bluuebunny/crossref_metadata_2025 huggingface dataset:
Compare the Effect of Addition of Low Dose Ketamine to Tramadol for the Prevention of Shivering Under Spinal Anesthesia
Authors: Sattar Abdul , Amin Palvesha , Bhatti Tahmina Karim , Ahmad Aqeel , Ali Tayyab , Chaudhry Abid Rafique
Published: April 2022

Objective: To see if adding a mild dosage of ketamine to tramadol can help avoid shivering when under spinal anaesthesia. Study Design: Randomized study Place and Duration: The study was conducted at the department of Anesthesia, Sindh Government Liyari General Hospital Karachi and Shiekh Khalifa Bin Zayed Hospital, Quetta for the duration of six-months from December 2020 to May 2021. Methods: There were one hundred and seventy patients of both genders undergoing inguinal hernia were included in this study. Informed permission was obtained before to calculating demographic information such as age, sex and BMI. Patients were divided equally into two groups. Group A had 85 patients and received low dose ketamine 0.25 mg/kg (K) into tramadol and group B had 85 patients and received tramadol 0.5 mg/kg (T) alone. Post-treatment effectiveness among both groups was compared in terms of shivering control. We used SPSS 19.0 version to analyze complete data. Results: In group I the mean age of the patients was 33.9±9.76 years and mean age in group II was 31.5±3.23 years. There were 55 (64.7%) males and 30 (35.3%) females in group I while in group II 65 (70.6%) were males and 30 (29.4%) females. HTN and diabetes mellitus were the most common comorbidities found among both groups. 50 (58.2%) patients in group I had ASA class II and in group II 54 (63.2%) had ASA class II. We found that low dose ketamine to tramadol was effective in reduction of shivering in 33 (38.9%) as compared to tramadol alone shivering found in 41 (48.2%) cases. Conclusion: We concluded in this study that low dose ketamine into tramadol under spinal anesthesia is an effective and useful in terms of reduction in shivering as compared to tramadol alone in patients undergoing surgery. Keywords: Spinal Anesthesia, Ketamine, Tramadol, Shivering
ABO Blood Grouping in Partial and Complete Hydatidiform Molar Pregnancy
Authors: Abro Afsheen , Ahmedani Rubina , Shaikh Saima Naz , Khan Shehmeen , Bhatti Urooj , Sodhar Andleeb Mumtaz
Published: April 2022

Objective: The present study was conducted to analyze the correlation of ABO blood groups in pregnant mother’s suffering from partial and complete Hydatidiform mole (HM) reporting at our tertiary care hospital. Study Design: Observational study Place and Duration: Liaquat University Hospital, Hyderabad/Jamshoro from May 2018 to October 2018. Methods: The present observational study analyzed the ABO blood groups of diagnosed cases of partial and complete type HM reporting at the Department of Obstetrics and Gynecology. A sample of 100 pregnant women suffering from Partial and complete HM and of their husbands was studied by inclusion criteria. ABO blood groups of these patients were determined as A, B, AB and O groups. Blood samples were processed for complete blood counts. Tests were performed at the Diagnostic and Research Laboratory, Liaquat University Hospital Hyderabad by forward and reverse ABO blood typing. Severity of GTD was assessed by WHO index score. Statistical comparisons of continuous and categorical variables run on SPSS ver. 21.0 at 95% confidence interval (P≤0.05). Results: Clinical presenting features bleeding PV, pain, hyperemesis gravidarum, grape like vesicles passage PV, no fetal heart sound, ovarian enlargement and hyperthyroidism. Partial and complete Hydatidiform mole was common in blood group A noted in 53 and 13 respectively. While Partial and complete Hydatidiform mole in blood group O was noted in 20 and 8 patients respectively (P=0.0001). The β–hCG ranged from 50,000 to 10, 00,000 mIU/mL. Conclusion: It is concluded, the hydatidiform mole proves strong association with blood groups A and O. Pregnant women complaining of bleeding PV, hyperemesis gravidarum, grape like vesicles passage with blood group A and O should be thoroughly investigated to minimize the maternal health risk. Keywords: Hydatidiform mole, Molar pregnancy, ABO blood groups
Follow-Up Clinico-Endoscopic Study among Young Patients with Peptic Ulcer Perforation: A Prospective Analysis
Authors: Rabbani Aftab , Numan Mohammad Saud , Dad Saqib Allah , Azam Muhammad , Adeel Bushra , Masood Ayesha
Published: April 2022

Background: One of the most common difficulties in the operation fatality is perforation peritonitis. The goal of this study was to identify risk factors for peptic ulcer disease (PUD) in young patients. Materials and method: In this study, 70 patients were evaluated and clinical examinations and endoscopies were performed at 8 weeks and 6 months. Place and Duration: A population‐based cohort study was conducted at the Gastroenterology department of Sharif Medical College, Lahore for one-year duration from January 2021 to December 2021. Result: Six patients died, and 4 patients were not followed up on, out of a total of 80 patients. There were 62 men and 8 women among the remaining 70 patients. The majority of the patients were between the ages of 35 and 40. After eight weeks, 34 (50%) had no infections on endoscopy, with 34 patients (48.6%) on treatment and 1 (1.4%) not on any therapies. The residual 35 patients (50%) had active ulcers and other positive endoscopic outcomes. Six months after surgery, 56 patients (80%) had no ulcers on endoscopy, with 34 on treatment and 12 without treatment. The rest 14 had some positive endoscopic findings. The study also revealed other factors linked with peptic ulcer perforation and impacting healing in the postoperative phase. Preoperative PUD symptoms, alcohol consumption, comorbidities, chronic drug consumption (NSAIDs/steroids), smoking, postoperative treatment given and H. pylori infection were all variables. Conclusion: All patients with peptic ulcer perforation should receive H2 blockers or proton pump inhibitors as a post - operative therapies, as well as an anti-Helicobacter pylori regimen. Postoperative follow-up should include routine endoscopic examinations of these patients to detect ulcer healing. Keywords: peptic ulcer disease, endoscopies, chronic drug consumption.
Use of Decompression and Transpedicle Fixation in the Patients of Thoracic Spine Tuberculosis
Authors: Haq Naeem Ul , Khan Abdus Samad , Ullah Hamid , Jalal Abdul
Published: April 2022

