Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Plasma DNA as a potential biomarker for breast cancer detection
No full textBreast cancer is a major malignancy among Indonesian women. It is often diagnosed inthe later stages of cancer, which leads to poor prognosis and survival of the patients.This study investigated plasma DNA concentration as a potential biomarker for breastcancer. The benefit of using this detection is the cost-effectiveness and the samples canbe collected from patients using non-invasive methods. Plasma samples were obtainedfrom healthy controls (n=18) and cancer patients (n=22). Each sample was split intotwo equal portions for DNA isolation using two different methods for the NaI methodand a commercially available kit (Qiagen/ QA) method. The DNA concentration wasdetermined by using a GeneQuant spectrophotometer (Pharmacia). The t-test was usedfor statistical analysis, which was performed using the SPSS 17.0 software. Compared tothe commercial method, extraction using NaI yielded higher DNA concentration, both fromsamples of healthy controls and cancer patients (p=0,008 and p=0.000, respectively).Furthermore, regardless of the isolation method used, the plasma DNA concentrationwas higher in healthy controls than in cancer cases (p=0,032 and p=0.005, for NaIand QA methods, respectively). In conclusion, isolation methods significantly affect DNAconcentrations. The plasma DNA concentration of healthy controls is significantly higherthan those of the cancer cases, suggesting that plasma DNA concentration might be apotential biomarker for breast cancer detection with less invasive sampling method thantissue biopsies
Clinical Characteristics of Adult Uncorrected Secundum Atrial Septal Defect, A Pilot Study
No full textABSTRACTAtrial septal defect (ASD) is the most frequent congenital heart disease in adulthood. Pulmonary hypertension (PH) complicating ASD compels patients seeking medical assistance because of its disabling symptom. Most adult ASD develop PH which render significant morbidity and mortality. The aim of the study is to characterize the clinical profiles of adult patients with ASD. The study design was cross sectional. The subjects were enrolled consecutively from outpatient clinics and inpatient wards. The demography, medical and imaging data were collected and recorded in case report form. Descriptive statistics was applied to characterize the subjects. Seventy-six subjects were enrolled. The majority were women (77.6 %) in the productive and child-bearing ages (63.2%). The most common symptoms were dyspneu on effort, fatigue, and palpitation. Most subjects had functional capacity of WHO class functional II (70.2 %). The mean oxygen saturation was 96.4 %. Based on the echocardiography examination, 77.6% of subjects had suffered from PH. The mean longest diameter of defects were 2.7 cm. The direction of blood flow was mostly left to right (77.6 %). Left and right ventricle function were within normal limit. Right heart catheterization showed mean left atrial pressure 11.5 mmHg, which confirmed the precapillary or arterial PH. Mean pulmonary artery pressure was 42.0 mmHg. The pulmonary artery resistance index mostly less than 4 Wood Unit/ m2 (63.7 %), indicating the feasibility to close the defect. Whereas 24.6 % of subjects were contraindicated for closing. Pulmonary artery hypertension (PAH) was diagnosed in 77.6 % subjects, meanwhile 13.2 % had borderline PAH. In conclusion, most adult ASD patients had developed PAH, mostly young women in productive ages, mainly visited hospital due to symptom of PH, the direction of flow predominantly left to right side and mostly had reduced functional capacity
DIPEPTIDYL PEPTIDASE 4 (DPP-4) INHIBITORS FOR THE TREATMENT OF TYPE 2 DIABETES MELLITUS
