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The Impact of Uncontrolled Type 2 Diabetes Mellitus on Chronic Rhinosinusitis Severity and Treatment Outcomes: A Prospective Cohort Study in Bandung, Indonesia Zainal Abidin Hasan; Aisyah Andina Rasyid; Hasrita Soleiman; Alexander Mulya; Pham Uyen; Maria Rodriguez
Sriwijaya Journal of Internal Medicine Vol. 3 No. 1 (2025): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v2i2.176

Abstract

Introduction: Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition, and type 2 diabetes mellitus (T2DM) is a known comorbidity that can exacerbate inflammatory processes. This study aimed to investigate the impact of uncontrolled T2DM on CRS severity and treatment outcomes in a cohort of patients in Bandung, Indonesia. Methods: A prospective cohort study was conducted at a private hospital in Bandung, Indonesia, from January 2020 to December 2022. Adult patients diagnosed with CRS (with or without nasal polyps) were enrolled and categorized into two groups: controlled T2DM (HbA1c ≤ 7%) and uncontrolled T2DM (HbA1c > 7%). CRS severity was assessed using the Sino-Nasal Outcome Test-22 (SNOT-22) and Lund-Mackay CT scoring. Treatment outcomes were evaluated at 3, 6, and 12 months post-initial treatment (medical and/or surgical) based on SNOT-22 scores, endoscopic findings, and the need for revision surgery. Results: A total of 240 patients were included (120 with controlled T2DM, 120 with uncontrolled T2DM). At baseline, the uncontrolled T2DM group had significantly higher mean SNOT-22 scores (58.5 ± 12.3 vs. 45.2 ± 10.1, p < 0.001) and Lund-Mackay CT scores (11.8 ± 3.5 vs. 8.2 ± 2.8, p < 0.001) compared to the controlled T2DM group. At 12 months, the uncontrolled T2DM group showed significantly less improvement in SNOT-22 scores (mean change: -15.4 ± 8.7 vs. -28.3 ± 9.2, p < 0.001) and a higher rate of revision surgery (18.3% vs. 5.8%, p = 0.002). Multivariate analysis revealed that uncontrolled T2DM (HbA1c > 7%) was an independent predictor of poorer treatment outcomes (OR: 3.45, 95% CI: 1.98-6.01, p < 0.001). Conclusion: Uncontrolled T2DM is associated with increased CRS severity and significantly poorer treatment outcomes in patients in Bandung, Indonesia. Effective glycemic control should be a crucial component of CRS management in patients with T2DM.
Preventing Cognitive Decline in Late-Life Depression: A Longitudinal Study on the Efficacy of Omega-3 Fatty Acid Supplementation in Older Adults in Palembang, Indonesia Sony Sanjaya; Febria Suryani; Pham Uyen; Maria Rodriguez; Muhammad Yoshandi
Scientia Psychiatrica Vol. 6 No. 4 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i2.190

