E-Journal Faculty of Medicine Universitas Padjadjaran / E-Jurnal Fakultas Kedokteran Universitas Padjadjaran
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Correlation of Leukocytes, Neutrophil-To-Lymphocyte Ratio, C-Reactive Protein, and Serum Lactate with Amputation Incidence in Diabetic Foot Ulcer Patients
No full textDiabetic foot ulcers are a major cause of approximately 85% of amputations in non-trauma patients. One of the contributing factors is the presence of extensive gangrenous infections. Effective management of diabetic foot infections to prevent amputation requires knowledge of various factors such as ulcer location, depth, neuropathy, vasculopathy, infection, and the presence of infection, which can be identified through inflammatory markers. This retrospective cohort study aimed to evaluate the correlation between leukocyte count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and serum lactate levels with the incidence of amputation in DFU patients. All DFU patients admitted to Dr. Hasan Sadikin General Hospital, Bandung, from January 1 to December 31, 2023, who met the inclusion criteria were included using purposive sampling. A total of 47 patients with diabetic foot ulcers were included in this study. The mean, median, and range of leukocytes were 18,532, 16,015, and 55,184, respectively, with higher values observed in amputation cases. NLR values were also higher in amputation cases, with a mean of 9.54, median of 6.00, and range of 47.32. Similarly, CRP levels were elevated in amputation cases, with a mean of 9.56, median of 6.75, and range of 26.16. There is a significant correlation between leukocytes, NLR, CRP, and serum lactate with the incidence of amputation in diabetic foot ulcer patients
Gastrointestinal Manifestations and Neutrophil-to-Lymphocyte Ratio as Marker of Occult Bleeding in COVID -19
No full textBackground: Coronavirus disease 2019 (COVID-19) was initially recognized as a respiratory illness; however, it has been gradually recognized as a disease that affects multiple organ systems, including the gastrointestinal (GI) tract. GI involvement ranges from mild symptoms, such as nausea and diarrhea, to complications like gastrointestinal bleeding. The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a simple biomarker of inflammation and disease severity in COVID-19.Objective: To describe gastrointestinal manifestations of COVID-19 and examine the association between NLR levels and occult gastrointestinal bleeding.Methods: This cross-sectional study was conducted in 2021 at the New-Emerging and Re-Emerging Infectious Diseases inpatient unit of Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia. COVID-19-positive patients aged ≥18 years with gastrointestinal symptoms were included, excluding those who were pregnant or had pre-existing GI disorders. Data were collected from medical records and patient interviews. Statistical analysis was performed using the Mann–Whitney U test, with p < 0.05 considered significantResults: The most frequent symptoms were appetite loss and nausea (93%), bloating and vomiting (87%), and diarrhea (57%). Occult GI bleeding occurred in seven patients (23.3%) who had significantly higher NLR values than those without bleeding (p = 0.041).Conclusion: The most frequent GI manifestations of COVID-19 are loss of appetite, nausea, bloating, vomiting, and diarrhea, while occult gastrointestinal bleeding occurs in about one-fourth of cases. Elevated NLR levels are associated with occult bleeding, suggesting its potential role as a simple and accessible biomarker of intestinal inflammation and disease severity
Evaluation of Kidney Proximal Tubule Following Immunization with Plasmodium falciparum CIDR1α-PfEMP1 Recombinant Protein in Rats
Full text linkMalaria vaccines are continuously explored as an approach to eradicate malaria. The cysteine-rich interdomain region 1α-Plasmodium falciparum erythrocyte membrane protein 1 (CIDR1α-PfEMP1) is an antigenic protein that can bind to the endothelial protein C receptor (EPCR) and CD36, resulting in microvascular obstruction. The PfEMP1-induced antibody can induce antibodies, reducing the severity of malaria risk by impeding cytoadherence and destructing rosette formation. Preclinical safety testing is an important step of vaccine development, including safety testing of the kidney as the main excretory organ. The proximal tubule has the most mitochondria to support its main role in reabsorption and excretion, making it prone to oxidative stress caused by foreign substances. This study aimed to evaluate kidney proximal tubule cells after CIDR1α-PfEMP1 immunization