The results showed that the stress level of students showed mild stress as much as 30.58%, moderate stress at 56.20%, and severe stress as much as 13.22%. The number of students who did self-medication was more than those who did not provide treatment for the symptoms, 79.34%.

A Review of Herbal Medicine-Based Phytochemical of Garcinia as Molecular Therapy for Breast Cancer

Data from globocan statistic in 2020 indicate that breast cancer has become highest incidence rate of cancer. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) are known immunohistochemistry (IHC) markers that mediate cell growth and survival signaling. Furthermore, regulator proteins, receptors, and their downstream signaling pathways have emerged as critical components in breast cancer formation and proliferation, and have become well-established therapeutic targets and the core focus of breast cancer therapy research. Garcinia is a big genus in the Clusiaceae family that contains a wide spectrum of biologically active metabolites for the chemical composition of their isolated fruits, stem barks, seeds, leaves, and roots, have resulted including polyisoprenylated benzophenones, polyphenols, bioflavonoids, xanthones, lactones, and triterpenes. This review article aimed to analyze the potential of Garcinia phytochemicals as a molecular therapy of breast cancer. The results showed that phytochemicals of Garcinia (i.e., α-mangostin, Cambogin, Gambogic Acid [GA], Garcinol, Griffipavixanthone, Friedolanostane triterpenoid, Hexane, Neobractatin, 7-Epiclusianone, xanthochymol - guttiferone E, and isoxanthochymol - cycloxanthochymol) have anticancer properties, including apoptosis, inhibition of proliferation, and metastasis. This review is important to provide information regarding phytochemicals of Garcinia as an alternative treatment for breast cancer patients. This article selected 28 article researches based on inclusion criteria with the keyword “Garcinia” and “Breast cancer”, in English, and available in full text and abstract searching on PubMed.

Economic Evaluations of HPV Vaccination in Targeted Regions of Low- and Middle-Income Countries: A Systematic Review of Modelling Studies

Background

In countries with limited resources, a targeted HPV vaccination strategy by focusing in selected regions is preferable to be implemented than a nationwide vaccination strategy.

Objective

This study aimed to review articles on economic evaluations of HPV vaccination in countries over the world that applied targeted vaccination strategies.

Methods

Approximately 1769 articles were obtained from two databases (1242 and 527 articles from PubMed and ProQuest, respectively). The inclusion criteria in this systematic review were studies about full economic evaluations of HPV vaccination in targeted area or sub-national level and written in English. Full-text screening was applied to evaluate the eligibility. Final articles obtained were referred to the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. Finally, we included only 4 articles that met all inclusion and exclusion criteria.

Results

Included studies in this review focused in different targeted regions, such as Punjab State in India, Vientiane in Lao PDR, Southern Vietnam in Vietnam, and Brazilian Amazon in Brazil. From 24 criteria in the CHEERS checklist, all included studies could meet 21 criteria (87.5%). All included studies in this review applied modeling approaches, which can estimate the number of cases and treatment costs averted. Applying various settings, the results of this study showed that HPV vaccination could potentially reduce the number of cervical cancer cases by 20–72%. Taking cervical cancer screening into account, this study showed that targeted HPV vaccination was cost-effective or even cost-saving.

Conclusion

Implementation of HPV vaccination in sub-national level as the initial step before nationwide vaccination is more favorable to be implemented in countries with limited budget.

Caffeic Acid Phenethyl Ester as a DHODH Inhibitor and Its Synergistic Anticancer Properties in Combination with 5-Fluorouracil in a Breast Cancer Cell Line

Introduction

A combination of chemotherapy agents is the best choice in breast cancer treatment to increase the patient survival rate. 5-fluorouracil (5-FU) is one of the drugs applied in combination with other drugs to control and delay development of cancer cells. Nevertheless, the occurrence of multidrug resistance and dose-limiting cytotoxicity have limited the efficacy of 5-FU treatment. Therefore, the discovery of new anti-breast cancer drugs should be pursued.

Objective

To study potency of a promising naturally derived compound, caffeic acid phenethyl ester (CAPE), for breast cancer treatment in single and combination with 5-FU.

Methods

Cytotoxicity of CAPE, 5-FU, and 5-FU+CAPE was studied by in vitro MTT experiment in MCF-7 cell line, and RT-PCR analysis was used to evaluate the change in gene expression due to the treatment. Moreover, an enzymatic assay and molecular docking analysis were applied to evaluate the possible mechanism of substance-induced apoptosis.

Results

The study revealed that a single treatment of CAPE showed cytotoxicity with IC₅₀ 6.6 ± 1.0 µM and 6.5 ± 2.9 µM at 24 h and 48 h, respectively. Meanwhile, 5-FU showed cytostatic activity. The 5-FU + CAPE has a synergistic effect at 24 h treatment with a CI = 0.5 and an additive effect at 48 h treatment with CI = 1.0. CAPE was also found to enhances the mRNA expression of caspase-8 and BAX within 6 hours in combination with 5-FU compared to 5-FU treatment alone. Our study reveals a new mechanism of CAPE which is related to the inhibition of human dihydroorotate dehydrogenase (HsDHODH) with an IC₅₀ of 120.7 ± 6.8 µM, by bound to the ubiquinone-binding site of the enzyme and could be responsible for inducing extrinsic and intrinsic apoptosis.