Abstract

Introduction: Late-life depression (LLD) is a prevalent condition in older adults and a significant risk factor for cognitive decline and dementia. In Indonesia, with its aging population and specific dietary patterns, understanding interventions for LLD-associated cognitive impairment is crucial. Omega-3 polyunsaturated fatty acids (PUFAs) offer potential neuroprotective benefits. This study aimed to assess the efficacy of long-term omega-3 PUFA supplementation in mitigating cognitive decline among older adults with LLD in Palembang, Indonesia. Methods: This 24-month, randomized, double-blind, placebo-controlled trial was conducted in Palembang. Three hundred sixty older adults (aged ≥60 years) with a current DSM-5 diagnosis of Major Depressive Disorder (MDD) and subjective cognitive complaints were randomized (1:1) to receive either daily oral supplementation of 2.2 grams of omega-3 PUFAs (containing 1320 mg eicosapentaenoic acid [EPA] and 880 mg docosahexaenoic acid [DHA]) or a matched placebo (corn oil). The primary outcome was the change in the Indonesian version of the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog-INA) score over 24 months. Secondary outcomes included changes in the Montreal Cognitive Assessment-Indonesian version (MoCA-INA), Geriatric Depression Scale (GDS-30), Instrumental Activities of Daily Living (IADL), serum Brain-Derived Neurotrophic Factor (BDNF), and high-sensitivity C-Reactive Protein (hs-CRP). Results: Over 24 months, the omega-3 group exhibited significantly less decline on the ADAS-Cog-INA compared to the placebo group (mean difference: -2.1 points; 95% CI: -3.8 to -0.4; p=0.018). Statistically significant benefits for the omega-3 group were also observed in MoCA-INA scores (mean difference: 1.5 points; p=0.025) and GDS-30 scores (mean difference: -2.5 points; p=0.011). BDNF levels increased significantly in the omega-3 group relative to placebo (p=0.008), while hs-CRP levels showed a non-significant trend towards reduction (p=0.072). Conclusion: Long-term supplementation with 2.2 g/day of EPA-rich omega-3 PUFAs resulted in a modest but statistically significant attenuation of cognitive decline and improvement in depressive symptoms in older adults with LLD in Palembang. These findings suggest that omega-3 PUFAs could be a valuable adjunctive therapeutic strategy in this specific Southeast Asian population.
CRISPRi-Mediated Repression of gtfB Attenuates Streptococcus mutans Virulence and Promotes Ecological Homeostasis in a Preclinical Cariogenic Biofilm Model Khairiel Anwar; Maria Rodriguez; Sony Sanjaya; Danniel Hilman Maulana; Karina Chandra; Isadora Selestine
Crown: Journal of Dentistry and Health Research Vol. 3 No. 1 (2025): Crown: Journal of Dentistry and Health Research
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/crown.v3i1.234

Abstract

Introduction: Streptococcus mutans is a primary etiological agent of dental caries, largely due to its capacity to form robust, acidogenic biofilms. This virulence is critically dependent on glucosyltransferases, particularly GtfB, which synthesizes the adhesive extracellular glucan matrix. Conventional antimicrobial strategies often lack specificity, leading to oral dysbiosis. This study aimed to develop and evaluate a highly targeted CRISPR interference (CRISPRi) system to silence the gtfB gene in S. mutans, thereby inhibiting its cariogenic potential without adversely affecting the viability of key oral commensal species. Methods: A CRISPRi system, comprising a nuclease-deactivated Cas9 (dCas9) and a single guide RNA (sgRNA) targeting the gtfB promoter, was engineered into S. mutans UA159. The efficacy of gtfB silencing was quantified via qRT-PCR. The consequential effects on bacterial growth kinetics, insoluble glucan synthesis, and single-species biofilm formation were assessed using spectrophotometry, anthrone assays, crystal violet staining, and confocal laser scanning microscopy (CLSM). The ecological impact was investigated in a multi-species biofilm model containing S. mutans and the commensal bacteria Streptococcus gordonii, Streptococcus oralis, and Actinomyces naeslundii, with microbial composition analyzed by species-specific qPCR. All research activities were conducted in Indonesia. Results: The CRISPRi system induced a profound and specific downregulation of gtfB mRNA expression by over 98% (p<0.001) in the engineered S. mutans strain compared to the wild-type. This silencing did not impair bacterial planktonic growth. However, it led to a significant reduction in insoluble glucan production by 85% (p<0.001) and a corresponding 79% decrease in total biofilm biomass (p<0.001). CLSM imaging confirmed the formation of structurally deficient biofilms with minimal extracellular matrix. In the multi-species model, repression of S. mutans virulence significantly altered the biofilm ecology, resulting in a 65% reduction in the proportional abundance of S. mutans and a concomitant increase in the representation of commensal species, thereby fostering a community structure more aligned with oral health. Conclusion: Targeted repression of the gtfB gene using a CRISPRi-based approach effectively 'disarms' S. mutans, neutralizing its primary cariogenic mechanism without being bactericidal. This strategy not only attenuates its virulence but also shifts the ecological balance in favor of beneficial commensal bacteria. These findings underscore the therapeutic potential of gene-targeted virulence modulation as a precise, ecologically-sound strategy for the prevention and treatment of dental caries.