Narra J (Journal)
Not a member yet
500 research outputs found
Sort by
Herlyn-Werner-Wunderlich syndrome: Challenges in diagnosis and management
Get PDFHerlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation characterized by a triad including uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. In this case report, we present a case of HWWS along with the challenges in diagnosis and multi-step treatment processes. A 25-year-old woman presented to Dr. Zainoel Abidin Hospital in Banda Aceh, Indonesia with a chief complaint of lower back pain for the past six months (two months after the marriage). The patient also complained of late menstruation, followed by thick yellow vaginal discharge resembling malodorous pus occurring after menstruation. Additionally, a history of fever and pain during intercourse was reported. Vaginal examination revealed purulent fluid emerging from a pinpoint hole on the right vaginal wall. Vaginal palpation revealed a two-branched uterus, along with a palpable cystic mass on the right vaginal wall. Ultrasound examination indicated the presence of the right and left hemi-uteri, measuring 4.7x1.35 cm and 5.7x1.26 cm in size, respectively with both ovaries appearing normal. Fluid accumulation was observed in the right hemivagina, while the left kidney exhibited normal features, and the right kidney showed signs of hypoplasia. The patient was diagnosed with uterus didelphys, fluid accumulation in the hemivagina, and right kidney hypoplasia. Magnetic resonance imaging (MRI) confirmed uterus didelphys and revealed narrowing of the right hemivagina, suggestive of HWWS. Hysteroscopy was performed to resect the vaginal septum with laparoscopic guidance, along with drainage of hematocolpos, pyocolpos and placement of an intracervical mold. Despite HWWs having conservative gradual management, it was opted to perform vaginal septum resection, hematocolpos and pyocolpos drainage and placement of an intracervical mould in this case, in order to relieve symptoms and restore the reproductive and sexual functions
Severe hypocalcemia as a cause of transient ischemic attack? A debatable case and evidence from literature
Get PDFHypocalcemia and transient ischemic attack (TIA) are different medical disorders; however, limited evidence suggests a possible link between the two. The underlying pathomechanisms by which hypocalcemia may cause cerebrovascular damage are difficult to comprehend. The aim of the study was to present an individual experiencing TIA that possibly due to severe hypocalcemia that associated with hypoparathyroidism after total thyroidectomy; and to explore the available evidence of its cause-effect relationship through available literature. A 68-year-old man presented to Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia with complaints of weakness, especially in the right limbs that had worsened in the last week. The patient experienced unconsciousness for an hour before the admission; disorientation and anterograde amnesia over the time of recovering of consciousness. Other complaints included frequent muscle cramps, numbness in both arms and legs, dizziness, swallowing difficulty, nausea, and vomiting. The patient had a history of total thyroidectomy for a large struma diffuse 18 years ago and was prescribed several medications. However, the patient was overwhelmed by forgetfulness which had become more frequent in recent months resulting in medication nonadherence. The vital sign was stable and Chovsteck's sign was positive. The Montreal Cognitive Assessment (MoCA) revealed impairment in the visuospatial/executive component and delayed memory. Laboratory tests revealed severe hypocalcemia, altered thyroid function, hypomagnesemia, elevated D-dimer and fibrinogen, and vitamin D deficiency. TIA and severe hypocalcemia were proposed as the diagnosis. Prompt initiation of appropriate treatment, including calcium supplementation, anticoagulation, and neuroprotective agents, led to significant clinical improvement. Evidence from available literature suggests that there is a possible link between severe hypocalcemia and TIA that occurred in this patient. However, more studies are warrant to establish this cause-effect relationship
Association between caregiver burden in family and hemodialysis compliance of chronic kidney disease patients in Aceh, Indonesia