Conclusion

This study demonstrated the cytotoxicity of CAPE potential to induce apoptosis of breast cancer MCF-7 cell line single and cytotoxic-cytostatic combination with 5-FU. Therefore, further studies to develop CAPE and its derivatives will be required to discover new candidates for breast cancer agents.

Phytochemical Analysis and Immunomodulatory Potential on Diabetic-Infected Tuberculosis by Fruit Etlingera rubroloba A.D. Poulsen

&lt;b&gt;Background and Objective:&lt;/b&gt; &lt;i&gt; Etlingera rubroloba&lt;/i&gt; (&lt;i&gt;E. rubroloba&lt;/i&gt;) A.D. Poulsen is an endemic plant in South-East Sulawesi and is a newly discovered species. This plant is expected to have the potential as an immunomodulator in patients with diabetes mellitus (DM), which can prevent tuberculosis infection by increasing the phagocytic function of macrophage cells and interleukin-12 (IL-12) levels. &lt;b&gt;Materials and Methods:&lt;/b&gt; Phytochemical analysis of the ethanolic extract of the fruit of &lt;i&gt;E. rubroloba&lt;/i&gt; A.D. Poulsen using Liquid Chromatography-Mass Spectrometry (LC-MS/MS) was carried out. The immunomodulatory potential &lt;i&gt;in vivo&lt;/i&gt; on BALB/c mice model DM was carried out by oral induction of TB antigen with extract dose, control positive, negative and normal groups. Furthermore, the phagocytic activity of macrophage cells can be seen with a microscope and the levels of IL-12 with the Elisa kit. &lt;b&gt;Results:&lt;/b&gt; The results showed the ethanol extract of the fruit of &lt;i&gt;E. rubroloba&lt;/i&gt; contained eight chemical compounds and had potential as immunomodulators in BALB/c DM mice induced by TB antigen by increasing the phagocytic activity of macrophage cells and levels of IL-12, which were significantly different from the negative control (p<0.05). &lt;b&gt;Conclusion:&lt;/b&gt; The chemical composition of the ethanol extract of the fruit of &lt;i&gt;E. rubroloba&lt;/i&gt; has the potential as an immunomodulator in TB antigen-induced DM &lt;i&gt;in vivo&lt;/i&gt;.

In-Vitro Anticancer Activity of Chemical Constituents from Etlingera alba Poulsen against Triple Negative Breast Cancer and in silico Approaches towards Matrix metalloproteinase-1 Inhibition

Etlingera alba (EA) is one of the endemic plants grown in Sulawesi. We determined the cytotoxic and anti-metastatic activity of isolates obtained from EA rhizome extract. IC50 value for 1,7-diphenyl-6-heptene-3-one, sitostenone, sinapyl alcohol diacetate, and sinapyl alcohol acetate were 134.59; 170 ; 128.11; and 161.96 μg/mL, respectively. The compounds also had anti-migration activity. 200-μg/mL Sitostenon exhibited the lowest migration rate (3.32%). The free bond energies of sitostenon, 1,7-diphenyl-6-heptene-3-one, sinapyl alcohol acetate, and sinapyl alcohol diacetate were -11.81; -8.25; -6.64; and -6.28 kcal/mol, respectively. All compounds were more effective in stabilizing the Matrix metalloproteinase 1 complex. Isolation from EA rhizomes have the potential to be developed as anti-metastatic for Triple-Negative Breast Cancer.

Translation and Validation of the Indonesian Version of the Adverse Drug Reaction Severity Level Instruments in Colorectal Cancer Patients

Introduction

Assessment of the severity of adverse drug reaction (ADR) is very rare in Indonesia. The severity of ADR can describe how serious this affects the clinical condition of the patient. In Indonesia, there are no instruments used to measure the severity of ADR.

Purpose

This study aims to translate, pilot test, and validate Hartwig instruments for measuring the severity of ADR in colorectal cancer patients in Indonesia.

Patients and Methods

The translation method was used forward-backward technique from English to Indonesian, then being retranslated from Indonesia to English. The instrument of Indonesian version was used to assess the severity of ADR as the effect of chemotherapy. The assessment was conducted to 10 colorectal cancer patients by 30 health workers. The test validity was done based on content validity ratio (CVR) and content validity index (CVI); meanwhile, the test reliability was based on intraclass coefficient correlation (ICC).

Results

All of the results of CVR present a value of >0.33, while the range of CVI moves between 0.8 to 1.0, which declares that the instrument is valid. The satisfactory alpha value for reliability is 0.996 with signification of 0.197 (p > 0.05) based on ANOVA analysis. Meanwhile, the ICC value of 0.896 indicates a good reliability among raters.

Conclusion

Indonesian version of Hartwig Instrument can be applied in measuring the severity of ADR caused by chemotherapy in colorectal cancer patients.

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/WTizlX2OIbU

ETLINGERA GENUS: PHYTOCHEMICAL SCREENING AND ANTICANCER ACTIVITY

Etlingera is one of the plant genera from the Zingiberaceae family and is widely distributed in Asia to the Pacific Islands, with various species ranging from 150 to 200 species. The Etlingera are commonly used as spices, vegetables, and traditional medicines. Many pharmacological activities have been reported from this genus, including antioxidants, antibacterials, cholesterol-lowering, anticancer, and others. The phytochemical content of Etlingera reported are phenolics, diarylheptanoids, flavonoids, steroids, alkaloids, and terpenoids.  Eight species from Etlingera, namely Etlingera elatior, E. pavieana, E. brevilabrum, E. pyramidosphaera, E. megalocheilos, E. coccinea, E. fimbriobracteata, and E. corneri are reported provided anticancer activity. This review article aims to review the phytochemical screening from Etlingera genus, and its anticancer activity.

