Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Factors influencing plateletpheresis donations in Yogyakarta, Indonesia
No full textDespite its life saving potential, regrettably, blood transfusion has yet to be optimally applied in Indonesia. Funding difficulties and both public and professional lack of knowledge hinders its progress. More lives can be saved by using a safer, more proper, and specialized blood transfusion procedure. Plateletpheresis, one method to obtain platelet products, requires a different donation procedure than that of whole blood-derived platelet. High quality plateletpheresis product donation will positively impact the transfusion efficacy and platelet recovery of the recipient, improving patient’s clinical state. This study analyzes factors from both the donor and donation procedure that influence the quality of plateletpheresis product. The study analyzes data of plateletpheresis donations from blood transfusion service and plateletpheresis transfusions from medical records at Dr. Sardjito General Hospital, Yogyakarta, Indonesia, within the period of August 2012 to January 2013 using cross sectional design. Forty-four plateletpheresis donations were obtained during the study. All donors were male with the following mean values; age 31.9 ± 9.9 years, weight 70.2 ± 10.2 kg, body mass index (BMI) 24.7 ± 3.2 kg/m2, hematocrit 44 ± 3.2 %, and procedure time 84.2 ± 19.2 min. The median value of platelet yield was 3.2x1011 (2.1x1011 – 4x1011). The median value of pre-donation platelet count was 248.5x103/μL (204x103/μL – 391x103/μL) and the mean value of product volume was 275 ± 22.9 mL. The results showed that pre-donation platelet count (r = 0.329; p 0.05). In conclusion, pre-donation platelet count and product volume of plateletpheresis influence the yield of plateletpheresis. However, the yield is not correlated to the post-donation platelet count. Thus, other clinical factors should be considere
The Impact of Malaria in Pregnancy on Infant Susceptibility to Malaria Infection
No full textMalaria infection during pregnancy is a significant global health problem with substantialrisks for pregnant women, her foetus, and the newborn child. Infant malaria is a majorpublic health concern in Timika, Papua. The aim of the study was to investigate the impactof malaria during pregnancy on infant’s susceptibility to malaria infections, the timing ofits occurrence, the number of malaria infections during pregnancy. This was a cohortprospective study conducted in Timika, Papua from October 2013 to September 2016.Malaria investigation was done by microscopic and PCR methods. Demographic data andmalaria status of mother-infant pairs were collected and analyzed by SPSS 22.0 version.One hundred seventy-eight infants consisting of 95 (53.37%) infants born to motherswith malaria and 83 (46.63%) without malaria 91 (51.12%) boys and 87 (48.88%) girlswere involved in the study. The mean of mothers’ ages were 25.35 ± 6.30 vs. 26.0 ±5.69 years. At the ages of 6 and 12 months, infants born to malaria positive motherswere more susceptible to malaria infections compared to infants born to malaria negativemothers with RR = 3.49; 95%CI: 1.02-11.96; p = 0.03 and RR = 8.74; 95%CI: 1.14-66.81; p = 0.01, respectively. Independent risk factors of infant susceptibility to malariainfection during the first year of life were malaria in pregnancy (MiP) in 2nd trimester (RR= 4.50; 95%CI: 1.5-13.49; p = 0.07), pregnant women who only got malaria infection1 time during pregnancy (RR=2.95; 95%CI: 1.04-8.33; p = 0.04), and Papuan ethnicity(RR=3.58; 95%CI: 1.22-10.59; p = 0.02). In conclusion, infant susceptibility to malariais associated with maternal malaria status during pregnancy. MiP in second trimester,pregnant women who only had malaria once and Papuan ethnicity were independent riskfactors for infant’s increased susceptibility to malaria infection
Onset to Hospital Admission Time and Disability in Patients with Ischemic Stroke
No full textThe predictive factors of disability in stroke patients are still varied and subject to debate. Lower onset to admission time has been known produces excellent outcomes with significantly lower rates of morbidity and mortality. Previous study about the onset admission time in patients with stroke ischemic in Indonesia is very limited. This was a retrospective cohort study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta Indonesia. A total of 1657 patients with ischemic stroke was admitted between 2015-2017 and 313 patients were included in this study adjusted by inclusion and exclusion criteria. Factors such as age, gender, onset, previous stroke, comorbidities and complications were assessed. Multiple logistic regression analysis showed onset > 6 hour (RR: 4.567; 95% CI: 2.372-8.792;p: 0.000), age (RR: 2.366; 95% CI: 1.357-4.125;p:0.002) and patients with complications (RR: 12.403; 95% CI:2.443-62.968;p:0.002) were independently significant increasing the risk of disability in patient with ischemic stroke. Onset to hospital admission time > 6 hour was significantly increasing disability on ischemic stroke patients. Giving treatment less than 6 hours could save the patient from disability