in rats. This study was conducted at the Laboratory of Biology Molecular and Biotechnology, Faculty of Medicine, University of Jember. Eight rats were injected subcutaneously with 150 µg of the protein and four rats were injected with 0.9% NaCl on days 0, 21, and 42. The rats were euthanized on day 56. The kidney histopathological slides were stained using Hematoxylin-Eosin (HE) and the necrotic proximal tubule cells were counted at five (5) visual fields (100 cells/visual fields). The average number of necrotic cells of the control and the treatment groups were 0.125±0.25 and 2.438±2.5972 while the Mann-Whitney test showed a significance value of p=0.12, indicating no significant difference between the control and treatment groups. In conclusion, there is no change in the kidney histopathology based on the proximal tubule necrotic cell count after CIDR1α-PfEMP1 immunization in rats
Clinical Features of Drug Eruption in An Indonesian Tertiary Hospital
Full text linkDrug eruption is a response to drugs undergoing sensitization, which is mediated by the immune system. Clinical features of drug eruptions, such as maculopapular drug eruption, Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS), are known as common drug reactions. This study aimed to explore the characteristics and clinical features of patients with drug eruptions at the Department of Dermatology and Venereology of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. This retrospective descriptive study used data from the department from patients treated between January 1, 2014 and December 31, 2018. Data were analyzed using Excel and SPSS software. In this study, 200 subjects were included, mainly consisting of female subjects (50.5%) and aged between 19 and 65 (89%). Maculopapular drug eruption (45%) was the most typical clinical presentation, followed by SJS/TEN (37.5%), and DRESS (3%). The analgesics and non-steroidal anti-inflammatory drugs (NSAID) group was the most commonly suspected causative drug (36.91%), with paracetamol (29.18% of total drugs consumed) as the most frequent NSAID causing the eruption. This was followed by the antibiotic-type drugs group (36.48%), with cotrimoxazole (9.87% of total drugs consumed) as the most common one. So, maculopapular drug eruption is the most common clinical presentation of drug eruption, with analgesics and non-steroidal anti-inflammatory drugs (NSAID) class as the most suspected causative drug. Further investigations are needed to get the accurate result
Effect of Nigella sativa on Growth and IGF-1 levels in Rats Prenatally Exposed to Pesticides
Full text linkNigella sativa contains antioxidants and can potentially improve growth disorders due to prenatal pesticide exposure. Pesticides affect the work of thyroid hormone, insulin, and Insulin-like Growth Factor that play essential roles in the growth and development processes. This study aimed to determine the effect of Nigella sativa supplementation on body weight and IGF-1 levels in mice, with a history of pesticide exposure in the womb. This study was conducted from October 14, 2023 to December 1, 2023 at the laboratory of the Center for Food and Nutrition Studies, Inter-University Center, Gajah Mada University, Indonesia. This experimental study used a cohort design and involved 20 pregnant female rats as the experimental animals. These rats were divided into several groups: K0 (control group with standard feed), K1 (group exposed to pesticides during pregnancy), and P1 and P2 (group exposed to pesticides. Followed by 10.8 mg/200gBW/day and 21.6 mg/ 200 gBW/day of Nigella sativa after birth, respectively). The pesticide dose used was 10 mg/200gBW/day orally. Anthropometric examinations was conducted at birth, and on day 7, day 14, day 21, and day 28. The examination of IGF-1 levels was performed on day 28 using the ELISA method. Results showed that the mean birth weights (g) of the rats by group were as follows: K0:6.09±0.12; K1:4.03±0.03, P1:4.03±0.02 P2:4.05±0.03. On day 28, the mean body weights (g) were as follows: K0:104.0±1.79; K1:65.17±1.47; P1:92.17 ± 3.19; and P2:102.00±1.41. The mean IGF-1 level (pg/mL) were as follows: K0:23.76±0.68; K1:9.03±0.24, P1:14.94±0.37; and P2:19.51±0.56. The ANOVA test presented a p-value of <0.001. Hence, Nigella sativa supplementation after birth significantly affects body weight and IGF-1 levels in rat model of prenatally exposed to pesticides
Clinical Approach to Differentiating Epileptic Seizures from Bipolar Disorder
