Indonesian Journal of Medicine (IJM)
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The Optimum Dose of Beta-Glucan for Stimulating Peripheral Blood Mononuclear Cells (PBMCs) to Produce Cytokines: In Vitro Study
Get PDFBackground: Beta-glucan has been frequently used in laboratory trials as an immunomodulator in both in vivo and in vitro studies, but the effective dose for measuring its performance has not been established. Like other immunomodulators, researchers must establish the right dose of beta-glucan in their laboratory experiments for the purpose of testing substances as immunomodulators without achieving false-positive or –negative results. This study aimed to determine the optimum dose of beta-glucan to induce cytokine production by peripheral blood mononuclear cells (PBMCs) in vitro.Subjects and Method: This was a laboratory experimental study. This study measured the production of two cytokines, including interferon gamma (IFN-γ) and interleukin 12 (IL-12), from the isolated PBMCs of healthy subjects. The doses of beta-glucan used as immunomodulator included 1, 5, 10, 20, and 50 μg/ml. Beta-glucan was added to the PBMC culture medium, and the PBMCs were cultured for 6 days. On the sixth day, the supernatant was harvested and the cytokine production was analyzed using sandwich enzyme-linked immunosorbent assay (ELISA). Cytokines were also analyzed using the human IFN-γ ELISA kit and the human IL-12 ELISA kit, and data analysis was performed by one-way ANOVA.Results: IFN-γ levels were found to be increased in the group treated with 5 μg/ml beta-glucan. The highest IFN-γ levels (70.0 pg/ml) were observed in the group treated with 10 μg/ml beta-glucan. The production of IL-12 increased sharply in the group treated with5 μg/ml beta-glucan but decreased in the group treated with 10 μg/ml beta-glucan. The mean cytokine levels of the beta-glucan group were found to be significantly different from those of the control group (p=0.001). One-way ANOVA revealed that the highest IL-12 production (77.2 pg/ml) occurred at a dose of 5 μg/ml beta-glucan. This average value was significantly different from the average production of IL-12 in the control group (p=0.001).Conclusion: The optimum dose of beta-glucan for stimulating PBMCs to produce IFN-γ in vitro was 10 μg/ml, while for the production of IL-12, the dose was 5 μg/ml. Both cytokines can be measured within 6 days of cell culture.Keywords: beta-glucan, immunomodulator, cytokinesCorrespondence: Meira Erawati. Faculty of Medicine, Diponegoro University. Jl. Prof. Soedarto, S.H, Tembalang, Semarang, Indonesia. Email: meiraerawati@gmail.com. Mobile: +62-81915339685Indonesian Journal of Medicine (2020), 5(2): 170-177https://doi.org/10.26911/theijmed.2020.05.02.1
Bilateral Hepatic Subcapsular Biloma: A Rare Case Report
Get PDFBackground: Biloma is loculated collection of bile that may develop due to iatrogenic causes, traumatically or spontaneously with biliary tree disruption. Hepatic bilateral subcapsular biloma is a rare complication of laparoscopic cholecystectomy and an even more scarce when it occurs spontaneously.Case Presentation: A 65 years old man came to our hospital with abdominal pain and en-larged abdomen. Six weeks earlier he underwent laparoscopic cholecystectomy in a private hospital, because of stone in the gall bladder and cholecystitis. The physical examination obtained no icteric and distended abdomen with pain on palpation. Laboratory findings were within normal limit with negative viral infection markers. Abdominal ultrasonography revealed chronic liver disease with giant liver cyst and ascites. Contrast abdominal multi-slice computed monography (MSCT) demonstrated bilateral hepatic subcapsular biloma. Laparatomy and drainage were then performed and he was discharged from the hospital several days later in good condition.Discussion: Biloma was first introduced by Gould and Patel in 1979. The incidence of past laparoscopic cholecystectomy biloma is very low, between 0.6% and 1.5%. Early accurate diagnosis is very important to determine the proper management. In our case, the biloma was found by using USG and MSCT. Usually it presents with right upper quadrant or epigastric pain, abdominal distention, fever and leukocytosis, but our patient did not have either fever or leukocytosis. Actually the first treatment choice is percutaneous catheter drainage but in our case laparotomy drainage was performed because of subcapsular, biloma in both right and left hepatic lobes.Conclusion: Bilateral hepatic subcapsular biloma is a rare case. One of its diagnostic tools is MSCT. Biloma drainage is the first choice of treatment.Keywords: Biloma, post laparoscopic cholecystectomy, drainageCorrespondence: Triyanta Yuli Pramana. Department of Gastroenterology and Hepatology Division, Dr. Moewardi Hospital/ Faculty of Medicine, Universitas Sebelas Maret. Email: typramana@gmail.comIndonesian Journal of Medicine (2020), 05(01): 52-56https://doi.org/10.26911/theijmed.2020.05.01.0
