Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Extended spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae clinical isolates and its susceptibility pattern to antibiotics at Dr. Soeradji Tirtonegoro General Hospital Klaten, Central Java
No full textGlobally, the prevalence of Klebsiella pneumoniae (K. pneumonia) producing extended spectrum beta lactamase (ESBL) has been increasing steadily. The susceptibility patterns of ESBL-producing K. pneumonia varies considerably among countries. Therefore, the investigation of ESBL-producing K. pneumoniae in clinical isolates and their susceptibility are warranted. This research aimed to determine the proportion of ESBL-producing K. pneumoniae and the antibiotic susceptibility patterns of clinical isolates from Dr. Soeradji Tirtonegoro General Hospital, Klaten, Central Java. Identification of K. pneumoniae was performed by analyzing colony morphology, microscopic examination, and biochemical testing using Microbact. Both antibiotic susceptibility testing and ESBL screening (using ceftazidime, cefotaxime, and ceftriaxone discs) were conducted using disc diffusion method according to CLSI. The positive results were confirmed with modified double disk synergy (MDDST) using amoxicillin-clavulanate, ceftazidime, cefotaxime, and cefepime discs. From 962 clinical bacterial isolates, 168 (17.46%) isolates were identified as K. pneumoniae, during June 2017-May 2018. K. pneumoniae was mainly isolated from the Intensive Care Units (ICU) (29.17%) and with sputum being the most common specimen (45.24%). Overall ESBL producers were 52.98%, with the majority from ICU (41.57%) and isolated from sputum specimens (40.45%). ESBL-producing K. pneumoniae showed high resistance to many antibiotics. The sensitivity of ESBL-producing K. pneumoniae isolated from respiratory tract samples against piperacillin-tazobactam, amikacin, and meropenem was more than 80%. In conclusion, among all K. pneumoniae isolates, ESBL K. pneumoniae was 52.98%. ESBL K. pneumoniae from respiratory tract specimens had a sensitivity of more than 80% against piperacillin-tazobactam, amikacin, and meropenem
Kajian kefalometrik (Studi perbandingan antara suku Jawa dan suku Naulu di pulau Seram, Maluku Tengah
No full textBackground: Regional variation in anthropometric measurements and anthroposcopic always found, even in one population or subrace. Therefore, it is interesting to study these composite physical traits in rural population of Indonesia with different environment. Objectives: To examine the characteristics of the cephalometry of Javanese population in Yogyakarta, and to compare with Naulunese population in Seram Island of Middle Maluku. Methods: 100 people of Java in Yogyakarta consists of 50 males and 50 females, aged 20 - 75 years, were studied and compared with Naulu people (62 males and 110 females). Stature, weight, maximum head breadth and length, minimal frontal breadth, bizygomatic breadth, face height, breadth and height of nasal were measured. Analysis of variance and t-test were used to study the difference of cephalometric between males and females of Javanese population, and to study the difference between Javanese and Naulunese populations. Results: The results showed that Javanese population has mesocephalic head, wide forehead, narrow face and mesorhine nasal type. There were significant differences between Javanese males and females in regard to their height, weight, bizygomatic breadth, face height, nasal breadth and nasal index. There were significant differences between Javanese and Naulunese populations in terms of their height, head breadth, minimal frontal breadth, face height, frontoparietalis and facial index. In addition, there were similarities of head shape, width forehead and nasal shape among both populations. Conclusions: The finding indicated that Javanese and Naulunese populations have mesocephalic head, wide forehead and mesorhine nasal type.Key words: cephalometric - Javanese - Naulunese - cephalic index - anthropometri
Association between sexual orientation and sexual contact with the incidence of human immunodeficiency virus (HIV) infection in Dr. Sardjito General Hospital, Yogyakarta