No full textABSTRACT Diabetes mellitus (DM) is a chronic disease which caused around 1.5 million deaths in 2012. Type 2 diabetes mellitus (T2DM) accounts for 90% of DM worldwide. The prevalence of T2DM is increasing due to obesity. Clinical guidelines recommend the use of metformin as the first-line treatment, followed by the addition of 1 or 2 oral antidiabetic drugs (OADs), such as sulphonylurea (SU), an alpha-glucosidase inhibitor, or thiazolidinediones (TZDs). Recently, newer agents such as dipeptidyl peptidase 4 (DPP-4) inhibitors have been added to those treatment algorithms. The DPP-4 inhibitor is a class of OAD that inhibits the DPP-4 enzyme. Sitagliptin, saxagliptin, vildagliptin and linagliptin are DPP-4 inhibitors available for the treatment of T2DM in Indonesia and many other countries. The DPP-4 inhibitors have similar glycemic efficacy. However, they produce a moderate improvement in glycated hemoglobin (A1C). There are limited numbers of head-to-head trials of DPP-4 inhibitors. In addition, there are no data on the long-term DPP-4 inhibitors use safety (more than two years), mortality, diabetic complications, or health-related quality of life. Although DPP-inhibitors are not used as initial treatment for a majority of patients with T2DM, DPP-4 inhibitors can be used as add-on therapy in T2DM patients who are intolerant to, have contraindications for, or uncontrolled with the use of metformin, SU, or TZDs. The exact role of DPP-4 inhibitors among several other agents to manage T2DM is not clear. There are only a small number of long-term studies on DPP-4 inhibitors assessing the glycemic decrease efficacy, important clinical outcomes (cardiovascular events, mortality), or safety. In patients with chronic renal failure considered to use DPP-4 inhibitors, linagliptin can be recommended. There are inadequate data to assess the effect of DPP-4 inhibitors on the occurrence of acute pancreatitis. Overall, DPP-4 inhibitors are well-tolerated
The percentage of macrophage numbers in rat model of sciatic nerve crush injury
No full textABSTRACTExcessive accumulation of macrophages in sciatic nerve fascicles inhibits regeneration of peripheral nerves. The aim of this study is to determine the percentage of the macrophages inside and outside of the fascicles at the proximal, at the site of injury and at the distal segment of rat model of sciatic nerve crush injury. Thirty male 3 months age Wistar rats of 200-230 g were divided into sham-operation group and crush injury group. Termination was performed on day 3, 7, and 14 after crush injury. Immunohistochemical examination was done using anti CD68 antibody. Counting of immunopositive and immunonegative cells was done on three representative fields for extrafascicular and intrafascicular area of proximal, injury and distal segments. The data was presented as percentage of immunopositive cells. The percentage of the macrophages was significantly increased in crush injury group compared to the sham-operated group in all segments of the peripheral nerves. While the percentage of macrophages outside fascicle in all segments of sciatic nerve and within the fascicle in the proximal segment reached its peak on day 3, the percentage of macrophages within the fascicles at the site of injury and distal segments reached the peak later at day 7. In conclusions, accumulation of macrophages outside the nerve fascicles occurs at the beginning of the injury, and then followed later by the accumulation of macrophages within nerve fascicle
Effect of Cognitive Behavior Therapy (CBT) Intervention on Serum Cortisol Level and Pain Score of Patients with Advanced-Stage Cervical Cancer
No full textABSTRACTCervical cancer is the most frequent cause of death related gynecology malignancy in Indonesia. Recent management of advanced-stage cervical cancer has still not been able to improve the prognosis. Chemotherapy and radiation intervention, as well as therapy may resulting pain and cause psychological stress for some patient, furthermore it could effect on the quality of life. Cortisol is a hormone of adrenal cortex, it secretes due to increased production of ACTH by anterior pituitary which is associated with stressful condition. To analyze the effect of Cognitive Behavior Therapy (CBT) intervention on serum cortisol levels and pain score of patients with advanced-stage cervical cancer. This experimental study was a double blind non-randomized clinical trial post-test group design. It was using two groups in this study, each group consisting of 15 subjects, the treatment group were given CBT and standard therapy, while the