A Case Report of Wellens’ Syndrome: An Ominous Sign of Left Anterior Descending Artery Critical Stenosis and Impending Anterior Myocardial Infarction
Get PDFBackground: Wellens’ syndrome is a potentially life-threatening condition, characterized by biphasic or deeply inverted T-waves changes in electrocardiographic (ECG) precordial leads, which associated with critical stenosis of left anterior descending (LAD) coronary artery and impending anterior myocardial infarction in patients presenting with unstable angina. This syndrome is an important sign for clinicians because delay in coronary angiography and revascularization may lead toanterior myocardial infarction, left ventricular dysfunction, and even death.Case presentation: A 50-year-old woman came to emergency department in a hospital in Bontang, with new onset intermittent typical chest pain lasting since 3 days. She had history of hypertension without regular medication. Physical examination was in normal ranges. An ECG obtained during chest pain-free period showed Wellens’ type A with biphasic T waves in V2-V6 and preserved R-wave progression. Troponin T was slightly elevated. During observation, the ECG pattern changed from Wellens’ type A to Wellens’ type B with deep T-wave inversions in V2-V6 and preserved R-wave progression.Results: The patient was initially treated with conservative treatment. On the next day, she was referred to percutaneous coronary intervention-capable hospital in Samarinda. Coronary angiography revealed 90% stenosis of mid LAD. A drug-eluting stent was successfully implanted with restoration of LAD flow. She was discharged on the following day in good condition with medication of dual antiplatelet therapy, angiotensin-converting enzyme inhibitor, beta-blocker, and statin.Conclusion: Clinicians should be aware of the ECG changes in Wellens’ syndrome, which may occur during pain-free period. Early recognition is crucial to avoid the development of anterior myocardial infarction. Immediate coronary angiography and revascularization is needed.Keywords: Wellens’ syndrome, critical stenosis, myocardial infarctionCorrespondence: Herick Alvenus Willim. Dr. Agoesdjam General Public Hospital, Ketapang, West Kalimantan. Email: [email protected] Journal of Medicine (2020), 05(03): 246-252https://doi.org/10.26911/theijmed.2020.05.03.1
Difference of Calcium Levels in Infants with Low Birth Weight
Get PDFBackground: Hypocalcemia is a condition that can cause serious disorders, especially in newborns. The occurrence of hypocalcemia is an event that often occurs in babies born that can be caused due to late parathyroid hormone function in calcium metabolism in the baby's body. Hypocalcemia is often associated with hypotension and disorders of the heart rhythm, symptoms that are often seen are apnea, tachycardia, lethargy, vomiting, and gastrointestinal disorders. This study aimed to analyze differences in calcium level between low birth weight infants.Subjects and Method: A cross sectional study was conducted at Dr Moewardi Hospital, Surakarta, Central Java, from December 2016 to April 2017. A sample of 158 LBW children was selected using consecutive sampling. The dependent variable is a decrease in calcium levels. The independent variable is low birth weight babies. Data collected by medical records. Data were analyzed using multiple logistic regression.Results: Calcium level ≥1.13 mmol/L (OR= 0.30; 95% CI= 0.15 to 0.57; p <0.001), no seizures (OR= 0.20; 95% CI= 0.06 to 0.64; p = 0.004), and QoTC (OR= 0.20; 95% CI= 0.07 to 0.572; p= 0.003) decreased the risk of low birth weight.Conclusion: Calcium level ≥1.13, no seizures, and QoTC decrease the risk of low birth weight.Keywords: low birth weight, hypocalcemiaCorrespondence: Sandi Nugraha. Department of Pediatrics, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta. Phone/Fax.0271-633348. Email:sssandi[email protected] Journal of Medicine (2020), 05(02): 131-136https://doi.org/10.26911/theijmed.2020.05.02.0
The Effect of Combination Avocado Juice Administration and Storytelling Therapy on Body Weight in Children with HIV/AIDS
Get PDFBackground: The incidence of HIV/AIDS is increasing. In 2015 there were 30,935 new cases, 41,250 in 2016 and 33,660 in 2017, where new case findings were also found in children aged less than 4 years and caused child deaths worldwide in 2011 to reach 230,000. At present there is no treatment that can cure the disease, so various efforts are made to support the health and quality of life of sufferers. The purpose of this study was to analyze the effect of providing a combination of avocado juice and storytelling therapy on the weight of a child with HIV / AIDS.Subjects and Method: This was a quasy-experimental with pre-post test design. A sample of 15 children with HIV/AIDS was selected for this study. The dependent variable was body weight. The independent variable was a combination of avocado juice and storytelling therapy. Weight data was measured using weight scales. Data were analyzed using the Wilcoxon test.Results: Body weight (kg) after intervention (Mean= 26.17; SD= 9.30) was slightly greater than before intervention (Mean= 25.30; SD= 9.16), with p= 0.002.Conclusion: Combination of avocado juice and storytelling therapy increased body weight in children with HIV/AIDS.Keywords: storytelling therapy, avocado juice, children with HIV/AIDSCorrespondence: Warsini. Nursing Academy of Panti Kosala, Surakarta, Central Java. Alamat Instansi Jl. Raya Solo-Baki KM. 4 Gedangan, Grogol, Sukoharjo, Jawa Tengah. Email: warsinimulyono@gmail.com. Mobile: 0816418071Indonesian Journal of Medicine (2020), 05(02): 148-152https://doi.org/10.26911/theijmed.2020.05.02.0
