Introduction. Soil Transmitted Helminthiasis (STH) is a Neglected Tropical Disease with almost 25% world population infected. Children were vulnerable to infection with morbidities affecting growth. STH infection alters children nutritional status which potentially causing anemia. Meta-analysis relating STH infections to hemoglobin (Hb) level and risk of anemia in children is limited. Aim. To compare hemoglobin levels and risk of anemia in children infected and uninfected with STH. Methods. Meta-analysis conducted from journals obtained from Pubmed, ScienceDirect, WileyLibrary, Cochrane, EBSCO, Proquest, DOAJ, and GoogleScholar from 2011-2021. Full text cross sectional studies on children with relevant topic is included, while unclear, inaccessible, or post interventional studies were excluded. Articles were analyzed in Review Manager 5.4 in mean difference (MD) and odds ratio (OR) with Confidence Interval (CI) of 95%. Result. Out of 25,683 articles in literature search, 29 were eligible for systematic review and meta-analysis. STH infection significantly decreases hemoglobin level (MD -0.2g/dL; p=0.02) and increases risk of anemia (OR 1.83; p<0.00001). Species analysis presented parallel result on Trichuris trichiura (MD -0.31g/dL; p=0.001 and OR 1.66; p=0.009), Hookworm (MD -0.56g/dL; p=0.02 and OR 3.3; p<0.00001), and multiple infection (MD -0.25g/dL; p=0.03 and OR 4.49; p=0.005). Ascaris lumbricoides didn’t show significance on hemoglobin level but comparable for risk of anemia (MD -0.16g/dL; p=0.17 and OR 1.57; p=0.001). Discussion. All STH infections exhibits lower hemoglobin level and higher risk of anemia caused by lower nutrition absorption and occult bleeding in gastrointestinal tract. Hookworm and multiple infections has the highest risk of anemia. Proportion of anemia may vary in studies and influenced by sociodemographic characteristics, but higher proportions occur in STH infected. Conclusion. Children infected with STH has lower hemoglobin level and in risk of anemia compared to uninfected children, hence further study is still needed to be conducted. Keywords: Anemia, Children, Hemoglobin, Infection, Soil Transmitted Helminths
In an inflammation, including appendicitis, vascular adequacy is required to supply anti-inflammatory substances and nutrition due to inflamed tissue remodeling. Normal tissue has balanced tissue regeneration and tissue destruction from apoptosis. While in inflammation, inflammatory substances tend to cause tissue destruction and lead to necrosis. This requires the tissue to increase cell regeneration to maintain tissue homeostasis in the appendix, induced mainly by oxygenation, nutrition, growth factors, and mainly anti-inflammatory substances that are obtained with vascular adequacy. This process needs active vascularization that can be achieved with neovascularization to ensure good vascularization to the tissue lacking from vascular damage. The ability of neovascularization is mainly related to growth factors acting in the endothelium and inducing neovascularization process. This mechanism is impaired in the process of inflammation by inflammatory substances causing endothelial dysfunction. As stated that vascular adequacy is related to growth factors such as vascular endothelial growth factors (VEGF) that may differ from one person to another, external and internal factors plays role in affecting individualized difference in adapting to inflammatory process, the expression of the VEGF may be a novel distinction to cut-off requirements of inflammation process in appendicitis would be self-limiting or continue to cause tissue necrosis and perforating appendicitis that urges surgical treatment to encounter the unstoppable inflammatory process in the appendix.
Pendahuluan: Apendisitis akut merupakan salah satu penyebab operasi gawat darurat dalam bidang gastroenterohepatologi. Hanya apendisitis yang terkomplikasi seperti perforasi yang memerlukan tindakan operasi. Saat ini belum ditemukan cara untuk menegakkan apakah pasien apendisitis yang datang perlu dilakukan operasi atau hanya dengan terapi konservatif dengan antibiotik. Salah satu pemeriksaan yang dapat dikaitkan pada apendisitis adalah Matriks Metalloproteinase (MMP). Tinjauan pustaka ini bertujuan untuk mengetahui potensi dan sensitivitas MMP sebagai biomarker untuk menentukan kemungkinan terjadinya perforasi pada apendisitis akut. Metode: Artikel dibuat dengan metode literature review dengan menggunakan textbook dan 21 jurnal, dengan 10 jurnal utama. Jurnal diperoleh dari search engine Pubmed, Cochrane, dan Google Scholar. Pembahasan: MMP memiliki sifat proteolitik terhadap matriks ekstraseluler pada jaringan ikat yang meningkat pada reaksi inflamasi. Ketidakseimbangan MMP terhadap Tissue Inhibitor of Metalloproteinase (TIMP) pada apendisitis menyebabkan peningkatan aktvitias proteolisis yang merusak dinding apendiks yang menjadi patofisiologi perforasi. Ekspresi dan konsentrasi MMP dijumpai meningkat secara signifikan pada pemeriksaan biopsi, imunohistokimia, cairan peritoneum, dan serum pasien yang mengalami komplikasi apendisitis dibandingkan dengan apendisitis tanpa komplikasi. MMP mampu membedakan apendisitis terkomplikasi dengan tidak, namun membutuhkan pemeriksaan TIMP untuk menentukan jenis komplikasi apendisitis. Simpulan: Pemeriksaan MMP dan TIMP berpotensi menjadi biomarker terjadinya perforasi pada apendisitis. Saran: Diperlukan penelitian lebih lanjut untuk menentukan nilai cut-off pada apendisitis.
ABSTRACT Introduction: Chronic Kidney Disease (CKD) is a common disease that is still being a public health problem, especially in the elderly, as a result of cardiovascular complication which is the most important cause of death among the elderly in developing countries. This literature review aims to comprehend the diagnostic accuracy of urinary NGAL in CKD. This literature review is made by doing literature searching on search engines such as Google Scholar, PubMed, and Sciencedirect, with utilizing NGAL, uNGAL, biomarker, CKD, and elderly as the keywords. From the process, 37 journals were obtained and used as this literature review references. Discussions: By analyzing the literatures, it is known that NGAL is a polypeptide that belongs to the lipocalin family, where the expression will increase in inflammations, including in the kidneys. In diagnosis of CKD, the diagnostic ability of urinary NGAL shown by AUC values were higher than the other biomarkers. In addition, urinary NGAL has a stronger correlation with the deterioration of kidney function, compared to that of plasma NGAL. Conclusion: In conclusion, urinary NGAL is a potential urinary biomarker in diagnosing CKD in the elderly. Keywords: Biomarker, CKD, NGAL, Urine
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