ETLINGERA GENUS: PHYTOCHEMICAL SCREENING AND ANTICANCER ACTIVITY

Etlingera is one of the plant genera from the Zingiberaceae family and is widely distributed in Asia to the Pacific Islands, with various species ranging from 150 to 200 species. The Etlingera are commonly used as spices, vegetables, and traditional medicines. Many pharmacological activities have been reported from this genus, including antioxidants, antibacterials, cholesterol-lowering, anticancer, and others. The phytochemical content of Etlingera reported are phenolics, diarylheptanoids, flavonoids, steroids, alkaloids, and terpenoids.  Eight species from Etlingera, namely Etlingera elatior, E. pavieana, E. brevilabrum, E. pyramidosphaera, E. megalocheilos, E. coccinea, E. fimbriobracteata, and E. corneri are reported provided anticancer activity. This review article aims to review the phytochemical screening from Etlingera genus, and its anticancer activity.

Parental Acceptance of Human Papillomavirus (HPV) Vaccination in Districts with High Prevalence of Cervical Cancer in West Java, Indonesia

BACKGROUND

Cervical cancer is the second-highest cause of death in women with cancer, which is mostly caused by human papillomavirus (HPV) infection, specifically HPV 16 and 18. Next to Pap smear and visual inspection with acetic acid, HPV vaccination is highly recommended to support preventive measures.

OBJECTIVE

This study aimed to determine parental acceptance of HPV vaccination in districts with high prevalence of cervical cancer and different levels of household income in West Java, Indonesia by taking several factors into account.

METHODS

A questionnaire was delivered to 286 parents who met the major inclusion criteria of having daughters at 5th or 6th grade of elementary schools in three selected districts: Bandung, Purwakarta and Karawang. In particular, logistic regression analysis was applied to investigate the correlation of acceptance towards HPV vaccination with sociodemographic factors.

RESULTS

Respondents in Bandung, Purwakarta and Karawang were willing to pay for HPV vaccine at a price range of US$ 1.38-20.69, US$ 0.07-34.48, and US$ 1.38-6.90, respectively. In addition, respondents' spouse was the key person influencing their decision to vaccinate their children.

CONCLUSION

Education level and health beliefs toward cervical cancer have significant correlation (p-value <0.05) with acceptance towards HPV vaccination.

Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient's perspective

Background

Previously treated tuberculosis (TB) patients are a widely reported risk factor for multidrug-resistant tuberculosis. Identifying patients’ problems during treatment is necessary to control TB, especially in a high-burden setting. We therefore explored barriers to successful TB treatment from the patients’ perspective, aiming to identify potential patient-centred care strategies to improve TB treatment outcome in Indonesia.

Methods

A qualitative study was conducted in a province of Indonesia with high TB prevalence. Participants from various backgrounds (i.e., TB patients, physicians, nurses, pharmacists, TB activist, TB programmers at the district and primary care levels) were subject to in-depth interviews and focus group discussions (FGDs). All interviews and FGDs were transcribed verbatim from audio and visual recordings and the respective transcriptions were used for data analysis. Barriers were constructed by interpreting the codes’ pattern and co-occurrence. The information’s trustworthiness and credibility were established using information saturation, participant validation and triangulation approaches. Data were inductively analysed using the Atlas.ti 8.4 software and reported following the COREQ 32-items.

Results

We interviewed 63 of the 66 pre-defined participants and identified 15 barriers. The barriers were classified into three themes, i.e., socio-demography and economy; knowledge and perception and TB treatment. Since the barriers can be interrelated, we determined five main barriers across all barrier themes, i.e., lack of TB knowledge, stigmatisation, long distance to the health facility, adverse drug reaction and loss of household income.

Conclusion

The main treatment barriers can be considered to strengthen patient-centred care for TB patients in Indonesia. A multi-component approach including TB patients, healthcare providers, broad community and policy makers is required to improve TB treatment success.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12005-y.

Effect of the roselle (Hibiscus sabdariffa L.) calyces drink on the physiological parameters of healthy adult subjects

The calyx of roselle (Hibiscus sabdariffa L.) has been the focus of attention of several studies, and although earlier studies on this plant showed it to possess antilipidemic and antidiabetic activities, none of these studies have assessed the effects of this plant on the physiological parameters of healthy subjects. The present study determined the effects of roselle calyx beverages on blood pressure, abdominal circumference, body mass index (BMI), hematological and urinary parameters, and the lipid profile of healthy subjects. Healthy subjects (n=30) were treated with a 200 ml roselle calyx beverage each morning and evening for 30 consecutive days. Every week the subjects were asked to perform some physical activity by following the Young Men's Christian Association step test. This study used a pre-post quasi-experimental design. Blood samples were taken before (day-0) and after the intervention (day-30). There was an increase in the levels of high-density lipoproteins (from 47.0 to 49.5 mg/dl; P=0.015), and a significant decrease in both systolic and diastolic (P=0.036 and P=0.030, respectively), and the abdominal circumference of the subjects (P=0.005). However, total cholesterol levels (191.2 to 191.9 mg/dl; P=0.821) and low-density lipoprotein levels (129.8 to 133.5 mg/dl; P=0.249) were slightly increased, although not significantly. A lower level of triglycerides (114.3 to 107.4 mg/dl; P=0.269) and very-low-density lipoprotein levels (22.8 to 21.4 mg/dl; P=0.681) was observed. No significant differences were detected in the BMI or the urinalysis parameters were identified. Based on these results, roselle (Hibiscus sabdariffa L.) may be used as a supplement to prospectively improve the health status of subjects. No serious adverse effects were observed during this trial.

