REVIEW ON THE CONCEPT OF SHAT KRIYAKALA

Diagnosis in Ayurveda is not always in terms of the name of the disease but in terms of the nature or phenomenon. This phenomenon is described in terms of Samprapti of the disease in each patient, comprising Dosha, Dushya and Adhishtana components. The prime factors in the pathogenesis of the disease are Dosha and Dushya. Shat kriyakala refers to the stage of development of a pathological process in which a physician can intervene by the most accurate treatment modality and medicine, thereby halting the progression of the disease process. By intricate understanding of the process of Shat kriyakala, the disease process could be arrested, and further complications can be avoided. In the current scenario, the concept of prevention has become broad-based. The natural history of disease is one of the significant elements of epidemiology. The course of a disease takes in individual people from its pathological onset until its eventual resolution. Natural history of disease is possible to correlate pre-pathogenesis with Sanchaya, Prakopa, Prasara and pathogenesis with Sthanasamsraya, Vyakti and Bhedavastha of Shat kriyakala. Recent studies have shown that it is possible to identify certain pre-clinical stages for many diseases like Parkinson’s disease, which can help in the early successful treatment. Shat kriyakala helps to arrest the disease process at the very early stage itself. Along with current technology, the need for research for validating the Shat kriyakala will benefit humankind in the long run.

Cancer Immunotherapy Biomarkers of Response and Toxicity; Current Limitations and Future Promise

Immune Checkpoint Inhibitors are monoclonal antibodies that are used to treat over one in three cancer patients. While they have changed the natural history of disease, prolonging life and preserving quality of life, they are highly active in less than 40% of patients, even in the most responsive malignancies such as melanoma, and cause significant autoimmune side effects. Licenced biomarkers include tumour Programmed Death Ligand 1 expression by immunohistochemistry, microsatellite instability, and Tumour Mutational Burden, none of which are particularly sensitive or specific. Emerging tumour and immune tissue biomarkers such as novel immunohistochemistry scores, tumour, stromal and immune cell gene expression profiling, and liquid biomarkers such as systemic inflammatory markers, kynurenine/tryptophan ratio, circulating immune cells, cytokines and DNA are discussed in this review. We also examine the influence of the faecal microbiome on treatment outcome and its use as a biomarker of response and toxicity.

Factor Analysis of Caesarean Section at Panti Waluya Hospital, Malang

The incidence of caesarean section in Indonesia has increased every year. Caesarean section is an alternative to delivery when vaginal delivery cannot be done. The problems studied are the factors that influence the action of cesarean section delivery. The purpose of the study was to analyze the factors of delivery by caesarean section at Panti Waluya Hospital, Malang. The design of the study used cross sectional. The population in this study was all parturition mothers who were in the medical records of Panti Waluya Hospital Malang in January-May 2021. The sampling technique in this study used Simple Radom sampling, obtained 55 samples that met the inclusion criteria (ie data in the medical record). The study was carried out at the Panti Waluya Hospital in Malang in May 2021. The instrument used observation sheet. The data taken came from secondary data, namely the patient's medical record. The independent variables of the study were maternal age, gestational age, employment status, parity, disease history, income, insurance, education, delivery distance. The dependent variable of the study was caesarean section. The data analysis used Fisher exact test and logistic regression test. The results showed that history of disease and delivery interval had a significant correlation with delivery, and the variable that was the determinant of CS delivery was history of disease (p=0.012; OR=8.463). It is necessary to carry out routine ANC for pregnant women, in order to avoid risk factors for childbirth by caesarean section.

Expanding Pharmacy Services to Support Public Health

Pharmacists have had long-standing roles in public health, and the COVID-19 pandemic has broadened and accentuated their efforts in this area. Many pharmacists may be interested to expand pharmacy services to further support public health. While not intending to be exhaustive, this paper suggests potential areas for increased engagement and provides ideas for pharmacists who want develop and implement new initiatives to optimize the health of their patients and communities. The core functions of public health and the natural history of disease are presented as models to identify opportunities for pharmacists’ interventions. A three-step framework with practical strategies and helpful resources is proposed to identify and operationalize new services. Finally, the pharmacist’s role in clinical-community linkages is presented. It is hoped that this paper will stimulate additional ideas and actions in the pharmacy community to support public health.