Get PDFPatient compliance toward undergoing treatment determines its success rate. Unfortunately, the compliance among hemodialysis patients is concerning. Supports from family has been suggested influence the patient compliance, especially from a family member who acts as a caregiver. The aim of this study was to determine the association between the level of caregiver burden and compliance in hemodialysis patients. A cross-sectional study was conducted at Dialysis Installation at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The study sample was family members who accompanied hemodialysis patients. The minimal number of patients was determined of which 67 respondents were required and therefore recruited. Caregiver burden was collected using direct interview using Caregiver Burden Assessment questionnaire. The results revealed that twenty-four respondents (35.8%) had moderate caregiver burden, while there were only nine respondents (13.4%) had very low caregiver burden. The majority of the hemodialysis patients were non-compliant (n=38, 56.7%). A Chi-squared test indicated a significant association between the status of caregiver burden and the patient compliance to hemodialysis (p=0.011). These findings stress the importance of addressing caregiver burden in ensuring the compliance of patients receiving hemodialysis
Green algae Caulerpa racemosa compounds as antiviral candidates for SARS-CoV-2: In silico study
Get PDFGreen algae (Caulerpa racemosa) are known to contain bioactive compounds which are hypothesized to have antiviral activities against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the anti-SARS-CoV-2 potential of compounds extracted from the green alga Caulerpa racemosa using in silico analysis. The extract was obtained through maceration with 96% ethanol and the compounds present in the extract were identified through gas chromatography-mass spectroscopy (GC-MS). The binding affinities were analyzed in silico using the PyRx application and visualized in the PyMOL software. GC-MS analysis of Caulerpa racemosa extract showed 92 spectral peaks, each of which was assigned to a bioactive compound. Of the six compounds with a strong binding affinity, n-[1-(1-adamantan-1-yl-propyl)-2,5-dioxo-4-trifluoromethyl-imidazo lidin-4-yl] 4-methoxy-benzamide had the lowest score (-8.1 kcal/mol) against the SARS-CoV-2 3C-like protease binding site, similar with that of remdesivir. The molecular dynamics calculations demonstrated that root means square deviation values of the selected inhibitors remained stable throughout a 15-nanosecond simulation. In conclusion, the in silico analysis suggests that Caulerpa racemosa extract is a potential antiviral candidate against SARS-CoV-2
A fatal case of Harlequin ichthyosis: Experience from low-resource setting
Get PDFHarlequin ichthyosis is a severe and fatal presentation of ichthyosis with an autosomal recessive inheritance. Infants with Harlequin ichthyosis have a high mortality rate, and a dismal prognosis; therefore the majority of neonates die shortly after birth from infection, heat loss, dehydration, electrolytic imbalances, or respiratory distress. The aim of this case report was to present a fatal case of Harlequin ichthyosis with no family history of any inherited skin disorder. A 3-day-old baby was presented to the emergency room with congenital abnormalities at birth, fissured hyperkeratotic skin, and thick yellow plates of scales. The parents had no history of consanguineous marriage, no relevant past medical history, and no family history of the same condition. The patient was unwell, pulse 162 times/minute, respiratory rate 48 times/minute, and axillary temperature 36.9oC. APGAR score was 8 in the 1st minute and 9 in the 5th minute. Based on the typical clinical appearance, the patient was diagnosed with Harlequin ichthyosis. Due to a lack of facility, a mutation analysis was not carried out. The patient was then transferred to the neonatal intensive care unit (NICU) and treated in a humidified incubator and medicated with intravenous antibiotics (ampicillin sulbactam 125 mg/12 hour and gentamicin 13 mg/24 hour), topically fusidic acid and mild emollients. A central venous catheter was used for intravenous access. The poor prognosis resulted in the patient dying at the age of 5-day-old. This case highlights that prenatal diagnosis is critical for early detection and disease prevention. Mutation screening for the ABCA12 gene is suggested for consanguinity marriages and with a history of ichthyosis
Profile and risk factors of pre-XDR-TB and XDR-TB patients in a national reference hospital for Sumatra region of Indonesia
