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Background & Aims Coronavirus disease 2019 (COVID-19) patients are at high risk of malnutrition, and their doctors are part of a multidisciplinary team, including nutritionists. However, adherence to nutritional guidelines may be difficult in the context of capacity constraints during the COVID-19 pandemic. The aim of this study was to investigate barriers to doctors’ adherence to nutritional guidelines and the impacts of guideline adherence on the outcomes of hospitalized COVID-19 patients. Methods A multinational electronic survey involving 51 doctors was conducted between November 2020 and January 2021 from 17 COVID-19-designated hospitals in countries with high (Indonesia) and low (Vietnam) numbers of confirmed COVID-19 cases. Results In general, doctors reported concerns related to nutritional practices in patients with Covid-19 which included feeling stress when performing medical nutritional therapy (65%), lacking self-efficacy or confidence in performing nutritional care (49%), lacking clear nutritional guidelines (45%), and experiencing budget limitations (33%). A regression analysis adjusted for age, country, and the number of hospitalized COVID-19 cases revealed that guideline knowledge (ß: -1.01 (-1.78, -0.23); p=0.012) and awareness of guidelines (ß: -1.37 (-2.66, -0.09); p=0.037) were negatively correlated with the length of stay of critically ill COVID-19 patients, but non-significant after adjusting for specialization of the doctor. When stratified according to country, a significant relationship between guideline adherence and length of stay of critically ill patients was only found in Vietnam [guideline adherence: ß: -0.55 (-1.08, -0.03); p=0.038; guideline knowledge: ß: -1.01 (-1.9, -0.13); p=0.027] after adjusting for age, specialty, and number of hospitalized COVID-19 cases. In Indonesia, the significant relationship between guideline adherence and mortality of COVID-19 patients remained strong (ß: -14 (-27, -1); p=0.033) after adjusting for age, specialty, and number of hospitalized COVID-19 cases Conclusions Inadequate nutritional knowledge is a key barrier to guideline adherence, and this was international and may be related to doctors’ specialties and the COVID-19 pandemic. Adherence to nutritional guidelines may represent a prognostic factor for survival in COVID-19 patients.

Reproductive health is a major concern for workers constantly exposed to chemicals at work, especially in developing countries. The problems mainly stemmed from chronic exposure to the chemicals contained in paint thinner, which is mainly toluene, used during automobile painting. Unfortunately, in Indonesia, there is no study on the reproductive health of male workers in automobile workshops, especially in relation to spermatogenesis. This study aimed to explore the possibility of reproductive problems, namely spermatozoa DNA fragmentation, among male workers in an automobile workshop in Malang. We recruited workers who have worked as automobile painters for years at an automobile workshop in Malang and have been chronically exposed to thinner. Semen samples were collected from 15 automobile workshop workers who were married and had children. Twelve office workers were used as the control group. The two groups of semen samples were tested with the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay combined with propidium iodide and analyzed by flow cytometry. The results showed a significant difference between DNA fragmentation of the control group and workshop workers at 14.9% and 47.66%, respectively. Risk factor analysis showed a significant increase in risk factors ( p = 0.001). Taken together, chronic exposure to paint thinner in those engaged in painting at the automobile workshop increased the risk of DNA fragmentation in spermatozoa. Our study highlighted the importance of health education for the risked workers on minimization of exposure, which could be recommended to the health policy makers.

Ginekomasti adalah pembesaran payudara laki-laki yang mengacu pada proliferasi komponen duktal. Ditemukan kasus ginekomasti yang jarang terjadi. Seorang pria berusia 44 tahun datang dengan keluhan utama pembesaran kedua payudara sejak tiga tahun terakhir. Pada pemeriksaan fisik, ditemukan ginekomasti kelas II (tanner IV) dengan galaktorhea. Pemeriksaan genitalia menunjukkan panjang penis 10cm dan volume testis 6mL dengan konsistensi lunak. Nilai testosteron 22,65ng/dL, LH <0,07mIU/mL, dan FSH <0,3mIU/mL. Pemeriksaan ultrasonografi (USG) payudara menunjukkan ginekomasti bilateral dengan ektasis duktal bilateral. Ultrasonografi (USG) abdomen menunjukkan tidak ada signifikansi yang terkait ginekomasti. Ultrasonografi (USG) skrotum menunjukkan testis yang normal di kedua sisi. Magnetic Resonansi Imagine (MRI) kepala (dengan kontras) ditemukan mikroadenoma hipofisis. Pasien didiagnosis sebagai ginekomasti dengan mikroadenoma hipofisis. Pasien direncanakan untuk mendapatkan terapi penggantian testosteron.

This study aimed to evaluate the effects of ciplukan (Physalis angulata L.) leaf ethanol extract on L-NG-nitroarginine methyl ester (L-NAME)-induced hypertensive rats. We randomly divided twenty-five Wistar rats into five groups. The sham group was given a PBS injection. The hypertensive group was injected with L-NAME on days 1 to 28. Three groups of hypertensive rats were given the extract on days 4 to 28. Blood pressure was measured using the tail-cuff method on days 0, 4, 10, and 27. The endothelial progenitor cells (EPCs) in the blood were measured by flow cytometry as a percentage of circulating angiogenic cells (CACs, CD34+/CD309+/CD45+) and endothelial colony-forming cells (ECFCs, CD34+/CD309+/CD45-). Serum NO and MDA levels, as well as serum SOD activity, were measured colorimetrically. Serum TNF-α levels were measured by the ELISA method. The ciplukan leaf extract reduced systolic and diastolic blood pressure, reduced the percentage of EPCs in the blood, increased serum NO levels, reduced MDA levels, increased serum SOD activity, and reduced serum TNF-α levels in L-NAME-induced hypertensive rats. It is concluded that ciplukan ethanol leaf extract exerts protective effects on L-NAME-induced hypertensive rats. These study results can strengthen the scientific basis of using ciplukan leaf ethanol extract to treat hypertension.