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Comprehensive management of Mayer-Rokitansky-Küster-Hauser syndrome management: A case report
Get PDFMayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also known as Müllerian aplasia, is a congenital condition characterized by uterine and upper vaginal aplasia. It affects females with a normal female karyotype and typical secondary sex characteristics. The aim of this case report was to highlight the multidisciplinary management approach for MRKH syndrome, focusing on tailored interventions to address physical and psychological challenges and improve reproductive prospects. A 26-year-old married female presented to Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, India in January 2023 with primary amenorrhea. Physical examination revealed a blind vagina and a hypoplastic uterus, indicative of MRKH syndrome. Further evaluation, including pelvic magnetic resonance imaging (MRI), confirmed Müllerian duct abnormalities and bilateral ovarian anomalies. The absence of a functional vagina significantly impacted the patient's quality of life, leading to difficulties with sexual intercourse and emotional distress related to infertility. A collaborative approach involving a gynecologist and a psychiatrist at AVBRH was initiated to address these challenges. The patient underwent vaginoplasty to create a neovagina, enhancing the sexual function and intimate relationship with the spouse. However, due to the hypoplastic uterus, achieving motherhood through traditional means was not possible. Therefore, assisted reproductive techniques, in particular surrogacy, were explored. Normal, functional ovaries were harvested from the patient for use in surrogacy procedures. This comprehensive management strategy exemplifies the challenges associated with MRKH syndrome and underscores the importance of tailored interventions and long-term follow-up. The case highlights the significance of collaborative care in improving the quality of life and reproductive prospects for individuals with MRKH syndrome
Effect of black garlic (Allium sativum) on gonadosomatic index, follicle-stimulating hormone level and spermatozoa quality: A study in monosodium glutamate-exposed rat model
Get PDFInfertility rates have risen significantly, one of which is due to monosodium glutamate (MSG) consumption. Recent studies have shown that flavonoids in black garlic (Allium sativum) act as antioxidants. The aim of this study was to assess the effect of black garlic extract (BGE) on gonadosomatic index, follicle-stimulating hormone (FSH) levels, and spermatozoa quality in rats exposed to MSG. Twenty-five healthy rats, aged ten to twelve weeks, were divided equally into five experimental groups: (1) negative control (NC), no intervention; (2) positive control (PC), fed with MSG 8 mg/kg; and (3) fed with MSG + BGE 200 mg/kg; (4) fed with MSG + BGE 400 mg/kg; and (5) fed with MSG + BGE 600 mg/kg. Oral MSG was administered once a day for two weeks before BGE administration was started for two weeks. The measured endpoints were gonadosomatic index, FSH levels, and spermatozoa concentration and quality (spermatozoa motility and abnormality). Analysis of variance (ANOVA) followed by Duncan's post hoc analysis was used to assess the measurement differences. The result suggested that the administration of BGE did not significantly affect the gonadosomatic index (p=0.513). Significant decreases in FSH levels (p=0.005) and spermatozoa concentration were observed in the PC group compared to other groups (p<0.001). Additionally, spermatozoa motility was significantly lower in the PC group compared to NC, BGE200, BGE400, and BGE600 (p<0.001), with higher motility noted in BGE200, BGE400, and BGE600 compared to PC (p<0.001). Furthermore, PC had significantly higher spermatozoa abnormalities compared to NC, BGE200, BGE400, and BGE600 (p<0.001). In conclusion, administration of BGE had a significant effect on the improvement of FSH levels and the quality of spermatozoa in rats exposed to MSG
Enhancing adolescent hypertension prevention in Indonesia through interactive multimedia: Model development and validation
Get PDFAdolescent hypertension is emerging as a significant health challenge. Peer-led interventions utilizing engaging multimedia platforms have demonstrated the potential to enhance prevention behaviors among adolescents. However, there remains a gap in the literature comparing the effectiveness of multimedia intervention with traditional lecture-based approach in adolescent hypertension prevention in Indonesia. The aim of this study was to compare the traditional lecture-based approach and interactive multimedia intervention (e-module, animated videos, and infographics) on adolescents' knowledge, attitudes, and practices regarding adolescent hypertension prevention. A quasi-experimental study with pre-test and post-test control group study was conducted from June to