Immunohistochemical Profile Of Breast Cancer Patients On Oncology Department, Moewardi Hospital, Surakarta, Indonesia
No full textImmunohistochemical is used to show hormone receptors on their surface. The aim of this study were to find information about immunohistochemical profile of breast cancer patient on oncology department, Moewardi Hospital, Surakarta Indonesia. A total 1.395 cases of breast carcinoma with Her2 profile were reviewed. The mean age of the patients was 45.7 (Ranged 23-73 years old). At time of diagnosis 739 (53%) patients were under 50 years of age. In this group the frequency of Her2 positive was higher than other. The incidence of patients above 50 years of age were significancy higher in Her2 positive with 363 (47%). Ductal invasive carcinoma is the most common type of breast carcinoma (86.9%). HER-2 Positive subtype was the most common subtype in the woman breast carcinoma (43.6%), which was followed by Basal like (31.3%), Luminal A (16.8%) and (8.3%). For tumor grading, the highest on G3 with the results 764 (54.7%). G3 got the highest results on Her2 positive with 535. We just divide the type of tumor consist of three parts (ductal, lobular, and other). In tumor type obtained the most data on ductal carcinoma with 878 (63%)
Expression of Tumor Necrosis Factor - α (TNF-α) and Interleukin 1-β (IL1-β) in Chronic Tubotympanic Suppurative Otitis Media
No full textChronic Suppurative Otitis Media (CSOM) is a common public health problem worldwide and a major cause of hearing impairment. It is also one of the neglected disease especially in developing countries. Cytokines are a group of glycoproteins that play a role in strengthening the immune and inflammatory reactions in various diseases, including inflammation of the middle ear. Some of the important inflammatory mediators found in middle ear fluids are Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β). Cytokines are thought to play a role in the ongoing inflammatory regulation. The aim of this study was to compare the expression of TNF-α and IL-1β in tubotympanic CSOM and in healthy control group. The mean of TNF-α serum level in tubotympanic CSOM was 0,553±1,59 pg/ ml, and 0,587±2,13 pg/ ml in control group. There was no statistically different of TNF-α between two groups (P > 0,05). Mean of IL-1β serum level in the tubotympanic CSOM and control group were 0,633±0,92 and 0,302±0,48, respectively. Although IL-1β levels were higher in the patient group, the difference was not statistically significant (P > 0,05)
The effect of measurable and regular exercise on ovariectomized Sprague Dawley rats in improving skin quality
No full textThe decline of estrogen level causes various skin changes including amount of fibroblast, the thickness of epidermis and dermis. Physical exercise is believed can increase the estrogen level and give benefit impacts on skin. It mechanism is often associated with the increase of extragonadal aromatization and estrogen serum, the activation of insulin-like growth factor (IGF), and the expression of estrogen receptor (ER). This study was conducted to investigate the effect of physical exercise in ovariectomized rat on the amount of fibroblast, the thickness of epidermis and dermis, the levels of ER β in skin and serum estrogen. Eight female Sprague Dawley rats aged 3 months were used in this study. Rats were divided into two groups i.e. Group 1 consisted of ovariectomized rats without physical exercise and Group 2 consisted of ovariectomized rats and given measurable and regular physical exercise. Rats ran on treadmill with the speed 18 m/min, the tilt of 5%, duration for 60 min/experiment/day, 5 times a week for 12 weeks. The amount of fibroblast, the thickness of epidermis and dermis, the levels of ERβ in skin and serum estrogen were measured after physical exercise. The result showed that there was a significant difference amount of fibroblast between group 1 and group 2 (p0.05). There was a significant positive correlation between the level of serum estrogen and the thickness of epidermis (p<0.05), and negative correlation between the serum estrogen level and the level of ERβ (p<0.05), and negative significant correlation between the level of ERβ and the thickness of epidermis (p<0.05). In conclusion, the amount of dermal fibroblast of ovariectomized rats increase after underwent measurable and regular exercise. There is correlation between the serum estrogen level and the thickness of epidermis as well as ERβ.