Clinical Manifestation, Surveillance, and Complication in Tuberous Sclerosis Complex in Dr. Moewardi Hospital
Get PDFBackground: Tuberous Sclerosis Complex (Bourneville’s disease) is genetic disorder with autosomal pattern of heritence that affecting differentiation sellular in many organ such as brain, lungs, cardiac with varible severity. Birth incidence is estimated to be 1:6000. The purpose of this study was to reported a case of patients with Bourneville’s disease (tuberous sclerosis complex) in Moewardi Hospital. Also reported surveillance and complication in this patient.Case Presentation: A male, 18 yearsold, with seizures, onset from infancy, tonic secondary generalized seizure pattern simultaneously throughout the body. Neurologic status examination found right hemiparese and mental retardation, Encountered in patients with skin disorders such as butterfly appearance with facial angiofibroma, forehead fibrous plaque dan shargreen patch. Abnormalities also appeared in the oral mucosa as multiple papules. When psychological tests patient had difficulty following instructions. Psychiatric examination showed moderate lower intelegence. EEG results slow waves at left parietal, there is severe electrofisiologic abnormality considered structural lesion in left parietal. CT showed multiple calcified nodules in subependymal right and left lateral ventricle. MRI showed atrophy and left sclerotic hippocampus with glosis in sub cortex occipito left parietal. To overcome the seizure patients given Carbamazepine. There was increasing of transaminase enzim, liver suspect liver angiomyolipoma.Conclusion: Based on clinical criteria for definite tuberous sclerosis complex patients met the criteria. The patients responded positively to carbamazepine that reduced seizure frequency. But somehow, patient's prognosis is worst. Presence of intellectual impairment and neuropsychiatric problems is a potential poor epilepsy control, and liver disfunction so that the necessary comprehensive management and surveillance involves other disciplines.Keywords:Tuberous sclerosis complex, congenital disorder, epilepsy, mental retardationCorrespondence: Baarid Luqman Hamidi.Department of Neurology, Dr. Moewardi Hospital/Faculty of Medicine, Universitas Sebelas Maret. Email: baarid@staff.uns.ac.idIndonesian Journal of Medicine (2020), 05(01): 47-51https://doi.org/10.26911/theijmed.2020.05.01.0
Multiple Hereditary Exostosis of Distal Ulna with Dislocation of Radial Head: A Case Report
Get PDFBackground: Multiple hereditary exostosis of the forearm is typically formed in the distal ulna causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostosis inhibits the growth of the ulna leading to an acquisition of a varus deformity in the radius which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. This study aimed to report the multiple hereditary exostosis of distal ulna with dislocation of radial head.Case Presentation: We present a case of a 14 year-old girl with main complaint of a bony prominence on her right elbow which limits the elbow flexion range of motion. 3D CT-Scan revealed a dislocation of radial head, shortening and posterior bowing of ulna. We performed excision of the prominent radial head, reconstruction, and temporary arthrodesis of the elbow.Results: The forearm deformity in patients with multiple hereditary exostosis related to the cross-sectional area of the distal ulnar physis was only one-quarter of the distal radius, the distal ulna is more involved in the condition. There was more longitudinal growth at the distal ulnar physis than at the distal radial physis, the distal ulnar physis contributed more total Ulnar Length than the distal radial physis did to Radial length. Known surgical interventions including simple excision, ulnar lengthening, corrective radial osteotomy, hemi-epiphyseal stapling of the distal radius, the Sauve-Kapandji procedure.Conclusion: Simple excision could improve the range of movement of the forearm but would not halt the progression of disease, particularly in younger patients. It was not effective in controlling progression of the deformity. Mature patients did not recur, but in patients that had been excised before puberty the results were varied and unpredictable.Keywords: multiple hereditary exostosis, radial head dislocation, excisionCorrespondence: Pamudji Utomo. Department of Orthopaedics and Traumatology Prof. Dr. R.Soeharso Orthopaedics Hospital, Surakarta. Email: utomodr@yahoo.com.Indonesian Journal of Medicine (2020), 05(01): 63-69https://doi.org/10.26911/theijmed.2020.05.01.1