Objective: Posterio-lateral decompression and transpedicle fixation for TB of the thoracic spine are the focus of the present study. Study Design: Cross-sectional/observational study Place and Duration: The study was conducted at the department of Neurosurgery, Mardan Medical Complex for duration of four years from July 2017 to June 2021. Methods: Total 18 patients of both genders with ages 18-65 years were included. Case demographics, such as age, gender and BMI, were gathered after obtaining written permission from all participants. Included patients were undergone posterio-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis. Post-operative outcomes among all patients were recorded in terms of reduction of pain score by VAS, improvement in neurological deficit and frequency of complications. All the data was analyzed by using the SPSS 20.0 version. Results: Among 18 cases, there were 12 (66.7%) males and 6 (33.3%) females with mean age 35.8± 8.51 years and had mean BMI 24.6±5.51 kg/m2. Post-operative improvement in the reduction of pain score was noted among 15 (83.3%) cases. According to ASIA score improvement in neurological deficit was recorded among 14 (77.8%) patients. Frequency of complications was 1 (5.5%). Conclusion: According to this research, it is safe to do posterior-lateral decompression and trans-pedicle fixation for TB of the thoracic spine. It is effective in relieving pain and improving neurological function. Complications are rare after this treatment. Because of this, it is a viable alternative to conventional surgical methods for the treatment of TB of the thoracic spine. Keywords: Thoracic Spine, VAS Scale, Spine Tuberculosis, Trans-pedicle Fixation, Posterolateral Decompression.
Incidence of Various Types of Gallstones in Association with Age
Authors: Rahman Faiz Ur , Iqbal Khawar , Khan Mohammad Shoaib , Mal Lekhraj , Sadiq Muhammad Attique , Rehman Khalil-Ur-
Published: April 2022

Aim: Gallstones are responsible for many hospitalizations and surgical interventions in our local population. Our main goal was to evaluate the relationship between age and gallstones as a risk factor in our local population. Methods: Cross-sectional study of all cholecystectomy patients with prior informed consent was conducted in the department of Surgery at Sheikh Khalifa Bin Zaid Hospital (PGMI), Quetta and Bacha Khan Medical Complex, Swabi for the duration of 06 months from 15th March 2021 to 15th August 2021. The stones are divided into 3 groups according to their colour: light yellow and whitish like a cholesterol stone, black and black-brown like a pigment stone, and laminated brownish or greenish yellow as mixed stones. The collected data was statistically processed using SPSS version 21. The types of stones were correlated with the age groups of the patients using the student’s test and / or the Chi-square test as appropriate. The confidence level was defined as 95% CI and p values below 0.05 were considered statistically significant. Results: The study included 100 patients 14(14%) men and 86 (86% women) with a female to male ratio of 13.2: 1, chi-square = 1190.70, p < 0.0001 and their mean age was 46.2 years (SD ± 9.4) (Range, 30 to 75 years). The most common pigment stones were found in 44 (44%). The highest incidence of gallstones was found in the age groups 41-50 and 31-40, 44% and 26%, respectively (p <0.05). Conclusion: From the study it can be concluded that age has an influence on the occurrence of gallstone disease. Keywords: Gallstone (GS); Pigment stones (PS); Mixed stones (MS); Cholesterol stones (CS);
A Cross-Sectional Study on Behavioral Manifestation in Alzheimer’s Disease Patients and their Association with Cognitive Impairment
Authors: Farooq Rizwan , Jawad Unaiza , Khan Imran , Rehman Muhammad , Irfan Muhammad Shoaib , Ullah Subhan
Published: April 2022

Background and Aim: Dementia psychological and behavioral symptoms are significantly associated to Alzheimer’s disease (AD). Clinical profile and characterization of Alzheimer’s disease patients might assist in evolution, diagnosis, and better treatment of the disease. The present study aimed to evaluate the behavioral manifestation of Alzheimer’s disease patients. Methodology: This multi-centered cross-sectional study was carried out on 96 Alzheimer’s disease patients in the department of Psychiatry Lahore General Hospital and Psychiatry unit, Khyber Teaching Hospital Peshawar, Pakistan for duration of six months from 1st July 2021 to 30th December 2021. Alzheimer’s disease patients with lower and higher Behavioural and psychological symptoms of dementia (BPSD) scores (≤25 and 26-50 respectively) were enrolled. The patient’s demographic details and clinical information were gathered. Mini-Mental State Examination (MMSE) was used for the evaluation of dementia severity whereas severity varies from mild 27-21 to severe ≤10. Demographic details, AD pharmacological treatments, psychotic breaks presence, AD diagnosis, treatment of concomitant diseases, and extrapyramidal symptoms such as hypokinesia, fluctuating cognition, tremors, etc. were secondary outcomes. Results: Of the total 96 AD patients, 44 (45.8%) had higher and 52 (54.2%) had lower BPSD scores. About 62 (64.6%) were women and 34 (35.4%) were male patients. The overall mean age was 79.6±8.4 years. The majority of the patients had a BPSD score at inclusion and the incidence of psychotic out breaks was reported in 19 (19.8%) patients. The prevalence of symptoms such as depression, delusions, lack of concentration, lack of cooperation, and tremors was 41 (42.5%), 33 (34%), 52 (54.6%), 34 (35.9%), and 52 (54.6%) respectively. Psychotic symptoms such as hallucinations, delusions, and delirium were significantly prevalent in patients with high BPSD scores whereas Apathy and tearfulness-like emotional symptoms were predominated in lower BPSD patients. ADAS-non cognitive score and MMSE were adversely related (p=0.0314), signifying BPSD and cognitive impairment correlation. Appetite changes and lack of concentration were prominently associated with MMSE (p=0.035 and 0.052). Conclusion: Our study found a higher prevalence of non-cognitive symptoms in Alzheimer’s disease patients. Also, BPSD and cognitive impairment are significantly associated with AD. ADAS-non cognitive is a useful assessment tool. Keywords: Behavioral Manifestation, Alzheimer’s disease, Cognitive Impairment
Outcome Comparison of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunt in Obstructive Hydrocephalus
Authors: Haq Naeem Ul , Ishaq Muhammad , Jalal Abdul
Published: April 2022