December 2023 in two senior high schools in districts of Pedurungan and Kedungmundu, Semarang, Central Java, Indonesia. To prepare the multimedia model, the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) framework and mapping intervention approach were employed to ensure effective decision-making at each step. A total of 100 high school students were involved, with 50 assigned to the intervention group and 50 to the control group. The intervention group received a multimedia model from the peer educators, while the control group received a traditional PowerPoint-based presentation from the community healthcare workers. The hypertension prevention knowledge, attitude, and practice were assessed using validated questionnaires with 20, 15, and 15 items, respectively. This study found that, after model implementation, significant improvements were observed in students’ knowledge, attitudes, and practices regarding hypertension prevention (all had p<0.001). Specifically, knowledge scores increased by 4.78 points, attitude scores by 10.64 points, and practice scores by 2.9 points. This study highlights that multimedia interventions could significantly improve hypertension prevention behaviors among adolescents by enhancing their knowledge, attitudes, and practices through engaging and interactive multimedia materials
Study of knee pain, fear of falling, and quality of life among community-dwelling older adults, Northern Thailand
Get PDFFall is the leading cause of disability and mortality due to unintentional injury in older adults. The aim of this study was to determine the prevalence and risk factors associated with knee pain, fear of falling, and quality of life among community-dwelling older adults in Northern Thailand. A cross-sectional study was conducted among older adults aged 60 and over. A total of 369 participants were enrolled from April to May 2024. Oxford knee score, a short version of the Falls Efficacy Scale International (FES-I) and World Health Organization quality of life-BREF-Thai, was measured. The results showed that the mean age was 69.4 years and 47 (12.7%) had a history of falls in the previous year. The prevalence of fear of falling was 39.3% for low, 22.5% for moderate, and 38.2% for high concern. Age, marital status, alcohol, history of falls, hypertension, arthritis, and osteoporosis were associated with fear of falling. After adjusting to age, gender, body mass index, education, marital status, smoking, alcohol, history of falls, and chronic disease, osteoarthritis of the knee was positively associated with increasing fear of falling (β: 0.361; p<0.001), while quality of life was negatively associated with fear of falling (β: -0.064; p<0.011). In conclusion, the identified determinants of fear of falling among the elderly indicated the need for fear of falling prevention programs targeting not only individual lifestyles but also chronic diseases. This study provides useful information that might help to develop and adopt effective policies for fear of falling control in Thailand
Antioxidant and immunomodulatory activities of ethanol extracts from Syzygium cumini L. Skeels and Pogostemon cablin Benth
Get PDFSyzygium cumini and Pogostemon cablin are mostly cultivated in tropical climates for culinary and perfumery purposes, yet their potential medicinal properties remain underreported. The aim of this study was to examine the antioxidant and immunomodulatory activities of ethanol extracts from S. cumini (EESC) and P. cablin (EEPC). Reflux extraction was carried out using 96% ethanol on the collected plant specimens to produce EESC and EEPC. Secondary metabolites of each extract were identified using gas chromatography-mass spectrometry (GC-MS). The extracts were measured for total phenol and flavonoid levels and 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity. The immunomodulatory activity test was carried out in vivo by assessing several parameters, including the phagocytic index via the carbon clearance method, organ indices, antibody titers, and delayed-type hypersensitivity (DTH) response, using sheep red blood cells (SRBC) as antigens. The extracts were also examined for their anti-inflammatory activity in acute and chronic inflammation models. In the DPPH antioxidant test, EESC and EEPC had IC50 values of 12.33 µg/mL and 182.17 µg/mL, respectively. Both extracts showed immunosuppressant activity, marked by a phagocytic index of <1. EESC yielded lower organ indices for the liver (p=0.025 at 200 mg/kg BW), spleen (p=0.028 at 100 mg/kg BW), and thymus (p=0.032 at 200 mg/kg BW) compared to the control group. For EEPC, lower organ indices were observed in the liver at 100 mg/kg BW (p=0.005) and 200 mg/kg BW (p=0.031). In the primary antibody titer and DTH tests, both EESC and EEPC showed immunosuppressant activity at 200 and 400 mg/kg BW (p<0.05). The extracts suppressed both the innate and adaptive immune systems. Both EEPC (p=0.004) and EESC at 100 mg/kg BW (p=0.03) significantly reduced serum TNF-α levels. In conclusion, EESC and EEPC have the potential as immunosuppressive and anti-inflammatory agents