Genetic variation of ABCB1 (rs1128503, rs1045642) and CYP2E1 rs3813867 with the duration of tuberculosis therapy: a pilot study among tuberculosis patients in Indonesia

Objective

The risk of contracting tuberculosis (TB) and the efficacy of TB therapy are affected by several factors, including genetic variation among populations. In the Indonesian population, data on the genes involved in drug transport and metabolism of TB therapy are limited. The aim of this study was to identify the genetic profile of the ABCB1 gene (rs1128503 and rs1045642) and CYP2E1 gene (rs3813867) in Indonesians with TB. This study was a cross-sectional study of 50 TB outpatients in Jambi city, Indonesia. Sociodemographic characteristics were obtained from medical records. Whole blood was collected, and genomic DNA was isolated. Single nucleotide polymorphisms were determined using polymerase chain reaction-restriction fragment length polymorphism with HaeIII, MboI, and PstI for rs1128503, rs1045642 (ABCB1), and rs3813867 (CYP2E1), respectively.

Result

The frequency of alleles of each gene was analyzed by Hardy–Weinberg equilibrium. The genetic profiles of ABCB1 rs1128503 and rs1045642 were varied (CC, CT, TT), while CYP2E1 rs3813867 was present in CC (wild type). The genetic variations of ABCB1 and CYP2E1 may have no significant correlation with the duration of TB therapy. Nevertheless, this study may provide as preliminary results for the genetic profiles of ABCB1 (rs1128503, rs1045642) and CYP2E1 (rs3813867) in the Indonesia population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05711-8.

Antiproliferation Activity and Apoptotic Mechanism of Soursop (Annona muricata L.) Leaves Extract and Fractions on MCF7 Breast Cancer Cells

Introduction

Breast cancer is the second most common cancer in women globally, and the incidence rate has increased annually. Traditional medicine is frequently used as a cancer treatment, and soursop or Annona muricata L (A. muricata) is a traditional medicinal plant that has been widely used as an anticancer treatment and requires more thorough study.

Methods

In this research, we prepared ethanol extract and three solvents, ie, ethyl acetate, n-hexane and water fractions of A. muricata leaves and assessed their antiproliferation and cytotoxic activity on MCF7 breast cancer cells compared with that on CV1 normal kidney cells; observation of cell morphology by stained with mixture of propidium iodide and 4',6-diamidino-2-phenylindole indicated that this treatment induced an ongoing process of apoptotic cell death in MCF7 cells. To clarify the cell death mechanism via apoptosis, we assessed the mRNA expression in the caspase cascade of caspase-9, caspase-3, and PARP-1, and anti-apoptotic, Bcl-2 which mediated cytotoxic activity of extracts and ethyl acetate fractions of A. muricata leaves against MCF7 cells.

Results

The ethanol extract, ethyl acetate, n-hexane, and water fractions of A. muricata leaves had IC₅₀ values of 5.3, 2.86, 3.08, and 48.31 µg/mL, respectively, in MCF7 cells but had no activity in CV1 cells. The high cytotoxic activity of A. muricata leaves was reflected by changes in the morphology of cancer cells that appeared after 6 h exposure to A. muricata leaf extract and ethyl acetate fraction; the membrane and nucleus of cells undergoing apoptosis were characterized by the rupture and loss of membranes and nuclei. The mechanism that mediates this cytotoxic activity in MCF7 cells was mediated through a decrease in the expression of Bcl-2 mRNA and an increase in caspase-9 and caspase-3 mRNA expression.

Conclusion

Therefore, the leaves of the medicinal plant A. muricata contained compounds that on extraction exerted a highly effective activity as an anticancer treatment for breast cancer via induced apoptotic cell death.

Characterization and acute oral toxicity of concentrated minerals of Pamekasan Madura seawater

Indonesia is a maritime country with abundant seawater mineral content. One of the regions with the highest salt production is Pamekasan Madura. Minerals are known to have many roles and benefits for our bodies, such as regulating fluid balance and metabolism. Therefore, this study aimed to characterize the physicochemical and microbial properties of concentrated minerals obtained through solvent evaporation and salt deposition for ± 60 days. Acute oral toxicity examination was performed as a first step in determining the safety of concentrated minerals to be used as a raw material for drugs. Based on the test results, the concentrated mineral has a clear yellow color, salty taste, and a bit bitter, odorless, with a pH of 6.6 ± 0.21. Concentrated minerals have high mineral content with levels of potassium, sodium, magnesium, boron, and calcium being 44734.1598 ± 12950.4633, 33192.1198 ± 2699.3419, 8738.1388 ± 100.4894, 2092.5715 ± 60.3224, and 276.9704 ± 13.1133 mg/Kg, respectively. The results of microbiological analysis of untreated concentrated minerals (without antimicrobials or sterilization) showed that the total plate count was within limits, including coliform and Salmonella. However, the total mold and yeast levels exceed the threshold. Based on the results of acute oral toxicity testing, the concentrated mineral is practically nontoxic. With high mineral content and low toxicity, it can be concluded that the concentrated minerals from Pamekasan Madura seawater is potential to be used as a raw medicinal material.

