Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Exercise as part of anxiety coping management in the Covid-19 pandemic era
No full textContainment effort in the COVID-19 pandemic could disrupt circadian rhythms which play an essential role in the development of mood and anxiety disorders. Exercise is one of several recommendations for anxiety coping during the COVID-19 pandemic. However, not every person has a similar response to an exercise stimulus and gets the same optimal benefits. For the best exercise results, we must consider individual needs and capacities, including circadian rhythm, in determining the exercise dose. This review briefly summarizes the exercise’ mechanism as an anxiolytic through skeletal muscle-brain crosstalk and designing exercise program with the individual optimal dose as part of anxiety coping management in the COVID-19 pandemic situation, considering exercise as good stress and circadian rhythm
Induced pluripotent stem cells and genome editing technology as therapeutic strategies for Duchenne muscular dystrophy
No full textDuchenne muscular dystrophy (DMD) is a rare genetic, progressiveand devastating skeletal and cardiac muscle disorder due to mutationof the dystrophin gene that affects 1 in 3500 young males. Currently,there is no curative management for this pathology. The development ofinducedpluripotent stem cells (iPSCs) offers a promising cell-based strategyfor the treatment of muscular dystrophy. Several techniques have beenestablished to generate functional myogenic progenitor cells derived fromiPSCs. In addition, technologies in genetic modification using ZFN, TALENs, orCRISPR/Cas9 demonstrate potent methods to restore dystrophin expression.However, current evidence shows that either iPSCs or gene editing carrya risk of oncogenesis caused by the integration of exogenous DNA into therecipient gene. Thus, the safety issue is a major challenge for translatingthis method into human clinical applications. This review briefly discussedrecent developments and progressions of iPSCs as well as genome engineeringtechnologies relevant to regenerative medicine, especially for the treatmentof DMD
Effect of nitrate administration on plasma nitric oxide levels in patients with peripheral arterial disease at Dr. Sardjito General Hospital, Yogyakarta
No full textPeripheral arterial disease (PAD) is a disease involving reduction of blood flow to the inferior extremity associated with atherosclerotic lesions. In 2010, more than 200 million people with PAD were reported globally, including 54.8 million in Southeast Asia. The high prevalence of PAD causes its management become challenging for clinicians. Nitric oxide (NO) has a role in endothelial function that is associated with the appearance of symptoms in PAD patients. Exogenous nitrate is usually used as a primary vasodilator in the treatment of angina pectoris and Prinzmetal angina. However, information concerning the role of nitrate administration to improve symptomatic PAD patients is limited. This study aimed to evaluate the effectiveness of exogenous nitrates in increasing plasma NO levels and improving PAD patients. A prospective pre-post clinical trial involving PAD patients who were registered in the vascular registry at Dr. Sardjito General Hospital, Yogyakarta was conducted. Primary endpoint was the change in plasma NO levels after short term administration of nitroglycerin oral 2.5 mg once daily (4 h) and long term (7 d). Analysis of variance test with Bonferroni posttest was used for statistical hypothesis testing. Among 33 subjects who completed this study, no negative side effects, and only one hypotensive patient was reported at the first follow-up after 4 h of the nitroglycerin administration. Plasma NO levels increased in the post 4 h and in the post 7 d administration. However, no statistically significant was observed (p > 0.05). Administration of exogenous nitrates in patients with PAD increases the plasma NO levels, even though it is not statistically significant
Comparison of diagnostic accuracy between clinical examination and magnetic resonance imaging (MRI) in diagnosing anterior cruciate ligament (ACL) rupture on Indonesian population
No full textAnterior cruciate ligament (ACL) injury is the most common knee ligament injured. Anterior drawer and Lachman tests are the most common physical examinations for helping diagnose ACL injuries, while magnetic resonance imaging (MRI) is the first choice of supporting examination for evaluating any internal abnormality of the knee. However, studies concerning the accuracy of those examinations in the Indonesian population are limited. This study aimed to compare the accuracy between the anterior drawer test, Lachman test, and MRI in diagnosing ACL injury in Javanese patients. This retrospective study used medical records data of patients who underwent knee arthroscopy in the Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital, Yogyakarta in 2018. The