Majalah Kedokteran Bandung
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Differences in Elastin and Collagen Levels in the Levator Ani Muscle of Primiparous and Multiparous Normal Postpartum Women
Full text linkThe levator ani, comprising the pubococcygeus, puborectalis, and iliococcygeus muscles, is crucial for supporting pelvic organs, maintaining continence, and ensuring pelvic stability. Weaknesses in these muscles or ligaments can lead to pelvic organ prolapse (POP), a condition where the pelvic organs descend and protrude through the vaginal introitus. Collagen and elastin, the key constituents of the extracellular matrix in the levator ani muscle, play a significant role in maintaining its structural integrity and can be influenced by parity. This study aimed to determine the differences in elastin and collagen levels of the levator ani muscle of primiparous and multiparous patients. This was an observational analytical study on 18 postpartum female patients consisting of 9 primiparous and 9 multiparous in January-March 2023. Samples were levator ani muscle biopsies from perineal lacerations of at least grade II from the inpatient Obgyn Department of the Faculty of Medicine, Universitas Brawijaya. Examination was done using the immunohistochemical method. Results showed that the percentage of histological area secreting elastin and collagen was higher in the primiparous group than multiparous, thus the levels were higher (p<0.001; p=0.001; p<0.05). In conclusion, elastin and collagen levels were lower in multiparous women compared to primiparous women. Future studies can evaluate factors affecting the decline in elastin and collagen in multiparous women using a larger sample size
Vitamin D Supplementation and Colorectal Cancer Patients Outcomes
Full text linkColorectal cancer is the third most encountered malignancy worldwide in 2018. Some earlier studies indicate a significant influence of vitamin D supplementation on the 5-year survival rate and the rate of metastasis progression in colorectal cancer patients. Studies investigating the effects of vitamin D supplementation on the outcomes of colorectal cancer patients are limited in Indonesia. Therefore, a double-blinded Randomized Controlled Trial (RCT) of the effect of vitamin D supplementation on the outcome of colorectal cancer patients was conducted from April 2022 to March 2023 at the digestive surgery outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung, Indonesia. In this study, 36 patients received vitamin D and 34 patients received a placebo. Data analysis performed using the multivariate analysis with multiple regression revealed no significant relationship between vitamin D supplementation and colorectal cancer patient outcomes. Furthermore, ANOVA analysis indicated no relationship between the analyzed independent and dependent variables in this study. No relationship was found between vitamin D supplementation and the outcomes of metastasis, mortality, and Karnofsky scores in colorectal cancer patients. Further research with a larger population is still needed to determine the benefits of vitamin D supplementation on the outcomes of colorectal cancer patients
Post Cesarean Pain Intensity and Wound Healing in ERACS and Conventional Method
Full text linkCesarean section is a common delivery method in Indonesia, with a prevalence of 17.6%. This method is used when vaginal delivery is not possible or in emergency cases, in an effort to prevent maternal and infant fatalities. Enhanced Recovery After Cesarean Surgery (ERACS) is a new method whose effectiveness has not been widely studied. The aim of this study was to compare post-cesarean pain intensity and wound healing in patients receiving ERACS and cesarean conventional methods at Bandung Kiwari General Hospital. This cross-sectional study used an analytic observational design and accidental sampling with 52 post-cesarean patients as the subjects during the three-months of study. Pain intensity was observed using the NRS instrument and wound healing was observed using the REEDA scale instrument on days one, two, and six post-surgery. The t-test analysis showed that the ERACS method had better pain intensity post-cesarean than the conventional method with a p-value of 0.000. However, there was no difference in wound healing between ERACS and conventional methods with a p-value of 0.136
Effectiveness of Short-Term Use Denosumab and Risedronate Using β-Crosslaps and Histopathology as a Parameter in Osteoporotic Rat Model
Full text linkOsteoporosis is a condition of decreased bone mass density. Pharmacological management uses drugs that decrease bone resorption or increase bone formation. The most commonly used drugs are bisphosphonates. Risedronate is one of these bisphosphonates. It inhibits osteoclasts, resulting in osteoclast apoptosis. Denosumab is a human monoclonal antibody that inhibits receptor activator kappa-B ligand, inhibiting osteoclast activation. Both drugs are widely used. Research on the efficacy of these two mechanisms has yet to obtain conclusive results. β-cross-laps is a parameter that can be used to evaluate the effectiveness of therapy through monitoring the bone resorption process. This experimental study used female rats >9 weeks old and was conducted at the Pharmacology and Therapeutic Laboratory, Universitas Padjadjaran Bandung, Indonesia, from June to September 2021. This study utilized a simple random sampling to allocate 24 experimental animals into three groups: control, risedronate, and denosumab. β-Crosslaps expression values before ovariectomy, post ovariectomy before receiving medication, and post ovariectomy and receiving medication was recorded and statistically analyzed using the SPSS version 24.0. The analysis of 24 samples revealed a statistically significant decrease in the median value of β-Crosslaps after ovariectomy in the denosumab group (p=0.036) when compared to the control group, whereas the decrease in the risedronate group was not significant (p=0.687). Administration of denosumab in rat models is more effective in reducing bone resorption compared to risedronate
