Invasive Fungal Infections (IFIs) can cause serious problems in cancer patients and may result in high morbidity andmortality. C-reactive protein levels increase in response to injury, infection, and inflammation. C-reactive protein increasesin bacterial infections (mean of 32 mg/L) and in fungal infections (mean of 9 mg/L). This study aimed to determineC-Reactive Protein (CRP) as a marker of fungal infections in patients with acute leukemia by establishing cut-off values ofCRP. This study was an observational analytical study with a cross-sectional approach and was carried out at the Departmentof Clinical Pathology and Microbiology of Dr. Moewardi Hospital in Surakarta from May until August 2019. The inclusioncriteria were patients with acute leukemia who were willing to participate in this study, while exclusion criteria were patientswith liver disease. There were 61 samples consisting of 30 male and 31 female patients with ages ranging from 1 to 70 years.Fifty-four patients (88.5%) were diagnosed with Acute Lymphoblastic Leukemia (ALL) and 30 (49.18%) were in themaintenance phase. The risk factors found in those patients were neutropenia 50-1500 μL (23.8%), use of intravenous line(22%), and corticosteroid therapy for more than one week (20.9%). The median of CRP in the group of patients with positiveculture results was 11.20 mg/L (11.20-26.23 mg/L) and negative culture results in 0.38 mg/L (0.01-18.63 mg/L). The cut-offvalue of CRP using the Receiver Operating Curve (ROC) was 9.54 mg/L (area under curve 0.996 and p. 0.026), with a sensitivityof 100%, specificity of 93.2%, Positive Predictive Value (PPV) of 33.3%, Negative Predictive Value (PPV) of 100%, PositiveLikelihood Ratio (PLR) of 1.08, Negative Likelihood Ratio (NLR) of 0 and accuracy of 93.4%. C-reactive protein can be used asa screening marker for fungal infections in patients with acute leukemia.

BACKGROUND: Cisplatin is one of the most potent chemotherapy drugs to treat various types of cancer, however the use of cisplatin has some the adverse effect, such as the increase of oxidative stress and inflammation by malondialdehyde (MDA) and nuclear factor kappa B (NF-kB) activation. Since the dosing of cisplatin is critical, we observed the effect of single and multiple doses of cisplatin injection on rats’ inflammation and oxidative stress level.METHODS: Total of 27 male Sprague-Dawley rats were divided into 9 sub-groups, each consisted of 3 rats. The baseline sub-group received no treatments; Group 1 (sub-group 1.1, 1.2, 1.3, and 1.4) were administered one single dose of 5 mg/kg BW/intravenously (i.v) of cisplatin; and Group 2 (sub-group 2.1, 2.2, 2.3, and 2.4) were given 0.2 mg/kg BW/i.v of cisplatin twice a week for two months. Rats were observed for their body weight, NF-kB, and MDA level based on the assigned group. RESULTS: Body weight loss was observed in the 1st week after treatment for Group 1, and 7th week for Group 2. Group 1 and Group 2 showed increasing level of NF-kB and MDA since the 1st observation, which was the 1st week and 5th week, respectively. NF-kB and MDA and levels were also significantly increasing in both groups for every week of observation (p<0.05).CONCLUSION: Cisplatin injection either in single or divided dose can induce inflammation and oxidative stress thus decrease the body weight. However, dividing cisplatin in smaller dose can delay the inflammation effect on subjects.KEYWORDS: cisplatin dose, MDA, NF-kB, body weight, inflammation, oxidative stress

Rheumatoid arthritis is a chronic systemic inflammatory autoimmune disorder characterized by persistent joint inflammation leading to cartilage and bone damage, disability, and systemic complications. The levels of APR such as SAA serum increase during synovitis. Previous studies have demonstrated the anti-inflammatory effect of M.oleifera leaf extract in the treatment of RA in animals; however, research data on humans remain limited. An experimental study on pre- and post-treatment of 40 RA patients was carried out by dividing subjects into 2 groups, including a standard therapy group and a standard therapy group added with M.oleifera leaf extract. The research was conducted at Dr. Moewardi Hospital, Surakarta from October 2020 to January 2021. The SAA levels were measured using ELISA. Paired T-test was used to analyze the differences in mean SAA levels before and after treatment. There was a significant difference between pre-treatment (346.57±54.40 ng/mL) and post-treatment (314.77±37.40 ng/mL) SAA levels in the standard therapy group added with M.oleifera leaf extract with p=0.01. Pre-treatment and post-treatment SAA levels in the standard therapy group were 322.68±87.01 ng/mL and 302.93±86.51 ng/mL, respectively with p=0.04. The mean of delta SAA in the standard therapy group added with M.oleifera leaf extract (-31.81±4.04 ng/mL) was greater than delta SAA in the standard therapy group (-19.75±4.07 ng/mL) with p=0.26. There was a significant decrease in SAA levels in RA patients on standard therapy and M. oleifera leaf extract.