No full textAnal intercourse has been known to have a high risk of human immunodeficiency virus (HIV) transmission. The objective of this study was to evaluate the relationship between sexual orientation and the mode of sexual contact with the incidence of HIV infection. This was observational analytic study with cross sectional design. Subjects were new male patient who visited sexually transmitted infection (IMS) clinics at Dr. Sardjito General Hospital, Yogyakarta during 2016. Data were obtained from medical records. The HIV status was established from HIV rapid test and enzyme-linked fluorescent assay (ELFA). Data were analyzed using descriptive test and Pearson’s chi-squared test with significance level of p< 0.05. Among 167 subjects, 47.91% were in the age group 17 - 25 years old. Forty subjects (24%) had HIV positive status. The majority of subjects were heterosexuals (111 subjects (66.47%)), 43 subjects (25.75%) were homosexuals, and 13 subjects (7.8%) were bisexuals. HIV positive subjects were more common in homosexual groups than were heterosexual and bisexual (
Effect of self surrender practice on insulin resistance in individuals withtype 2 diabetes mellitus without depression: asingle-blinded randomized controlled trial
No full textSelf surrender practice (latihanpasrahdiri/LPD) is a form of relaxation therapy that has been increasingly used, not only in the treatment of psychosomatic diseases, but also of other non-psychosomatic diseases. Previous studies reported thatSSP shows modest improvement on clinical parameters of type 2diabetes mellitus(T2DM) patients,not onlydepression symptoms improvement, but also glycemic control.However, the effect of LPD on insulin resistance has not been investigated. The study aimed to investigate the effect of LPD on insulin resistance in T2DM patients without depression. This was a single-blinded, randomized, controlledtrial conducted in outpatient unit of the Department of Internal Medicine, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Central Java.The subjects of the study were T2DM patients aged over 30 yearsand had no depression.Fourthy-four T2DM patients were randomized into two groups as the controlgroup and the treatment group who underwent SSP group for eight weeks. The data of insulin resistancemeasured by HOMA-IR, perceived stress scale (PSS), fasting plasma glucose (FBG), HbA1c, and two hour plasma glucose (PPG)levels of both groups werecollected and statistically analysed.No significantly different in the patient’scharacteristics of both groups was observed.At the end of the study period, the LPD group showed reduction of HOMA-IR and HbA1c but not statistically significant, (ΔHOMA-IR = -0.39±1.52; p = 0.976; HbA1c=-0.55±0.85%; p = 0.189). The FBG and PPGincreased in the LPD group compared to control but also not statistically significant (ΔFBG=10.16±50.33; p=0.294; PPG=40.74±69.35; p=0.062). We also observed the decrease of stress level in LPD group compared to control groupbut it was no statistical significance (ΔPSS=-5.09±6.47; p=0.655).Self surrender practice (LPD) decreasesHOMA-IR, improves glycemic control (HbA1c) and reduces stress levels in T2DM patients without depressionAlthough the theyarenot statisticallysignificant, however they may be clinically significant
Polyherbal formulation containing Saoropus androgynous, Trigonella foenum-graceum, and Moringa oleifera increased the expression of mRNA smooth muscle α-actin (ACTA2) and cytokeratin 14 (CK14) in lactating rats
No full textPolyherbal formulation (PHF) containing extracts of Sauropus androgynous, Trigonella foenum-graceum and Moringa oleifera has been proven can induce milk production in animal model. However, its molecular of action has not been elucidated, yet. This study aimed to investigate the effect of the PHF on the mRNA expressions of α-actin smooth muscle (ACTA2) and cytokeratin 14 (CK14) on the myoepithelial cells of the lactating rats mammary glands. Thirty female Wistar rats were divided into five groups with six of each. Group I was orally administered aquadest. Group II, III, and IV rats were orally administered the PHF at dose level of 26.25, 52.5, and 105 mg/kg once a day, for 15 days, respectively. Group V was orally administered 2.7 mg domperidone. On 16th day, rats were sacrificed. Mammary glands were isolated and processed for mRNA expression analysis using real-time polymerase chain reaction (qRT-PCR). The results demonstrated that the mRNA expression of ACTA2 and CK14 increased in dose-dependent manner in the groups of PHF. Significantly different between the Group III, IV, and V compared to Group I was observed (p 0.05). In conclusion, the PHF increases the mRNA expression of ACTA2 and CK14 on myoepithelial cells of the mammary glands on lactating rats
The role of transcatheter arterial chemoinfusion (TACI) in unresectable adenocarcinoma colorectal:a case report