Objective: The aim of this study is to compare the outcomes of endoscopic third ventriculostomy versus ventriculoperitoneal shunt in Obstructive Hydrocephalus. Study Design: Randomized/Control study Place and Duration: Neurosurgery Department, Mardan Medical Complex, Mardan for the duration 04 years from April 2017 to April 2021. Methods: Sixty individuals of both sexes were brought in for consultation. Involved individuals had hydrocephalus that blocked their airways. The written consent of every patient allowed the collection of comprehensive demographic data, including age, gender, and body mass index (BMI). CT and MRI scans were performed on patients. Two groups of patients were formed, and the patients were split evenly between the two. An endoscopic third ventriculostomy was performed on group I, whereas ventriculoperitoneal shunt was implanted in group II patients. Efficacy and complications of therapy were evaluated at six-month intervals. All collected data were analyzed by using the SPSS 24.0 edition. Results: There was no any significant difference of age among both groups. Majority of the patients among both groups were males. Mean hospital stay in group I was lower 3.4± 6.45 days as compared to group II 8.1±1.35 days. Success rate in group I was higher 25 (83.3%) as compared to group II 20 (66.7%). Complications in group II was higher among 10 (33.3%) cases as compared to group I 5 (16.7%) in which CSF leak was the most common. Recurrence rate in group I was 4 (13.3%) and in group II was 6 (20%). Conclusion: In this research, we found that the endoscopic third ventriculostomy is an effective and safe procedure for treating patients with obstructive hydrocephalus as compared to ventriculoperitoneal shunt because of its low complication rate and decreased recurrence rate. Keywords: Ventriculoperitoneal Shunt, Obstructive Hydrocephalus, Endoscopic Third Ventriculostomy, Complications, Recurrence
Outcome of Percutaneous Peritoneal Drainage in High Risk Perforated Peritonitis
Authors: Ali Mukhtiar , Younis Sarmad , Ashraf Aqeel , Hussain Fazal , Sial Capt Ihsanullah , Sadiq Muhammad Attique
Published: April 2022

Study Design: Prospective study Place and Duration: The study is conducted at Surgical A ward Mardan Medical Complex, Mardan and Surgery department of Ahmed Hospital, Bagh Azad Kashmir during the period from June to November 2021. Methods: There were 85 patients of both genders with ages 22-80 years included. Patients were included into the study after obtaining written permission from all participants. All the patients had high perforation peritonitis treated with percutaneous peritoneal drainage with local anesthesia. Post-operative success rate, mortality and complications among all cases were recorded. SPSS 22.0 version was used to analyze complete data. Results: Among 85 cases, 54 (63.5%) were males and 31 (36.5%) patients were females with mean age 51.7±8.71 years. COPD was mostly found among 29 (34.1%) cases, followed by ischaemic heart disease in 20 (23.5%) cases, congestive heart failure in 14 (16.5%) cases, cerebrovascular stroke 12 (14.1%) and 10 (11.8%) patients had comorbidity of steroid use. After drainage, improvement observed in urine output and in blood pressure. Post-operative effectiveness was found among 70 (82.4%) cases and 15 (17.55) patients died. In Post-operative, we found that the surgical site infection (SSI) was the most common symptom followed by chest infection. Conclusion: According to our findings and experience, the use of percutaneous peritoneal drainage under local anaesthesia in patients who have been reported late or are critically ill improves their general condition and allows them to be better prepared to undergo further surgery, which could ultimately save their lives. Keywords: Percutaneous Peritoneal Drainage, Perforated Peritonitis, Mortality, Complications
Prevalence of Piriformis Muscle Tightness among Undergraduate Medical Students
Authors: Muhammad Atta , Rana Muhammad Rizwan , Amin Tooba , Angela Christina , Pereira Felicianus Anthony , Bhutto Mazhar Ali
Published: April 2022

Objectives: To determine the prevalence of piriformis muscle tightness among allied health students, and its relationship with age, gender and year of study. Methods: A cross sectional study was conducted. A sample size of 259 was calculated using Open Epi v3.01. Allied health students from physical therapy, occupational therapy and prosthetics & orthotics programs participated in this study, which lasted 4 months. After obtaining informed consent, data was collected through a self-developed questionnaire. Piriformis muscle tightness, and symptom recurrence, was determined using the FAIR test. Results: Average age of participants was 21.94±1.81 years. Females comprised of 79.9% of the study population. High percentage (85.3%) were from the physical therapy program. Most common posture was crossed leg sitting (48.3%). Positive FAIR test was found in 41.7% of the population. Strong correlation between age-group with FAIR test was noted (p=0.036). Conclusion: Piriformis muscle tightness is prevalent in those who engage in prolonged sitting postures. Furthermore, strong association of piriformis tightness with age is present, whereas no relationship with gender and year of study has been observed. Keywords: Piriformis muscle tightness, Piriformis muscle syndrome, Low back pain, Sedentary individuals, FAIR test.
Determine the External or Intraluminal Antibiotics Prevent Catheter-Related Communicable Disease in Persons Receiving Hemodialysis when Comparing to No Antibiotic Treatment
Authors: Ali Umar , Khan Zahid Ullah , Khalid Sidra , Anjum Nisar Haider , Jaffar Murtaza , Arshad Syma
Published: April 2022

Aim: Catheter-related diseases increase illness and mortality in dialysis patients. To determine if topical or intraluminal antibiotics prevent catheter-related bloodstream contagion in persons receiving hemodialysis when comparison to no antibiotic treatment. Methods: Inclusion and exclusion criteria chose controlled randomized studies utilizing topical or intraluminal antibiotics for contagion control measures in individuals receiving hemodialysis using catheters. Results: Pooled rate ratios for outcomes were estimated using fixed-effects modelling. Topical antibiotics decreased rate of bacteremia (ratio, 0.23 [96 percent confidence interval, 0.13 to 0.41]; 0.11 vs. 0.46 case of bacteremia per 120 catheter-days), exit-site contagion (ratio, 0.18 [CI, 0.09 to 0.39]; 0.07 vs. 0.42 case of infection per 120 catheter-days), catheter removal, in addition hospitalization for infectious disease. Intraluminal antibiotics decreased the risk of bacteremia and the necessity for catheter placement (Rate ratio, 0.33 [CI, 0.23 to 0.48]; 0.13 vs. 0.34 instance of bacteremia per 120 catheter-days). Intraluminal antibiotics did not lower rate of exit-site contagion appreciably, and no hospitalization statistics remained provided for some of those medicines. Conclusion: Antibiotics, including external and intraluminal, lowered the risk of bacteremia hence necessity for catheter elimination of problems. It is uncertain if all these tactics will result in antibiotic resistance and loss of potency over time. Keywords: Catheter-related diseases, dialysis patients, Topical or intraluminal antibiotics.
Patients Present with Left Bundle Branch Block and its Cardiac Structure Disease during Trans Thoracic Echocardiography
Authors: Arbab Irfan Ali , Memon Faraz Farooq , Rafique Muhammad , Mal Sharwan Bhuro , Kubra Ghulam , Rasheed Shazia
Published: April 2022

