Open Access Indonesian Journal of Medical Reviews

Targeting Interleukin-6 Signaling with Tocilizumab in Atherosclerosis: A Meta-Analysis of Anti-Inflammatory Effects and Plaque Stabilization

Ali Zainal Abidin, Tri Nisdian Wardiah, Taufik Indrajaya, Nur Riviati — Wed, 22 Jan 2025 01:18:53 +0000

Atherosclerosis, a chronic inflammatory disease, is the leading cause of cardiovascular disease. Interleukin-6 (IL-6) plays a crucial role in atherogenesis, making it a potential therapeutic target. Tocilizumab, an IL-6 receptor antagonist, has shown promise in reducing inflammation and stabilizing atherosclerotic plaques. This meta-analysis aimed to evaluate the efficacy and safety of tocilizumab in atherosclerosis by analyzing its impact on inflammatory markers and plaque characteristics. A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to January 2024. Studies evaluating the effects of tocilizumab on inflammatory markers and plaque characteristics in patients with atherosclerosis were included. Randomized controlled trials (RCTs) and observational studies with a comparative arm were eligible. Data were extracted and pooled using a random-effects model. Nine studies (n=1248 participants) met the inclusion criteria. Tocilizumab significantly reduced CRP levels (standardized mean difference [SMD] -1.23; 95% confidence interval [CI] -1.56 to -0.90; p<0.001) and IL-6 levels (SMD -0.87; 95% CI -1.12 to -0.62; p<0.001) compared to control groups. A significant reduction in plaque volume (SMD -0.45; 95% CI -0.71 to -0.19; p=0.001) and an increase in fibrous cap thickness (SMD 0.38; 95% CI 0.12 to 0.64; p=0.004) were also observed. No significant increase in adverse events was reported in the tocilizumab group. This meta-analysis demonstrates that tocilizumab effectively reduces inflammation and promotes plaque stabilization in atherosclerosis. These findings suggest that tocilizumab may be a promising therapeutic strategy for preventing cardiovascular events in patients with atherosclerosis. Further large-scale RCTs are needed to confirm these findings and establish the long-term safety and efficacy of tocilizumab in this population.

Ultrasound-Guided Superficial Cervical Plexus Block for Anterior Cervical Discectomy and Fusion in a Patient with Herniated Nucleus Pulposus: A Case Report

Elanda Rahmat Arifyanto, Aura Ihsaniar — Thu, 23 Jan 2025 08:36:48 +0000

Anterior cervical discectomy and fusion (ACDF) is a surgical procedure performed to alleviate pressure on the spinal cord and nerve roots in the neck. Effective pain management is crucial for optimal postoperative recovery. Superficial cervical plexus block (SCPB) has emerged as a safe and effective regional anesthesia technique for head and neck surgeries. This case report describes the successful use of ultrasound-guided SCPB for ACDF in a patient with a herniated nucleus pulposus. In this study, a 48-year-old male patient presented with lower extremity weakness and hypoesthesia following a fall. Magnetic resonance imaging (MRI) revealed a herniated nucleus pulposus at the C5-6 level. The patient underwent ACDF surgery under ultrasound-guided SCPB. Levobupivacaine 0.5% 10 cc was administered bilaterally. The patient tolerated the procedure well, with no complications or adverse events. Postoperative pain was effectively managed with SCPB, and the patient's neurological symptoms improved significantly. In conclusion, ultrasound-guided SCPB is a safe and effective anesthetic technique for ACDF surgery in patients with herniated nucleus pulposus. It provides adequate pain control, reduces opioid requirements, and facilitates early mobilization and recovery.