Get PDFThe low treatment rate, low treatment success rate and high mortality rate of patients with pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB) need serious attention. The aim of this study was to describe the profiles of patients with pre-XDR-TB and XDR-TB cases and to determine associated risk factors of their incidence in Indonesia. A retrospective case-control study was conducted at H. Adam Malik General Hospital in Medan, North Sumatra of which all sensitive-drug TB (SD-TB), pre-XDR-TB, and XDR-TB patients aged 18 years or older treated between October 2019 to June 2022 were included. Chi-squared test or Kruskal Wallis test and multiple logistic regression were used to determine the risk factors associated with pre-XDR-TB and XDR-TB incidence. A total 16 patients of case group (15 pre-XDR-TB and one XDR-TB) and 116 SD-TB patients (control group) were included in the final analysis. Out of total patients within case group, 62.5% were male, 43.8% aged between 56–65 years, 62.5% graduated from high school or equivalent, and 25% were unemployed. The majority of patients had no comorbid (62.5%), had history of anti-TB treatment (93.8%), and had secondary resistance (93.8%). Multivariate analysis indicated that age (OR: 10.01; 95%CI: 1.49–66.91, p=0.018) and previous history of anti-TB treatment (OR: 216.25; 95%CI: 18.62–2511.60, p<0.001) were significantly associated with incidence of pre-XDR-TB and XDR-TB. This study highlights that having previous history of anti-TB treatment and older age are the predictors of the incidence of pre-XDR-TB and XDR-TB
Single-nucleotide polymorphism of interleukin-10 promoter (IL-10 -819C/T) in leprosy patients with and without erythema nodosum leprosum, and household contacts
No full textLeprosy, caused by Mycobacterium leprae, is a chronic infectious disease that impacts the skin and peripheral nerves, causing long-term disability. The invasion of M. leprae into the body triggers immunologic responses and single single-nucleotide polymorphisms in cytokine-encoding genes may influence predisposition and susceptibility, possibly predicting the incidence of leprosy reactions. The aim of this study was to assess the gene polymorphism of interleukin-10 promoter IL-10 −819C/T in leprosy patients, leprosy patients with erythema nodosum leprosum (ENL) reaction, and household contacts. A total of 54 individuals were included, with 18 in each group. Skin smear and histopathologic examinations were used to confirm the diagnosis of leprosy and ENL. The polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) technique was used to determine the polymorphism. The results confirmed the presence of polymorphism of which all TT, CT, and CC genotypes presented. The TT genotype was most prevalent in household contacts (94.4%) followed by ENL (50%), and leprosy patients (44.4%). The CT genotype was most frequently detected in leprosy patients (50%), followed by ENL cases (44.4%), and household contacts (5.56%). In contrast, CC was mostly presented in ENL cases (5.56%), only 1% in leprosy patients, and absent among household contacts. Although the most prevalent allele in all three groups was the T allele, the C allele presented in 27% and 30% of ENL and leprosy patients, respectively and only 5% in household contact individuals. This study suggests that the polymorphism variations of IL-10 −819C/T are higher in leprosy and ENL patients compared to household contacts. Since this data is preliminary, larger studies are needed
Parents’ willingness to pay for COVID-19 vaccination for children in Malaysia using the contingent valuation method
Get PDFChildren are susceptible and a potential source of transmission for coronavirus disease 2019 (COVID-19). However compulsory COVID-19 vaccination programs among children have not been a focus in Malaysia. The aim of this study was to measure parents’ willingness to pay (WTP) for the COVID-19 vaccine and analyze the effects of socioeconomic variables on parents’ WTP. An online cross-sectional study was conducted in Malaysia with two waves of surveys (i.e., different samples for each wave), March and June 2021. The study participants were Malaysian parents above 18 years old. Parents were randomized between two vaccine effectiveness profiles (95% and 50% effectiveness) and two risk levels of an adverse event (5% and 20% risk of fever). The WTP was estimated using a double-bounded dichotomous choice. Socioeconomic variables such as age of parent, gender, insurance, income, and education were examined. A total of 292 parents in March 2021 and 271 in June 2021 were included in the study. The vaccine safety and effectiveness profile did not significantly impact the WTP. In March 2021, the estimated WTP ranged from RM344.74 to RM399.64 (US95.6) across vaccine profiles and between RM377.55 and RM444.33 (US106.3) in June. Insurance status was associated with the parents’ WTP, and during the June wave, the age of parents influenced the WTP. Implementing subsidies or free vaccinations is considerable to increase herd immunity and prevent transmission of COVID-19 in Malaysia