Management of Hereditary Breast and Ovarian Cancer. The Asian Experience
No full textBRCA1/BRCA2 mutations are the most common high penetrant genes associated with an increased lifetime risk for hereditary breast and ovarian cancer (HBOC). Although genetic testing is standard of care in Western developed countries, there are still variations in availability of genetic testing and risk assessment for HBOC in Asia. Depending on the countries, there are variations in the clinical strategies and cancer management. The Asian BRCA Consortium has grouped together 14 Asian countries and reviewed genetic counselling/testing uptake rates and clinical management options in these countries. Moreover economic factors, healthcare and legal frameworks, and cultural issues affecting the genetic service availability in Asia were discussed. Mutation spectrum, and VUS rates and the increase use of NGS gene panel testing poses more decisional issues in the clinical management of Hereditary Breast cancer in Asia. These will be discussed.Keywords: BRCA1/BRCA2, germline, HBOC, Asia BRCA Consortium, NGS
Optogenetics, A Futuristic Panacea in Genetics
No full textAbstractOptogenetics is the constellation of optics, genetics and bioengineering which unites genetic engineering with optics to notice and manage the function of genetically targeted groups of cells with light, often in the intact animal, via light-sensitive microbial membrane proteins (opsins). Light-sensitive genes specifically including the genetically targeted light-gated channels channelrhodopsin-2 (ChR2) and halorhodopsin (NpHR) result in intracellular ion flow during optical illumination. Afterward, the neurons encounter a series of changes resulting from membrane depolarization or hyperpolarization. Although the rooted origins of optogenetics is from neuroscience, it can be potentially applied in neuropsychocardioncology (neurology, psychiatry, oncology, and cardiology).This critical review will explicate a comprehensive summary of the roles of optogenetics in the field of neuropsychocardioncology.Optogenetics can be potentially developed as neuroprosthetics and direct NpHR in the management of spastic movement disorders. Optogenetics can control of larynx muscle contraction in vivo, using both transgenic ChR2 expressing mice and viral transduction of muscle.In epilepsy, the efficacy of optogenetics is proved. Pyramidal cells in the cortex were transduced with halorhodopsin, and photoinhibition of the neurons decreased electrical seizure activity. Optogenetic and DREADD technologies are in their early stages, particularly with respect to PD research or therapy.In autism and schizophrenia, behavioral deficits may arise from elevation in the cellular balance of excitation/inhibition (E/I balance) within neuronal microcircuits. This hypothesis was tested by optogenetically elevating the E/I balance in the medial-prefrontal cortex using a step-function opsin (SSFO), together with red-shifted opsins (C1V1). Increased excitation in excitatory pyramidal neurons, lead to social-cognitive dysfunctioning which are similar to those seen in autism. Cortical gamma oscillations are an indicator of enhanced information processing, which is highly affected in schizophrenic patients.Using optogenetic technology, researchers divulge the characterization of phosphatidylinositol 3-kinase (PI3K) in Rac1-dependent lamellipodial motility in PC-3 prostate cancer cells. PI3K, acting downstream of Rac1, has an important role in the initiation of lamellipodial extension, which underlies prostate cancer cell invasion and metastasis. As in Parkinson, human cells can be engineered to deliver the excitatory (hM3Dq receptor) and/or the inhibitory (hM4Di receptor) form so that cellular activity may be turned up or down.The optogenetic TCU (tandem-cell-unit) strategy can be valuable in appraising tissue graft integration and cell delivery in the myocardium during cardiac tissue repair procedures. Low-energy pacing strategies can be srutinized by optogenetic investigations. Specifically, optical stimulation can be aimed for strategic structures of the conduction system. Optogenetic studies have already contributed to a better understanding of the neural circuits affected in many disorders. A conceptual and mutual understanding of multidisciplinary approaches and collaboration will enable researchers, clinicians, stakeholders, government develop and apply optogenetics in comprehensive medical services and health care.Keywords: optogenetics, opsins, neuropsychocardioncology, SSFO, DREADD, TCU.
