Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Raynaud Phenomenon: Diagnosis and Management
Get PDFRaynaud’s phenomenon (RP) is a chronic episodic attack of digital ischemia provoked by exposure to cold or emotional stres. This phenomenon affects 3-5% of the population, with female ratio more than men and is categorized into a primary and secondary form. Primary form of RP is idiopathic, meanwhile the secondary form is associated with underlying diseases and other condition such as connective tissue disease, obstructive arterial disease, neurologic disorders, drugs and toxin, hyperviscosity disorders, infections, endocrine disturbance, neoplasms, and occupation or environmental exposure. Until today, to classified and build the diagnosis of RP is still a clinical challenge. Therefore, a careful history and a physical examination, together with laboratory tests and nailfold capillaroscopy are mandatory. A combination of conservative measures and medications can help in the management of RP. The approach to the RP patients requires therefore a coordinated care of specialists including dermatology
Efficacy of Lidocaine and Ketamine Combination on Reduction of Pain Intensity, Improvement of Functional State and Central Desensitization of Chronic Low Back Pain
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Background: Chronic low back pain (LBP) prevalence is approximately 20% of world population. Central and peripheral sensitization are considered as the main mechanism of pain chronification. This study hypothesize that lidocaine and ketamine combination reduces pain intensity, improves functional state and central desensitization of chronic low back pain. It is by modulating central sensitization in sub-anesthetic dose, prolonging inactivation of Na-channel, blocking NMDA-receptor and preventing secondary hyperalgesia.
Aim of study: To evaluate the efficacy of lidocaine and ketamine combination on the intensity of pain, functional state and central desensitization of chronic low back pain.
Methods:. This double blind randomized control trial study was carried out in Mohammad Hoesin General Hospital, Palembang, Indonesia from May 2018 to January 2019. A total of 20 patients with low back pain that last for more than 3 months, aged >18 years old, of either sex who were willing to be enrolled in this study, were randomly allocated into one of the two groups of 10 each. The treatment group (n=10) received standardized therapy (analgesic and physiotherapy) + intravenous ketamine 0.5 mg/kg + lidocaine 2 mg/kg and the control group (n=10) received standardized therapy + 100 ml Nacl 0.9%. Pain intensity, functional state, and central desensitization were measured before the treatment, day 7 after treatment, and a month after treatment using Numeric Pain Rating Scale (NPRS), Functional Pain Scale (FPS), and Central Sensitization Inventory (CSI).
Results: The administration of ketamine 0.5 mg/kg + lidocaine 2 mg/kg resulted in NPRS and CSI changes was effective since the 7th day post intervention (p-value=0.021 and p-value=0.001) while on FPS changes, it was effective since the 30th day post intervention (p-value=0.000)
Conclusion: From the result, it could be concluded that the administration of ketamine and lidocaine is effective on decreasing pain intensity and central desensitization in chronic LBP
The Effect of Vitamin D Supplementation on the Increase in CD4 count of HIV/AIDS Patients Receiving Antiretroviral Therapy
Get PDFIntroduction. Vitamin D plays a role in health overall, but hypovitaminosis D stilloccurs throughout the world. HIV/AIDS patients are prone to suffer fromhypovitaminosis D because of the infection itself and the side effects of antiretroviraltherapy. Various effort have been tried to improve the immune status of HIV/AIDSpatients, one of them is by adding vitamin D. Vitamin D acts as an antiinflammatoryso that it can prevent apoptosis of CD4 T cells and increase CD4 cell count.Methods. This is a randomized control trial add on a study that aims to determinethe effect of vitamin D to increase in CD4 counts of HIV / AIDS patients who havereceived antiretroviral drugs. Subjects were HIV / AIDS patients who had receivedantiretroviral drugs. A total of 20 subjects were divided randomly into two groups;one group received vitamin D (calcitriol 0.5 mcg per day) for eight weeks, and theother group that received a placebo. Each group was measured of CD4 cell countbefore and after treatment. Results. There was a significant increase in the CD4 cellcount of the vitamin D group (p = 0.046), but not in the CD4 cell count of bothgroups (p = 0.985). The comparison of mean CD4 cell counts between groups beforetreatment was not significantly different (p = 0.057), but after treatment, it becamesignificantly different (p = 0.040). Conclusion. Vitamin D has been successful inincreasing CD4 cell count in the vitamin D group, and it is recommended to giveHIV / AIDS patients to increase CD4 cell count
Critical Congenital Heart Disease in Newborn: Early Detection, Diagnosis, and Management
Get PDFCritical congenital heart disease (CHD) is a type of CHD that requires early intervention in the first year of life to survive. Morbidity and mortality increases significantly if newborns with critical CHD experience delay in the initial diagnosis and management. The infants may develop cyanosis, systemic hypoperfusion, or respiratory distress as the main manifestations of critical CHD. Pulse oximetry screening for early detection of critical CHD must be performed in newborns after 24 hours of age or before discharge from hospital. Generally, infants with critical CHD require patency of the ductus arteriosus with infusion of prostaglandin to maintain pulmonary or systemic blood flow. After initial management, the infants must be immediately referred to tertiary care center for definitive intervention.
