Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Effects of Dioscorea esculenta and Eubacterium rectale on insulin receptor substrate 1 (Irs1) Expression in skeletal muscle and homeostatic model assessment-insulin resistance (HOMA-IR) in diabetic rats
No full textLow expression of insulin receptor substrate 1 (Irs1) is associated with insulin resistance and type 2 diabetes mellitus (type 2 DM). This study was performed to evaluate the effects of Dioscorea esculenta and Eubacterium rectale on the Irs1 expression in the skeletal muscle and the homeostatic model assessment-insulin resistance (HOMA-IR) of diabetic rats. Twenty-five male Wistar rats were divided into five groups i.e. non diabetic rats Group 1; diabetic rats as Group 2; diabetic rats + D. esculenta as Group 3; diabetic rats + E.rectale as Group 4 and diabetic rats + both E. rectale and D. esculenta as Group 5. Rats were made diabetic with induction of intraperitoneally injection of nicotinamide and streptozotocin. After four weeks of the interventions, the blood and skeletal muscles were taken. The Irs1 expression was analyzed with immunohistochemical staining, plasma glucose levels was analyzed using a spectrophotometer, and insulin was analyzed using ELISA methods. All intervention groups reduced plasma glucose levels and HOMA-IRs (p<0.001) and increased Irs1 expression. The greatest reduction of plasma glucose levels and increase of Irs1 expression in the skeletal muscle were found in Group 4, however, the lowest of HOMA-IR was seen in Group 5. These results suggested that D.esculenta, E.rectale, and the combination reduced plasma glucose levels and HOMA-IR by increasing Irs1 expression in skeletal muscle
Assessing downgrading of esophageal adenocarcinoma after neoadjuvant chemotherapy: a case report
No full textEsophageal carcinoma, squamous cell carcinoma, and adenocarcinoma, are a deadly serious malignancy. The delay in diagnosis due to the lack of specific symptoms in the early stages of the disease and the nature of esophageal cancer is very aggressive lead to a poor prognosis with a survival rate of small. Current management of esophageal cancer is recommended multimodal approach in the form of neoadjuvant chemotherapy or combined radiochemotherapy (CRT) and with surgery. In this article, multimodality treatment using chemotherapy and surgery on esophageal adenocarcinoma was reported. A 52-year-old male presented with a total obstruction of the esophagus and was planned to perform temporary gastrostomy for chemotherapy preparation. Gastrostomy found a solid and fixed tumor located in the gastroesophageal junction, with the size of 7 x 6 x 5 cm3. He underwent a chemotherapy using the regimen of 8 cycles paclitaxel without radiotherapy due to the long queue of radiotherapy schedule. After chemotherapy, we re-evaluated and planned to perform surgical removal of the tumor. During surgery, we found a total obstruction along with fibrosis of the esophagus but found no tumor/mass. We performed partial esophagectomy and end to side anastomosis using anastomosis end to side using the CDH25 circular stapler. Surgery was carried out by the thoracoabdominal approach. The patient was discharged on day 12 in a stable condition and was undergoing soft diet. We planned to evaluate the patient using Carcinoembryonic Antigen (CEA) test and Positron Emission Tomography (PET) scan. In conclusion, multimodality treatment using chemotherapy and surgery on a case of one-third distal esophageal adenocarcinoma provides good results
Oncoplastic breast surgery in Asia
No full textOncoplastic breast conservation surgery has given a new light to the options of performing breast conserving surgery by combining oncological principles of breast cancer surgery with plastic surgery techniques. The ultimate oncoplastic achievement would be the conversion of what normally would be considered as an oncologic and/or cosmetic failure when using standard techniques of breast conserving surgery into both oncological and cosmetic success and to avoid mastectomy where possible.Most Techniques are fairly well established. However surgical techniques may also need to be adjusted based on the cohorts that the treatment is offered to. For example, for larger breasts, the technique is more forgiving. However for smaller breast, there is still a limitation of the cosmetic outcome when a high percentage of breast volume has been excised no matter how good the technique or the surgeon is.Various aspects of oncoplastic breast surgery technique will be discussed and its applicability to Asian Cohorts.