Multi-criteria decision analysis to prioritize the introduction of new vaccines in Indonesia by using the framework of the strategic multi-attribute ranking tool for vaccines (SMART vaccines)

Background: Decision-making processes regarding new vaccine prioritizations are complex. The objective of this study was to prioritize the introduction of new vaccines in Indonesia.Methods: A multi-criteria decision analysis (MCDA) was applied in this study. A preliminary data collection form was developed to collect country-specific data in relation to 30 pre-defined attributes. In particular, an open-ended questionnaire was conducted among targeted respondents from global level, national level and vaccine manufacturers, which were involved in the financial flows of new vaccine procurement in Indonesia. For setting new vaccines priorities, targeted respondents were asked to assign weight on 10 selected criteria.Results: Top 3 attributes with the highest weight from respondents were premature deaths averted per year, incident cases prevented per year, and cost-effectiveness. Applying criteria scores and weight assessment, the result showed that PCV, rotavirus, HPV, and JE would be on the 1st, 2nd, 3rd, and 4th rank for setting new vaccine priority in Indonesia. There was a significant difference score (p value <0.05) between all these vaccines.Conclusions: PCV, rotavirus and HPV vaccines should be more prioritized than JE vaccine. This ranking is in line with the WHO's priority list, which potentially illustrates the validity and usefulness of our MCDA-approach.

Phytochemical Screening, Toxicity Activity and Antioxidant Capacity of Ethanolic Extract of Etlingera alba Rhizome

&lt;b&gt;Background and Objective:&lt;/b&gt; &lt;i&gt;Etlingera alba &lt;/i&gt;(Blume) A.D. Poulsen is one of the plants of the genus &lt;i&gt;Etlingera&lt;/i&gt; which is commonly found in Southeast Sulawesi. The research is still lacking, thus, we assumed other species related to &lt;i&gt;E. alba,&lt;/i&gt; specifically from the genus&lt;i&gt; Etlingera&lt;/i&gt; that provides antioxidant and radical scavenging activity, namely &lt;i&gt;Etlingera elatior&lt;/i&gt; (Jack) R.M. Smith. Thus, this study aimed to assess the antioxidant and toxicity activity as well as its secondary metabolites. &lt;b&gt;Materials and Methods:&lt;/b&gt; &lt;i&gt;Etlingera alba&lt;/i&gt; rhizome was extracted with 96% ethanol. The radical scavenging activity was assayed with 1,1-diphenyl-2-picrylhydrazyl (DPPH) and antioxidant activity was assayed with 2,2'-azino-bis-[3-ethylbenzothiazoline sulphonate (ABTS) assay for radical cation decolourization&lt;i&gt; in vitro&lt;/i&gt;. Both Ascorbic Acid (AA) and Trolox were used as positive control. The secondary metabolites were identified by Thin Layer Chromatography (TLC) and LSMS/MS analyzed the difference between compounds. According to results performed with TLC and LCMS/MS. &lt;b&gt;Results:&lt;/b&gt; The extract exhibited antioxidant properties using both DPPH and ABTS method. The LC&lt;sub&gt;50&lt;/sub&gt; of the extract was 608.42±18.31 mg L&lt;sup&gt;&lt;/sup&gt;&lt;sup&gt;1&lt;/sup&gt;.&lt;i&gt; Etlingera alba &lt;/i&gt;rhizome extract contains alkaloids, flavonoids, terpenoids and steroids. The compounds detected in the extract were E-p-Coumaric acid aschantin, 2-Methoxyanofinic acid, Chavicol-β-D-glucoside, Myristicanol B, ent-16α,17-Hydroxy-19-kaurenoic acid, 5-Hydroxy-7,8,2'-trimethoxyflavone, Methyl ursolate and Spinasterol. &lt;b&gt;Conclusion:&lt;/b&gt; &lt;i&gt;Etlingera alba&lt;/i&gt; rhizome contains several compounds that might be responsible for antioxidant activity and the extract itself classified as medium toxic.

Genetic Polymorphisms and the Efficacy of Platinum-Based Chemotherapy: Review

Previous studies have indicated that genetic variations in individuals may result in changes in gene expression and amino acids. The effect of these changes may lead to different responses to platinum-based chemotherapy. A vast response rate interval and a short survival rate indicate that the efficacy and efficiency of the selection of chemotherapy have not been optimized. This article aims to illustrate the potential relationship of various genetic polymorphisms in response to platinum-based chemotherapy for several types of cancer. This review was conducted using articles from the last three- and five-year periods (2014-2019) that use gene polymorphism and its relationship to the efficacy of platinum-based chemotherapy as their theme. A total of 26 out of 488 relevant articles were included based on specific criteria. Through various mechanisms, genes, including ERCC1, ERCC2/XPD, XPC, XPA, XRCC1, APE-1, PARP1, OGG1, ABCC2, MRP, GSTP1, GSTM1, GSTT1, MATE1, and OCT2, have been associated with patient response to platinum-based chemotherapy. We conclude that genetic polymorphism analysis is recommended for the management of cancer so that each patient can be administered therapy based on his or her genetic profile to achieve an effective and efficient outcome.