The accuracy of fine needle aspiration biopsy to diagnose breast neoplasm
No full textBreast lump is a very common complaint among women, especially during the reproductive year. Fine needle aspiration biopsy (FNAB) is a less invasive procedure. It is usually performed as an initial diagnosis prior to the operative procedure. The accuracy of the FNAB in Indonesia needs to be elaborated. The study aimed to evaluate the sensitivity and specificity of FNAB in diagnosing breast neoplasm. This is a retrospective study with cross sectional design, involving 145 patients with breast lump who underwent FNAB and histopathology examination in Dr. Sardjito General Hospital, Yogyakarta, from 2012 to 2014. Data analysis showed that female to male ratio was 23. 2:1 commonly occurred at 41-50 years old. Forty-one cases (28.28%) diagnosed as a benign lesion with fibrocystic changes as the most frequentcase (11.19%). The malignant case was 104 cases (71.72%) with ductal carcinoma as the highest case (51.49%). FNAB achieved a sensitivity of 85.58%, a specificity of 100% and a total accuracy of 89.66% in determining the benign or malignant breast lump. The accuracy, sensitivity and specificity of FNAB in diagnosing ductal carcinoma were 83.58%, 85.51% and 81.54%, respectively. The accuracy, sensitivity and specificity of FNAB to diagnose fibrocystic changes lesion were 85.82%, 26.67% and 93.28%, respectively. FNAB can be used as an alternative diagnostic tool to diagnose breast neoplasm. It provides rapid, cheaper, effective, valuable, and less invasive procedure in diagnosis of breast lump.
Risk of zidovudine-induced anemia on human immunodeficiency virus (HIV) infection patients with different CD4 cell counts
No full textAnemia is the most common hematologic abnormality in patients with human immunodeficiency virus (HIV) infection. This abnormality is associated with HIV infection itself, HIV-related opportunities infections or drug use. Zidovudine (AZT) is the most common cause of anemia in HIV patients. Recent study showed anemia in HIV patients is also associated with CD4 cell counts. Aim of this study was to evaluate the risk of anemia on HIV patients with different CD4 cell counts after AZT-based antiretroviral therapy (ART).This retrospective cohort study was conducted using medical record of HIV patients in Dr. Soetomo General Hospital, Surabaya. Subjects who fulfilled the inclusion and exclusion criteria were divided into two group i.e. HIV patients with CD4 cell counts 200-350 cell/mm3 and those with CD4cell counts ≥350 cell/mm3. All available demographics, clinical and laboratory data of subjects before and after AZT-based ART were then recorded and evaluated. Ninety-seven HIV patients (50 male and 47 female) were involved in this study. The result showed that the anemia incidence significantly increased after AZT-based ART (p0.05). Gender, age, weight and clinical stage were not associated with anemia incidence (p>0.05). In contrast, anemia incidence is associated with Hb level before AZT therapy (p<0.05). In conclusion, the anemia incidence in HIV patients after AZT based ART is not associated with the level of CD4 cell counts, however it is associated with Hb levels before AZT therapy