Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Sensitivity of Total Protein Creatinine Ratio in Urine for Diagnosis Diabetic Nephropathy
No full textABSTRACTDiabetic nephropathy is one of diabetic complication characterized by proteinuria and impaired renal function. Confirmation of diagnosis based either on urine value of albumin excretion rate (AER) 30-300 mg/24 hours or albumin creatinine ratio (ACR) 30-300 mg/g or total protein creatinine ratio (TPCR) 150-500 mg/g. It is reported that TPCR measurement is more acceptable since it is convenient, fast and does not require special preparation. The aim of this study is to investigate the accuracy of TPCR for diagnosis of diabetic nephropathy among type 2 diabetic patients.This was a diagnostic test study which involves 86 type 2 diabetic patients where urine TPCR value equal or more than 150mg/g was independently and blindly compared with AER as a refference standard to diagnose diabetic nephopathy. The inclusion criteria were type 2 diabetic patients that suspected suffer from diabetic nephropathy (long of illness is more than 4 years) and agree to participate in this study. Those whom were suffer from at least on of the following diseases urinary tract infection, congestive heart failure, liver dysfunction, pregnancy, multiple myeloma, microangiopathy hemolytic anemia (MAHA) and incomplete data were excluded from the study. The results of the study were analyzed using 2x2 table in order to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio for positive test result/LR(+),likelihood ratio for negative test result/LR(-),and accuracy. The average of TPCR among diabetic nephropathy patient was 248.07 mg/g. It was significantly higher as compared to those non diabetic nephropathy patient (103.52 mg/g). It was found 75 true positive result, 9 true negative result, and 2 false positive result. The result showed that TPCR had a sensitivity, specificity, positive predictive value, and negative predictive value of 97.4%, 100%, 100%, and 81,8% respectively to diagnose diabetic nephropathy.Total Protein Creatinine Ratio (TPCR) with value equal or more than 150 mg/g in the morning sample urine can be used to diagnose diabetic nephropathy.Keywords: diabetic nephropathy, total protein creatinine ratio, sensitivity, albumin excretion rate, diagnostic test stud
Development of motor learning implementation for ischemic stroke: finding expert consensus
No full textThe main purpose of this study was to investigate motor learning implementation forischemic stroke from experts on the field of motor learning in stroke patients includingthe neurologist, medical rehabilitation specialists and physiotherapists. To collect thedata and answer the research questions, statements were made on the basis of thestudy of literature and the grains exploration of the statements in the questionnaire usingthe Delphi Method. Formulation development model was based iteration or judgmentof experts. Validation assessment statement grain tested by the Content Validity Ratio(CVR) and Content Validity Index (CVI) was used to analyze the data. The finding clearup that CVR value of each item statement was 1 and the value of CVI also 1. There were6 indicators in a 26-point declaration on the implementation of the development model ofmotor learning intervention for ischemic stroke. Six indicators included basic theories thatsupport the importance of intervention motor learning, motor learning stages, principlesof motor learning, dosage, timing of and kinds of motor learning interventions that can beprovided as well as application development intervention model motor learning, allowinggiven for ischemic stroke. In conclusion, based on the content validity of the results ofthe consensus expert judgments are six indicators of the importance of motor learningapplication for ischemic stroke
SCN1A exon 26 variants in epilepsy and migraine patients
No full textEpilepsy and migraine are common neurological diseases in many populations. Mutation of the voltage gated natrium channel Nav1.1 (SCN1A) are important causes of different genetic epilepsies and can also cause familial hemiplegic migraine (FHM-III). This study aimed to identify SCN1A gene variation in patients with epilepsy and common migraine. Gene variation analysis of exon 26 of the SCN1A gene was carried out in 33 patients with epilepsy, 33 patients with migraine and 30 control individuals from Neurology Polyclinic at Dr. Zainoel Abidin General Hospital, Banda Aceh. The PCR and direct sequencing methods were performed in this study. SCN1A gene variations were identified in two epilepsy patients. These gene variations located at exon 26 were four silent mutations in patient E27 at position A4440T (Leu1480Leu), T4443C (Leu1481Leu), A5046G (Leu1682Leu) and C5121T (Asp1707Asp). One silent mutation in patient E30 at position G5505A (Glu1835Glu). None of these gene variations were identified in controls and patients with common migraine in this study. This study has identified 5 genetic variations of SCN1A in patients with epilepsy but not in common migraine. The mechanism and relationship between these variants and epilepsy need to be clarified