Risk factors of pulmonary tuberculosis in Indonesia: A case-control study in a high disease prevalence region
Get PDFTuberculosis (TB) remains one of the most widespread infectious diseases in the world, with high mortality and morbidity rates, contributing to a significant disease burden, particularly in developing countries. The aim of this study was to determine the risk factors of TB among the population aged 17 years (late adolescent) and above in one of the high TB prevalence countries, Indonesia. A case-control study was conducted in Banda Aceh, Indonesia, involving newly diagnosed pulmonary TB patients who visited one of the eleven community health centers in Banda Aceh. The controls were individuals matched by age and sex who lived near the cases and had no TB infection. A total of 16 risk factors were assessed. Hierarchical multivariable logistic regression models were used to examine the association between the risk factors and the occurrence of TB. A total of 196 cases and 196 controls were included in the study. Multivariable logistic regression analysis identified 11 independent predictors for the occurrence of TB after controlling possible confounders. Patients who lived in houses with insufficient light exposure were 77 times more likely to develop TB compared to those living in houses with sufficient light exposure (adjusted odds ratio (AOR): 77.69; 95%CI: 27.09, 222.79). The study also showed that people who had close contact with TB patients (AOR: 25.39; 95%CI: 2.10, 306.52), had poor knowledge of TB (AOR: 24.2; 95%CI: 6.89, 85.17), had comorbidities (AOR: 4.49; 95%CI: 1.35, 14.89), insufficient food utilization (AOR: 3.41; 95%CI: 1.51, 7.71), negative preventive behavior (AOR: 3.39; 95%CI: 1.49, 7.72), low education level (AOR: 3.08; 95%CI: 1.26, 7.55), and insufficient housing humidity (AOR: 2.89; 95%CI: 1.18, 7.12) were associated with increased the odds of having TB. Being employed, having income above minimum wage, and having good nutritional intake were protective factors for developing TB. In conclusion, the determinants of TB among people aged 17 years and older are a clear indication of the need for TB prevention programs targeting not only individual risk factors but also environmental risk factors, particularly providing adequate housing conditions. This study provided useful information that might help to develop and adopt effective policies for TB control in Indonesia
Association between triglyceride-glucose index and hypertension: A systematic review and meta-analysis
Get PDFThe triglyceride-glucose (TyG) index is a simple and reliable indicator of insulin resistance, which is an important contributor to the development of hypertension. The aim of this meta-analysis was to determine the dose-response association between the TyG index and the incidence of hypertension. An extensive search was conducted through several databases, including PubMed, EMBASE, ScienceDirect, and Scopus until June 1, 2024. The TyG index was used as the exposure, and the incidence of hypertension was measured throughout the TyG index intervals. The effect estimates were presented as odds ratios (OR) in both the unadjusted and adjusted models. Adjusted OR were carried out from all included studies to eliminate the possibility of confounding factors being involved in the incidence of hypertension. A total of 108.936 participants (mean age: 48.2 years old, male sex: 47%, mean body mass index: 23.9 kg/m2) from 14 observational studies were included. The TyG index in the most eminent category was related to a higher risk of hypertension in both unadjusted (OR: 2.59, 95%CI: 2.03–3.31, p<0.001; I2: 97.1%, p<0.001) and adjusted model (OR: 1.74, 95%CI: 1.39–2.19, p<0.001; I2: 92.2%, p<0.001). Dose-response meta-analysis for the adjusted OR showed that the linear association analysis was not significant per 0.1 increase in the TyG index. The dose-response curve became increasingly steeper at the TyG index above 8.5. In conclusion, the TyG index was shown to be strongly linked with hypertension in a non-linear dose-response manner
Lung adenocarcinoma size as a predictor of distant metastasis: A CT scan-based measurement
