Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Pro-inflammatory cytokine (IL-6) and total count lymphocyte profiles in COVID-19 patients with different severity levels
No full textCOVID-19 is caused by the SARS-CoV-2 infection that attacked the human respiratory system. In severe conditions, it causes pneumonia, kidney failure, acute respiratory distress syndrome (ARDS), and even death. The SARS-CoV-2 infection triggers the immune cells to secrete an excess of pro-inflammatory cytokines lead to cytokine storm. It is believed to become one of the mechanisms that cause the ARDS condition. The level of pro-inflammatory cytokines will differ with each case severity. This study aimed to evaluate the profile of pro-inflammatory cytokines in COVID-19 patients with different severity. Therefore, it could be used as therapeutic approach for cytokine storm conditions. It was a cross sectional study using plasma samples of COVID-19 patients from Jakarta Islamic Hospital, Pondok Kopi and Dr. M. Goenawan Partowidigdo Hospital, Cisarua, Indonesia. The COVID-19 patients with severe (n=20) and mild to moderate (n=25) severity were involved in this study. As negative control plasma sample from healthy subjects (n=13) was used. Plasma IL-6 levels were measured using the ELISA technique and plasma lymphocyte levels were measured using a hematology analyzer. The results showed that no significant difference between severity and gender was observed (p=0.256). Meanwhile, there is a significant difference in IL-6 level between negative control, mild-moderate, and severe categories (p=0.015). The average IL-6 level in severe categories was higher than mild-moderate and negative control categories, with values 105.375, 59.75, and 64.577 pg/mL, respectively. This result becomes supporting evidence that there is a cytokine storm condition in severe COVID-19 patients. Furthermore, the lymphocyte level in the severe group is significantly lower than the mild to moderate group. This result may indicate lymphocytopenia in the severe group
Untranslated region-5' and viral protein 1-based genetic stability analysis of bulk polio in Indonesia 2010-2019
No full textCases of vaccine-associated paralytic poliomyelitis (VAPP) continued increasingly from 2010-2019 in the world. Oral polio vaccine (OPV) is the live attenuated virus-based vaccine that could genetically revert to neurovirulent during the vaccine production process or when the virus replicates in the human body. The poliovirus neurovirulence is determined by the UTR-5' region and VP1 coding region. UTR-5' played a role in protein translation and VP1 was responsible for the immunogenicity of the virus. Some reported mutations in UTR-5' and VP1 could affect the neurovirulence of poliovirus. In this study, we analyzed the genetic stability of the UTR-5' and VP1 in the bulk of OPV types -1 and -3 produced in 2010 - 2019. The results of the analysis of UTR-5' sequences in Sabin strain types-1 and -3 and VP1 sequences on Sabin virus type 1 did not show any mutations. Meanwhile, the VP1 sequences in Sabin strain type 3 showed nucleotide mutation C2493U that caused the substitution amino acid Thr6Ile amino acid in all samples of the type 3 bulk polio test. Based on the results of in silico analysis, this mutation in VP1 did not contribute significantly to the neurovirulence of the virus
Congenital cystic adenomatoid malformation: a case report
No full textCongenital cystic adenomatoid malformation (CCAM) is a rare condition defined by multiple cysts produced in the lung that occur during the fetal period, with respiratory distress as presenting symptoms. Untreated CCAM may lead to repeated lung infection and pneumothorax. Many surgical techniques have been used to treat CCAM. However, those techniques showed various results. Moreover, less studies were performed to evaluate the effect of those surgical techniques in treating CCAM patients. We reported a management of a rare pediatric case of CCAM referred to the Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital. The patient was a 29-day-old male baby who presented with pneumothorax on the right lung due to CCAM. The plan of treatment for the patient was lobectomy until pneumonectomy on the affected lung. During the thoracotomy procedure, we found that all lobes in the right lung were covered with fibrous tissue. Based on this finding, a decortication procedure to remove the fibrous tissue continued by a bullectomy procedure with the insertion of a chest tube were performed. The patient continuously showed improvement in breathing and wound healing, thus making the patient discharged from the hospital on the nineteenth postoperative day. The cause of CCAM is thought to be congenital abnormalities of the bronchiole epithelium that produce multiple cysts. Due to its rarity and lack of research on CCAM, many CCAM patients are misdiagnosed/underdiagnosed. Common surgical methods used in this patient are lobectomy with continuation until pneumonectomy or bilobectomy, if necessary, to prevent recurrence. Parenchymal saving methods can be considered because they have the same outcome as lobectomy. As performed in this patient, thoracotomy decortication continued with bullectomy is adequately capable of alleviating respiratory distress symptoms and is thus described as successful
