Universitas Kristen Indonesia

Bracing is considered the most effective treatment for developmental dysplasia of the hip (DDH) in infants aged < 6 months with reducible hips. The Tübingen splint was developed as an advancement in abduction brace for managing hip dysplasia, in stable and unstable hip cases. In this systematic review and meta-analysis, the outcomes of the Tübingen splint in treating patients with DDH aged < 6 months were evaluated. The outcomes were categorized according to the Graf classification (IIa, IIb, IIc, IId, III, and IV), based on success and complication rates.

The systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted using Scopus, Embase, PubMed, Cochrane Library, and Google Scholar from inception to March 2024. The primary outcomes were the success rate for each Graf type, and the secondary outcome involved evaluating the complication rate through conditional subgroup analysis.

Nine observational studies involving 1456 hip cases were analyzed. Tübingen splint resulted in an overall success rate of 86% (95% confidence interval [CI] [0.80-0.92]; P < .01; χ² = 87%), with 97% (95% CI [0.94-1.00]; P < .01; χ² = 66%) for Graf type II DDH, 94% (95% CI [0.91-0.97]; P = .41; χ² = 2%) for Graf type III DDH, and 48% (95% CI [0.26-0.71]; P < .01; χ² = 86%) for Graf type IV DDH. The overall complication rate was 2% (95% CI [0.00-0.03]; P < .01; χ² = 65%), including 1% (95% CI [0.00-0.01]; P = .47; χ² = 0%) of avascular necrosis and 6% (95% CI [0.03-0.08]; P = .69; χ² = 0%) of residual acetabular dysplasia.

These findings support the use of the Tübingen splint as a highly effective first-line conservative treatment option for DDH in infants under 6 months of age, demonstrating notable efficacy, particularly for Graf types II and III cases.

III.

We have previously shown a difference between the gut microbiota composition of stunted and non-stunted children in East Nusa Tenggara, Indonesia. The current study aimed to perform an intervention with a probiotic, Lactiplantibacillus plantarum IS-10506, and its UHT-treated postbiotic compared to placebo in order to accomplish catch-up growth in the stunted children, possibly through modulation of the gut microbiota. Apart from the maltodextrin (placebo), probiotic, and postbiotic in chocolate milk, all groups also received a functional and nutritional biscuit and had access to newly constructed water wells as well as soap to improve hygiene. The results show that independent of treatment, the stunted children had a significantly higher increase in height and zlen (corrected for age) compared with their age- and gender-matched controls but a significantly lower increase in weight. Several potential pathogenic taxa declined in all groups, among which was Escherichia/Shigella (adjusted.p = 6.44 × 10^-15), but so did some beneficial taxa, such as Bifidobacterium and Akkermansia. Faecalibacterium, which was already higher in the stunted children at baseline, increased independent of treatment. Changes in the relative abundance of several taxa of the microbiota correlated with the changes in anthropometric measures. In conclusion, although there was no difference between the interventions, understanding the dynamics and the role of the gut microbiota in this process might allow healthcare providers to develop targeted nutritional strategies aimed at optimizing health outcomes for children at risk of stunting, thereby addressing a critical global health issue.

Candida species are the predominant cause of fungal infections in patients treated in hospital, contributing substantially to morbidity and mortality. Candidaemia and other forms of invasive candidiasis primarily affect patients who are immunocompromised or critically ill. In contrast, mucocutaneous forms of candidiasis, such as oral thrush and vulvovaginal candidiasis, can occur in otherwise healthy individuals. Although mucocutaneous candidiasis is generally not life-threatening, it can cause considerable discomfort, recurrent infections, and complications, particularly in patients with underlying conditions such as diabetes or in those taking immunosuppressive therapies. The rise of difficult-to-treat Candida infections is driven by new host factors and antifungal resistance. Pathogens, such as Candida auris (Candidozyma auris) and fluconazole-resistant Candida parapsilosis, pose serious global health risks. Recent taxonomic revisions have reclassified several Candida spp, potentially causing confusion in clinical practice. Current management guidelines are limited in scope, with poor coverage of emerging pathogens and new treatment options. In this Review, we provide updated recommendations for managing Candida infections, with detailed evidence summaries available in the appendix.