Water-soluble propolis and bee pollen of Trigona spp. from South Sulawesi Indonesia induce apoptosis in the human breast cancer MCF-7 cell line

Bee products are best known as one of the beneficial natural products providing multiple pharmacological effects, such as antimicrobial, antiviral, anti-inflammatory and anticancer effects. The present study aimed to identify potent products derived from the stingless bee Trigona spp. from Luwu Utara (South Sulawesi, Indonesia), focussing on the water-soluble extract of propolis and bee pollen, against the proliferation of the human breast cancer MCF-7 cell line. The results from DPPH (2,2-diphenyl-1-picrylhydrazyl) method of antioxidant assay revealed that water-soluble propolis and bee pollen had high antioxidant activity, with half-maximal effective concentrations against DPPH radicals of 1.3 and 0.4 mg/ml, respectively. Additionally, water-soluble propolis and bee pollen exhibited a significant antiproliferative activity in MCF-7 cells, with IC₅₀ values of 10.8±0.06 and 18.6±0.03 mg/ml, respectively (P<0.05). Significant cytotoxic effects were observed after 24 h of treatment via microscopic and flow cytometric analysis, where a morphological change toward late apoptosis was observed. By contrast, honey had low antioxidant activity and no antiproliferative effect in MCF-7 cells. The water-soluble propolis also exerted its antiproliferative effect in the human keratinocyte HaCaT cell line. The antiproliferative activity was similar (P>0.05) at 24 and 48 h of treatment, with IC₅₀ at 2.7±0.06 mg/ml and <0.4 mg/ml, respectively. Notably, bee pollen was less toxic to HaCaT cells after 24 h of treatment than the water-soluble propolis, with IC₅₀>50 mg/ml. Its antiproliferative activity was significantly increased after 48 h of treatment, with IC₅₀ at 9.6±0.07 mg/ml (P<0.05). In addition, similar to other poplar propolis, the high-performance liquid chromatography-ultraviolet and electrospray ionisation mass spectrometry analyses revealed that caffeic acid phenethyl ester was not the main bioactive compound of the samples examined. Furthermore, two major proteins (between ~50 and 75 kDa) were identified in the water-soluble propolis and bee pollen. The present results suggested that water-soluble propolis and bee pollen may have the potential to be elaborated further as a breast anticancer therapy.

Knowledge, Attitudes, and Practices of Lung Cancer Risk Factors in West Bandung Society

BACKGROUND

Lung cancer is one of the leading causes of morbidity and mortality worldwide, so prevention of lung cancer is necessary. The aim of this study was to measure level of knowledge, attitude, and actions concerning risk factors of lung cancer in West Bandung.

MATERIALS AND METHODS

The research was conducted by quantitative study design with a quasi-experimental approach. Measurement of respondents' knowledge, attitudes, and actions was carried out by giving questionnaires of knowledge, attitudes, and actions. Questionnaires were given to respondents before and after providing education about risk factors of lung cancer. Respondents were from 42 societies in Bandung. The data obtained were tested by using comparison and correlation test.

RESULTS

The results showed a significant difference between knowledge and attitudes (P = 0.001). Meanwhile, the action did not change significantly (P > 0.05). Correlation test showed that knowledge and attitude had a correlation of P = 0.001 in the pretest and P = 0.23 (P < 0.05) in the posttest.

CONCLUSION

This research concludes that the level of knowledge and attitudes toward risk factors of lung cancer has increased.

Polymorphism Of The APM1 Gene In Subjects With Central Obesity Related To Lower High-Density Lipoprotein Cholesterol

BACKGROUND

Central obesity is a risk factor for metabolic syndrome. Subjects with central obesity have a higher risk of developing type 2 diabetes and cardiovascular disease. Many conditions affect the prevalence of central obesity, including energy expenditure, aging, proinflammatory conditions, and hormonal, genetic, and ethnic differences. Polymorphism of the APM1 gene, encoding the protein adiponectin, is closely related to metabolic syndrome. Adiponectin influences fatty acid oxidation and glucose intake in muscle. Therefore, variation in the APM1 gene is associated with diabetes and obesity.

PURPOSE

The aim of the present study was to investigate the correlation of the single-nucleotide polymorphism (SNP) of the APM1 SNP rs2241766 with body mass index (BMI) and lipid profiles in Indonesian (Bandung) subjects.

PATIENTS AND METHODS

Genotyping of the APM1 gene was performed using the Amplification Refractory Mutation System. Whole blood and serum of 54 subjects with central obesity (waist circumference [WC] ≥90 cm) and 53 healthy subjects (WC <90 cm) were collected. Measurements of the lipid profile (low-density lipoprotein [LDL], high-density lipoprotein [HDL], and total cholesterol [TC]) and BMI were examined.

RESULTS

The TT and GT genotype were observed (no GG genotype) in all subjects. The TC, LDL, fasting blood glucose, and BMI did not show a significant correlation between genotype variations of APM1 with central obesity. Otherwise, subjects with central obesity with the TT genotype had lower HDL levels than those with the GT genotype (p = 0.014, significant OR 1.045; 95% CI).

CONCLUSION

This finding suggests that the T allele of the APM1 SNP rs2241766 is dominant in the Bandung population, and subjects with the homozygous TT genotype have a higher incidence of metabolic disorder.

Inhibition of Phosphorylated c-Jun NH(2)-terminal Kinase by 2',4'-dihydroxy-6-methoxy-3,5-dimethylchalcone Isolated from Eugenia aquea Burm f. Leaves in Jurkat T-cells

Background:

Indonesian medicinal plants have been used for their anticancer activity for decades. However, the therapeutic effects of medicinal plants have not been fully examined scientifically. As cancer is a major health problem worldwide, searching for a new anticancer compound has attracted considerable attention. Our previous study found that 2’,4’-dihydroxy-6-methoxy-3,5-dimethylchalcone, an active compound isolated from leaves of Indonesian medicinal plants Eugenia aquea Burm f. (Myrtaceae), had anticancer activity in MCF-7 human breast cancer cells through induction of apoptosis.