control group were only given a standard therapy. The study was conducted in the gynecology oncology ward and the gynecology oncology clinic of Dr. Moewardi Hospital Surakarta and Prodia Laboratory, from January - March 2015. Cortisol level of the treatment group was 1.03 ± 0.71 mg / dL, and the control group was 11.41 ± 7.34 mg / dL. Pain score in the treatment group was 4.46 ± 0.83, and the control group was 7.34 ± 0.74. There are significant differences in serum cortisol level decrease (p = 0.00) and pain score (p = 0.00) between the CBT intervention with standard therapy group compared and the standard therapy only group
Evaluation of artemisinin-based combination therapy (ACT) to uncomplicated falciparum malaria patients in Purworejo District, Central Java, Indonesia
No full textArtemisinin-based Combination Therapy (ACT) to treat uncomplicated Plasmodiumfalciparum malaria has been applied in Purworejo District, Central Java, Indonesia, since2004. However evaluation of the two ACT regimens used ie: Artesunate Amodiaquine(AAQ) and Dihydroartemisinin-Piperaquine (DHP) co-administered with Primaquine (PQ)has not been performed. This study aims to evaluate the efficacy and side effects ofAAQ+PQ and DHP+PQ treatment in uncomplicated falciparum malaria in Purworejo. Inthis descriptive and observational study, 46 Pf infected patients who fullfill the inclusionand exclusion criterias were recruited from December 2010 to August 2011. StandardACT treatment were given to the patients followed by WHO drug efficacy evaluation for28 days. The clinical symptoms and adverse events was also evaluated over the course ofthe treatment. From all recruited subjects, 37 patients received DHP+PQ and 9 patientsreceived AAQ+PQ. On the DHP+PQ treated patient, all subjects were free of asexualand sexual parasites by Day-3 while on AAQ+PQ treated patient, this parasite clearancewas achieved faster as early as on D-2 at the latest. On the otherhand, the disappearanceof fever was also last longer in DHP+PQ treated patient which in one patient last onD-14, while in AAQ+PQ treated patient, the symptom of fever dissappeared by D-2at the latest. No Early or Late Treatment Failures were found on either DHP+PQ orAAQ+PQ treatment as well as clinical and parasitological failures. However, the presenceof adverse events cause by both drugs should not be ignored to ensure drug compliance
Indonesian medicinal plants as sources of secondary metabolites for pharmaceutical industry
No full textMedicinal plants are widely used in traditional medicine in both underdeveloped anddeveloping countries in the word until now. Some secondary metabolites isolated frommedicinal plants have been developed as modern drugs. New antimalarial artemisinin isan example of modern medicine that developed from Artemisia annua L, a plant usedin China since 4,000 years ago. Indonesia is endowed with a rich natural resource.The biodiversity comprises thousands plant species. Therefore, Indonesian flora andfauna are a remarkable opportunity for the development of secondary metabolites forpharmaceutical industry. The Indonesian National Agency for Drug and Food Control,Republic of Indonesia (Badan Pengawas Obat dan Makanan, Republik Indonesia = BPOMRI) classifies traditional medicine into three classes, namely jamu (Indonesian indigenoustraditional medicine), standardized herbal medicine and phytopharmaca based on itsscientific evidences. The BPOM also determined 9 medicinal plants for focusing researchfor drug development. This paper discusses some secondary metabolites and theirpharmacological activities of the following 9 selected Indonesian medicinal plants namelyPiper retrofractum Vahl, Andrographis paniculata Ness, Curcuma xanthorrhiza, Psidiumguajava L, Syzigium polyanthi, Morinda citrifolia, Guazuma ulmifolia Lamk, Zingiberofficinale, and Curcuma domestica collected from various publications. Furthermore,several modern drugs derived from medicinal plants are also discussed
THE EFFECTS OF THE ETHANOL EXTRACT OF MAHONI SEEDS (Swietenia macrophylla King) ON THE DIABETIC RATS INDUCTED WITH STREPTOZOTOCIN