Background and Purpose: Left bundle branch block (LBBB) is a communal electrocardiographic (ECG) finding that may or may not be associated with overt heart disease at diagnosis. The current study was performed to determine the clinical picture and structural abnormalities of the heart diagnosed by transthoracic echocardiography in patients with left bundle branch block. Methods: This cross-sectional observational study was conducted over a six-month period in the Interventional Cardiology Unit Liaquat University Hospital Hyderabad from July 2021 to December 2021. Adult patients of both sexes with LBBB, symptomatic or asymptomatic, were recruited from an outpatient hospital setting and underwent elective Transthoracic echocardiography (TTE) after demographic / clinical data and informed consent were obtained. The TTE results were recorded and presented as frequency and percentage. Results: 120 patients were examined; 74 men and 46 women. The study population mean age was 52.7 ± 1.5 years, range (22-76) years. In a history, 10 (8.3%) patients had mild dyspnoea (NYHA class I-II) and 9 (7.5%) severe dyspnoea (NYHA class III-IV). Echocardiograms of only 11 (9.2%) patients were normal. The structural abnormalities observed included abnormal septal motion in 96 (80%), mitral regurgitation in 16 (13.3%), and left ventricular dilatation with left ventricular end-diastolic dimension> 60 mm in 23 (19.2%). LVEF was normal in 80 (66.7%) cases (> 50%); 18 (15%) had a LVEF of 25-35% and 12 (10%) had a LVEF of 35-50%. Conclusion: The possibility of structural cardiac abnormalities on echocardiography is high in patients with LBBB. Keywords: Transthoracic echocardiography, Left bundle branch block (LBBB), Structural heart disease.
How can we Minimise Pain During and After Carpal Tunnel Decompression?
Authors: Anwar Muhammad Waseem , Nazar Mudassar , Baig Abul Qayum , Ahmad Shabbir , Imran Muhammad , Usman Rashid
Published: April 2022

Objective: Our Study objective was to asses pain severity in a series of patients who underwent carpal tunnel release (CTR) surgery with a technique that minimise tourniquet inflation time. Material and Method: Our study represented a prospective case series conducted from June 2021 to Dec 2021 in Islam Medical College Sialkot and CMH Lahore. A total of 160 patients with a clinical diagnosis and positive EMG/NCS were included. The patients were asked to complete a proforma which assesses pain on basis of Visual Analogue Scale (VAS) at 3 occasions; (1) at initial out patient appointment (2) in post operative area after surgery (3) at 12 weeks post CTR surgery. Questions were asked to assess pain severity at surgery site and over area of tourniquet inflation. Results: 160 patients were included in our study with a median age of 50years (range 33-65). There were 110 females and 50 males (ratio 2.2:1). The average tourniquet time was 8 minutes (range 6-9.5). 91.8% (n-147) of our patients had a VAS of 1 at both the wound and tourniquet site post-operatively. 5% had a score of 3 and 4.2 had a VAS score of 4 (n-8 and n-5 respectively). 27 were operated in past for contralateral CTD as well and remaining 133 patients said they would prefer to be operated for other side by similar method. Conclusion: Our technique is safe and effective in reducing pain post CTR surgery.
Frequency of Jaundice in Pregnancy and its Maternal and Fetal Outcome
Authors: Kanwal Sahrish , Habib Aneela , Begum Amina , Naz Urooj , Ali Saima , Kazi Sarha
Published: April 2022

Background: During pregnancy, jaundice is important medical disorder more commonly seen in developing countries than developed one. Jaundice in pregnancy carries a grave for both the fetus and mother. This study is design to identify the frequency of jaundice in pregnancy and its maternal and fetal outcome to establish current local data for other health care providers. Aim: To determine the frequency of jaundice in pregnancy and its maternal and fetal outcome. Study Setting: This was a descriptive case series study conducted at the department of Obstetrics and gynecology of Civil hospital Karachi for the duration of 6 months from July 2018 to January, 2019. Subject and Methods: A total of 507 pregnant women were included in this study. The frequency of jaundice in pregnancy and its maternal and fetal outcome data was documented on pre designed proforma. Results: - The average age of the women was 25.91±4.46 years. Frequency of jaundice in pregnancy was 8.28%. Hepatic encephalopathy, disseminated intravascular coagulation, atonic PPH and maternal mortality was significantly high in those pregnant women who had jaundice. Similarly fetal outcome, still birth was 20% (20/40%) in which fresh still birth and macerated still birth was 15% and 5% which were not statistically significant while all were late neonatal death and which was significantly high in jaundice pregnant cases [45% vs. 9.7%; p=0.0005] . Conclusion: Jaundice in pregnancy is rare, but remains clinically important because of serious adverse effects on both the mother and the fetus. These disorders are complex and should be managed by experienced physicians in specialized centers. Keywords: Jaundice, disseminated intravascular coagulation, Atonic PPH
Prevalence of Appendix Perforation in Patients Presenting with Acute Appendicitis: A Cross-Sectional Study
Authors: Ghias Nighat , Tasneem Aisha , Mal Lekhraj , Memon Abdul Salam , Owais Muhammad Abid , Tasneem Bushrsa
Published: April 2022

Aim: To find out the frequency of perforated appendix among patients presenting with acute appendicitis. Study design: A cross-sectional study Place and Duration: This study was conducted at Sindh Employee Social Security Hospital Landhi Karachi, Pakistan from July 2020 to November 2021. Methodology: This study includes 205 patients. All the details like age, gender, and previous history associated with diabetes and fasting blood sugar were noted. The surgeries were performed by a single surgeon who detected the presence and absence of a perforated appendix. Results: Mean age of patients was 28 years with a standard deviation of ±13.63. A total of 64% of patients were male and 26% were female. About 11% of patients had perforated appendix after acute appendicitis. Conclusion: The frequency of perforated appendix in this study was 11% in patients undergoing appendectomy for acute appendicitis. Keywords: Appendicitis, perforated appendix, adults, prevalence
Effectiveness of Emergency Ligation of Internal ILIAC Artery in Controlling Post-Partum Hemorrhage
Authors: Bashir Humaira , Khan Sabeeha , Baber Rubina , Taskeen Rehana , Rafique Iram , Shahwar Durri
Published: April 2022

