Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Risk factor of metabolic syndrome in Javanese population based on determinants of anthropometry and metabolic measurement
No full textThe prevalence of metabolic syndrome (MetS) is high worldwide which it can increase the risk of some diseases such as cardiovascular disease, type 2 diabetes mellitus even mortality. The prevalence pattern and determinants of MetS risk factors might differ among ethnics in Indonesia. This study aimed to determine the anthropometry and metabolic measurements determinants to predict the MetS prevalence of the Javanese population in Yogyakarta. It was a case control study conducted from December 2018 to March 2019 involving 214 Javanese subjects aged 20-74 years resided in Yogyakarta Special Region, Indonesia. NCEP ATP III criteria were used to identify MetS as case and not diagnosed with MetS as control. The results showed that BMI, WC, BP, total cholesterol and HDL-C were significantly different between MetS and non MetS patients (p5 by 9.54 time. In conclusion, WHtR is a better marker for MetS prediction independently. However, the WHtR in combination with WC and total cholesterol/HDL-C ratio are better for MetS prediction in the Javanese population
Effectivity of alkaline water on the clinical improvement in laryngopharyngeal reflux
No full textLaryngopharyngeal reflux (LPR) is the reflux of gastric acid through theupper oesophageal sphincter causing mucosal damage of the larynx, thegastrointestinal tract, and the upper airway. Alkaline water has the ability towithstand acidic conditions in the body, the formation of carbonic anhydrase,and reepithelization. This study aimed to investigate the effect of alkaline wateron the clinical improvement in LPR patients. A randomized control trial withpre-test and post-test control group design on LPR patients aged 18 to 60 y.o.was conducted at the ENT-HS outpatient clinic of Dr Kariadi Central Hospital,Semarang, Central Java, Indonesia. Thirty subjects were recruited and dividedinto two group with 15 subjects in each group. In the control group, the subjectswere given standard therapy and mineral water. In the treatment group, thesubjects were given standard therapy and alkaline water. The diagnosis ofLPR was made if the reflux scoring index (RSI) was ≥13, and the reflux findingscore (RFS) was >7. ,After two weeks of intervention, the clinical improvementswere evaluated by reassessing the RSI score. The data were analyzed usingthe Shapiro-Wilk test and independent t-test. The results showed that the mostcommon main complaint was throat clearing [11 subjects (37%)]. Based on theRSI score, there were clinical improvements in both the control (p <0.001) andthe treatment groups (p <0.001). However, there was no significant differencein the RSI score before and after the intervention in the control (p = 0.058)and the treatment groups (p = 0.322). In conclusion,tbe d there is an effect ofalkaline water on the clinical improvement of LPR patients. However, there isno significant difference in the clinical improvement between the control andthe treatment groups
Pulmonary arterial hypertension after atrial septal defect closure: a case report
No full textMost patients with congenital heart disease (CHD) who underwent successful shunts defect repair can be remained asymptomatic for years. It leads to a high number of losses to follow-up after patients discharge. After closure, pulmonary hypertension (PH) prevalence seems to be high and associated with increased morbidity and mortality. We reported a 55 y.o. female diagnosed with pulmonary arterial hypertension (PAH) and atrial fibrillation (AF) 31 years after atrial septal defect (ASD) closure by surgery, who never had routine follow-up evaluation because she remained asymptomatic for years. Physical examination revealed heart enlargement with irregular rhythm and pan systolic murmur in the fourth left sternal border. Electrocardiogram showed AF normal ventricular response, right axis deviation and suggestive for right ventricular hypertrophy. Laboratory testing found the NT pro-BNP level was 2,476 pg/mL. The chest X-ray showed enlargement of the heart and was representative of PH. From echocardiography study, transthoracic and transoesophageal echocardiography, we found no sign of residual shunt. There were right atrial and right ventricular dilatation, severe tricuspid regurgitation (TR) and a high probability of PH with TR velocity of 4.46 m/s. Right heart catheterization concluded mean pulmonary arterial pressure 46 mmHg, flow ratio 1.1, and pulmonary artery resistance index 15.5 Woods unit.m-2. We highlight this case because of the high incidence of PH long after defect closure. The high number of lost to follow-up patients can lead to morbidity and mortality
Epidermophyton floccosum as apossible aethiological agent of tinea capitis: a case report