Objective:

To investigate the molecular mechanism of 2’,4’-dihydroxy-6-methoxy-3,5-dimethylchalcone antiproliferative activity.

Materials and Methods:

Leaves of E. aquea were extracted by ethanol, fractionated by ethyl acetate, n-hexane, or water, and isolated for its active compound. Jurkat T-cells were treated with 2’,4’-dihydroxy-6-methoxy-3,5-dimethylchalcone for 12 and 24 h, and a cell viability assay and real-time-reverse transcriptase polymerase chain reaction for interleukin-2 (IL-2) mRNA measurement were performed. The effects of active compound to mitogen-activated protein kinases were also examined to investigate the mechanism of its antiproliferative activity.

Results:

2’,4’-dihydroxy-6-methoxy-3,5-dimethylchalcone inhibited Jurkat T-cell proliferation with a half maximal inhibitory concentration of 59.5 mM. Although IL-2 mRNA expression was slightly increased after treatment, it inhibited c-Jun N-terminal kinase expression but not p38 and extracellular signal-regulated kinase expression.

Conclusions:

Our study indicated that the molecular mechanism mediating the antiproliferative activity of 2’,4’-dihydroxy-6-methoxy-3,5-dimethylchalcone may be attributed to the stimulation of an immunological microenvironment in the cells.

SUMMARY

2’,4’-dihydroxy-6-methoxy-3,5-dimethylchalcone was isolated from Eugenia aquea. The antiproliferative activity of 2’,4’-dihydroxy-6- methoxy-3,5-dimethylchalcone significantly showed in Jurkat T-cells with a half maximal inhibitory concentration of 59.5 mM through inhibition of c-Jun N-terminal kinase phosphorylation. Interleukin-2 mRNA expression was also slightly increased after treatment with the compound, and this result may be indicated to the stimulation of the immunological microenvironment in T-cells.

Abbreviations used:E. aquea: Eugenia aquea, IL-2: Interleukin-2, MAPK: Mitogen-activated protein kinase, ERKs: Extracellular signal-regulated kinases, JNKs: c-Jun N-terminal kinases, p38: p38 MAPK, PI3K: Phosphatidylinositol-3 kinase, IC₅₀: Half maximal inhibitory concentration.

Catechin Isolated from Garcinia celebica Leaves Inhibit Plasmodium falciparum Growth through the Induction of Oxidative Stress

BACKGROUND

Resistance of antimalarial drugs to Plasmodium falciparum has become a major concern in malaria eradication. Although it is also affected by several socioeconomic factors, a new antiplasmodial agent is needed for a global malaria control program.

OBJECTIVE

In this study, we attempted to uncover the antiplasmodial properties of Garcinia celebica, an Indonesian medicinal plant, along with the responsible compound and its possible mechanism.

MATERIALS AND METHODS

The G. celebica leaves were ethanol extracted and fractionated based on their polarity using n-hexane, ethyl acetate, and water. The antiplasmodial activity was tested in vitro against chloroquine-resistant P. falciparum at 100 μg/ml for 72 h. The active compound of the most active ethyl acetate fraction was subsequently isolated using column chromatography and identified by nuclear magnetic resonance.

RESULTS

The IC₅₀ of (+)-catechin, the characterized compound, against P. falciparum was 198 μM in 24 h and experiment. The isolated catechin inhibited P. falciparum growth in both trophozoite and schizont stages. An additional experiment also suggests that the antiplasmodial property of catechin occurs through the induction of the oxidative stress to P. falciparum.

CONCLUSION

This result shows that the potential of catechin and its antimalarial properties should be explored further.

SUMMARY

Garcinia celebica leaf extract and fractions inhibit Plasmodium falciparum growthCatechin, the active compound of Garcinia celebica leaf extract, inhibits Plasmodium falciparum growth in a time- and dose-dependent manner Abbreviations used: RBC: Red Blood Cells; IC50: Inhibition Concentrattino 50; MeOH: Methanol; RPMI: Roswell Park Memorial Institute; EI: Electron Ionization.

ANTIBACTERIAL PROPERTIES OF SELECTED PLANTS CONSUMED BY PRIMATES AGAINST ESCHERICHIA COLI AND BACILLUS SUBTILIS

Bacterial antimicrobial resistance is a major health problem worldwide. Plants consumed by non-human primates are potentially safe for humans. In this study, we examined the potential antibacterial properties of plants consumed by non-human primates in Indonesia. We studied the antibacterial properties of the leaf extracts of 34 primate-consumed plants against Escherichia coli and Bacillus subtilis in vitro. The plants were collected from the Pangandaran Conservation Area, West Java Province, Indonesia. The leaves were dried and then powdered by crushing and the potential active ingredients were extracted with 95% ethanol at room temperature for 24 hours. The obtained solvent was then dried at 50ºC under reduced pressure. The antibacterial properties of each product were then tested to determine the minimum inhibitory and minimum bactericidal concentrations using the broth microdilution technique and a disc diffusion test was also performed. The results show Kleinhovia hospita, Dillenia excelsa and Garcinia celebica had the best antibacterial properties against Escherichia coli and Ficus benjamina, Ficus altissima, and Elaeocarpus glaber had the best antibacterial properties against Bacillus subtilis. Some of the studied leaf extracts in our study have the potential to be developed into antibacterial medications and need to be studied further.