Inflammatory response in COVID-19 contributes greatly to disease severity. Mesenchymal Stem Cells (MSCs) have the potential to alleviate inflammation and reduce mortality and length of stay in COVID-19 patients. We investigated the safety and effectiveness of normoxic-allogenic umbilical cord (NA-UC)-MSCs as an adjunctive treatment in severe COVID-19 patients. A double-blind, multicentric, randomized, placebo-controlled trial involving severe COVID-19 patients was performed from January to June 2021 in three major hospitals across Java, Indonesia. Eligible participants (n = 42) were randomly assigned to two groups (1:1), namely the intervention (n = 21) and control (n = 21) groups. UC-MSCs dose was 1 × 106 /kg body weight on day D0, D3, and D6. The primary outcome was the duration of hospitalization. Meanwhile, the secondary outcomes were radiographical progression (Brixia score), respiratory and oxygenation parameters, and inflammatory markers, in addition to the safety profile of NA-UC-MSCs. NA-UC-MSCs administration did not affect the length of hospital stay of severe COVID-19 patients, nor did it improve the Brixia score or mMRC dyspnoea scale better than placebo. Nevertheless, NA-UC-MSCs led to a better recuperation in oxygenation index (120.80 ± 72.70 baseline vs. 309.63 ± 319.30 D + 22, p = 0.038) and oxygen saturation (97.24 ± 4.10% vs. 96.19 ± 3.75% in placebo, p = 0.028). Additionally, compared to the placebo group, the treatment group had a significantly smaller increase in PCT level at D + 22 (1.43 vs. 12.76, p = 0.011). No adverse effects, including serious ones, were recorded until D + 91. NA-UC-MSCs therapy is a very safe adjunct for COVID-19 patients. It improves the oxygenation profile and carries potential to suppress inflammation.

Community-Acquired Pneumonia (CAP) is the most common cause of death and illness in the world. Increased IL-6 can be used as an early indicator of infection or inflammation. Ginseng is a popular herbal medicine. The anti-inflammatory effect of Ginseng is mediated by its ability to inhibit Nuclear Factor Kappa Beta (NF-kB), a proinflammatory regulator to initiate the synthesis of cytokines TNF-α, IL-1β, IL-6, and IL-8. Clinical trial research, quasi-experimental design with a pretest-posttest approach was carried out on 26 community pneumonia patients who were hospitalized at Dr. Moewardi Hospital, Surakarta from October 2020 to January 2021 using purposive sampling. The independent variable was Ginseng extract (GinsanaR) at a dose of 2x100 mg and the dependent variable was serum IL-6 levels. Serum IL-6 levels were measured using the Sandwich Enzyme-Linked Immunoabsorbent Assay (ELISA) method. Mean IL-6 levels in the control group on day 0, day 3, and day 14 were 232,89+156,61 pg/mL, 113,46±83.30 pg/mL and 66.18±66.02 pg/mL, respectively (p=<0.001). Mean IL-6 levels in the treatment group on day 0, day 3, and day 14 were 519,55±609,19 pg/mL, 205.41±329.17 pg/mL and 133,59±291,68 pg/mL, respectively (p=<0.001). Delta IL-6 levels in the control group and the treatment group on day 3 compared to day 0, the mean of the IL-6 control group -119,42±111,70 pg/mL, the mean for the IL-6 treatment group -314,14±532,16 pg/mL; On day 14 compared to day 0, the mean of the IL-6 control group was -166,70±135,54 pg/mL, the mean of the IL-6 treatment group was -385,96±547,10 pg/mL; On day 14 compared to day 3, the mean IL-6 control group was -47.28±47.47, the mean IL-6 control group was -71.82±58.16. The post hoc test (Wilcoxon) obtained a p-value < 0.05, suggesting that Ginseng extract has a significant effect on reducing serum IL-6 serum levels in community pneumonia patients.