Smoking cessation reduces ratio of total cholesterol/high density lipoprotein (HDL) cholesterol levels on adult people in Yogyakarta Special Region
No full textCigarette smoking is a major cause of cardiovascular disease due to elevation of free radical substances as well impairment in lipid metabolism. Smoking cesation has been linked with reduced risk of mortality. However, data regarding cardiovascular disease (CVD) risk factor in former smoker is limited. The aim of the study was to evaluate the CVD risk factor among smoker, non-smoker and former smoker in Yogyakarta Special Region, Indonesia. A cross-sectional design from 86 apparently healthy male, aged between 25-50 years old was performed for this study. From total subjects, 45 subjectsare smokers, 26 are non-smokers and 15 are former smokers. Body weight, height, and blood pressure were also measured from the subjects. Blood was drawn for assessment of total cholesterol (TC), triglyceride, low density lipoprotein (LDL), high density lipoprotein(HDL) and C-reactive protein (CRP) concentrations. We found significant difference in the level of HDL, cardiovascular risk index (LDL/HDL ratio), atherogenic index (TC/HDL ratio) and also in systolic blood pressure among groups (p<0.05). Smoking person hadsignificantly low HDL level with high CVD risk index and atherogenic index (p<0.05). The CVD risk index was not different between former smoker and smoker groups. Serum CRP level was not different among the groups. In conclusion, smoking is associated with increased risk of CVD. Smoking cessation slightly decrease the CVD risk
Accuracy of albumin creatinine ratio in comparison with albumine excretion rate for diagnosis diabetic nephropathy in type 2 diabetes mellitus
No full textDiabetic nephropathy (DN) is one of complications in diabetic patients manifested bymicroalbuminuria with minimal level of 30 mg/24 hour which is measured at least 2 timesin the period of 3 to 6 months. Microalbuminuria can be measured either albumin excretion rate (AER) or albumin creatinine ratio (ACR). Measurement of ACR is an alternative parameter recommended by WHO in 2011 to diagnose diabetic nephropathy since it is more convenient, fast and not requires special preparation. The purpose of this study was to investigate accuracy of ACR to diagnose DN in type 2 diabetes mellitus (T2DM) patients.This was a diagnostic test study involving 80 T2DM patients. In this study ACR value equal or more than 30 mg/g was independently and blindly compared with AER as the gold standard. The data were analyzed using 2x2 tables in order to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Other data were analyzed using statistic descriptive. Eighty T2DM patients consisting of 38males and 42 females participated in this study. They had suffered from T2DM on average9.5 years, and the average of ACR value was 55.5 mg/g. Total result of true positive andtrue negative was 77. Three result were false negative but none of false positive result.The ACR value equal or more than 30 mg/g had sensitivity, specificity, PPV, and NPV of95.9%, 100%, 100%, and 66.7% respectively. In conclusion, the ACR value equal or morethan 30 mg/g derived from morning urine sample can be used to diagnose DN in T2DMpatients
Prevalence ratio of free fatty acid in obese group with non-alcoholic fatty liver disease
No full textNon-alcoholic fatty liver disease (NAFLD) is liver disorders characterized by macrovesicular fatty liver, fibrosis, cirrhosis that not associated with alcohol consumption. The prevalence of NAFLD has risen with a pandemic of obesity. The increase of free fatty acid (FFA) oxidation will induce endoplasmic reticulum stress that cause mitochondrial dysfunction and lead to increase reactive oxygen species (ROS) production causing apoptosis of liver cells. The aim of study was to determine the prevalence of FFA in the obese group. This was an observational analytical study with cross-sectional design to determine the prevalence ratio of FFA in the obese group with NAFLD compared to the group without NAFLD. Obese women who fulfill the inclusion and exclusion criteria were involved in this study. Five mL venous blood sample was collected for the measurement of lipid profile, liver enzyme and FFA. Fatty liver was evaluated using abdominal USG. The Chi-square test was used to analyze different proportions of FFA between the both groups. Sixty four subjects were participated in this study and classified into obese with NAFLD (39 subjects) and obese without NAFLD (25 subjects). The prevalence ratio of FFA with cutoff value ≥2.66 nmol/mL in the obese group with NAFLD was 4.3 times higher than those without NAFLD (95% IC: 3.5 – 42.3; p<0.001)