No full textColorectal cancer (CRC) is the fourth most common cancer in worldwide. In the last 10 years, the mortality rate of CRC decreased by more than 20% and 5-year survival remains approximately 60% due to the rising developments in diagnostic techniques and optimization of surgical, neoadjuvant and palliative therapies. We reported a case of 80-year-old woman with diarrhea, blood in the stool and weight loss for a year. The patient was diagnosed with colonic polyp eight years ago. In double-contrast barium enema (DCBE) showed filling defects in sigmoid with pedunculated form. Optical colonoscopy demonstrated tumor in sigmoid. Computed tomography (CT) abdomen showed circumferential thickening and luminal narrowing of sigmoid colon with stranding of the serosa and mesenteric fat as well as enlarge pericolic nodes without distant metastasis. Based on American Joint Committee on Cancer criteria the stage was T3N1M0. From histopathological diagnosis, the tumor was well differentiated adenocarcinoma. We concluded as unresectable adenocarcinoma colorectal. Patient received transcatheter arterial chemoinfusion (TACI) with oxaliplatin and bevacizunab in three courses every 2 months. After first TACI, symptoms and patient’s performance status improved without systemic side effects. Arteriography imaging showed decrease in tumor staining after third TACI. CT evaluation showed a significant decrease of tumor size, without nodal and distant metastasis.In this case, TACI treatment with oxaliplatin and bevacizumab in unresectable adenocarcinoma colorectaldemonstrated improvement of patient’s performance status, partial response, decrease stage and symptoms, without systemic side effects. It is proven that TACI treatment may be an effective palliative therapy for unresectable colorectal cancer. Further studies should be performed to verify these findings.We reported a case of a woman with unresectable adenocarcinoma colorectal showed good results after received TACI treatment
Effects of resistant starch of mixed tubers snacks on glucose metabolism, leptin, visceral fat and body mass index in type 2 diabetes mellitus (T2DM)
No full textResistant starch could lower blood glucose, decrease adipocyte in adipose tissue and affect satiety hormones such as leptin. Tubers and pumpkin have high content of resistant starch, but their effectiveness to type 2 diabetes mellitus (T2DM) has not been known clearly. This research was conducted to determine the effectiveness of snack consumption made from tubers and pumpkins to BMI, visceral fat, glucose and leptin levels in the blood of T2DM patients and the correlation between the variables. The research method was pre-post clinical trial. Sixteen T2DM patients were in treatment (RS) and control groups. Subjects in RS group were given snack twice daily for 4 weeks. After following wash out process for 4 weeks, the same subjects was continued as subjects’ control. Paired t-test and/or Wilcoxon-test was used to analyze the differences between values before and after treatment in the group and between groups. Pearson test was used to analyze the correlation of BMI, visceral fat, glucose and leptin level. The visceral fat was increased in RS group (p=0.04) after 4 weeks consuming snack but decrease in control group (p=0.04) without significant change of BMI. Leptin level was decreased (p=0.00) in RS group. Blood glucose significantly decreased (p=0.01) and leptin level increased slightly in control group. Comparing the RS and control group at the end of study, there were significantly different in the variation of visceral fat in the female groups (p=0.05) and leptin (p=0.05). Visceral fat correlated with BMI in the RS and control group. In conclusion, the mixed tubers and pumpkin snack decreased the leptin level but increased visceral fat
The difference of nasal mucosal cytology features in gas station workers compared to non-gas station workers
No full text The pollutants contained in an outdoor air environment for example gasoline vapors can cause epithelial inflammation, metaplasia, and dysplasia. This study aimed to determine the difference in cytological nasal mucosa between gas station workers and non-gas station workers. This research used a cross-sectional design. There were 80 samples with inclusion criteria: aged 20-50 years, worked more than 3 months, consisting of 40 gas station workers (exposed group) and 40 non-gas station workers (unexposed group) who did not use nasal drops in the last ten days. The exclusion criteria of both groups were: 1) patients with acute rhinitis, 2) had nasal trauma, 3) had nasal surgery, 4) consume alcohol, 5) history of allergic rhinitis, and 6) refused to participate in the study. All samples performed