MRI and the clinical examination results were compared to the arthroscopy results as the gold standard. The study showed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the anterior drawer test were 86.67% (95%CI: 69.28-96.24%), 80% (CI: 44.39-97.48%), 92.86% (CI: 78.88-97.84), 66.67% (CI: 43.28-83.98%), and 85% (CI: 70.16-94.29%), respectively. Lachman test had 96.67% (CI: 82.78-99.92%) sensitivity, 90% (CI: 55.50-99.75%) specificity, 96.67% (CI: 81.86-99.47%) PPV, 90% (CI: 56.44-98.43%) NPV, and 95% (CI: 83.08-99.39%) accuracy. The diagnostic parameters of MRI were 83.33% (CI: 65.28-94.36%) for sensitivity, 60% (CI: 26.24-87.84%) for specificity, 86.21% (CI: 74.21-93.14%) for PPV, 54.55% (CI: 31.77-75.57%) for NPV, and 77.50% (CI: 61.55-89.16%) for accuracy. In conclusion, the Lachman test has better accuracy than the anterior drawer test. Both the anterior drawer and Lachman tests had higher accuracy compared to the MRI
Risk factors of sensory hearing loss in nasopharyngeal carcinoma patients obtaining conventional radiotherapy
No full textPrevious studies proven that cochlear hair cells’ death plays an important role in sensorineural hearing loss due to radiation exposure. Other studies compared the differences between the impact of conventional radiotherapy (CRT) and intensity modulated radiation therapy (IMRT) on hearing loss in patients with nasopharyngeal carcinoma. Although, few differences found in some clinical manifestation, however no statistical analysis had been carried out. The aim of study was to evaluate the risk of sensory hearing loss in nasopharyngeal carcinoma patients who received CRT compared to IMRT. A case control study was performed on nasopharyngeal carcinoma patients who received radiotherapy at Dr. Sardjito General Hospital, Yogyakarta. The result of DPOAE between NPC patients who received CRT and IMRT was compared in this study. Statistical analysis was performed using chi square test and multivariate analysis. The result showed that patients who received CRT significantly altered the risk for sensory hearing loss in the contralateral ear as much as 11.2 times according to the multivariate analysis (CI 95%: 2.2 – 56.6; p=0.004). In conclusion, the risk of sensory hearing loss in patients with nasopharyngeal carcinoma who received CRT is a greater compared to IMRT
Correlation of histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) to the platelet count in patient with dengue viral infection
No full textThrombocytopenia is often associated with clinically worse outcomes in dengue viral infection (DVI) patients. Histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) have been reported to induce thrombocytopenia. These drugs are administered to DVI patients due to misinterpretation of abdominal pain. The study aimed to evaluate the correlation between H2RA and PPI administration with thrombocytopenia event on hospitalized DVI patients. An analytical retrospective cross-sectional study was conducted using medical records of the patient admitted by final diagnosed DVI in seven major hospital in Bandung from January 1st to December 31st, 2015. Patients were separated into two groups i.e. with and without H2RA and PPI. Pearson point biserial analysis was then applied to evaluate the correlation of each drug administration to platelet count of DVI. A total of 4005 patients with final diagnosed DVI involved in this study. About 11.0% and 25.1% of the patients received H2RA and PPI, respectively. Mostly the DVI patients receiving H2RA (55%) and PPI (50.8%) showed the platelet count <50.000/mm3. A very weak positive correlation between the administration of H2RA (p <0.001; r=0.103) and PPI (p <0.001; r=0.138) with the low platelet count of the patients was observed. In conclusion, the administration of H2RA and PPI is correlated to the low platelet count in DVI patients. Although the correlation is weak, H2RA and PPI should be administered with caution due to its thrombocytopenia side effect
Endoscopic dacryocystorhinostomy as an option management of syndrome- related congenital dacryocystocele: a case report
No full textCongenital dacryocystocele (CD) is a rare anomaly of the medial region of the orbit, caused by distal at the level of the valve of Hasner and proximal at the level of the valve of Rosenmuller obstruction of the lacrimal system. It may present as isolated abnormalities or maybe associated with syndromes. We described a neonate with a history of bilateral enlarged lacrimal sacs below medial canthal tendon with blue-grayish color and epiphora. Computed tomography (CT) scan resulted in congenital dacryocystocele. She was given topical antibiotics and Crigler massage as conservative treatment. In the first week, the right eye got a complete resolution. Otherwise, the left eye’s lesion was worsening. The patient underwent endoscopic dacryocystorhinostomy (En-DCR) and silicone intubation on the left eye. Epiphora resolved with no recurrence at one month follow up. Conservative treatment and En-DCR have a success rate with no complication and widely used nowadays. In the case of CD associated with a syndrome, multidiscipline workups and treatment are essential