Risk Factors Analysis of Hypertension Incidence at Karangtengah Public Health Center, Wonogiri Regency

Hypertension is the most common disease found in Karangtengah Health Center, Wonogiri Regency. The incidence of hypertension can be influenced by factors such as: factor that can not be changed consists of age, gender, family history of illness and modifiable factors consisted of obesity, occupation, and smoking history. Of these risk factors, still unknown factors which increse the incidence of hypertension in Karang Tengah Public Health Center. The purpose of this study was to determine the relationship of these risk factors with the incidence of hypertension and the determinants of the incidence of hypertension in Karangtengah Public Health Center, Wonogiri Regency. This type of research is analytic observational with a cross-sectional design. The sample of this study used the total sampling method, namely all medical record data of new adult patients (>26 years) with a history of chronic diseases who came to Karangtengah Public Health Center, Wonogiri Regency in October 2020 and this study was conducted in March 2021. There were 76 patients. Most of the patients had hypertension (n=42; 55.3%), including the category of elderly (n=55; 72.4%), women (n=41; 53.9%). More patients had a family history of disease (n=50; 65.8%), were obese (n=40; 52.6%), had minimal work activities (n=44; 57.9%), and had a history of smoking (n=42; 55.3%). The risk factors associated with the incidence of hypertension were age, gender, family history of disease, BMI, occupation, and smoking history (all p<0.05). Keywords: Hypertension, age, family history, BMI, occupation

Evaluation of clinical outcomes of patients with mild symptoms of coronavirus disease 2019 (COVID-19) discharged from the emergency department

Introduction This study was performed to determine the clinical outcomes of patients with mild symptoms of COVID-19 discharged from the emergency department. Methods The present descriptive-analytical cross-sectional study was performed on 400 patients discharged with a diagnosis of COVID-19 from the emergency departments of hospitals affiliated to Tabriz University of Medical Sciences in the time period of 21 March-21 June, 2020. The disease characteristics and demographic data were collected by phone calls during the first, third, and fourth weeks using a researcher-made questionnaire. Finally, the data were analyzed by univariate logistic regression and cross-tabulation using the IBM SPSS Statistics for Windows, version 20. Results In the first week of follow-up, 23(5.8%) patients died, of whom seven patients were female and 16 were male (mean age of death: 70.73±3.27). Out of 41 (10.3%) patients with underlying diseases, 7 (17.1%) died; but out of 359 (89.8%) cases with no history of disease only 16 (4.5%) died. The risk of death in subjects with a history of underlying diseases was 3.27 times higher than those without a history of disease (P = 0.02) (OR = 3.27, 95% CI, 1.20–8.87); and this risk was 1.41 times higher in patients with more family members (P = 0.04) (OR = 1.41, 95% CI, 1.01–1.97). Furthermore, 81 (20.3%) patients had spread the virus to others in their households and disregarded hygiene guidelines such as washing hands, keeping social distancing, and wearing face masks after discharge. In addition, family members of these patients were 16.37 times more likely to be infected than patients who followed the protocols (P ≤ 0.001) (OR = 16.37, 95% CI, 9.10–29.45). Conclusion Since our findings showed that mortality rate is high in the first week after patients’ referral to the emergency departments, the health status of infected people should be carefully monitored daily in this period.

A Pathogenic Presenilin-1 Val96Phe Mutation from a Malaysian Family

Presenilin-1 (PSEN1) is one of the causative genes for early onset Alzheimer’s disease (EOAD). Recently, emerging studies have reported several novel PSEN1 mutations among Asians. In this study, a PSEN1 Val96Phe mutation was discovered in two siblings from Malaysia with a strong family history of disease. This is the second report of PSEN1 Val96Phe mutation among EOAD patients in Asia and in the world. Patients presented symptomatic changes in their behaviors and personality, such as apathy and withdrawal in their 40s. Previous cellular studies with COS1 cell lines revealed the mutation increased the amyloid-β42 (Aβ42) productions. In the present study, whole-exome sequencing was performed on the two siblings with EOAD, and they were analyzed against the virtual panel of 100 genes from various neurodegenerative diseases. In silico modeling was also performed on PSEN1 Val96Phe mutation. This mutation was located on the first transmembrane helix of PSEN1 protein, resulting significant intramolecular stresses in the helices. This helical domain would play a significant role in γ-secretase cleavage for the increased Aβ42 productions. Several other adjacent mutations were reported in this helical domain, including Ile83Thr or Val89Leu. Our study suggested that perturbations in TMI-HLI-TMII regions could also be associated with C-terminal fragment accumulation of APP and enhanced amyloid productions.