The effect of combination of hemofilter, pre- and intraoperative methylprednisolone administration on systemic inflammatory response syndrome (SIRS) post open heart surgery
No full textSystemic inflammatory response syndrome (SIRS) occurs in almost all patients whom undergo open heart surgery causes the increase its morbidity and mortality. The effect of pre- and intraoperative methylprednisolone administration combined with hemofilter application in cardiopulmonary bypass machine in the reduction of SIRS incidence remains controversial. This study aimed to evaluate the effect pre- and intraoperative methylprednisolone administration combined with hemofilter on SIRS incidence after open heart surgery. This was an experimental study using prospective randomized open-blinded evaluation (PROBE) design. Ninety-five patients from Dr. Sardjito General Hospital, Yogyakarta, and Dr. Cipto Mangunkusumo General Hospital, Jakarta, who had open heart surgery within the period of December 2011 to May 2012 were enrolled in this study. The patients were randomly allocated into two groups i.e. Group A (48 patients) received pre-; intra-; and postoperative methylprednisolone (15; 5 and 5 mg/kg BW, respectively) and hemofilter and Group B (47 patients) just received intra- and postoperative methylprednisolone (15 and 5 mg/kg BW). The SIRS incidence was evaluated in 3; 24; 48 and 72 hours post surgery. This study showed that the SIRS incidence in Group B at 3 (OR= 0.12; 95%CI=0.03-0.39; p< 0.001) and 24 (OR= 0.38; 95%CI=0.14-0.996; p< 0.031) hours postoperative were significantly higher than that in Group A. In conclusion, pre- and intraoperative methylprednisolone administration combined hemofilter significantly decrease the SIRS incidence post open heart surgery
The Experience of Breast Reconstructive Microsurgery
No full textAutologous techniques in oncoplastic breast surgery may result in graft donor site morbidity. Microsurgery has become a new surgical modality for breast reconstruction; it is a less invasive procedure. In recent experience, we have applied microsurgical technique in oncoplastic breast procedures to minimize morbidity.We reviewed the charts of breast cancer/tumor patients with microsurgical reconstruction.From February 2013 to July 2016, we performed 36 perforator flaps for breast reconstruction. The mean age of the patients was 44.4±6.7 years old, with the median tumor size of 3.7 (1.5-20) cm. No special type of carcinoma (NST) was accounted in 25 (69.4%) cases. Oncoplastic breast conserving surgery (OPS) was the procedure of choice in 17 (47.2%) cases and mastectomy was followed by free flap in 19 (52.8%) patients. In OPS, we used various perforator flaps to cover the defect. Thoracodorsal artery perforator flap (TDAP) was the most common technique used in 8 (22.2%) cases, then lateral intercostal artery (LICAP) flap in 6 (16.7%) cases, anterior intercostal artery (AICAP) flap in 1 (2.8%) cases, and superficial epigastric artery (SEAP) flap in 2 (5.6%) cases. Deep inferior artery perforator (DIEP) free flap was the reconstruction option after mastectomy. During follow-up with the mean time of 12.7±11.4 months, there were 1 local recurrence, 2 regional and systemic metastases, and 1 death due to cerebrovascular disease. There were no flap loss after pedicle perforator reconstruction but total flap necrosis occurred in 5 patients with DIEP free flap. In one patient, we successfully salvaged the flap that had venous congestion. There was no seroma at donor site and no limitation in abdominal wall function after DIEP reconstruction.In our experience, microsurgical reconstruction in breast surgery has been a safe procedure and has less donor site morbidity. Flap failure rate may be improved by refining microsurgical techniqu
Mammographic Density and Estrogen Receptor α Gene Polymorphism in Javanese Women
No full textEstrogen plays important roles in breast cancer as it binds its receptor in breast tissue. The most studied variants in estrogen receptor α encoded by ESR1 gene are the ESR1 PvuII and XbaI polymorphisms, which were associated with lower sensitivity to estrogen. We determined the proportion of ESR1 XbaI and PvuII polymorphisms in Javanese woman in Yogyakarta, Indonesia and analyzed the correlation between genetic variations with mammogram density. ESR1 XbaI and PvuII polymorphisms of 50 cases and 58 controls were identified using PCR-RFLP. Breast density was assessed based on digitizer mammograms. Quantitative analysis was performed using an interactive program based on cumulus of two thresholds. Mean of density and frequencies of SNPs were compared between cases and controls to identify the association between SNPs and cancer susceptibility. Mammographic density was significantly higher in cases (52%) than controls (0.41%) (p 0.05), while the proportion between AA and GG was significantly different (p < 0.05). Haplotype 2 (CG/PX) was associated with lower sensitivity to estrogen and reflects a decrease of mammographic density. These findings were consistent with other studies that showed that ESR1 polymorphisms may affect breast cancer risk through differences in breast density.
