Background: Social media is widely used by medical students, including for learning purposes since it facilitates their involvement in the communities of inquiry where they can share, express, and engage in the development of knowledge. Navigating the use of social media requires self-regulated learning (SRL) skills. Hence, studies on the relationships between social media use and SRL skills are necessary. Aim: This study aims to investigate the relationships between social media use and students’ SRL skills. Methods: A cross-sectional study was conducted using two validated questionnaires: the Social Networking Sites for Medical Education questionnaire (SNSME, 19 items) and the Motivated Strategies for Learning Questionnaire (MSLQ, 81 items). Cross-cultural adaptation and exploratory factor analysis (EFA) were also completed for the SNSME questionnaire, followed by descriptive and bivariate analysis. Results and discussion: The SNSME questionnaire is valid for use in the current setting and consists of three subscales: (1) attitudes towards the use of social media for learning and knowledge development, (2) the use of social media for information sharing and interaction, and (3) the use of social media for knowledge development and research. Among 1,122 respondents, male students presented lower scores than female students in the total score of social media for learning (80 vs. 82, p 0.007), and public medical students showed higher scores in terms of attitudes towards the use of social media for learning and knowledge development compared to private medical students (83 vs. 81, p 0.007). The differences in SRL scores for different education stages and among students from public and private medical schools were statistically significant (426 vs. 418, p 0.003, and 436 vs. 418, p < 0.001, respectively). Levels of correlation between social media use and SRL scores were low to moderate (R 0.195–0.462, p < 0.001). Conclusions: The adapted SNSME questionnaire in the current setting is valid and the use of social media for learning is influenced by gender and the learning environment. This study highlights the importance of supporting students in using social media for learning purposes as well as using social media as a means to increase their SRL skills.

Immunological non-response (INR) to antiretroviral therapy (ART) is a critical concern for PLHIV, characterized by inadequate CD4⁺ T-cell recovery despite virological suppression. This retrospective study analyzed medical records of virologically suppressed adult PLHIV on ART (2004–2024) at two hospitals in Surabaya, Indonesia, using four operational categories to identify clinical and demographic determinants of INR. Patients were classified as immunological responders (IRs) or non-responders (INRs) based on four definitions: INR1 (CD4⁺ gain < 100 cells/mm³), INR2 (CD4⁺ < 350 cells/mm³), INR3 (meeting of either criterion), and INR4 (meeting of both criteria). Of 464 patients, 382 were analyzed. Baseline CD4⁺ < 200 cells/mm³ strongly predicted INR2 (aOR = 5.60, 95% CI: 2.95–10.62) and INR3 (aOR = 4.46, 95% CI: 2.39–8.29), while anal sexual transmission was protective against INR2 (aOR = 0.42, 95% CI: 0.19–0.92) and INR3 (aOR = 0.41, 95% CI: 0.19–0.89). By month 12, IR groups had over 350 CD4⁺ cells/mm³, with faster recovery slopes in months 0–6 (IR: >20 vs. INR: <10 cells/mm³/month). INR1 and INR4 had flat or negative slopes at 12–24 months, while IR groups had positive slopes. Baseline CD4⁺ was the strongest INR predictor, suggesting the value of early ART and individualized care for Indonesian PLHIV.

Retinoblastoma (RB) is the most common primary intraocular malignancy of childhood. There is no therapies that can eradicate specifically the whole cancer cells without any side effects. The disialoganglioside 2 (GD2), one of the cancer’s cell markers that can be treated using immunotherapy, is expressed in RB. Through this fact, immunotherapy based on chimeric antigen receptor (CAR)-engineered T cells targeting cancer-specific antigens has shown great potential in treating this cancer. Although in recent studies show that immune cells are not able to destroy cancer cells because in every cancer cells there is protein programmed death ligand 1 (PD-L1). This literature review also shows the potential technology using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-CRISPR associated protein (Cas9) method to silence PD-1 in CAR T cell, so PD-L1 can not deactivate CAR T Cell through PD-1 signaling. The combination using CAR T cell and CRISPR-Cas9 will be the great therapy to eradicate RB without any side effect.

