Involvement of lipids in immune system regulation: A mini-review

An immune system recognizes and responds to antigens entering the body. Maintaining these roles, components of the immune system need energy obtained from nutrients such as carbohydrates, proteins, and lipids. This study reviews and discusses roles of lipids, particularly fatty acids, in regulations of the immune system. This study was conducted by conducting a literature study on published research articles written in English. The articles were obtained from PubMed and Google Scholar by using search keywords: lipid, fatty acids, immune, regulation, inflammation, and response. Lipids are a group of biomolecule compounds composed of carbon, oxygen, and hydrogen, and they are classified into simple, compound and complex lipids. Fatty acids are compound lipids that act as a main fuel for metabolism, an essential component for all membranes, and a gene regulator. Fatty acids have a modulating effect on immune cells, such as: acting as a host defence, activating the immune system, interacting with nuclear transcription factors, playing roles in inflammatory responses, promoting apoptosis, as well as influencing lymphocyte proliferation, cytokine production, and Natural Killer (NK) cell activities. However, the modulation of the immune system by lipids is influenced by various factors such as concentration and types of fatty acids, types of immune cells, and species. This study is suggested to provide an overview of beneficial roles of lipids in maintaining immunity.

Digital image analysis of immunohistochemistry KI-67 using QuPath software in breast cancer

Background: Today, pathology services are more developed for quantitative diagnostic evaluation. The quantitative diagnostic evaluation requires detailed accuracy and can be done using digital image analysis (DIA). Assessment of the Ki67 labelling index (LI) in breast carcinoma needs to be done quantitatively. A visual evaluation of Ki67 LI using light microscopy has high inter-observer variability. The evaluation of Ki67 LI could be done digitally with the DIA technique to overcome the inter-observer variability. The DIA technique is carried out by counting the Ki67 LI manually or automatically with bioimage analysis software. QuPath is one of the bioimage analysis software, has characteristics of cross-platform, intended for bioimage analysis and digital pathology. Objective: This study aims to compare the manual and automatic calculation of Ki67 LI digitally. Methods: This study was a cross-sectional study; a total of 240 digital Ki67 images from 30 slides were analyzed by counting manually and automatically using QuPath. Results: Statistical analysis using the T-test showed no significant difference between the manual and automatic counting of Ki67 LI (p = 0,801, α = 0,05). Conclusion: Digital image analysis using QuPath can be used to calculate the Ki67 LI automatically.

Skin manifestations of COVID-19 in a pregnant woman with premature rupture of membranes: A case report

The number of COVID-19 cases, especially with pregnancy, remains a problem in the world and in Indonesia. The main clinical symptoms include fever (temperature >38oC), cough, and shortness of breath. In addition, it can be accompanied by fatigue, myalgia, gastrointestinal symptoms such as diarrhea, and even recently found manifestations of skin disorders. Skin manifestations in COVID-19 pregnant patients are still a rare condition. Skin manifestations can be an early sign of such infection, which therefore requires clinicians’ notice to allow them to conduct early COVID-19 screening in pregnant women for better outcomes of the mother and the baby. We present a 26-year-old primigravida at 39 weeks of gestational age with premature rupture of membranes and COVID-19 infection. Her complaints included itchy maculopapular rash and urticaria, then the pregnancy was terminated by a caesarean section, and the baby was born with good conditions. The skin lesions were given a mixture of corticosteroid cream and fusidic acid. The mother and the baby were discharged in a good condition.

Histopathological changes in liver, kidney and teratogenic effects of mice on exposure to mosquito repellent