Correlation between high sensitivity C reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity in post COVID-19 syndrome patients
Get PDFPost coronavirus disease 2019 (COVID-19) syndrome is one of the causes of reduced functional capacity and work productivity, in particular for healthcare workers. The pathophysiology of the post COVID-19 syndrome is related to complex and multisystem inflammatory mechanisms, and cardiopulmonary exercise rehabilitation program is one of the efforts to improve the recovery process for patients with post COVID-19 syndrome. The aim of this study was to determine the correlation between the level of high sensitivity C-reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity (VO2max) in individuals with post-COVID-19 syndrome who received moderate- and high-intensity supervised cardiopulmonary exercise. A prospective cohort study was conducted at the Integrated Cardiac Rehabilitation Center of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The supervised cardiopulmonary exercise was conducted for six weeks according to the participant's baseline VO2max. Spearman's and Pearson's correlation tests were used to assess the correlations. A total of 30 individuals (19 and 11 had moderate and high intensity exercise, respectively) were involved in this study. At moderate intensity exercise, the average Hs-CRP and NLR were 3.3 mg/L and 1.99, respectively; while at high intensity, the values were 3.8 mg/L and 1.79, respectively. No significant correlation between Hs-CRP level and functional capacity in both moderate-intensity and high intensity groups. In contrast, NLR was negatively correlated with functional capacity (r=-0.545, p=0.016) in moderate intensity exercise group. In conclusion, NLR value was negatively correlated with functional capacity in individuals with post-COVID-19 syndrome after receiving moderate intensity supervised cardiopulmonary exercise program. Therefore, moderate intensity of cardiopulmonary exercise maybe be used as a program to accelerate the recovery for those with post COVID-19 syndrome
Safety evaluation and effects of cascara pulp Gayo Arabica coffee cream as anti-photoaging in animal model
Get PDFProlonged sunlight and ultraviolet (UV) exposure causes premature skin aging called photoaging and coffee-derived topical antioxidants may help to reduce this process. Since a significant amount of antioxidant-rich cascara pulp are wasted in coffee processing, this study aimed to evaluate the safety of cascara extract cream of Gayo Arabica coffee pulp (CECGACP) as anti-photoaging in male Wistar rats (Rattus norvegicus) by assessing the skin primary irritation index (PII), skin macroscopic changes and the level of tumor necrosis factor-alpha (TNF-α). Twenty-five rats were randomly divided into five different groups: negative control (base cream only), positive control containing L-ascorbic acid 3%, and three treatment groups treated with cream containing 5%, 7.5% and 10% of CECGACP. The CECGACP was extracted, formulated into cream as a topical treatment and applied on the backs of the rats two times a day, once before the UV exposure and four hours after the exposure. After four weeks, the skins were macroscopically examined, and the TNF-α levels were measured. The PII was assessed after applying the cream 24 hours before UX exposure. Our data suggested that CECGACP was considered safe because there were no erythema and edema formation on the skin of the rats with PII score of 0 (classified as no irritation or negligible). After UV exposure, all rats had visible wrinkles and erythema on the skin in particular in the first week. After administration of CECGACP, both wrinkles and erythema were decreased. The levels of TNF-α varied from 0.15±0.02 ng/mL in the negative control and CECGACP 7.5% rat groups to 0.19±0.03 in the positive control group; however, there was no significant difference among all the groups. Our study suggests that CECGACP is safe to use in Wistar rats and able to reduce the erythema and edema due to UV exposure. However, the application of CECGACP does not provide a significant reduction of TNF-α levels