Full text linkDistinguishing between epileptic seizures and bipolar disorder in clinical setting presents a significant challenge due to overlapping symptoms and the complex mechanism underlying both conditions. This study offers a novel perspective by integrating the latest research and clinical practices to explore this intricate diagnostic landscape. Unlike previous studies that primarily focused on isolated aspects, this study synthesizes recent advancements in neuroimaging, wearable technology, and machine learning to enhance diagnostic accuracy. Data sources searched were Google Scholar, PubMed, and ScienceDirect using the keywords of ‘epileptic seizures’, ‘bipolar disorder’, ‘diagnosis’, ‘neuroimaging’, ‘wearable technology’, and ‘machine learning’. Following the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) methodology, the findings highlight how the variability of mood episodes and their resemblance to seizure activity often complicate differential diagnosis. Moreover, they underscore the potentials of emerging technologies, such as real-time monitoring via wearable devices and AI-driven diagnostic tools, in refining current clinical approaches. This study emphasizes the necessity of clinic awareness regarding subtle but crucial distinctions between bipolar disorder and epileptic seizures. By leveraging continuous monitoring and data-driven insights, an innovative framework that combines clinical expertise with advanced technology is proposed, paving the way for more precise and effective diagnostic methods
Antibacterial Activity of Mangrove Leaves Extract (Rhizopora Apiculata) Against Salmonella typhi Growth
Full text linkMangrove leaves (Rhizopora apiculata) contain antibacterial chemical compounds with antibacterial properties against various pathogens. Salmonella typhi, the causative agent of thyphoid fever, triggers a systemic infectious disease that can lead to complications and deaths if not treated properly. This study aimed to screen the phytochemical content of R. apiculata leaf extract, evaluate its antibacterial activity against S. typhi, and determine the optimal inhibitory concentration. Leaves were collected from the Sicanang mangrove forest in Belawan, North Sumatra, Indonesia, and extracted using the maceration method with 96% ethanol. Antibacterial effectiveness was assessed using disc diffusion method by measuring the zone of inhibition after exposure to mangrove leaf extract at concentrations of 40%, 60%, 80%, and 100%, with chloramphenicol as a positive control, to determine the most effective concentration for inhibiting the growth of Salmonella typhi. The results of the study showed that there were differences in inhibition zones in each group. Mangrove leaves extract at a concentration of 100% is the most effective in inhibiting the growth of Salmonella typhi compared to 80%, 60%, and 40% concentrations
Effect of Moringa Oleifera Leaf Extract on FGF21 mRNA Expression in Male Wistar Rats’ Skeletal Muscle Under Sedentary Condition
Full text linkBackground : Fibroblast growth factor 21 (FGF21) is a muscle-derived myokine whose expression changes in response to elevated reactive oxygen species (ROS), primarily generated by cytochrome c oxidase complex IV (COX IV) in skeletal muscle. Moringa oleifera (MO) is known for its antioxidant potential, which may influence FGF21 expression and oxidative stress pathways. This study aimed to evaluate the effects of MO leaf extract on FGF21 mRNA expression and mitochondrial oxidative capacity in skeletal muscle under sedentary conditions. Methods: This semiquantitative analytic study used 10 sedentary male Wistar rats, divided into control and treatment groups. The treatment group was administered 200 mg/kg of MO leaf extract, while the control group was given a standard diet and water for 12 weeks. COX IV and FGF21 mRNA levels in the soleus muscle were measured using real-time polymerase chain reaction. Statistical analysis included the Shapiro–Wilk normality test, Levene’s homogeneity test, independent t-test, or Mann–Whitney test, with significance set at p<0.05.Results: The treatment group exhibited lower COX IV (0.6414 vs 0.7388) and higher FGF21 (0.9414 vs 0.7157) mRNA levels compared to the control group; however, the differences were not significant (p=0.354 and p=0.170, respectively). Conclusions: Although FGF21 may act as a therapeutic response to decreased mitochondrial activity, MO supplementation in sedentary conditions shows no significant effect on mitochondrial oxidative function or FGF21 expression. Nonetheless, these findings contribute to understanding metabolic regulation and highlight the potential role of antioxidants and active lifestyle interventions in promoting wellness and preventing muscle decline due to aging.
