Introduction: Intracranial hypertension is an emergency condition that needs to be recognized as soon as possible. Lumbar puncture, the gold standard diagnostic procedure for intracranial hypertension, is contraindicated in some conditions while brain imaging procedures may be too difficult to be performed on critically ill patients. To solve this problem, this study aims to assess an alternative method to detect intracranial hypertension by measuring optic nerve sheath diameter using ocular ultrasound and optic nerve sheath diameter difference in each etiology. Methods: This cross-sectional study was conducted at the Emergency Department of Dr Iskak Tulungagung General Hospital. Sixty-nine patients who visited the emergency room for the first onset of intracranial pathology were included for optic nerve sheath diameter measurement by ultrasound. Subjects were divided into elevated and non-elevated intracranial pressure groups based on head computed tomography scan findings. The optic nerve sheath diameter results were compared and analyzed. Result: There were 29 subjects in the elevated intracranial pressure group and 40 subjects in the non-elevated intracranial pressure group. The mean of optic nerve sheath diameter in the elevated and non-elevated intracranial pressure groups was 0.63 ± 0.06 and 0.57 ± 0.06 cm, respectively ( p = 0.000). Based on receiver operating characteristics analysis, 0.58 cm was the most optimal cut-off value. Conclusion: Ultrasonographic optic nerve sheath diameter can be used to predict elevated intracranial pressure in suspected patients who are contraindicated to invasive intracranial pressure measurement or critically ill. There were significant differences between elevated and non-elevated intracranial pressure groups in stroke and trauma subjects.
SARS-CoV-2 (COVID-19) remains a very high risk to this date. The COVID-19 mortality rate is relatively high since it potentially causes various complications and cytokine storms, thereby increasing the mortality rate of those infected. Consumption of healthy food/drink is one of the means to boost the immune system and prevent COVID-19 infection. One of the interesting plants to use in this case is Saussurea costus. This plant contains active ingredients that can serve as anti-inflammatory, antitumor, antibacterial, antiseptic, antifungal agents, etc. However, studies on the role of the active ingredients as an anti-inflammatory agent to treat COVID-19, prevent cytokine storms, and improve COVID-19 patient outcomes are rarely found. In this in silico study, a total of 75 compounds in Saussurea costus were analized and five of which showed the greatest potential as the drug candidates, namely isoalantolactone, isozaluzanin C, arbusculin a, β-costic acid, and picriside B. Three target proteins were utilized in this study, including IL-6R, NFKB1, and TNFR1. The ligand samples were minimized before the molecular simulation process, and then the target proteins were sterilized. Furthermore, biological activity tests were conducted on the (anti-inflammatory and immunosuppressant) drug candidate compounds, followed by a druglikeness analysis, and ended with blind dockings to screen the potential compounds of the natural ingredients. The analysis of the docking results was performed using LigPlot+. The analysis results signified that according to the predicted probability with medium confidence (Pa > 0.3), all of the drug candidate compounds of Saussurea costus in silico indicated biological activities as anti-inflammatory and immunosuppressant agents, which could be categorized as drug-like molecules. In addition, the molecular docking analysis results in this study suggested that the five active compounds of Saussurea costus showed an affinity for the aforementioned target proteins. Among the five active compounds, picriside B had the lowest binding affinity for IL-6R, NFKB1, and TNFR1, with total energies of -6.3kcal/mol, - 6.5kcal/mol, and -9.0 kcal/mol, respectively. In addition, picriside B also demonstrated the most interactions with all of the target proteins. This compound was able to form hydrophobic and hydrogen bonds with the three target proteins. The other four active compounds could be potentially utilized as adjuvant therapy for COVID-19 because these compounds had an affinity for and many chemical bond interactions with the three target proteins.
Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the etiology of an outbreak Covid-19. SARS-CoV-2 has a structural part consisting of spike glycoprotein, nucleoprotein N, membrane M and envelopes small membrane pentamer E. Immunoinformatic approach epitope analysis is developed to identify both weak and robust epitopes. Our study aims to identify several epitopes present in the spike glycoprotein, envelope, and membrane protein from the SARCoV-2 surface, with the help of insilico approach that highly potential as vaccine candidates. Analysis of antigeninicity was performed with the Kolaskar and Tongaonkar Antigenicity software. Epitope Mapping was analyzed using Linear Epitope Prediction Bepired. The structure of proteins with epitope regions was visualized by software Pyrex and PyMOL. Conserve analysis was performed using bio edit software. HLA mimicry was analyzed through HLAPred software. Molecular docking between the epitope with HLA I and HLA II was validated by Chimera and PyMOL software. The toxicity test for candidate vaccine peptides was carried out using ToxinPred software. Our study found seven potential epitope candidates as vaccine candidates. The seven epitopes were derived from spike proteins (5 epitopes), envelope proteins (1 epitope), and membrane proteins (1 epitope). All epitope codes are conserved and are not the same as HLA in Humans. The docking test results show a value with low affinity so that a strong bond can provide a high immune response. Toxicity tests show that all epitopes are non-toxic and safe to use as vaccine ingredients. Seven peptides from the spike, envelope, membrane protein that showed potential as vaccine candidates against Covid-19.
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