No full textTinea capitis is a superficial fungal infection of scalp that affects particularly school-aged children. It is usually caused by dermatophytes, although Epidermophyton floccosum can cause the tinea capitis. Tinea capitis caused by the E. floccosum is quite interesting because it can confirm the sporadic occurrence of hair parasitism by this dermatophyte. In this article, it was reported tinea capitis caused by E. floccosum. A 15-year-old girl, presented with itchy scaly alopecia on scalp since 1 week ago. The patient denied any contact with cat or dog, and there was not any family history. On physical examinations, lymphadenopathies were found at both lateral neck and alopecia with scales and crusts, lenticular to nummular sizes, at scalp. Hair-pull test was positive. The trichoscopy examination found comma hairs, broken hairs, and black dots. The fungal culture examination discovered the growth of E. floccosum. The patient was diagnosed with tinea capitis and treated with 500 mg of griseofulvin orally, 10 mg of cetirizine orally, and 2% of ketoconazole shampoo. Epidermophyton floccosum is an anthropophilic dermatophyte that frequently causes tinea cruris, tinea pedis, tinea corporis and onychomycosis, but not tinea capitis. Several reports have showed the capability of E. floccosum in perforating hairs and causing tinea capitis. In conclusion, E. floccosum is a possible aethiological agent of tinea capitis through its ability to perforate hairs
Predictive factors for recurrence in patients with Graves’ Disease following treatment with methimazole
No full textGraves’ disease (GD) contributes for 60–80% of all hyperthyroidism. Methimazoleis the first line drug and most commonly used as antithyroid drug (ATD). However,the relapse rate following ATD therapy is 40–50%. The aimed of this studywas to evaluate long-term ATD treatments and to identify prognostic factorsthat contribute to GD recurrence. A total of 46 GD patients who referred to theEndocrinology Clinic, Dr. Sardjito General Hospital, Yogyakarta between January2016 and December 2018 with thyrotropin receptor antibody (TRAb) tested andtreated with methimazole were included in this study. Size of goiter was measuredbased on WHO grading system and eye syndrome based on NOSPEC score system.Patients were classified into recurrence and remission groups based on TRAbevaluation at 12 month following treatment. Result of thyroid hormone level (FT4)and subject characteristic as predictive factors observed at 3-, 6- and 12-month post-treatment were compared and analyzed.Among 46 patient involved in this study, 23patients demonstrated remission of hyperthyroidism based on TRAb evaluation at12-month. The size of thyroid at onset of disease in 30 (65%) patients was grade 2 orabove (p<0.05). Free FT4 levels at the end of observation (12 month) was 1.9±0.6 ng/dL in recurrent and 1.4±0.5 ng/dL in remission group (p<0.05). TRAb levels at earlyof study was higher in the recurrent group (p<0.05). Logistic regression analysisdemonstrated that thyroid size, FT4 level, and TRAb at diagnosis were associatedwith recurrencies. In conclusion, GD patients with large thyroids size, high TRAblevels, and high FT4 level at the onset of disease tended to fail to respond to ATD andwere associated with recurrence incidence
Genetic variant of TGF-ß associated with decreased renal function in type II diabetes mellitus patient: single center pilot study in Indonesia
No full textThe interaction between genetic factors, blood glucose and hypertension plays a role in the onset of diabetic kidney disease (DKD) in type II diabetes mellitus (T2DM). Genetic variation of TGF-ß1 is associated with renal complication in T2DM with varying results between ethnicities. The Jambi Malay ethnic, which is the majority ethnic in Jambi Province, is an area that reports an increased prevalence of T2DM with DKD as the most frequent microvascular complications. In addition, previous study reported controlling blood glucose not associated with DKD indicating genetic may have play a role in DKD in this population. Studies related to genetic variation and decreased kidney function in T2DM patients has never been performed in this ethnic group. This study aimed to investigate the role of TGF-ß genetic variation as risk factor for decreased renal function in T2DM patients from Jambi Malay ethnicity. We conducted a cross sectional study involving 70 patients with T2DM. The inclusion criteria for renal complication based on a decrease in the glomerular filtration rate (GFR) of less than 60 mL/min/1.73. The genotyping method used was amplification refractory mutation system polymerase chain reaction (ARMS-PCR) for TGF-β1 rs1800470 T/C. Bivariate and multivariate analysis was performed to analyze phenotype and genotype association. The result of bivariate analysis showed T2DM patients with genotype CT (p:0.006; OR:0.125; 95% CI:0.027-0.575) and CC (p:0.007; OR:0.104; 95% CI:0.020-0.546) or C allele carrier (p:0.003; OR:0.117; 95% CI:0.027-0.500) had lower risk for decreased renal function than TT genotype. Multivariate analysis that included blood pressure and age variables showed the same finding for CT (p:0.007; OR:0.086; 95% CI:0.014-0.508) and CC genotype (p:0.022; OR:0.115; 95% CI:0.018-0.731). It is concluded from this study that T2DM patients with genotype CT, CC and carrier allele C have a lower risk for suffering kidney complications than genotype TT