Infant appendicitis with perforation: a case report
No full textAppendicitis is one of the most common surgical emergencies in children. In the USA, there are 70,000 cases are diagnosed each year. Acute appendicitis is a rare case, barely considered in the diagnoses, and probably causes acute abdominal sepsis in neonates. It affects males generally 75% of the time and 25%-50% of all reported cases occur in premature infant. Almost 50 cases have been reported over the last 30 years. We reported a 5 month-old baby girl whom transferred to our hospital from a peripheral hospital. Previously, the baby diagnosis was low-type obstruction. At the time of admission to our hospital, the baby presented with a history of abdominal distension and did not pass stools after 48 h. Oxygen and oral gastric tube were administered. Exploratory laparotomy surgery was performed through a transverse incision. This report is a retrospective review of one patient with appendicitis perforation presented in our hospital
Prognostic factor for prolonged ventilator usage and ICU occupancy time after mitral valve replacement surgery: a retrospective cohort study
No full textThis study was conducted to identify the prognostic factors for prolongedventilator usage time and ICU occupancy time after mitral valve replacement(MVR) surgery. It was a retrospective cohort study involving 70 MVR surgerypatients at Dr. Sardjito General Hospital, Yogyakarta, Indonesia during theperiod of January 2013 to December 2018. Prognostic factors as independentvariables including age, gender, heart failure, ejection fraction, pulmonaryhypertension, chronic pulmonary disease, active endocarditis, renalinsufficiency, duration of aortic cross clamp (AOX) time and cardiopulmonarybypass (CPB) time were evaluated. Where as the dependent variables werethe prolongation of ventilator usage time (>24 h) and the intensive care unit(ICU) occupancy time (>96 h). Of the total 70 studied patients, 25 patients(35.7%) used ventilator >24 h, meanwhile 15 patients (21.4%) occupied the ICU>96 h. Patients who used ventilator >24 h had CPB time ≥126.5 min (OR=10;95%CI=2.581-41.252), renal insufficiency (OR= 14; 95%CI = 1.487-150.970), andactive endocarditis (OR=7; 95%CI = 1.257-45.213). Meanwhile, patients whooccupied the ICU >96 h had age ≥40 years old (OR=6.4; 95% CI = 1.26-15.3),CPB time ≥126.5 min (OR=5.7; 95% CI = 1.8-38.1), and heart failure with NYHAfunctional classification 3 (OR=9.8; (95% CI = 1.4-67.2). In conclusion, theprognostic factors for prolonged ventilator usage time after MVR surgery areCPB time ≥126.5 min, renal insufficiency and active endocarditis. Furthermore,the prognostic factors for prolonged ICU occupancy time are age ≥40 years old,heart failure with NYHA functional classification 3 and CPB time ≥126.5 min
Effects of valsartan compared with telmisartan in reducing insulin resistance on type 2 diabetes mellitus (T2DM) patients with hypertension
No full textInsulin resistance is a major risk factor for patients with type 2 diabetesmellitus (T2DM). Telmisartan and valsartan are angiotensin II type I receptorblockers (ARBs) that are often used in patients with metabolic syndrome andT2DM. This study aimed to compare the effect of valsartan and telmisartan inreducing insulin resistance on T2DM with hypertension. Patients of T2DM wereopen-label screened at the Endocrinology Policlinic, Department of InternalMedicine, Dr. Sardjito General Hospital, Yogyakarta, and then randomized intotwo groups. The first group received valsartan 80 mg per day up to 160 mg perday, the second group received telmisartan 40 mg per day up to 80 mg per dayin addition with life-style modifying and diabetes therapy. Homeostasis modelassessment of insulin resistance (HOMA-IR), triglyceride and HDL cholesterollevels of patients were measured before and after receiving telmisartan andvalsartan for 12 weeks. A total of forty-nine outpatients were involved in thisstudy comprised of 25 female patients (51%) and 24 male patients (49%) with27 patients (55.1%) received telmisartan and 22 patients (44.9%) receivedvalsartan as the hypertension therapy. No significantl difference were observedbetween telmisartan group compared with valsartan group in HOMA-IR (14.01± 16.39 vs. 5.31 ± 3.51; p=0.053), triglyceride levels (165.71 ± 94.70 vs 144.41 ±48.33 mg/dL; p=0.620), HDL-C level (48.57 ± 9.78 vs 49.24 vs 49.24 ± 12.56 mg/dL;p=0.999). In conclusion, telmisartan demonstrated no difference compared tovalsartan in reducing insulin resistance on T2DM patients with hypertension
Ultraviolet phototherapy for treatment of various dermatoses