Treatment of severe pelvic bleeding remains a major challenge in obstetrics and Gynecology. In this situation, an attempt was made with variable success at bilateral internal iliac artery ligation (BIAL). Aim: The purpose of this study was to evaluate the effectiveness of this procedure in females with intractable pelvic hemorrhage. Methods: This observational study was conducted at the Department of Obstetrics and Gynecology of Mufti Mehmood Teaching Hospital D I Khan for one year duration from January 2021 to December 2021. During the study period, a total of 35 emergency internal iliac arteries ligation and, if necessary, gradual uterine de-vascularization or cesarean hysterectomy were performed as a life-saving procedure. Results: Haemotasis was successfully achieved in 33 patients. Of the 35 patients who required a cesarean hysterectomy, two patients died of multiple organ dysfunction following the hysterectomy. However, no complications related to BIAL were observed in any of the other patients. The mortality rate was 5.7% in this study. Conclusions: In our study, BIAL was recognized as a safe and effective treatment procedure for life-threatening obstetric haemorrhage. But for unknown reasons, the procedure is much less practiced than other radical options. Keywords: ligation of internal iliac artery, emergency, pelvic bleeding
Efektivitas Penggunaan Nanopartikel Karbon Sebagai Pewarna Nodus Limfa Dalam Limfadenektomi Pada Kanker Kolorektal: Sebuah Kajian Sistematik
Authors: Audrey Jessica
Published: April 2022

Pendahuluan: Kanker kolorektal (KKR) merupakan keganasan ketiga paling sering ditemukan di dunia yang menyebabkan setidaknya 881.000 nyawa hilang dalam setahunnya. Meskipun telah bermunculan beberapa opsi terapi baru, bedah reseksi tetaplah pengobatan pilihan untuk KKR. Mengingat kemungkinan terjadinya metastasis ke nodus limfa di sekitarnya, limfadenektomi yang lengkap merupakan faktor prognosis yang penting sekaligus menentukan stadium kanker. Baru-baru ini, nanopartikel karbon ini telah muncul sebagai pelacak nodus limfa untuk KKR. Namun, kajian mengenai efektivitasnya masih belum ditemui.Tujuan: Mengevaluasi efektivitas nanopartikel karbon dalam mendeteksi nodus limfa dan meningkatkan akurasi penahapan pada KKR.Metode: Kajian sistematik ini dilakukan dengan menelusuri PubMed, Scopus, EBSCOHost, dan Cochrane, mencari studi-studi yang mengimplementasikan nanopartikel karbon untuk melacak nodus limfa dalam reseksi KKR. Penilaian kualitas studi dilakukan dengan instrumen penilaian yang sesuai.Pembahasan: Kajian ini meliputi 10 studi dengan total subjek sebesar 1387 orang. Nanopartikel karbon terbukti efektiv dalam meningkatkan jumlah nodus limfa yang direseksi dan meningkatkan deteksi nodus limfa kecil yang berukuran <5 mm. Jumlah nodus limfa positif tidak berbeda signifikan dengan kontrol; namun, nanopartikel karbon meningkatkan akurasi penahapan stadium sehingga mengurangi risiko understaging. Selain itu, waktu bedah dan kehilangan darah pun berkurang dibandingkan dengan metode konvensional. Tidak ada efek samping signifikan yang dilaportan.Simpulan: Nanopartikel memberikan potensi yang menjanjikan sebagai pewarna nodus limfa untuk meningkatkan reseksi serta akurasi penahapan pasien KKR.
VAKSIN DNA HEAT SHOCK PROTEIN 65 (HSP65) DENGAN KLK YANG TERENKAPSULASI NANOPARTIKEL PLGA SEBAGAI INOVASI TERAPI PREVENTIF DAN KURATIF TUBERKULOSIS
Authors: Firmansyah Jaya , Nafisah Hana , Yasmin Nabila Rayhan
Published: April 2022

Pendahuluan: Tuberkulosis merupakan salah satu penyakit dengan angka mortalitas yang tinggi. Untuk mencegah penyebaran tuberkulosis adalah dengan pemberian vaksin BCG. Namun, efek perlindungan dari vaksin BCG bervariasi dari 0-80% dan menurun secara signifikan setelah 10-15 tahun. Jadi, dibutuhkan inovasi vaksin baru yang lebih protektif. Tujuan dari tinjauan pustaka ini adalah untuk mengetahui efektivitas penggunaan vaksin DNA hsp65 dengan nanopartikel PLGA berkapsul dengan adjuvan KLK sebagai inovasi terapi preventif dan kuratif untuk tuberkulosis.

Metode: Makalah yang telah ditinjau diperoleh menggunakan mesin pencari seperti Google Scholar, Proquest, Science Direct, dan PubMed dengan rentang publikasi dari 2010 hingga 2020 dan makalah dipilih validitas dan reliabilitasnya. Kemudian dilakukan tinjauan pustaka dan penulisan artikel.

Pembahasan: Vaksin DNA hsp65 dapat memicu produksi sitokin, seperti IFN-γ, IL-2, aktivitas sel CD4 + dan CD8 + T yang lebih tinggi daripada vaksin BCG. Ada penurunan yang signifikan pada tingkat MTB pada tikus yang disuntik dengan vaksin hsp65. Kombinasi vaksin Hsp65 + KLK menunjukkan kerusakan paru-paru dan area inflamasi paling sedikit dan respon Th1 dan produksi IL-10 tertinggi di antara vaksin lainnya. Untuk meningkatkan efisiensi vaksin DNA hsp65 + KLK, dilakukan pengurangan dosis menjadi dosis tunggal dengan menggunakan nanopartikel PLGA biodegradable sebagai sistem pembawa antigen.