The effects of duration of mesenteric artery ligation to the ratio of TNF-α/IL-10 in a rat model of acute mesenteric ischemia (AMI)
No full textThe mortality rate of acute mesenteric ischemia (AMI) is high due to the delay in diagnosis.Determination of potent biomarker for early AMI is the key in reducing the mortality. As aproinflammatory cytokine, the level of TNF-α might be affected during the ischemia andreperfusion, with the prediction duration of 60-120 min. High TNF-α level may stimulatethe upregulation of IL-10 as an inhibitor of TNF-α. This provides a new opportunity forearly diagnosis of AMI by measuring the ratio between those two cytokines. The purposeof this study was to investigate the effect of duration of the mesenteric artery to theratio of TNF-α/IL-10 in a AMI rat model. This was an experimental study using Wistarrat. We performed mesenteric artery in 28 male rats to produce an AMI model, withligation duration of 0, 30, 60, 90, 120, 150, and 180 minutes. At the end of ligation,blood samples were taken for measurement of TNF-α and IL-10 level using ELISA. For themicroscopic examination of tissue necrosis, intestinal organ samples were taken and madeinto paraffin blocks and stained using Haematoxylin-Eosin. TNF-α increased in minute 120compared to other treatment groups (p<0.05). IL-10 increased in minute 180 comparedto control group (p<0.05). Microscopic examination showed that the duration of ligationaffects the structure and morphology of intestinal mucosa characterized by discolorationof organs along with increasing the ligation duration. Ligation of the superior mesentericartery was found to be significantly increased the TNF-α level and to be compensated byincreasing IL-10. It is assumed that when the IL-10 level, that has protective effect as aninhibitor, higher than TNF-α level as a proinflammatory cytokine on duration 150 minutes,it means no more inflammatory or cells is dead. Therefore TNF-α/IL-10 ratio can be usedas a biomarker candidate of prognosic factor management of AMI
Simple reaction time: how it relates to body mass index (BMI), gender and handedness in Ghanaian students
No full textThe purpose of this study was to examine the relationship between gender, handedness and body mass index (BMI) with simple reaction time. The study was conducted amongst 501 (232 females and 269 males) untrained University of Cape Coast students, Ghana whose ages ranged from 17-29 years. In this study it was found that males had faster reaction times than females, likewise the mean reaction time of the left hand was also faster than that of the right hand. There was however no significant difference in the mean reaction time across BMI classes In conclusion, simple reaction time is influenced by gender and handedness but appears not to be influence by BM
Cytogenetic Analysis for Research and Services
No full textAbstractThat the correct chromosome number in man is 46 was first recognized by Tjio and Levan in 1956. Perhaps few Indonesians know that Tjio was an Indonesian scientist studying in Sweden and then living in the US. Cytogenetic analyses are commonly performed to determine both structural and numerical chromosome aberration, whilst changes in chromosomes can lead to birth defects, syndromes, or even cancer. Several chromosomal aneuploidy syndromes were identified after the establishment of various chromosome banding techniques in late 1960’s. Specific cell culture media was found to express fragile site in the beginning of 1970’s and since then, inherited Fragile X Mental Retardation syndrome could be diagnosed. However, some female permutation cases have been often misdiagnosed. Further molecular analysis has resolved this problem by revealing more CGG repeats in the promoter region FMR1 gene, which is related to the expression of fragile site and the severity of the diseases.In Disorder of Sex Development (DSD), early gender assignment and reconstruction surgery has been challenged because of the dilemma of gender identity development in later life. Cytogenetic analysis for the first-line gender assignment is