Apoptosis induced in MCF-7 human breast cancer cells by 2',4'-dihydroxy-6-methoxy-3,5-dimethylchalcone isolated from Eugenia aquea Burm f. leaves

During a previous study that aimed to identify anticancer agents within primate-consumed plants, the present group identified that Eugenia aquea (E. aquea) possessed potential as a source of anticancer agents. The ethanol extract of E. aquea leaves exhibited strong inhibitory activity against the proliferation of the human breast adenocarcinoma MCF-7 cell line. The inhibition of proliferation was determined using an MTT assay. The present study was performed to isolate the active compound within the E. aquea leaves that generated the aforementioned activity, and resulted in the isolation of 2',4'-dihydroxy-6-methoxy-3,5-dimethylchalcone, which was identified through the analysis of spectroscopic data. This compound was examined for its inhibitory activity against the MCF-7 cell line using a MTT assay, and the ability of 2',4'-dihydroxy-6-methoxy-3,5-dimethylchalcone to induce apoptosis through the activation of the poly(adenosine diphosphate-ribose) polymerase (PARP) protein was also investigated. The results of the present study revealed that the isolated compound inhibited cell proliferation in a dose-dependent manner, possessed an IC₅₀ of 74.5 µg/ml (250 µM) and promoted apoptosis via the activation of PARP. It was concluded that these results indicated a requirement for additional investigations into 2',4'-dihydroxy-6-methoxy-3,5-dimethylchalcone in order to provide a basis for the use of this compound in the management of cancer.

Induction of caspase cascade pathway by kaempferol-3-O-rhamnoside in LNCaP prostate cancer cell lines

Prostate cancer has become a leading cause of mortality in humans. Previous studies have shown the potential anticancer properties of kaempferol-3-O-rhamnoside in breast cancer cell lines. In the present study, the anticancer potential of kaempferol-3-O-rhamnoside was investigated in LNCaP human prostate cancer cell lines. The inhibition of cell proliferation was investigated using MTT assays, whereas its ability to induce the caspase-cascade pathway was investigated by western blotting. The results showed that kaempferol-3-O-rhamnoside inhibits the proliferation of LNCaP cells in a dose-dependent manner by upregulating the expression of caspase-8, caspase-9, caspase-3 and poly (ADP-ribose) polymerase proteins. Although further studies are required, the results of the present study indicate the potential application of kaempferol-3-O-rhamnoside in cancer treatment.

Assessment of patient care indicators at community pharmacies in Bandung City, Indonesia

Community pharmacies supply medications; therefore are involved in the patient care process. The objective of this study was to study the quality of patient care given by these pharmacies. We conducted a cross sectional study of 13 community pharmacies in Bandung City, Indonesia. Data collected were patient care indicators whose standard is defined by the World Health Organization (WHO). These were assessed by observing 1961 subjects who presented to the studied pharmacies to receive their medication. The average dispensing time was 62 seconds. Ninety-six percent of the prescribed medicine was dispensed correctly and 99% of the prescribed medication was sufficiently labeled. Only 88% of patients were able to repeat the correct dosage regimen of their prescribed medicines. Although the average dispensing time was greater than the recommended 60 seconds, the dispensing time ranged from 3 to 435 seconds. Greater attention should be focused on making sure the patient understands the dosage regimen correctly to ensure patient compliance with the correct regimen.

Antibiotic resistance in sepsis patients: evaluation and recommendation of antibiotic use

BACKGROUND

The appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance can reduce the mortality rate and increase the rational use of antibiotics.

AIMS

We analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis.

MATERIALS AND METHODS

A retrospective observational study was conducted in adult sepsis patient at one of Indonesian hospital during January-December 2011. Data were collected from the hospital medical record department. Descriptive analysis was used in the processing and interpretation of data.

RESULTS

A total of 76 patients were included as research subjects. Lung infection was the highest source of infection. In the 66.3% of clinical specimens that were culture positive for microbes, Klebsiella pneumoniae, Escherichia coli, Staphylococcus hominis were detected with the highest frequency. The six most frequently used antibiotics, levofloxacin, ceftazidime, ciprofloxacin, cefotaxime, ceftriaxone, and erythromycin, showed an average resistance above 50%.

CONCLUSIONS

The high use of antibiotic with a high level resistance requires a policy to support its rational use. Local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients.

Kaempferol-3-O-rhamnoside isolated from the leaves of Schima wallichii Korth. inhibits MCF-7 breast cancer cell proliferation through activation of the caspase cascade pathway

Plants consumed by non-human primates represent potential drug sources for human disease management. In this study, we isolated kaempferol-3-O-rhamnoside as an active compound from the leaves of Schima wallichii Korth., a plant commonly consumed by non-human primates. Its anti-cancer activities, including its ability to induce apoptotic mechanisms, were investigated in MCF-7 breast cancer cells. Results showed that in MCF-7 cells, kaempferol-3-O-rhamnoside inhibits cell proliferation in a dose-dependent manner and promotes apoptosis via the activation of the caspase signaling cascade, which includes caspase-9, caspase-3 and PARP. Our results provide a basis for further exploration of kaempferol-3-O-rhamnoside as an active compound for potential anti-cancer therapeutics.