Impact of Covid-19 Pandemics on Urology Practices and Residency Training in an Indonesian Tertiary Hospital
Full text linkThe World Health Organization (WHO) declared Covid-19 as a global pandemic on March 11, 2020. Alterations in health service provisions must be applied to maintain prime services and decrease the number of healthcare workers exposure to Covid-19 by reducing the number of patients and workload, as well as cancelling elective surgeries. This study aimed to describe the urological services and residency training program during a Covid-19 year at Dr. Hasan Sadikin General Hospital, Bandung, which is a tertiary health center and teaching hospital in Indonesia. This was a comparative retrospective study conducted from January 2019 to December 2020 that compared the number of patients in inpatient and outpatient settings and emergency department, as well as surgical procedures performed before and during Covid-19 pandemic. Data were obtained from the administration department of the hospital, showing a reduction of 40,94%, 7.39%, 32.3%, and 53.89% of total inpatients, outpatients, emergency cases, and surgical procedures, respectively, in the urology department of the hospital when compared to the previous year. The number of surgeries that could be performed by residents was reduced by 30-60%. This current study showed the decreased number of patients and urological operative procedures during COVID-19 pandemic. This is assumed to give negative impacts to the urological residency training due to the limited exposure to variety of cases and surgical skill procedures
Predictive Factors of Amputation for Post-Bypass Surgery on Vascular Trauma Patients
Full text linkn Indonesia, most vascular trauma is linked to traffic collisions. According to the Statistics Indonesia (Badan Pusat Statistik, BPS), there were 116,411 accidents in 2019. Limb salvages become important in vascular trauma, which is performed through, among others, vascular bypass surgery. However, secondary amputation still occurs after vascular bypass. This study aimed to determine the predictors of secondary amputation after vascular bypass due to vascular trauma. This study used descriptive analysis of medical records and univariate analysis. Medical records of patients with vascular trauma underwent vascular bypass in Dr Soetomo Regional Hospital, Indonesia, from January 2018 to December 2020 were collected. Independent variables were age, MESS, time interval between the incident of trauma to the first incision of bypass surgery, penetrating and blunt injury, injured arterial segment, multiple injuries, and obesity. The dependent variable was secondary amputation. Fisher Exact Test was used to analyze the correlation between dependent and independent variables. Results showed a significant difference between patients with a MESS score of >7 and those with a MESS score of ≤7 (p=0.044), where more patients with a MESS score of >7 experienced secondary amputation. Other variables showed no significant difference (p>0.05). This study concluded that MESS could be used as a predictor of secondary amputation in vascular trauma after vascular bypass. Further studies using multivariate analysis and a larger sample need to be conducted to get further insights on this phenomenon
Medical Student Performance in Diagnosing Common Findings of CT Scan
Full text linkDiagnostic radiology is a key diagnostic tool in many different conditions and ccrucial for monitoring, treating, and predicting outcomes. Accurately interpreting basic radiological images is a paramount skill for medical professionals. Therefore, this study aimed to assess clinical-phase medical students and interns' knowledge on evident findings on CT scans. This observational cross-sectional study was conducted in a single region in Saudi Arabia from May 2022 to December 2022. An electronic questionnaire were used to collect data. Twenty-one radiograph-based questions were used, for which students were asked to provide the best diagnosis and report their confidence for each question. Ethical approval was obtained. A convenience sampling technique was used to recruit the participants and SPSS were used for data analysis. Two hundred fifty-two medical students were included, with a mean age of 23.02 (SD=1.52) year. Of those, females comprised 65.1% and 86.1% of the total participants were in the clinical year. Most students with above-average knowledge were internship students (37.1%) compared to 9.7% among clinical year students (p=0.001). In addition, students with average knowledge had a higher level of confidence (7.62/10) compared with students with average knowledge (5.24) and students with below-average knowledge (5.24 and 5.057, respectively; p=0.001). In conclusion, the high percentage of incorrect responses reported by the current study reflects a strong deficit in the baseline CT knowledge among medical students. Further interventions are necessary to ensure better radiographic education for future physicians