No full textUltraviolet (UV) radiation has been applied to treat many chronic skin diseases. Based on the wavelength, UV radiation consists of three types, namely ultraviolet C (UVC), ultraviolet B (UVB), and ultraviolet A (UVA). The types of UV that are widely used in dermatology are narrowband ultraviolet B (NB-UVB), broadband ultraviolet B (BB-UVB), UVA1, and psoralen combined with UVA (PUVA). The interaction between UV and the skin determines the effectiveness of phototherapy. The biological effects of UV are used in the management of inflammatory skin diseases, malignancies, and various rare dermatoses. Apart from these benefits, UV increases the risk of photoaging and skin cancer. Therefore, further researches are necessary to enhance the effectiveness and safety of phototherapy. This literature review discusses the role of phototherapy in various dermatoses other than psoriasis and vitiligo
Evaluation of oxidative stress levels using glutathione peroxidase (GPx) expression on hyperglycemia-induced rats testis
No full textDiabetes mellitus (DM) is a global health problem with an estimated 422 million cases worldwide. Previous studies reported a correlation between hyperglycemia and oxidative stress‐related male infertility in DM. Glutathione peroxidase (GPx) can cause DNA damage due to oxidative reactions. Therefore, it could be used as potential indicator of antioxidant therapy. The study aimed to evaluate the expression level of GPx on the hyperglycemia-induced rats. This was an experimental case-control study using 27 Wistar rats divided into three groups i.e. hyperglycemia induction for four weeks group, eight weeks group, and a control group with no intervention. Following after induction, total RNA from the rats' testis was extracted, and GPx expression was analyzed using qPCR. Data were analyzed using SPSS, and a p 0.05). In conclusion, hyperglycemia increases GPx mRNA expression in rats. It may change the testicular environment's oxidative processes and impairs male reproductive function in the Sertoli cells with no exception
Centella asiatica : alternative dry skin therapy in type 2 diabetes mellitus
No full textDiabetes mellitus (DM) in Indonesia has rapidly increased during recent years. World Health Organization (WHO) predicted that in 2030, Indonesia would be ranked fourth for the largest DM patients in the world. As the disease progresses, uncontrolled type 2 DM (T2DM) results in dry skin as the most prevalent skin disorder. Despite the prevalence and morbidities that lead to infection, ulcer, gangrene that can lead to amputation when insufficiently treated, dry skin in T2DM has limited therapeutic options. Currently, available therapies for dry skin in T2DM have not considered factors of hyperglycemia and hyperinsulinemia, which disturb skin homeostasis. Nonetheless, in T2DM, there are neuropathy and biostructural changes of the skin which induce dry skin. Alternative herbal medicine, Centella asiatica is getting well-known nowadays because of its vast amount of benefits. Centella asiatica has been studied for its antioxidant, antidiabetic, anti-inflammation, antiglycation, and neuroprotective activities. Furtherly, these properties may display benefits when introduced to T2DM dry skin therapy. The previous clinical study had shown that topical C. asiatica improved dry skin. This clinical study was also supported by in vitro studies. Currently, pharmacological profile studies of C. asiatica including dosage, toxicity, and safety have been available. This article aimed to review the current literature on the potential of C. asiatica as an alternative to treat dry skin in T2DM
Distribution and clinical characteristic of malaria patients in Weoe Public Health Center, Malaka District, East Nusa Tenggara in 2019
No full textMalaria remains a health problem in Indonesia including in East Nusa Tenggara (ENT) Province where its incidence is high. Weoe Public Health Center located in Malaka District, ENT Province has an important role as the front-line in the malaria control. The high number of malaria cases in this area may induce an economic burden due to unproductiveness at workplaces even death. This study aimed to overview the distribution and clinical characteristics of malaria patients in Weoe Public Public Health Center, Malaka District. This was a descriptive cross sectional study with saturated sampling method using secondary data of patient’s medical record from January-December 2019. Malaria patients treated at the Weoe Public Health Center from eight villages were selected in this study. The data of the time of ill, patient’s residence, gender, age, complaints, temperature, type of malaria, therapy, treatment results, and follow up blood smear tests result were collected. Among 815 patients suspected malaria, 198 (24.3%) were confirmed malaria positive caused by Plasmodium falciparum (41.4%) and P. vivax (58.6%). The highest cases occurred in February which reached 36.4% of the total cases. The highest incidence of malaria was found in Weoe Village (2.33%), dominated by male patients (57.6%), and mostly occurred at age 6-12 years (29.3%). Patients presented with fever (100%) followed by non-classical malaria complaints such as nausea and vomiting (46%), headache (33%), chills (30.8%), and flu symptoms (14.1%). All malaria patients were treated with combination of dihydroartemisinin-piperaquine (DHP) and primaquine (PQ) with a 100% cure rate and follow up blood smear test are negative from malaria parasite