No full textbackground: Hyperglycemia causes oxidative stress and lead to diabetes complications. MDA is the result of peroxyde lipids due to the increasing ROS and causes glomerular hypertrophy resulted in a decrease marked with the increasing filtrate rate with the increasing creatinine serum and the presence of protein in the urine. Swietenia macrophilla King has as antidiabetic activity of which its parts to be used are often seeds that contain saponins.Objective: The study was conducted to determine the effects on renal protection by observing the serum creatinine parameters, MDA, and urinary protein.Methods: The subjects were 30 Wistar strain white rats aged 6-8 weeks weighing 180-200 grams. The subjects were conditioned with 60 mg/kgBW streptozotocin induced diabetes. Subjects were grouped into the control group, the diabetes, the ethanol extract of mahogany seeds (S. macrophylla King) 50 mg/kgBW group, 100 mg/kgBW and 200mg/kgBW groups. The administering of ethanol extract of mahogany seeds (S. macrophylla King) was conducted for ± 21 days and serum creatinine inspection parameters, MDA and urinary protein before and after the extract mahogany.Results: The study showed that within the group of ethanol extract of mahogany seeds (S. macrophylla King) 50 mg/kgBW, 100 mg/kgBW, 200 mg/kgBW there are decreasing levels of blood glucose, serum creatinine, urine protein MDA and significant with p <0.05 and ethanol extract of mahogany seeds (S. macrophylla King) 200mg/kgBW give effect best.Conclusion: Administering ethanol extract of mahogany seeds (S. macrophylla King) to Wistar strain rats can prevent complications towards impaired renal function by observing the decline of serum creatinine, MDA and urinary protein. Keywords : hyperglycemia, Swietenia macrophylla King, serum creatinine, MDA, urinary Protein
Hypophosphatemia in lung disease. Is there any cause and effect relationship ?
No full textMany reports showed that hypophosphatemia is prevalent in patients of lung disease with respiratory failure. Correction for hypophosphatemia may improve respiratory capacity, hence, morbidity and mortality. Serum phosphate levels may reflect intracelluler phosphate pool. A decrease in intracellular phosphate may implicate muscular adenosine tri-phosphate (ATP) and red blood cell 2,3 di-phosphoglycerate (DPG) synthesis. Reduction in respiratory muscle ATP will reduce respiratory since ATP is the the source of energy for muscle contraction. Reduction in red blood cel 2,3 DPG will shift hemoglobin dissociation curve to the left that lead to the disturbance of oxygen extraction by the cells. Hypoxia may be resulted from those processes, therefore, recoils the poor capacity of the respiratory muscle. Underlying primary lung diseases may partly play a role in the genesis of hypophosphatemia. Drugs often used for the disease, such as corticosteroids, xathine identification and treatment of hypophosphatemia in lung disease with or without respiratory failure in order to improve morbidity and mortality of the patients.Keywords : hypophosphatemia - adenosine tri-phosphate - 2,3 di- phosphoglycerate - hypoxia – respiratory- failure
Analysis of haplotype associated with mutation in a-thalassemia
No full textB-thalassemia is mainly caused by point mutation of B-gene. There are more than 130 mutations, while only a little more than 20 haplotypes in B-gene. Many types of mutation are assosiated with one haplotype. On the other hand, one type of mutation may be associated with more than one chromosome haplotypes. The association of mutation and haplotype raises many questions. An analysis of haplotype has proved to be very useful to discover many aspects of thalassemia. The occurrence of certain mutation in a population might be predicted from the common haplotype of the population. Haplotype has been used to answer the question whether a certain mutation has multiple or single origin; for example the multiple origin of BE-gene in Cambodian population and the single origin of codon 39(CAG -+TAG) are associated with nine different haplotypes in Sardinia. It is suggested that haplotype probably influences the manifestation of thalassemia resulting in thalassemia intermedia.Key words : thalassemia - haplotype - point mutation - recombination - phenotyp