Keywords: congenital heart disease, duct-dependent circulation, ductus arteriosus, prostaglandi
Treatment of Infantile Hemangioma
Get PDFInfantile hemangioma represents the most common benign tumour arising ininfancy. The natural history of infantile hemangioma is characterized by aproliferative phase during the first few months of life, followed by slower involutionover the years. Evolution of infantile hemangioma has four stages, contain nascent,proliferation, involution, and involuted. Most infantile hemangioma do not requireactive treatment and involute without leaving significant residual. However, someinfantile hemangioma is problematic due to complications such as ulceration,interference with a vital function, or potential disfigurement. The managementapproach for IH contains active non-intervention and active intervention. Thedecision of treatment is based on many factors, including size and location,psychosocial implication, risks and benefits of the proposed therapy. Earlyrecognition of infantile hemangioma is essential for optimal management andpreventing complication
Assessment of the Neutrophil Lymphocyte Ratio and Mean Platelet Volume in Pregnancy
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Introduction: Hypertension in pregnancy is a common complication that affects maternal and fetal morbidity and mortality. Comprehensive handling is needed to overcome the incidence of hypertension in pregnancy so that it does not get worse. The use of inflammatory markers is widely used as a predictor of the incidence of hypertension in pregnancy, especially preeclampsia. Neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) values are believed to predict the incidence of hypertension in pregnancy.
Aim of study: The purpose of this study was to determine the ability of both the NLR and MPV values to predict the incidence of hypertension in pregnancy.
Methods: This research is an analytic observational study using secondary data from medical records. The data were taken from the Cimacan Regional Hospital from January to December 2019. The variables were then tested statistically to see the difference in the mean. If there are significant results, the predictor's ability will be tested again with the ROC curve test.
Results: The results of statistical tests between the normotensive pregnancy group and pregnancy with hypertension showed that the mean difference was significant in the NLR variable with P-value of 0.004 and MPV with a P-value of 0.005. Then the NLR and MPV values were tested again by the ROC Curve method. The AUC results on the NLR variable (AUC: 0.562 / p-value: 0.022) and MPV (AUC: 0.560 / p-value: 0.022).
Conclusion: Although NLR and MPV had differences mean between the two groups, their ability to predict pregnancy with hypertension was very low.
Keywords: Pregnancy; Hypertension; Preeclampsia; NLR; MPV
Evaluation of CTEV Management in Children's Walking Ability Assessed by "BANGLA" Club Foot Tool Score System
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Congenital talipes equinovarus (CTEV) or clubfoot is a congenital deformity that involves an abnormal position of the calcaneonaviculare complex. "Bangla clubfoot tool score system" is an assessment that indicates the effectiveness of CTEV management. The purpose of this study was to evaluate the management of CTEV on children's ability to walk as assessed by the Bangla clubfoot tool score system.
A cross sectional study was conducted at the Hospital Dr. Mohammad Hoesin Palembang. There were 24 CTEV patients who received CTEV management before the age of 3 years and were not associated with a neurological disorder. A comparison of the average total Bangla clubfoot score tool system was analyzed by assessing parental satisfaction, walking ability and clinical examination.
The majority of CTEV patients were women (58.3%) with and mostly being treated before 1 year old (79.2%). The most types of CTEV were bilateral (70.8%), and most of them performed surgery (66.7%). Assessment with the Bangla clubfoot tool system shows that the level of parental satisfaction is sufficient, gait is good, but physical foot examination is poor (20%). The score is influenced by age at first therapy and compliance using the brace.