Get PDFPrevious studies have associated tumor size with metastasis and prognosis in lung carcinoma; however, a precise cut-off for predicting distant metastasis in lung adenocarcinoma remains unclear. The aim of this study was to determine the cut-off point for predicting distant metastasis in lung adenocarcinoma. A cross-sectional study was conducted at Dr. Moewardi Hospital, Surakarta, Indonesia from January 2022 to September 2023. Total sampling was employed, involving patients over 18 years old with a confirmed diagnosis of lung adenocarcinoma based on lung computed tomography (CT) scan findings, who had not yet received chemotherapy and had confirmed metastasis outside the lung. The study's dependent variable was the incidence of distant metastasis, while the independent variable was lung adenocarcinoma size. Two experienced thoracic radiologists measured lung adenocarcinoma size by assessing the longest axis using chest multi-slice computed tomography (MSCT) in the lung window setting. Receiver operating characteristic (ROC) curve analysis determined the optimal tumor size cut-off for predicting distant metastasis. From a total of 956 thoracic cancer patients, 108 were diagnosed with lung adenocarcinoma. After applying the inclusion and exclusion criteria, 89 patients were eligible. In the present study, tumor size predicted 68.1% of distant metastasis cases, with a cut-off point of 7.25 cm, yielding a sensitivity of 61.9% and a specificity of 61.5%. Tumors >7.25 cm had a 2.60-fold higher risk of distant metastasis compared to smaller tumors, with larger tumors more likely to spread to various sites. In conclusion, lung adenocarcinomas larger than 7.25 cm have a 2.60-fold increased risk of distant metastasis, making tumor size a crucial predictive factor. The study provides valuable insights for radiologists and can improve diagnosis accuracy and treatment planning by emphasizing tumor size as a key factor in managing lung adenocarcinoma
Comparison of total and partial parenteral nutrition to achieve calorie target among treated children in the intensive care unit
Get PDFThe achievement of recommended calorie targets for parenteral nutrition in pediatric patients receiving treatment in the pediatric intensive care unit (PICU) in Indonesia remains suboptimal, necessitating cautious implementation of this nutritional intervention alone. The aim of this study was to compare the effectiveness of total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) in achieving the calorie requirements of pediatric patients receiving treatments in the PICU. A cross-sectional study was conducted in the PICU at H. Adam Malik General Hospital, Medan, Indonesia, among patients aged between 28 days to 18 years. The consecutive sampling method was employed to collect samples based on predetermined inclusion and exclusion criteria. The assessments of recommended calorie achievement targets were conducted up to 240 hours after initial nutrition treatment. Other possible factors associated with the achievement of the nutrition target were also assessed between groups, such as demographic data, length of treatment, nutritional status, and underlying diseases. A total of 30 patients were included in each group (TPN and PPN). There were no significant differences in age, weight, height, sex, or underlying diseases between groups. All patients in both groups achieved the target calorie requirements after 168 hours. Our data indicated that the percentage of patients who met the target calorie requirements was significantly different at initial treatment, 72 hours, and 120 hours post-treatment between groups (all had p<0.001). The percentages of patients who met the nutritional requirements (carbohydrate and protein) were also significantly different between the TPN and PPN groups (all had p<0.001). This study highlights that the administration of PPN to children resulted in faster achievement of calorie targets compared to TPN
Effect of moderate-intensity aerobic exercise on bladder TGF-β1 and type I collagen expressions in diabetic rat model
Get PDFTransforming growth factor-beta 1 (TGF-β1) and type I collagen play crucial roles in the pathogenesis of diabetic bladder disease (DBD). Moderate-intensity aerobic exercise increases antioxidant activity to help manage DBD. The aim of this study was to evaluate the effect of moderate-intensity aerobic exercise on the expression of TGF-β1 and type I collagen in the detrusor and lamina propria of the bladder in a type 2 diabetes mellitus (T2DM) rat model. A true experimental design with a post-test-only control group design was conducted with white rats (Rattus norvegicus), divided into three groups: a T2DM model group sacrificed after T2DM induction and diagnosed with T2D from a fasting blood glucose (FBC) test (Group C), a T2DM model group that did not receive exercise (Group NE), and a T2DM model group that received moderate-intensity aerobic exercise (Group E). Moderate-intensity aerobic exercise was conducted over six weeks, with a frequency of five days per week for 60 minutes per session. The findings revealed a significant reduction in TGF-β1 expression in the lamina propria in Group E compared to Group C (p=0.004) Additionally, both Group E (p=0.002) and Group NE (p=0.028) showed a significant reduction in type I collagen expression in the lamina propria compared to Group C. These findings provide a basis for further investigation regarding the mechanism of non-pharmacologic DBD management by employing moderate-intensity exercise