Simpulan: Kombinasi vaksin DNA hsp65 dan KLK dapat memicu respon imun spesifik terhadap MTB dan dengan enkapsulasi PLGA dapat meningkatkan efisiensinya, sehingga berpotensi tinggi sebagai terapi preventif dan kuratif tuberkulosis.
CLINICAL OUTCOMES OF IVERMECTIN IN COVID-19 TREATMENT: AN EVIDENCE-BASED CASE REPORT FROM SYSTEMATIC REVIEWS AND META-ANALYSES
Authors: Theola Jason , Hermanadi Muhammad Ikrar , Gibran Kahlil , Ihsan Syarifaha
Published: April 2022

Background: Ivermectin has demonstrated beneficial results on clinical outcomes in COVID-19 patients. Several countries have included ivermectin in their guidelines, though WHO recommended against its usage. Therefore, this study was aimed to establish the clinical outcomes of ivermectin in COVID-19 patients by an evidence-based method.

Method: Article searching was completed in PubMed, Cochrane, and Scopus from July 9 - 10 2021. The results were limited to only systematic reviews and meta-analyses. Hand searching was conducted to obtain relevant studies from external resources. The results were evaluated using inclusion and exclusion criteria. The full texts were obtained and critically reviewed using Oxford Centre for Evidence-Based Medicine critical appraisal tools.

Result: Three systematic reviews and meta-analyses were selected and critically reviewed. All three studies were considered valid, important, and applicable. However, the quality of these studies varied from low to high. 

Conclusion: Overall studies showed that ivermectin has the potential to improve clinical outcomes in COVID-19 patients.
POTENSI KOMBINASI NANOPARTIKEL FULLERENOL DAN INHIBITOR UREASE DALAM TATALAKSANA FARMAKOLOGIS INFEKSI HELICOBACTER PYLORI
Authors: Dyson Nathaniel Gilbert , Fakhri Aldithya
Published: April 2022

Pendahuluan: Helicobacter pylori menginfeksi lebih dari 50% populasi manusia di dunia. Hingga saat ini, tatalaksana farmakologis untuk infeksi Helicobacter pylori masih memiliki banyak tantangan, terutama resistensi antibiotik dan efek samping penggunaan PPI. Berbagai studi terbaru mengungkap bahwa nanopartikel fullerenol yang dimodifikasi dan dikombinasikan dengan inhibitor urease memiliki kemampuan untuk mengeradikasi Helicobacter pylori.

Metode: Pencarian literatur dilakukan pada tiga database, yaitu PubMed, Scopus, dan Google Scholar, secara independen dengan kriteria inklusi dan eksklusi yang telah ditentukan sebelumnya. Hasil pencarian dengan metode tersebut didapatkan 5 studi yang terpilih yang digunakan dalam kajian literatur ini.

Pembahasan: Nanopartikel fullerenol dapat mengalami proses pinacol rearrangement dan memiliki gugus fungsional karboksil atau karbonil yang dapat berperan menyerupai aktivitas enzim peroksidase untuk menghancurkan polisakarida pada dinding sel Helicobacter pylori. Biotoksisitas dari nanopartikel fullerenol termodifikasi pada uji toksisitas dengan Drosophila melanogaster menunjukkan tidak adanya efek samping yang berarti. Inhibitor urease, seperti katekol dan p-benzonequinol, dapat menurunkan sintesis ammonia sehingga menurunkan pH lumen lambung. Kondisi ini akan menghambat pertumbuhan Helicobacter pylori dan meningkatkan kerja nanopartikel fullerenol termodifikasi. Biotoksisitas dari inhibitor urease juga sangat rendah dibuktikan dengan terjadinya perubahan morfologis sel glioblastoma (GL-15) manusia secara in vitro konsentrasi di atas 200 μM.

Simpulan: Nanopartikel fullerenol memiliki sifat seperti enzim peroksidase yang dapat menghancurkan dinding sel Helicobacter pylori. Sedangkan inhibitor urease mampu menurunkan sintesis ammonia sehingga menurunkan pH dan mencegah infeksi. Kombinasi antara FNP dan inhibitor urease sangat potensial sebagai alternatif tatalaksana farmakologis infeksi Helicobacter pylori.
KADAR C-REACTIVE PROTEIN, D-DIMER, DAN LAKTAT DEHIDROGENASE SEBAGAI PREDIKTOR LUARAN COVID-19 PADA ANAK: SEBUAH KAJIAN SISTEMATIS
Authors: Lam Macmilliac , Celcilia Laureen
Published: April 2022

Pendahuluan: Coronavirus Disease (COVID-19) merupakan penyakit infeksius akibat virus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Di tengah lonjakan kasus COVID-19, Indonesia memiliki tingkat kematian anak akibat COVID-19 yang tertinggi di dunia. Hingga saat ini, belum banyak studi yang menjelaskan karakteristik laboratorium COVID-19 pada anak. Kajian sistematis ini bertujuan untuk menilai signifikansi dari temuan laboratorium, khususnya c-reactive protein (CRP), D-dimer, dan laktat dehidrogenase (LDH), untuk memprediksi keparahan COVID-19 pada anak.

Metode: Kajian sistematis dilakukan melalui PubMed, Scopus, Cochrane, dan Google Scholars untuk mencari studi yang meninjau nilai prognosis dari c-reactive protein (CRP), D-dimer, dan laktat dehidrogenase (LDH) pada anak dengan COVID-19. Penilaian kualitas studi dilakukan dengan instrumen Newcastle-Ottawa Scale.

Pembahasan: Kajian sistematis ini meninjau 11 studi dengan total 3424 subjek. Kadar c-reactive protein (CRP) meningkat secara signifikan pada pasien anak dengan COVID-19 berat/kritis. Selain itu, anak-anak dengan komplikasi memiliki tingkat c-reactive protein(CRP) dan D-dimer yang lebih tinggi.

Simpulan: Sebagai kesimpulan, kadar c-reactive protein (CRP) dapat menjadi biomarker yang potensial untuk meningkatkan identifikasi dan perawatan dini pada penyakit COVID-19 berat pada anak. Penelitian lebih lanjut mengenai kadar D-dimer dan laktat dehidrogenase (LDH) sebagai penanda keparahan COVID-19 masih dibutuhkan untuk memberikan rekomendasi kuat.
HUBUNGAN KONSENTRASI HEMOGLOBIN DARAH DENGAN KEJADIAN INFARK MIOKARD AKUT DI RUMAH SAKIT UNIVERSITAS SUMATERA UTARA PERIODE 2018-2019
Authors: Namli Sugiono
Published: April 2022

Pendahuluan: Penyakit jantung koroner (PJK) merupakan penyebab terbesar kematian dan kecacatan di dunia dan infark miokard akut (IMA) merupakan bentuk PJK yang tersering. Penyebab kejadian infark miokard tersering adalah ketidakseimbangan suplai dan kebutuhan oksigen. Penurunan konsentrasi hemoglobin (Hb) akan menyebabkan penurunan pengangkutan oksigen dalam aliran darah koroner. Tujuan penelitian ini adalah mengetahui hubungan antara konsentrasi hemoglobin dengan kejadian infark miokard akut di Rumah Sakit Universitas Sumatera Utara periode 2018–2019.