Background: This comprehensive review aimed to evaluate the efficacy and safety of combining laser or light therapy with topical agents for melasma treatment. Methods: A comprehensive search was conducted utilizing PubMed, NCBI, Google Scholar, ScienceDirect, Wiley, Embase, and the Cochrane Library. The search aimed to identify pertinent studies from the database’s inception until August 31, 2024. This research encompassed 11 randomized controlled trials including 461 people. The melasma area and severity index and its modified variant (mMASI) were employed for outcome assessment. The Cochrane risk-of-bias tool was used to assess study quality. The GRADE (grading of recommendations assessment, development and evaluation) approach was employed to assess the certainty of evidence. Sensitivity analyses were performed to evaluate the robustness of findings. Data were analyzed using RevMan 5.4.1. Results: Combination therapy demonstrated no significant benefit at 4 weeks, but statistically significant improvements at 8, 12, and 16 weeks (standardized mean difference [SMD]: −0.55; 95% confidence interval: −0.74 to −0.36; P < .00001), indicating a cumulative therapeutic effect. Moderate heterogeneity was observed ( I ² = 64%). Sensitivity analysis excluding parallel-design studies (Souza, Bansal, Verma, Qu) confirmed the robustness of efficacy outcomes, with a similar effect size (SMD: −0.45) and reduced heterogeneity ( I ² ≈ 41%). Safety analysis showed a significantly higher risk of adverse events in the combination group (OR: 8.96; 95% confidence interval: 3.71–21.64), mainly erythema and post-inflammatory hyperpigmentation. The certainty of evidence was rated as moderate for efficacy and very low for safety outcomes. Both were judged critically important (importance score 9 and 8, respectively) for clinical decision-making. Conclusion: These findings suggest that combination therapy can effectively enhance melasma treatment. However, careful patient selection and monitoring are crucial due to the risk of side effects. Further large-scale studies with standardized protocols are recommended to validate these findings and optimize treatment strategies.

Introduction: Severe COVID-19 in pregnancy is strongly associated with preterm infant late-onset sepsis (LOS), which is a major cause of morbidity and mortality in infants. Recently, Lactoferrin, an iron-binding protein significantly discovered in human colostrum, shows potential effect on reducing the risk of preterm infant LOS and mortality by its immunomodulatory properties. Therefore, this study aimed to evaluate the effect of Lactoferrin on reducing the risk of preterm LOS, necrotizing enterocolitis (NEC), and mortality in preterm infants. Methods: This study followed the guidelines provided by PRISMA. A literature search was conducted with PubMed, Cochrane Library, Google Scholar, and ScienceDirect. The combined effect of LOS, NEC and mortality incidence were presented as risk ratios (RR) with a 95% confidence interval (CI) using a random-effects model (REM) or fixed-effects model (FEM) forest plot. Furthermore, the heterogeneity level was checked by I2 and the p-value of the chi2 test. Results: The incidence of LOS was significantly higher in the control than lactoferrin supplementation group [RR=0.65, 95% CI (0.56,0.77), p<0.00001, I2=56%]. However, there were no significant differences in NEC [RR=0.80, 95% CI (0.63,1.02), p=0.10, I2=39%] and mortality [RR=0.94, 95% CI (0.77,1.13), p=0.49, I2=39%], despite the trends are higher in the control group. Conclusion: This meta-analysis showed that enteral lactoferrin supplementation in preterm infants was associated with a significant reduction in LOS, but not NEC stage II or III and all-cause mortality. Registered Protocol: The protocol of this review was already registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42021279189.

Background: WHO recommended the use of 80% FiO2 in patients undergoing general anesthesia with endotracheal intubation (ETI) to prevent surgical site infection (SSI). However, the ongoing debate regarding efficacy and safety raises because further trials have been published. We conducted a review based on recommendations in terms of SSI as the primary outcome and adverse events as the secondary outcome in both patients with or without ETI.Method: A literature search was carried out by PubMed, ScienceDirect, and Google Scholar for RCTs in all-type surgical patients who administrated 80% FiO2 compared with 30–35% FiO2. Pooled relative risks with a 95% confidence interval were conducted for meta-analysis. Result: Based on 23 RCTs included in the analysis, there were no significant differences in terms of SSI (RR,0.85; 95%CI, 0.72 to 1.01; p=0.07), sepsis (RR,1.47; 95%CI, 0.78 to 2.76; p=0.23), postoperative hospitalization days (PHD) (RR,0.16; 95%CI, -0.67 to 0.98; p=0.71), ICU admission (RR,0.94; 95%CI, 0.78 to 1.13; p=0.50), reoperation required (RR,0.78; 95%CI, 0.30 to 2.06; p=0.62), and 30-days mortality (RR,1.18; 95%CI, 0.76 to 1.84; p=0.45). In contrast, even though the subgroup analysis showed association that PHD longer in high FiO2 group for colorectal surgery (RR,0.80; 95%CI, 0.24 to 1.35; p=0.005), the high FiO2 significantly reduced SSI and anastomotic leakage in abdominal surgery (RR,0.78; 95%CI, 0.62 to 0.99; p=0.04 and RR,0.55; 95%CI, 0.36 to 0.85; p=0.008).Conclusion: This meta-analysis provides evidence that administration of 80% FiO2 even though association with longer of PHD in colorectal surgery, it is associated with a reduction in SSI and anastomotic leakage in patients who underwent abdominal surgery. It contrasts for sepsis, ICU admission, reoperation required, 30-day mortality, SSI, and PHD in all-type surgery.