Background: Mosquito repellent technology has changed from conventional technology to electric technology, which is more secure and practical. All insect repellent contains chemical compounds that can endanger health. D-Allethrin, the first pyrethroid generation of mosquito repellent is used commercially. Some studies in multi-ethnic population found transplacental transmission in pregnancy. Objective: This study aims to evaluate influences of D-Allethrin in mosquito repellent on liver and kidney, and teratogenic effects in foetal mice. Methods: An experimental laboratory design was conducted in 18 pregnant female Balb/c mice. They were randomized into 3 groups: Group K, P1 and P2. Group K was not given anything. Group P1 and P2 were given exposure pathways of mosquito repellent with inhalation for 12 and 24 hours, in a period of gestational age (0-18 days). On day 19, a Cesar surgery was conducted to take their foetuses and to count the number of living foetuses, dead foetuses, disability, and morphological abnormalities. Results: The administration of allethrin inhalation with dose 12 hours and 24 hours significantly damage mice’s kidney and liver microscopically (p<0.05). A microscopic result of the liver were necrosis in portal areas, hydropic degeneration of lobules, infiltration of inflammatory cells, and fibrosis in the portal area causing a sinusoidal portal to widen. Kidney examination obtained necrosis and hydropic degeneration, as well as the infiltration of lymphocytes and erythrocytes. Teratogenic effects in the foetuses were prematurity and failure of foetal development. Conclusion: Exposure pathways of D-Allethrin in mosquito repellent affected the microscopic appearance of the liver, kidney, and teratogenic effects in the foetuses.

Therapeutic Plasma Exchange (TPE) as an effective supportive therapy for COVID-19 case with Acute Respiratory Distress Syndrome (ARDS) and thrombophilia: A case report

Coronavirus Disease (COVID-19) has rapidly spread and caused a high number of mortalities. To this day, effective therapy to cure this virus is yet to be found. A number of treatments were tested; however, the result is not satisfactory. Therapeutic plasma exchange (TPE) is one of the supportive therapies applied to treat COVID-19 patients with moderate to severe symptoms. We reported 41 years old male patient diagnosed with severe COVID-19 infection, acute respiratory distress syndrome (ARDS), and thrombophilia. The patient received a therapy following the Ministry of Health’s guideline for COVID-19 handling. On the third day, respiratory failure occurred with a P/F ratio of 255 and the chest X-ray result showed vascular streak and ground-glass opacity; thus, the hospital decided to perform TPE. The TPE was performed twice in 5 days interval. After TPE was administered, clinical development is observed both subjectively in the form of reduced symptoms, normal respiration rate, and objectively, the improvement in blood gas analysis, increased O2 saturation, and a decrease in interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) level significant clinical laboratory and radiological improvement possibly due to cytokine storm which is remedied by TPE action.

The correlation between skin type and acne scar severity in young adults

Background: Acne is the most common skin disorder, especially in adolescents and youths. Inflammation due to acne may leave scar tissue. The scar severity may correlate with gender and skin type. Objective: This study aims to investigate the correlation between gender, skin type, and acne scar severity in youth. Methods: This is a cross-sectional study with 132 (81 female) medical college students aged from 18 to 23 participated in the study. Skin type was assessed using a Baumann Skin Type questionnaire. Acne scar severity was evaluated using the Qualitative Global Scarring Grading. Skin examination was conducted through the image from the face photograph. Lambda test was used to confirm the correlation between gender, skin type, and acne scar severity. Multiple logistic regression was applied to determine the odd risk of gender and skin type to moderate-severe acne scar. Significance was set at p<0.05. Results: Most of the participants (80.3%) had oily skin, and 22 participants (16.7%) had moderate-severe acne scar. A weak positive correlation was confirmed between skin type and acne scar severity (p<0.01, r=0.3). Oily skin type has 4.3 times greater risk of developing more severe acne scar (p<0.01, 95%CI = 1.90-9.90). Conclusion: Skin type is correlated with acne scar severity. Oily skin type is at greater risk of developing severe acne scar.