Pharmacogenomics and Pharmacogenetics: Some Cases in Oncology
No full textABSTRACTPharmacogenomics and pharmacogenetics plays an important role in understanding how genetic variants influence drug efficacy and toxicity. In the case of cancer, both efficacy and toxicity of therapeutic agents determine the improvement of survival and quality of life in cancer patients. Effective treatment of Cancer, one of the most deadly diseases in the world, is importance for extending patient survival. Genetic variation influences the response of an individual to drug treatments that impact the efficacy and toxicity of the drugs. Understanding individual genetic variation is potential to make therapy safer and more effective by determining more appropriate drug selection and drug dosage for each individual patient. In the context of cancer, tumors may have specific disease-defining mutations, but a patient’s germline genetic variation will also affect drug response. Advance research technologies approach such as GWAS and next-generation sequencing technologies, statistical genetics analysis methods and clinical trial design have shown promise for discovery of genetic variants associated with drug response in cancer. Understanding the molecular characteristics of both the tumor and the patient, and establishing their relation with drug outcomes will be critical for the identification of predictive biomarkers and to provide the basis for individualized treatments. Since cancer is also frequent in Indonesia, pharmacogenomics study in oncology and its implementation in the clinical practice is important. Broad collaboration at national and international level could foster the application of personalized medicine in oncology
The Expression of hsa-miR-155-5p in Plasma Samples Of Breast Cancer Before And After Chemotherapy
No full textBreast cancer has emerged as the most common cancer-related mortality among women worldwide. Therefore, early cancer detection using biomarkers such as microRNA is needed. One of microRNAs that has an important role in breast cancer development is miR-155. Hsa-miR-155-5p is an oncomir that is commonly dysregulated in breast cancer. This study aims to determine the expression of hsa-miR-155-5p in breast cancer patient’s plasma before and after chemotherapy. We collected 64 samples from breast cancer patients admitted to Dr. Sardjito Hospital in Yogyakarta. RNA from plasma was extracted using RNA Isolation Kit miRCURY-Biofluid. cDNA synthesis was performed using cDNA Synthesis kit II and quantification of miR-155-5p using ExiLent SYBR Green master mix (Exiqon). qRT-PCR results were then analyzed with Livak's method and compared (before and after chemotherapy) with t-test. Expression of miR-155-5p in the breast cancer patients’ plasma after chemotherapy was significantly increased (10.59 times) when compared to before chemotherapy (p = 0.001). We concluded that there was upregulated expression of miR-155-5p after chemotherapy than before chemotherapy. There has not been a known, relevant pathway between hsa-miR-155-5p and chemotherapy regimens nor resistance to chemotherapy. Keywords: Breast cancer, plasma, hsa-miR-155-5p, oncomiR, chemotherapy
Pulmonary artery vegetation in a pediatric patient with ventricular septal defect: a case report