brushing at 1/3 anterior nose inferior turbinate and cytology examination. The statistical analyses used X2 tests. From the exposed group we found 18 (45%) with inflammation, 17 samples (42.5%) with metaplasia, and 9 samples (22.5%) with dysplasia, while in the unexposed group there were 10 (20.5%) with inflammation, 4 (10.0%) with metaplasia and 2 (5.0%) dysplasia. There were statistically significant differences in nasal mucosal cytology, particularly metaplasia (p: 0.001; RP: 6.65; 95% CI: 1.78-27.01) and dysplasia (p: 0.023; RP: 5.52; 95% CI: 1.22-32.10) between both group samples. It can be concluded that there are statistically significant differences involving metaplasia and dysplasia in nasal mucosa cytology features of gas station workers compared to non-gas station workers
Sequence variation of latent membrane protein 2A (LMP2A)gene from Epstein-Barr virus epitope cytotoxic T-lymphocyte (CTL)related to human leucocyte antigen-A24 (HLA-A24)in peripheral blood sample and cytobrushof nasopharyngeal cancer patients
No full textEpstein-Barr virus (EBV) infects lymphocyte B and triggers latent phase in the host so that it causes nasopharyngeal carcinoma (NPC). Latent membraneprotein 2A (LMP2A) epitope CTL-HLA-A24 is a target for recognition by cytotoxic T lymphocyte(CTL). The change in the epitope could influence the latency of particular EBV in the host due toits ability to evade immune surveillance mediated by CTL. The study aimed to determine thesequence variation of LMP2A epitope CTL-HLA-A24 gene from the peripheral blood samples and cytobrush of the NPC patients. Case-series study was conducted with total 16 cytobrush samples from NPC patients. DNA isolation, polymerasechain reaction (PCR) and gene sequencing were performed in this study. From cytobrush samples of NPC patients, it was found the changes of base sequence variation of LMP2A gene from GGC>GGA, CCA>CCC, TGC>TCC, GGT>GGC and TCT>ACT. CCA>CCC and TGC>TCC variations were found in epitope associated with HLA-A2 where there was a change of epitope sequence from TYGPVFMCL to TYGPVFMSL caused by missense mutation. The change of base sequence caused amino acid alteration from cysteine to serine. Whereas the variation of CCA>CCC did not change the sequence of amino acid proline so that the epitopewas unaffected. In epitope associated HLA-A2 (CLGGLLTMV), there was a change in base sequence from GGT to GGC, but there was no changes in amino acid and still as glycine. There were some new variations: in the upstream sequence of LMP2A from GGC>GGA which is silent mutation and the other variation is in downstream sequence of LMP2A from TCT>ACT which is missense mutation. Thesequence variations of LMP2A gene found in this research were GGC>GGA, CCA>CCC, TGC>TCC, GGT>GGC and TCT>ACT. In our research, we found another variation compared the previous research. The variation was in the upstream sequence of LMP2A from GGC>GGA which is silent mutation and the other variation is in the downstream sequence of LMP2A from TCT>ACT which is missense mutation
The role of nickel contact allergy in nummular dermatitis in Indonesia
No full textIn the recurrence of nummular dermatitis (ND) as a problem for patients, it is necessary to identify interferon-γ (IFN- γ), interleukin-4 (IL-4), interleukin-17 (IL-17), and stimulation of lymphocytes against nickel. This study aimed to investigate the role of nickel contact allergy in ND. Forty-two patients with ND were studied and 42 healthy subjects who were equal in age, sex and atopy history as control. All subjects underwent nickel skin patch test, detection of IFN-γ, IL-4, IL-17 in blood, and lymphocyte stimulation assays. To determine cut off point of the variables, receiver operator characteristic (ROC) curves were calculated. Bivariate and multivariate analyses were performed to measure the strength of association using odds ratio (ORs) and 95% confidence intervals (95% CI). Statistical analysis was performed using McNemar X2-square test and multiple conditional logistic regression. Nickel contact allergy was shown by nickel patch test (OR= 3.5; 95% CI = 1.09–14.60), stimulation index/SI (OR= 29; 95% CI = 4.81-1184.43), IFN-γ (OR= 4.25; 95% CI = 1.39–17.36). These results were supported after multivariate analysis with conditional logistic regression which showed nickel patch test (OR= 9.63; 95% CI= 1.02–109.38; p= 0.04), SI (OR= 42.19; 95% CI = 2.32–766.03; p= 0.01), IFN-γ (OR= 11.51; 95% CI = 1.08–122.63; p= 0.04). Nickel contact allergy is an important risk factor for ND. Patients with ND are recommended to be tested for nickel contact allergy