Dynamic myelin regulation as a novel form of neural plasticity
No full textDynamic changes in myelin could optimize information transmission in neuralcircuits and enhance conduction velocity. This review aimed to provide anunderstanding of how dynamic myelin plasticity is important in neuronalactivity and how astrocytes have an important role that is not equal in theperipheral nervous system. Myelin is dynamically regulated by neuronalactivity. It takes part continuously in nervous system plasticity duringdevelopment. Newly differentiating oligodendrocytes can create a new myelinsheath. Mature myelin sheaths can grow again in adults. Oligodendrocytesinteract with astrocytes in the central nervous system through gap junctions.Astrocytes have an important role as synaptic network integrators; therefore,decreasing astrocyte numbers will cause a loss of presynaptic plasticity. Theconcept considers plasticity as a mechanism that depends on myelination.Higher brain functions and myelination interplay in the hippocampus andprefrontal cortex. The mechanism and function of these changes remainpoorly understood. Genetic, neural activity, environment, and axonal activitymight play important roles. Dynamic myelin regulation reveals a new form ofneural plasticity. Myelination is similar to synapse formation and plasticity. Itenables plasticity in the central nervous system and helps improve the learningprocess
Effect of kelor (Moringa oleifera Lam) ethanolic leaves extract on uterus of pregnant mice and its teratogenicity
No full textMoringa oleifera Lam (Moringaceae) is a source of additional dietary. It contains 9 essential amino acids, calcium, iron, potassium, magnesium, zinc and vitamins A, C, E and B which have a major role in the immune system. Previous study reported that M. oleifera Lam can increase the hemoglobin of breastfeeding mothers. In contrast, M. oleifera Lam is well known as abortifacient plant, therefore it is not recommended to use during pregnancy. The aim of this study was to evaluate the effect of M. oleifera Lam ethanolic leaves extract M. oleifera Lam on uterus of pregnant mice and its teratogenic effect. Twenty pregnant female Balb/c mice were used in this experimental study. Mice were randomized divided into four groups with five mice in each group. Group C as control, mice were not given anything. Group T1-T3 were given M. oleifera Lam ethanolic leaves extract during pregnancy age 7-18 days with doses of 10, 20 and 30 mg/kg BW, respectively. Phytochemical analysis was performed quantitatively and qualitatively. On day 19, a caesarean section was performed to take the uterus, count the number of living foetus, dead foetus, disability, and other morphological abnormalities. No significant difference between all groups was observed. The abortifacient effect was not also observed in the uterus. Qualitative phytochemical analysis results showed that alkaloids, flavonoids, phenols, steroids, and tannins are identified in this extract. Quantitative steroids analysis results showed that the extract contained steroids of 1057.6 ppm. In conclusion, the M. oleifera Lam ethanolic leaves extract at dose of 30 mg/kg BW does not show any effect on the uterus of pregnant mice. Further study concerning the effects on other organs and hormones is recommended
Innovative approach of nanoformula moisturizer applications in atopic dermatitis: a review
No full textThe skin barrier defect is the first step in the development of atopic dermatitis (AD). Various therapeutic guidelines recommend using moisturizers to maintain the skin barrier and the prevention of AD. The use of a moisturizer in the form of barrier cream is considered to improve the skin barrier. However, this dosage form is occlusion and has an oily texture, resulting in patient noncompliance with therapy. Various techniques were developed to improve patient compliance in applying topical preparations, one of which is by developing nanotechnology. Recent studies aim to develop nanoformula preparations because they can help deliver drug molecules to specific targets with minimize side effects. The application of nanoformula moisturizer is promising in the management of AD because of its ability to reduce water loss and prevent irritation and produce formulations with a thinner texture to increase therapeutic compliance in AD patients.