No full textABSTRACTIntroduction: Infective endocarditis (IE) is one of the congenital heart disease complications which is frequently seen in ventricular septal defects (VSD). The Duke criteria are the diagnostic criteria for IE. One of the major criteria is evidence of vegetation. In VSD complicated with IE, vegetation is frequently found on the opening of the defect, on the right ventricular side of the opening, on the tricuspid valve, and less frequently it is found on the pulmonary valve. Vegetation found in the lumen of pulmonary artery is rarely reported.Case report: A 6 years old boy was consulted with congenital heart disease. His chief complaint was shortness of breath. He came with unspecific signs and symptoms with a history of frequent hospitalization due to pneumonia and paleness. Chest X-ray showed enlargement of heart chambers. Transthoracic echocardiography (TTE) revealed moderate size VSD and multiple vegetation on right ventricle outflow tract, pulmonary artery valve, and inside the lumen of main pulmonary artery and right pulmonary artery. The blood culture showed a positive result for S. viridans. He was treated with parenteral antibiotic and operated on later. We successfully performed evacuation of the vegetation and VSD closure.Conclusion: We reported a rare case of pulmonary artery vegetation in a boy with moderate VSD that we treated with combination of parenteral antibiotic followed by successful surgical vegetation evacuation and VSD closure.ABSTRAKPembukaan: Endokarditis infektif merupakan salah satu komplikasi penyakit jantung bawaan yang sering menyertai defek septum ventrikel (VSD). Kriteria Duke merupakan kriteria diagnosis untuk endokarditis infektif. Salah satu kriteria mayor nya adalah bukti adanya vegetasi. Pada VSD dengan komplikasi endokarditis infektif, vegetasi sering ditemukan pada pembukaan dari defek, pada ventrikel kanan, pada katup trikuspid, dan yang paling jarang pada katup pulmonalis. Vegetasi pada arteri pulmonalis jarang dilaporkan.Laporan kasus: Anak laki-laki berusia 6 tahun dikonsultasikan dengan penyakit jantung bawaan. Keluhan utamanya adalah sesak nafas. Pasien datang dengan tanda dan gejala yang tidak khas dengan riwayat rawat inap berulang karena pneumonia dan pucat. X-ray dada menunjukkan pembesaran ruangan-ruangan jantung. Transthoracic echocardiography menunjukkan VSD berukuran sedang dan vegetasi multiple pada right ventricle outflow track, katup pulmonalis, dan didalam lumen arteri pulmonalis komunis dan arteri pulmonalis kanan. Kultur darah positif untuk S. viridans. Pasien menerima antibiotik parenteral dan menjalani pembedahan setelahnya. Kami berhasil melakukan evakuasi vegetasi dan penutupan VSD.Kesimpulan: Kami melaporkan kasus vegetasi arteri pulmonal pada anak laki-laki dengan VSD sedang yang kami terapi dengan kombinasi antibiotik parenteral diikuti dengan pembedahan evakuasi vegetasi dan penutupan VSD.Keywords: pulmonary artery; vegetation; ventricular septal defect; infective endocarditis; surger
Mechanism of cytotoxic activity of chalcone derivatives against K562 leukemia cell lines
No full textTwo chalcone derivatives i.e. (E)-1-(4-aminophenyl)-3-(2,3dimethoxyphenyl)-prop-2-en-1-one (Compound-1), and (E)-1-(4-aminophenyl)-3-phenylprop-2-en-1-one) (Compound-2),has been proven to have potential cytotoxic activity. The aim of this study was toevaluate the effect of these compounds on PI3K/Akt signalling pathway in K562 celllines. After incubation with the tested compounds, AKT, caspase-3, STAT3 and cyclinD1 concentrations were measured using ELISA. Furthermore, cell cycle was analysedusing flowcytometry. Imatinib and isotretinoin were used as positive control, whereascell culture without treatment was used as negative control. The AKT concentration aftertreatment with Compound-1 and -2 was significantly lower than that control, imatiniband isotretinoin (p0.05). The cyclin D1concentration after treatment with Compound-1 and -2 was significantly lower than thatcontrol, imatinib and isotretinoin (p<0.05). In addition, Compound-1 and -2 arrested G0/G1 and G2/M phase in K562 cell lines, with comparable results to imatinib and isotretinoin.In conclusion, the mechanism of cytotoxic activity of Compound-1 and -2 are through thePI3K/Akt signalling pathway inhibition, apoptosis induction by upregulation of apoptoticmarkers, and inhibition of cell cycle progression by regulating cell cycle-related factors