Fig Leaf (Ficus carica Linn.) Extract as a Potential Alternative Treatment for Oral Thrush Caused by Candida albicans

Gusbakti Rusip, Shieny Lokanata, Vivin Lydia — Thu, 06 Mar 2025 02:10:32 +0000

Oral thrush, primarily caused by Candida albicans, is a common opportunistic fungal infection affecting the oral mucosa. The increasing resistance of C. albicans to conventional antifungal agents has led to a search for alternative treatments. Fig leaf (Ficus carica Linn.) has been traditionally used for its medicinal properties and has shown promising antifungal activity. This study aimed to evaluate the inhibitory potential of ethanol extract of fig leaf against C. albicans in vitro. Fig leaves were collected, dried, and extracted using ethanol. The extract was then screened for its phytochemical constituents. The antifungal activity of the extract was assessed using the disc diffusion method against a standard strain of C. albicans. Different concentrations of the extract were tested, and the diameter of the inhibition zones was measured. Data were analyzed using one-way ANOVA and post hoc LSD tests. The ethanol extract of fig leaf exhibited significant antifungal activity against C. albicans. The inhibition zones increased with increasing concentrations of the extract. The most effective concentration was 80%, which showed a mean inhibition zone diameter of 12.65 ± 1.22 mm. Phytochemical screening revealed the presence of flavonoids, triterpenoids/steroids, glycosides, saponins, and tannins in the extract. In conclusion, the ethanol extract of fig leaf has the potential to be developed as an alternative treatment for oral thrush caused by C. albicans. Further studies are needed to investigate its efficacy in vivo and to identify the specific active compounds responsible for its antifungal activity.

Impact of Etelcalcetide on Cardiovascular Outcomes and Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism: A Meta-Analysis

Nurul Ramadhani Umareta, Fitri Rahmariani, Zulkhair Ali — Mon, 03 Mar 2025 05:06:48 +0000

Secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis patients, contributing to cardiovascular disease and mortality. Etelcalcetide, a novel calcimimetic agent, has shown promise in managing SHPT. This meta-analysis aimed to evaluate the impact of etelcalcetide on cardiovascular outcomes and mortality in hemodialysis patients with SHPT. A systematic search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify randomized controlled trials (RCTs) comparing etelcalcetide with placebo or other active treatments in hemodialysis patients with SHPT. The primary outcomes were cardiovascular events (composite of myocardial infarction, stroke, heart failure, and cardiovascular death) and all-cause mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Seven RCTs (n=4,520 patients) were included in the meta-analysis. Etelcalcetide was associated with a significant reduction in cardiovascular events (RR 0.85, 95% CI 0.75-0.96, p=0.01) and all-cause mortality (RR 0.88, 95% CI 0.79-0.98, p=0.02) compared to placebo. No significant difference in cardiovascular events or mortality was observed between etelcalcetide and cinacalcet. In conclusion, etelcalcetide appears to be effective in reducing cardiovascular events and mortality in hemodialysis patients with SHPT. Further studies are needed to confirm these findings and to assess the long-term impact of etelcalcetide on cardiovascular health in this population.

Successful Surgical Management of Partial Obstructive Ileus Secondary to Intra-abdominal Tumor: A Case Report

Bambang Irwansyah, Ida Bagus Budhi Surya Adnyana — Mon, 03 Mar 2025 08:00:31 +0000

Partial obstructive ileus, characterized by incomplete intestinal blockage, can arise from various etiologies, including intra-abdominal tumors. These tumors, often compressing or obstructing the bowel lumen, necessitate prompt diagnosis and intervention to prevent severe complications. This case report presents a 42-year-old woman with partial obstructive ileus secondary to an intra-abdominal tumor, highlighting the diagnostic process, surgical management, and clinical outcomes. A 42-year-old female presented to the emergency department with abdominal distension, pain, and a two-day history of constipation. Physical examination revealed abdominal tenderness, and radiographic imaging confirmed partial obstructive ileus with pneumoperitoneum. Initial management focused on hemodynamic stabilization, fluid resuscitation, and nasogastric decompression. Subsequently, an exploratory laparotomy was performed, revealing an intra-abdominal tumor causing intestinal obstruction. Segmental tumor resection was successfully conducted, alleviating the obstruction. In conclusion, this case underscores the importance of considering intra-abdominal tumors in the differential diagnosis of partial obstructive ileus. Timely surgical intervention, including tumor resection, can effectively address the obstruction and improve patient outcomes. Further research is warranted to explore the long-term outcomes and prognostic factors associated with this condition.