Changes in Astigmatism After Phacoemulsification with a Superior Incision
No full textSurgically induced astigmatism (SIA) is a common phacoemulsification procedure for senile cataracts. The size, location, and incision type significantly influence the SIA degree. This study aimed to evaluate the effect of a superior incision on astigmatism levels in patients both before and after phacoemulsification for senile cataracts. This retrospective analytical observational study utilized a cohort at Sultan Agung Islamic Hospital, Semarang, Indonesia, between November 2023 and May 2024. The accessible population consisted of patients treated during the study period. A total of 65 eyes from patients who underwent phacoemulsification with a superior incision were included in the study. Twenty-five patients (38.5%) exhibited against-the-rule (ATR) astigmatism before the surgical procedure, which decreased to 16 patients (24.6%) following surgery. In contrast, after phacoemulsification with a superior incision, the number of patients with with-the-rule (WTR) astigmatism increased from 61.5% to 75.4%. The astigmatism value before phacoemulsification with a superior incision was 1.274±1.02, while the value was 0.945±1,02 afterwards. The Wilcoxon Test revealed a significant difference (p<0.05) in the mean of astigmatism values before and after the procedure with a superior incision, indicating the surgical effect on reducing astigmatism. This study confirms that phacoemulsification using a superior incision significantly reduces postoperative astigmatism, particularly in patients with WTR astigmatism. Combining small incisions and sutureless techniques enhances corneal stability, accelerates healing, and improves surgical outcomes
Early Left Ventricular Structural Changes With Preserved Function in Overweight and Obese Adolescents: A Speckle-Tracking Echocardiography Study
No full textBackground: Overweight and obesity in adolescents are associated with dyslipidemia and may contribute to early cardiovascular remodelling. Speckle-tracking echocardiography (STE) is a sensitive imaging technique capable of detecting early myocardial functional alterations before the onset of clinical symptoms. This study aimed to evaluate the correlation between cardiac chamber dimensions, left ventricular (LV) geometry and function, and lipid profiles in overweight and obese adolescents. Methods: A cross-sectional study was conducted from June to September 2023, involving 51 overweight and obese adolescents aged 15–18 years in Bandung, Indonesia. Anthropometric measurements, fasting lipid profiles (triglycerides, total cholesterol, LDL, HDL), and transthoracic echocardiography were obtained. LV dimensions, LV mass index (LVMI), ejection fraction (EF), fractional shortening (FS), and global longitudinal strain (GLS) were assessed. Associations were analyzed using Pearson correlation.Results: Participants were predominantly male (64.7%) with a mean age of 16.3±0.6 years. Overweight (47.1%) and obesity (52.9%) were almost equally distributed with a mean BMI of 29.6±4.1 kg/m². LVMI correlated negatively with total cholesterol (r=−0.356; p=0.005), HDL (r=−0.351; p=0.006), and LDL (r=−0.280; p=0.023). The LV posterior wall thickness and LV end-diastolic diameter were also inversely correlated with selected lipid parameters. Interventricular septal thickness in systole correlated positively with triglycerides (r=0.270; p=0.028). No significant correlations were found between lipid profiles and LV function parameters, including EF, FS, and GLS (p>0.05).Conclusions: In overweight and obese adolescents, lipid profiles are associated with early alterations in LV structural dimensions while LV systolic function remains preserved. These findings support the importance of early cardiovascular screening and lifestyle modification to reduce future cardiometabolic risk