Aedes aegypti as potential vector of filariasis in Pekalongan, Central Java Province, Indonesia

Background: The filariasis elimination program in Indonesia has been conducted, but new cases and some chronic cases are still often found. Objective: This study aims to determine levels of endemicity and to identify filarial worm species in filariasis cases and s and their surrounding communities by using microscopic examination, polymerase chain reaction (PCR), and to examine levels of infection in vectors mosquito by surgery and PCR. Also to to determine that Ae. aegypti can act as vector of filariasis. Methods: This study was conducted at 10 locations in Pekalongan Regency, Central Java Province, with a cross sectional design. Intravenous blood sampling was conducted on 102 respondents consisting of 10 elephantiasis patients and 92 non-elephantiasis patients at night, starting at 8 pm, then examined microscopically and PCR. Mosquitoes in this study were collected by using a human landing collection method for 12 hours from 6 pm to 6 am by volunteers. Artificial infection of microfilaria W. bancrofti was held against Cx. quinquefasciatus and Ae.aegypti from laboratory collection. Results: Results of this study found that there were 5.729 of mosquitos, consisting of 8 species, namely Culex quinquefasciatus, Culex vishnui, Culex tritaeniorhynchus, Aedes aegypti, Aedes albopictus, Anopheles subpictus, Anopheles vagus, and Armigeres kesseli. Microfilarial (mf) rate was 0.89%, and and the blood PCR showed infection rate of 3.92% and the blood PCR showed infection rate of 3.92%. No larva was found in female mosquito dissection. The PCR results showed that the infection rate was 9.10% in Ae. aegypty pool respectively. Artificial infection results was negative both dissecting microscopis and PCR. Conclusion: This study revealed that the locations were low of filariasis endemicity. The mf rate was less than 1%, and there was a moderate density to high density of microfilaria in the patients. The low level of infection rates in mosquito is suggested as an alert to its potential transmission.

Relationship between knowledge of acute respiratory tract infection and use of face masks in motorcyle online drivers

Background: Data in 2013 states that the prevalence of acute respiratory infections (ARI) is 25%. One of the factors that cause ISPA is air pollution. This factor is one of the risk factors for motorcycle taxi drivers who are always exposed to air pollution. Knowledge of ARI that is sufficient to influence the use of masks can help prevent ARI from occurring. Objective: This study aims to determine the relationship between knowledge of ARI and the behaviour of using masks among online motorcycle drivers. Methods: This study was an analytical observational with a cross-sectional design attended by 139 online motor cycle drivers around Grogol, Petamburan, West Jakarta, from July to December 2017. Data collection was done by filling out a questionnaire that includes demographic data, the use of masks, and knowledge of ARI. Data analysis used Fisher's test with significance level p<0,05. Results: A total of 139 respondents were collected, consisting of 131 (94.2%) men and 8 (5.8%) women. The average age of ≥ 30 years old is 77 (55.4%) people. Most respondents' education level was SMA/SMK/SLTA as many as 111 (79.9%) people. From the results of Fisher's test, it was found that the probability value p=0.362 was greater than the significance value (0.05). Conclusion: There is no significant relationship between the level of knowledge about ARI and the use of masks among online motorcycle drivers.

Irregular menstrual cycles as a risk factor of type 2 diabetes mellitus in women of childbearing age

Background: Irregular menstrual cycles are a risk factor for developing type 2 diabetes mellitus (DM) in women. Objective: This study aimed to evaluate irregular menstrual cycles as a risk factor of type 2 DM in women of childbearing age with body fat percentage, waist-hip ratio, diet quality, and physical activity as confounding factors. Methods: This was a case-control study. Its subjects were subjects with type 2 diabetes mellitus (n=31) and subjects without any clinical evidence of abnormal glucose regulation (n=31) who attended Puskesmas (Community Health Centre) Rowosari, Tembalang, Semarang with over 30 years of age. Based on their menstrual cycles, they were divided into two groups: women with irregular menstrual cycles, and those with regular menstrual cycles. Cochran Mantel-Haenszel test was used to control their confounding factors. Results: There was an association between irregular menstrual cycles and type 2 DM (p<0.05) with a 7.2 greater risk on women of childbearing age (OR = 7.2, 95% CI=2.18-23.75). By the Cochran Mantel-Haenszel test, the association was still significant; women with over percentage of body fat and central obese with irregular menstrual cycle had 4,85 times and 4,37 times of sequentially greater risk on type 2 DM (OR = 4.85, 95% CI=0.98-23.95 vs OR = 4.37, 95% CI=0.93-20.51). Conclusion: The irregular menstrual cycles was a risk factor of type 2 DM, especially in obese women of childbearing age.