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Adjunctive Micronutrient Therapy in Sepsis: Associations with Inflammation and Organ Dysfunction Prima , Agus; Lubis , Bastian
Journal of Society Medicine Vol. 5 No. 1 (2026): January
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.256

Abstract

Introduction: Despite advances in supportive care, sepsis remains a major cause of morbidity and mortality among critically ill patients. Adjunctive therapies targeting inflammation and endothelial dysfunction, such as thiamine and ascorbic acid, have gained increasing attention in recent years. Matrix metalloproteinase-9 (MMP-9) and its inhibitor TIMP-1 are key biomarkers involved in inflammatory dysregulation and organ dysfunction in sepsis. Methods: This retrospective cohort study was conducted over 12 months at Haji Adam Malik General Hospital. A total of 147 adult patients with sepsis were initially enrolled and categorized into four groups: normal saline (control), thiamine, ascorbic acid, and thiamine–ascorbic acid combination therapy. Propensity score matching was applied to achieve comparable baseline characteristics, resulting in 25 patients in each group. Serum MMP-9 and TIMP-1 levels were measured at the Integrated Laboratory, Faculty of Medicine, Universitas Sumatera Utara. The clinical outcomes included incidence rates, MMP-9/TIMP-1 ratios, and Sequential Organ Failure Assessment (SOFA) scores. Results: Combination therapy did not significantly reduce the incidence rate (OR 1.19; 95% CI 0.37–3.80) or MMP-9/TIMP-1 ratio (OR 0.34; 95% CI 0.09–1.30) compared to the control. In contrast, a single administration of ascorbic acid and thiamine significantly reduced the incidence rates and improved the MMP-9/TIMP-1 balance. Combination therapy was not associated with improved SOFA scores (OR 2.66; 95% CI 0.85–8.36). Conclusion: Combined thiamine and ascorbic acid therapies did not confer any superior clinical or biomarker benefits. Single-agent thiamine or ascorbic acid therapy demonstrated favorable effects on the incidence rate, MMP-9/TIMP-1 ratio, and organ dysfunction in patients with sepsis.
In Vitro Antibacterial Activity of Curcumin and Protocatechuic Acid Against Extended-Spectrum β-Lactamase–Producing Klebsiella pneumoniae Isolated from Chronic Cough Sputum Hayati, Zinatul; Iwan Tona , Azwar; Prima , Agus
Journal of Society Medicine Vol. 5 No. 1 (2026): January
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.258

Abstract

Introduction: Curcumin and protocatechuic acid are naturally occurring phenolic compounds that have been investigated for their potential antimicrobial properties. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae is a major clinical concern because of the limited therapeutic options. This study aimed to isolate and identify K. pneumoniae ESBL from the sputum of patients with chronic cough and evaluate the antibacterial effects of curcumin and protocatechuic acid. Methods: A laboratory-based experimental study was conducted using sputum specimens from 100 patients with chronic cough. Bacterial isolation and identification were performed using standard microbiological procedures, followed by the confirmation of ESBL production. The antibacterial activities of curcumin and protocatechuic acid at 25 %, 50 %, and 75% concentrations were assessed using the disc diffusion method. Statistical analyses were performed using one-way analysis of variance (ANOVA) followed by post hoc testing. Results: Nine bacterial species were identified in the sputum samples. Klebsiella pneumoniae accounted for 27.5% of isolates, of which 7.5% were confirmed as ESBL-producing strains. Curcumin, at all tested concentrations, produced inhibition zones of approximately 6 mm, with no statistically significant differences between the concentrations tested. In contrast, protocatechuic acid demonstrated concentration-dependent antibacterial activity, producing mean inhibition zones of 20.6, 16.0, and 10.8 mm at 25%, 50%, and 75% concentrations, respectively, with statistically significant differences. The antibacterial effect of 75% protocatechuic acid was comparable to that of 10 µg meropenem. Conclusion: Curcumin showed no significant antibacterial activity against ESBL-producing K. pneumoniae, while protocatechuic acid exhibited significant and concentration-dependent inhibitory effects. These findings suggest that protocatechuic acid is a potential natural antibacterial agent against ESBL-producing K. pneumoniae.