important in newborn with DSD. Proper diagnosis with hormonal and mutation analysis should be elucidated to avoid medical, psychological, and social aspect in adult life. The most frequent genetic cases in our clinical experiences have been Androgen Insensitivity Syndrome and Congenital Adrenal Hyperplasia. Female Complete Androgen Insensitivity Syndrome (CAIS) with main symptom primary amenorrhea without cytogenetic analysis has often been diagnosed as inguinal hernia because of testicle location and size.Diagnosis and treatment of several leukemias and lymphomas, as well as some solid tumors, depend on cytogenetic analyses to demonstrate consistent, specific chromosomal aberrations. Chromosome analysis in hematologic malignancy is indicated to support diagnosis, select therapy regimen, and elaborate prognosis. Specific chromosome translocations have been identified for hematologic malignancy. The breakpoints of several of these translocations have been cloned. Several loci of oncogene have been identified and sequenced. Molecular genetic analysis will replace cytogenetic analysis and shift the requirement for studying metaphase cells. Therefore, chromosome analysis in genetic disease and cancer should be attained with advanced molecular techniques, such as Fluorescence In Situ Hybridization (FISH) and microarray CGH analysis. Cytogenetic analysis is still useful and applicable in genetic disease diagnosis, sexual assignment, and hematologic malignancy in the laboratory with minimal equipments. Molecular analysis as a part of health care services in Indonesia has been limited in research centers in university setting; therefore, a comprehensive diagnosis with genetic analysis has often been improbable
BRCA1 and BRCA2 Germline Mutations in Asian and European Populations
No full textWomen who carry a pathogenic mutation in the breast cancer susceptibility genes BRCA1 or BRCA2 (BRCA) have markedly increased risks of developing breast and ovarian cancers during their lifetime. It has been estimated that their breast and ovarian cancer risks are in the range of 46-87% and 15-68%, respectively. Therefore it is of utmost clinical importance to identify BRCA mutation carriers in order to target unaffected women for prevention and/or close surveillance and to help affected women choose the best chemotherapy regimen.Genetic testing for BRCA germline mutations is expanding in clinical oncology centers worldwide. Given the high costs of complete BRCA gene screens, a lot of effort has been expended on deciding upon whom to test. Relevant issues involved in decision making include the prior probability of a woman having a BRCA mutation, which is a function of her age and her disease status, her ethnic group, and her family history of breast or ovarian cancer.The frequency and spectrum of mutations in these genes show considerable variation by ethnic groups and by geographic regions. Most studies have been conducted in European and North American populations, while studies in Asian, Hispanic, and African populations are fewer. In most populations, many BRCA mutations were identified, which were distributed all over the genes. However, in some populations, a relatively small number of specific BRCA mutations are recurrent and account for the majority of all mutations in that population. Many of the recurrent mutations are founder mutations, which were derived from a common ancestor. Founder mutations are present in Ashkenazi Jewish, European, and Islander (Faroe, Easter, and Pitcairn) populations. Such mutations have also been identified in patients from several Asian, South American, and African countries. Population-specific genetic risk assessment and genetic mutation screening have been facilitated at low costs. Given that mutations in the BRCA genes are distributed in populations throughout the world, it is important that the benefits of genetic testing and of targeted therapies be made available not only to women from developed countries in Europe and North America, but also to those from less developed countries in Asia, Africa and South America