Parents must continue to support their children to undergo integrated management after therapy to maintain their walking ability
The Effect of KatG S315t M. Tuberculosis Gene Mutation on Conversion Rate of MDR-TB Patients with Shorter-Course Treatment
No full textBackground. Resistance to the INH drug is most often caused by a mutation of the KatG S315T M.Tb gene. MDR TB treatment with short-term WHO mixes using high-dose INH drugs is considered less effective in this mutation condition because it causes high resistance to INH. The effectiveness of MDR TB treatment can be seen from the sputum smear conversion rate. This study was aimed to determine the effect of the S315T katG gene mutation on the treatment response of patients with MDR TB who received WHO short-term alloys at Dr Moh Hoesin general hospital, Palembang, Indonesia.
Method. This study uses observational analytic with a prospective cohort approach. The study subjects were MDR TB patients at Dr Moh Hoesin general hospital, Palembang, Indonesia, and a PCR-RFLP examination was performed to see the katG gene, followed by sputum smear evaluation at the end of the first and second months of treatment to assess the speed of conversion. Data analysis using SPSS 25 with the chi-square statistical test.
Results. The frequency of katG S315T M.Tb gene mutations was 51.85%. The majority of MDR TB sufferers experience rapid conversion (92.59%). 64.29% of the katG S315T gene mutation group experienced sputum smear conversion after one month, 28.57% after two months, and 7.14% after three months of treatment. There was no significant difference in conversion speed in the two groups (p = 0.741).
Conclusion. There was no effect of the S315T M.Tb katG gene mutation on the speed of sputum smear conversion of MDR TB patients who received short-term alloy treatment
Efficacy of Adapalene 0.1% Versus Tretinoin 0.025% Cream as Treatment of Mild Acne Vulgaris
No full textAbstract
Introduction: Acne vulgaris (AV) is a chronic inflammatory of the pilosebaceous unit. Topical retinoid is a mainstay of mild AV first-line treatment.
Aim of study: To assess the efficacy of topical retinoid for the treatment of mild AV.
Method: The randomized double-blind clinical trial was conducted from June to September 2019 at Dr. Mohammad Hoesin General Hospital Palembang. A total of 70 mild AV patients who fulfilled inclusion criteria were enroled consecutively. Patients randomly treated with adapalene 0.1% cream or tretinoin 0.025% cream and evaluated every 2 weeks for 8 weeks to examine the number of AV lesion (inflammation, non-inflammation and total lesion).
Result: There are reduction in number of inflammatory and non-inflammatory lesions at both groups but only inflammatory lesion was statistically significant (p <0.05). Total lesions also decrease in adapalene and retinoin group (21.66 vs 5.75, 22.21 vs 7.96, respectively) and statistically significant (p <0.05).
Conclusion: Adapalen 0.1% cream showed non-inferiority to tretinoin 0.025% cream in efficacy, especially in the reduction of non-inflammatory and total lesions
Efficacy of Alpha Lipoic Acid Supplementation In Chemotherapy-Induced Peripheral Neuropathy
Get PDFBackground. Chemotherapy-induced peripheral neuropathy is a side effect of several chemotherapy drugs and a significant cause of chronic pain in cancer patients, which affects patients' long-term quality of life. The neurotoxic chemotherapy agents most reported to cause neuropathic pains are platinum and taxane. This study aimed to determine the efficacy of alpha-lipoic acid supplementation in chemotherapy patients.
Methods. This study used a randomized, double-blind clinical trial in the oncology haematology clinic in the Department of Internal Medicine at Mohammad Hoesin General Hospital Palembang from November 2018 to July 2019. Samples were taken from patients who met the inclusion criteria and signed informed consent forms to join the study. This studyused SPSS version 22.0 for Windows to analyze the data.
Results. This research studied 30 subjects who were divided into alpha lipoic acid groups and placebo groups with 15 samples each. The alpha-lipoic acid group showed a significant decline in the Toronto Clinical Scoring System (TCSS) after treatment (p = 0.000) compared to the placebo group (p = 0.164).
Conclusions. Treatment with a 600 mg single dose each day of alpha-lipoic acid for 12 weeks effectively improved patients condition significantly