Earlobe crease as a marker of coronary heart disease: a systematic review
No full textEarlobe crease (ELC) is a wrinkle-line in the skin that surrounds the ear approximately one third of the length between the tragus and the posteroinferior edge of the earlobe. Since the first study in 1973, the relationship between ELC and coronary heart disease (CHD) remains unclear. In addition, the pathogenesis of ELC has not well described, yet. This review aimed to evaluate the relationship between CHD and the presence of ELC using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. Eligible studies obtained from PubMed and Google Scholar using relevant keywords were collected. The assessment of quality of the studies was carried out based on the National Heart Lung and Blood Institute. Among 21 studies collected, 19 studies reported a correlation between the ELC and CHD indicating that ELC as a potential marker of CHD. Seven studies reported a significant association of ELC with CHD after adjusting confounding variables such as age, sex and other risk factors for atherosclerosis in analysis. Seven studies reported that subjects with ELC had more significantly severe CHD based on coronary angiography. The sensitivity of the ELC was reported between 30-98% and the specificity between 43-91%. Two studies reported no relationship between ELC and CHD after adjustment of age in analysis. Earlobe crease is a dermatological sign which was reported to have potential as a marker of CHD. Further study with large sample in population from various ethnics is needed in order to obtain a robust conclusion regarding the clinical importance of ELC in predicting CHD
Low level of plasma VEGF-A and C allele of -2578*C/A polymorphism in the VEGF-A gene are risk factors of diabetic foot ulcer in Javanese ethnic
No full textDiabetes mellitus (DM) is caused by abnormal insulin secretion, impairedinsulin action, or both. Approximately 12-25% of type 2 diabetes mellitus(T2DM) patients will develop diabetic foot ulcers (DFU). Vascular endothelialgrowth factor (VEGF) is a group of platelet-derived growth factors (PDGF)which have a potential role in angiogenesis. Low levels of VEGF-A can causeinsufficient angiogenesis leading to wound healing inhibition. The 2578*C/Apolymorphism of VEGF-A gene has been reported as a candidate markerfor the DFU development. However, the variant role in the development ofDFU in Javanese ethnic needs to be clarified. This study was conducted tocompare VEGF-A levels and the -2578*C/A polymorphism of the VEGF geneamong diabetic patients with and without DFU in Javanese ethnic. In thiscase-control study, the T2DM individuals with DFU as case group (n=19) andwithout DFU as control group (n=41) were recruited. The VEGF-A levelsweredetermined by ELISA. The ARMS-PCR technique was applied to investigate thepresence of -2578*C/A polymorphism of the VEGF gene. Data were analyzedwith independent t, Mann-Whitney, Chi-square, and Kruskal-Wallis tests withsignificance level of p<0.05. The median of plasma VEGF-A level was significantlydifferent between case and control groups (p=0.001). The genotype frequencyof -2578*C/A polymorphism of VEGF gene was no difference between case andcontrol groups. However, individuals with C allele have a higher risk factor todevelop DFU than A allele (CC+CA vs AA;p=0.042; OR=2.5). The plasma VEGF-Alevels were lower in T2DM subjects with DFU than those without DFU. Inconclusion,individuals with C allele of -2578*C/A polymorphism of VEGF geneare more susceptible to have DFU than individuals with A allele in Javaneseethnic with T2DM
Treatment of functioning pituitary macroadenoma with endoscopic transsphenoidal surgery: a case report
No full textPituitary macroadenomas are benign tumors in the pituitary gland measuring more than 1 cm in diameter. Pituitary adenomas account for 8 to 10% of all intracranial tumors and occur primarily in the anterior pituitary lobe and rarely in the posterior lobe. Most pituitary macroadenomas are non-functioning tumors, which show clinical symptoms due to tumor pressure and do not increase hormonal activity. In this case, a 40 y.o. woman was diagnosed with a pituitary macroadenoma after showing clinical symptoms of a functioning tumor, namely acromegaly, prognathism, and large, beefy hands and feet, for the past 4 years. Complaints were accompanied by amenorrhea, intermittent cephalgia, and hemianopsia in the right eye. Blood laboratory tests revealed increased levels of prolactin and growth hormone, while the results of computed tomography (CT) scans and magnetic resonance imaging (MRI) of the head indicate the presence of a pituitary macroadenoma. Endoscopic transsphenoidal surgery, a minimally invasive procedure, was performed with minimal complications