The Effect of Bima Traditional Baby Massage on Sleep Pattern among Infants aged 5-12 Months
Get PDFBackground: Massage was a tactile stimulation that has physiological and biochemical effects in the body. Baby massage was a fun way to relieve tension and anxiety, especially in infants. Gentle massage will help relax the muscles so that the baby becomes calm and sleeps soundly. Good quality sleep can achieve optimal growth and development. The purpose of this study was to determine the effect of pe'e culture (baby massage) on the sleep needs of babies aged 5-12 months.Subjects and Method: This research was a quasi-experimental study with a pre and post test design in the same group. The number of samples in this study were 30 respondents using purposive sampling technique. The dependent variable of this study was sleep resting children aged 5-12 months. The independent variable was Bima traditional massage (pe'e). Data analysis was performed using the Wilcoxon test.Results: Average sleep quality of children aged 5-12 months after treatment (Mean= 2.73; SD= 6.40) is higher than before treatment (Mean= 1.47; SD= 5.07), and statistically significant (p= <0.001).Conclusion: Culture Baby massage (pee) can improve sleep rest patterns in infants aged 5-12 months.Keywords: baby massage, sleep patterns, sleep quality, age 5-12 monthsCorrespondence: Kurniadi. Health Polytechnics, Ministry of Health, Mataram, Lombok, West Nusa Tenggara. Email: [email protected] Journal of Medicine (2020), 05(02): 142-147https://doi.org/10.26911/theijmed.2020.05.02.0
The Differences of Folliculogenesis between Treated with Letrozole and Letrozole-Electroacupuncture in Women with Polycystic Ovary Syndrome
Get PDFBackground: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that most often causes infertility. It occurs due to the failure of folliculogenesis, thus causing non-ovulation. Letrozole is a 3rd generation drug of non-steroidal aromatase inhibitors, which can increase ovulation rates. Electroacupuncture is the insertion and manipulation of needles into acupuncture points (acupoints) that are selected specifically based on the meridian system and connected to the electrode stimulator. This study aimed to determine the differences of the effects of letrozole and letrozoleelectroacupuncture (letrozole-EA) on the improvement of folliculogenesis in women with PCOS.Subjects and Method: This was an analytic observational study with a case-control design. This study was conducted at the Gynecology Polyclinic and Sekar Clinic, Dr. Moewardi Hospital, Surakarta. A sample of 30 infertile women aged 20-45 years was selected by fixed disease sampling. The criteria of the PCOS were determined based on Rotterdam criteria. The dependent variable was the diameter of the follicle. The independent variables were the administration of letrozole and letrozole-EA. Transvaginal ultrasound of Voluson P6 was used to measure the folliculogenesis. The data were analyzed by independent t-test.Results: On the second day after treatment, the diameter of the follicles in the letrozole-EA group (mean= 6.92; SD= 1.60) was bigger than the letrozole group (mean=5.66; SD=1.11), and it was statistically significant (p=0.004).Conclusion: Combination of letrozole and letrozole-EA therapy is more effective in increasing follicular diameter development than letrozole therapy only.Keywords: polycystic ovary syndrome, folliculogenesis, Letrozole, electro-acupunctureCorrespondence: Yulyanti. Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia. Email: dr.yulyanti@gmail.com. Seluler: +6285264806570.Indonesian Journal of Medicine (2020), 05(03): 214-223https://doi.org/10.26911/theijmed.2020.05.03.0
Association between Serum Calcidiol Levels and Cognitive Function in Geriatric Patients
Get PDFBackground: The role of vitamin D toward cognitive function is as neuroprotective in which vitamin D will increase neurotrophic factor production which contributes to supporting neuron life sustainability, development, and function. The study aims to analyze the association between calcidiol serum level and cognitive functions of geriatric patients.Subjects and Method: A cross-sectional study was conducted at Geriatric Polyclinic of dr. Moewardi Hospital, Surakarta. A sample of 30 geriatric patients was selected randomly. The dependent variable was cognitive functions (MMSE score). The Independent variable was calcidiol serum level. The data were analyzed by Spearman test.Results: There was no difference of calcidiol serum level with MMSE score (OR= 1.00; p= 0.478).Conclusion: There was no difference in calcidiol serum level with MMSE score.Keywords: cognitive functions, calcidiolCorrespondence: Sandy Anandhita. Masters Program in Family Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java. Email: [email protected]. Mobile: 082227940410Indonesian Journal of Medicine (2020), 05(03): 185-190https://doi.org/10.26911/theijmed.2020.05.03.02