Metode: Penelitian ini menggunakan metode analisis dengan desain cross sectional dengan sampel yang diambil dari Rumah Sakit Universitas Sumatera Utara dari Maret sampai December 2019. Penelitian menggunakan data sekunder dari rekam medis pasien rawat inap dengan diagnosis IMA di departemen kardiologi Rumah Sakit Universitas Sumatera Utara periode 2018–2019. Data yang dikumpulkan kemudian dianalisis menggunakan program SPSS v.24.

Hasil: Terdapat 19 pasien IMA, yang didominasi usia 51–60 tahun. Pasien IMA didominasi oleh laki-laki. P value 0,864 didapatkan melalui analisis bivariate dengan metode Chi-Square.

Pembahasan: Penelitian ini sesuai dengan temuan Sarnak dkk., yang menyatakan bahwa Hb merupakan faktor risiko independen terjadinya PJK akan tetapi menjadi tidak signifikan jika dikombinasi dengan faktor risiko lain yang merupakan keterbatasan dalam penelitian ini.

Simpulan: Tidak ditemukan hubungan antara nilai hemoglobin dengan kejadian infark miokard akut.
Potensi Injeksi Intra-artikular Sel Punca Mesenkimal sebagai Terapi Osteoartritis Lutut:
Authors: Yusuf Vincentius Mario , Leonita Ivena , Setiawan Aurielle Annalicia , Yusuf Muhammad
Published: April 2022

Pendahuluan: Osteoartritis (OA) merupakan penyakit sendi kronis multifaktorial (inflamasi, mekanis, metabolik) yang paling sering ditemukan terutama pada sendi lutut. Terapi OA kini masih bersifat simtomatik menggunakan NSAID dengan efek samping yang cukup berat pada penggunaan jangka panjang. Oleh karena itu, diperlukan terapi kausatif terbaru yang dapat meminimalisir efek samping dan memiliki efikasi yang tinggi. Mesenchymal stem cells (MSC) memiliki potensi yang menarik untuk diteliti lebih lanjut sebagai terapi OA.

Metode: Pencarian literatur dilakukan menggunakan mesin pencari PubMed, Cochrane, ScienceDirect, dan ProQuest, dengan kata kunci “knee osteoarthritis” dan “mesenchymal stem cells” dan dengan rentang publikasi dari 2011-2021. Penelitian RCT yang meneliti penggunaan injeksi MSC secara intra-artikular untuk OA lutut dimasukkan ke dalam tinjauan ini. Pengukuran hasil yang diambil meliputi Visual Analog Scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), hasil MRI (WORMS, volume kartilago dan ukuran defek kartilago), dan efek samping.

Pembahasan: MSC dapat meningkatkan penilaian klinis OA, dilihat melalui perbaikan skor WOMAC dan VAS secara signifikan dan perbaikan radiologis yang dilihat melalui skor WORMS, defek dan volume kartilago. MSC memiliki properti anti-inflamasi, imunomodulasi dan kemampuan stimulasi tumbuhnya sel-sel mirip kartilago yang dapat membantu penyembuhan dan penghambatan perkembangan OA. Efek samping yang ditimbulkan cenderung ringan dan bersifat self-limiting sehingga aman untuk penggunaan pada manusia.

Simpulan: Injeksi MSC secara intra-artikular berpotensi efektif sebagai metode terapi OA lutut dengan efek samping yang minimal.
THE ASSOCIATION BETWEEN TUBERCULOSIS RISK FACTORS AND VITAMIN D SERUM LEVEL ON TUBERCULOSIS PATIENS
Authors: Harahap Fadlan Hafizh
Published: April 2022

Background: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis which attacks various organs. Tuberculosis has risk factors for age, sex, nutritional status, HIV infection, history of diabetes, corticosteroid use, and history of primary TB. Prolonged tuberculosis causes a decrease in vitamin D levels in blood serum.Objective: This study aims to look at the association of risk factors to serum vitamin D levels in TB sufferersMethod: Research conducted is analytic with cross-sectional design. The sample of the study were 30 patients with TB in Haji Adam Malik General Hospital, Teladan and Amplas primary health center Medan who had met the inclusion and exclusion criteria. Results: Pearson correlation test showed there was an inverse correlation between BMI and vitamin D levels (p = 0.007; r = -0.482) and there was no significant relationship between age and vitamin D levels. Fisher exact test found no association between vitamin D levels on corticosteroid use (p = 1,000), history of diabetes (p = 0.469), HIV coinfection, and primary TB (p = 1,000). Conclusion: In conclusion, there is an inverse correlation between the BMI value and vitamin D levels. No association was found between vitamin D levels and age, corticosteroid use, and history of diabetes.
Potensi siRNA Terenkapsulasi Nanopartikel sebagai Agen Silencing sflt-1 dan nrf-2: Inovasi Terapi Efektif terhadap Preeklamsia
Authors: Winarta Sanjaya , Loa Raimond , Thosal Renaldo
Published: April 2022