The predictor factor of final visual acuity (VA) of acute retrobulbar neuritis patients receiving optic neuritis treatment trial (ONTT) regiment
No full textThe study aimed to investigate the efficacy of intravenous optic neuritis treatment trial (ONTT) regiment on the treatment ofpatients with acute retrobulbar neuritis.This was a cross sectional studyusing medical records data of patients diagnosed with unilateral or bilateral retrobulbar neuritis by normal funduscopic findings and typical optic neuritis perimetry results within 14 days of onset fromtheNeuro-ophthalmology Clinic, Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta from January to December 2015. Medical records data of patients who received 1000 mg methylprednisolone IV per day for 3 days followed by 11 days 1 mg/kg body weight oral prednisolone were reviewed. Visual acuity (VA) at onset, final VA at time of follow up, delta VA improvement and time of follow up were included in the analyses.Twenty data of patients aged 33.95±8.07 years with VA at onset of 1.96±0.81 (~ 1 mCF) were analyzed in this study. Significantly improvement in final VAafter treatment to be 1.39±1.12 (~5mCF) was reported (p=0.001). The VA at onsetwas a predictive factor for final VA (p 0.05). In conclusion, there is VA improvement after the treatment of ONTT regiment. The VA at onset is a predictive factorof final VA on patients with acute retrobulbar neuritis.ABSTRAKPenelitian ini bertujuan mengkaji efektivitas regimen optic neuritis treatment trial (ONTT) intravena pada pengobatan pasien dengan neuritis retrobulbar faseakut. Penelitian potong lintang ini menggunakan rekam medis pasien yang didiagnosis neuritis retrobulbar unilateral atau bilateral dengan temuan funduskopi normal dan hasil perimetri neuritis optik yang khas dalam waktu 14 haris etelah onset dari Klinik Neuro-optamalmologi, Departemen Oftalmologi, Rumah Sakit Umum Pusat Dr. Sardjito, Yogyakarta dari Januari-Desember 2015. Data rekam medis pasien yang menerima1000 mg metilprednisolon IV per haris elama 3 hari diikuti oleh prednisolon oral selama 11 hari dengan dosis 1 mg/kg berat badan dianalisis. Ketajaman visual (VA) saat onset, VA akhir saat tindaklanjut, peningkatan VA, dan waktu tindak lanjut dianalisis. Sebanyak 20 data pasien berumur 33,95 ±8,07 tahun dengan VA saat onset 1,96 ±0,81 (~ 1 mCF) dianalisis dalam penelitian ini. Perbaikan VA akhir menjadi 1,39±1,12 (~5mCF) dilaporkan (p=0,001). Ketajaman visual saat onset merupakan factor predictor VA akhir (p0,05). Dapat disimpulkan, terdapat peningkatan VA pasien setelah pengobatan regimen ONTT. Ketajaman visual saat onset merupakan factor prediktor VA akhir pada pasien dengan neuritis retrobulbar akut