Correlation between Duration of Placement of Non-tunneled Hemodialysis Catheter and Positive Bacterial Culture Incidence in Hemodialysis Patients
Full text linkNon-tunneling hemodialysis catheter is one of the most convenient vascular accesses for hemodialysis in End Stage Kidney Disease (ESRD) patients. However, these catheters have the highest morbidity among all available accesses. Current guidelines recommend that non-tunneled hemodialysis catheters be placed for no more than 2 weeks to prevent bacterial contamination. This study was conducted in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, throughout January-December 2021. A correlation test with a prospective observational analysis design was applied to find the link between the duration of non-tunneled hemodialysis catheter placement and the incidence of positive bacterial culture on the catheter. Pearson correlation test was used to see the strength of the correlation, with a significance limit of 0.05. This study involved 28 subjects. The most common location for catheter placement was in the jugular vein, and laboratory examinations showed no correlation between leukocyte values and positive bacterial culture results. Hypertension and diabetes mellitus were not significant risk factors (p-value 0.887). At ≤14 days of catheter placement, only 1 (6.7%) of the subjects presented a positive culture result. Most of the positive bacterial culture results were found at a duration of 15-30 days of placement, (n=8; 53.3%). The results of the Pearson test showed a p-value of 0.036 and an r-value of 0.399, indicating a significant result with a strong correlation between the two variables. The duration of placement of hemodialysis catheters has a positive correlation with the incidence of positive bacterial cultures, which can increase the risk of systemic infection associated with hemodialysis catheters
Phenotypic and Molecular Detection of Carbapenemase-Producing Acinetobacter baumannii Strains from Clinical Specimens in Dezful Teaching Hospital
No full textNowadays, antibiotic resistance in bacteria has become a global problem. Therefore, the identification of resistant strains of bacteria has attracted special attention in a pursue to choose more effective treatment solutions. One of the most common mechanisms of resistance is the production of carbapenemase enzyme in Acinetobacter baumannii. This present study aimed to detect carbapenemase-producing strains by phenotypic and molecular methods in clinical specimens collected in Ganjavian Hospital of Dezful between June 2021 and May 2022. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion and Etest assay, while the extended-spectrum beta-lactamase production (ESBLs) and Metalobetalactamases (MBLs) were detected by combined disk method using ceftazidime and ceftazidime/clavulanic acid disks and imipenem and imipenem /EDTA disks, respectively. Molecular detection of blaIMP, blaSPM, blaOXA-23, and blaOXA-24, blaOXA-58, blaGES genes was performed. Of a total of 54 strains, the highest resistance rate was for cephalosporins (98.1%), and ciprofloxacin (94.2%), in contrast to minocycline (13%). ESBL and MBL producers were 26% and 80%, respectively. All isolates had intermediate resistance against colistin. The most prevalent gene in the carbapenem-resistant A. baumannii (CRAB) was blaOXA-23, followed by blaOXA-24, blaGES, blaIMP, and blaOXA-58 genes. Present report highlights the existence of CRAB and intermediate resistance to colistin and also the co-existence of several genes from different carbapenemase classes in this region. Therefore, resistant strains should be identified promptly and specific treatment protocols should be devised to control the dissemination of resistance genes in therapeutic settings
Dysobinol Extracted from Chisocheton Macrophyllus Triggers Proliferation Inhibition, Potential Apoptosis, and Cell Cycle Arrest of He La Cancer Cell Lines
Full text linkDysobinol is a new limonoid from C. macrophyllus seeds reported to have an anticancer activity. This study aimed to determine the cytotoxic activity of Dysobinol against HeLa cancer cell lines and evaluate its mechanism of action by determining the expression level of several carcinogenesis genes related to apoptosis and cell cycle. In this experimental study, the cytotoxic activity was determined using the MTS assay and gene expression by real-time reverse transcriptase PCR. The result shows that Dysobinol has an anticancer activity in a dose and time-dependent manner against HeLa cells and was categorized as toxic with IC50 values of 52.92, 52.70, and 14.96 μg/ml for 24, 48, and 72 hours, respectively. Dysobinol significantly increased the expression of Bax, Cas-8, and Cas-3 and decreased the expression of Cyc D1 at both doses (IC50 and 2x IC50) but only high doses (2x IC50) could affect Cas9 and NF-κB expressions, indicating that Dysobinol can induce apoptosis via the extrinsic pathway and inhibits the cell cycle through the Cyc D1 regulator. Dysobinol has the potential to be developed as a chemotherapy drug or an adjuvant agent for cervical cancer treatment