ABSTRAK

Pendahuluan: Kematian ibu dapat terjadi pada waktu kehamilan ataupun terminasi kehamilan. Terdapat sekitar 295.000 kematian ibu di dunia pada tahun 2017. Indonesia sendiri merupakan negara dengan angka kematian ibu ke-3 terbesar di Asia Tenggara. Salah satu penyebab terbanyak dari kematian ibu adalah preeklamsia. Preeklamsia biasanya dialami oleh ibu hamil dengan kehamilan yang berusia lebih dari 20 minggu, dimana terjadi peningkatan tekanan darah dan proteinuria, serta dapat menyebabkan banyak komplikasi. Metode terapi definitif preeklamsia yang ada saat ini hanyalah melalui terminasi kehamilan yang bisa memberikan banyak dampak negatif terhadap janin, seperti kelahiran preterm, pertumbuhan janin terhambat, gangguan pernapasan, hingga kematian. Saat ini, beberapa penelitian menunjukkan bahwa sebuah molekul small interfering RNA (siRNA) mempunyai potensi untuk menjadi agen terapi yang lebih efektif terhadap preeklamsia. Oleh karena itu, telaah literatur ini bertujuan untuk menganalisis potensi siRNA sebagai inovasi pengobatan preeklamsia pada ibu hamil. Metode: Telaah literatur ini dilakukan pada artikel dari beberapa database medis berupa NCBI pubmed, Elsevier, dan Google Scholar, dengan pencarian kata kunci “Nanopartikel”, “Nrf2”, “Preeklamsia”, “sFlt1”, dan “siRNA”. Pembahasan: Didapatkan 6 jurnal utama yang berkorelasi dengan tujuan pembuatan telaah literatur ini dan diperoleh informasi bahwa molekul siRNA dapat melakukan silencing terhadap komponen Soluble fms-like tyrosine kinase-1 (sFlt-1) dan Nuclear factor erythroid 2-like 2 (Nrf-2) yang berperan dalam patofisiologi terjadinya preeklamsia. Selain itu, stabilisasi penggunaan formulasi ini dapat ditingkatkan dengan mengenkapsulasi siRNA di dalam nanopartikel. Simpulan: Formulasi siRNA terhadap sFlt-1 dan Nrf-2 dapat menjadi formulasi baru yang berpotensi untuk menjadi suatu inovasi agen terapi preeklamsia yang lebih efektif.
POTENSI PITAVASTATIN DENGAN NANOPARTIKEL POLY(DL-LACTIDE-CO-GLYCOLIDE) (PLGA) DRUG DELIVERY SYSTEM SEBAGAI TERAPI ADJUVAN PADA PENYAKIT JANTUNG KORONER
Authors: Wiguna Visakha Vidyadevi , Haq Abiyyu Didar , Suari Luh Gde Sri Adnyani
Published: April 2022

ABSTRAK

Pendahuluan: Selama pandemi COVID-19, terjadi peningkatan kebiasaan gaya hidup yang tidak sehat terutama gaya hidup sedentari yang meningkatkan risiko terkait penyakit kardiometabolik. Salah satu penyakit yang memiliki hubungan erat dengan gaya hidup sedentarisme adalah Penyakit Jantung Koroner (PJK). PJK adalah penyebab kematian paling umum penyakit kardiovaskular dengan 12% dari semua kematian di seluruh dunia. Terapi Percutaneous coronary intervention (PCI) pada fase akut infark miokard dapat mengurangi luas infark, tetapi akibat adanya cedera reperfusi membatasi efikasi terapeutiknya.

Metode: Metode yang digunakan dalam penulisan tinjauan pustaka ini adalah dengan pencarian dan tinjauan literatur dari berbagai pusat data daring dan search engine. Pencarian dilakukan dengan menggunakan kata kunci “pitavastatin”, “drug delivery system”, “nanoparticle”, “PLGA”, “myocardial infarction”, “ischemic-reperfusion injury”. Dari hasil pencarian literatur, 34 literatur relevan dan digunakan untuk tinjauan pustaka ini.

Pembahasan: Pitavastatin merupakan statin yang memiliki efek signifikan terhadap perubahan pada LDL-C, TG, dan HDL-C. Selain itu, pitavastatin juga memiliki efek kardioprotektif pada cedera iskemia reperfusi dengan menurunkan stres oksidatif dan meningkatkan antioksidan intraseluler. Nanopartikel PLGA mampu meningkatkan efek terapeutik, dari pitavastatin, terutama untuk cedera iskemik- reperfusi dengan sistem penghantaran zat aktif yang cepat dan efek anti-inflamasi yang dimilikinya.

Simpulan: Pitavastatin yang dienkapsulasi dengan nanopartikel PLGA mampu mencegah terjadinya cedera iskemik-reperfusi miokardial pada pasien infark miokard. Tindakan pencegahan untuk cedera iskemik-reperfusi miokardial yang seringkali mengalami hambatan dalam penghantaran obat akibat durasi yang tersedia sangat singkat dapat diatasi dengan nanopartikel PLGA.
POTENSI PROBIOTIK SEBAGAI REGULATOR SITOKIN INFLAMASI DALAM PERBAIKAN KLINIS PASIEN COVID-19
Authors: SUCIANGTO WILLIAM , Zainal Ahmad Taufik Fadillah , Nasrum Nada Indira Ramadhani
Published: April 2022

ABSTRAK

Coronavirus disease 2019 (COVID-19) merupakan sebuah pandemic global yang diakibatkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Penelitian-penelitian terbaru menunjukkan bahwa fenomena badai sitokin, replikasi virus yang tinggi, dan terhambatnya persinyalan Interferon type 1 (IFN-I) berkontribusi terhadap keparahan klinis COVID-19. Progresivitas respon IFN-I yang lambat mengakibatkan peningkatan akumulasi monosit patogenik sehingga terjadi imunopatologi paru, kebocoran vaskular, dan respon sel T suboptimal. Selain itu, berbagai studi lainnya juga melaporkan bahwa pemberian probiotik dapat memediasi respon antivirus terhadap coronavirus yang menyerang manusia. Dalam studi literatur ini kami mendiskusikan potensi probiotik dalam meregulasi badai sitokin dan produksi Interferon tipe 1 yang dapat memperbaiki gejala klinis pada pasien-pasien COVID-19. Studi ini dibuat berdasarkan hasil sintesis kualitatif beberapa literatur valid. Hasil review ini menunjukkan bahwa beberapa jenis probiotik mampu menekan produksi sitokin pro-inflammatori yang terlibat dalam fenomena sitokin dan merangsang produksi IFN tipe 1. Melalui mekanisme pencegahan terjadinya badai sitokin dan meningkatkan produksi IFN tipe 1, probiotik memiliki potensi sebagai regulator sistem imun yang dapat meningkatkan luaran klinis pada pasien-pasien COVID-19. Namun demikian, penelitian dengan skala lebih besar dan lebih lanjut masih diperlukan untuk  membuktikan bahwa probiotik mampu menjadi solusi dalam tatalaksana infeksi-infeksi akibat virus.