The cortisol level, depression anxiety stress score, and quality of life in patient with advance stage cervical cancer after two years of psychorative intervention

Background: Cervical cancer is the second most cancer in women after breast cancer. Emotional stress is the most common comorbid attacking women with advanced-stage cervical cancer, where 13- 40% are depressed which can increase mortality by 39%. Management of cervical cancer has so far focused on standard chemoradiation treatment, but has paid less attention to other aspects such as cognitive, psychological, spiritual and physical. The study aims to determine cortisol levels, Depression Anxiety Stress (DAS) score and quality of life for patients with advanced-stage cervical cancer after two years of psychocurative intervention

Methods: The pretest-posttest group design experimental study, continued previous studies, 30 subjects with advanced-stage cervical cancer patients, divided into 15 subjects received standard and psychocurative treatments, the other 15 as controls only received standard therapy. Psychocurative is done independently three times a week for two years based on psychocurative smart books. Home visits are conducted once per week to monitor, motivate the subject to do the psychocurative independently properly and discipline. Cortisol levels, DAS scores and quality of life were measured before and after treatment, the data were analysed by paired t-tests in the SPSS 25 program.

Results: One control group subject died before the study was completed. Before and after psychocurative, cortisol levels in the treatment group were 12.29 ± 4.36 and 6.71 ± 3.88 with p<0.05. The Depressive scores were 14.13 ± 3.02 and 8.46 ± 3.07 with p<0.05. The Anxiety scores 12.13 ± 1.64 and 6.73 ± 2.40 with p<0.05. The Stress scores were 14.40 ± 2.64 and 7.27 ± 2.81 with p<0.05. The quality of life score of the physical domain were 55.00 ± 6.54 and 62.67 ± 8.63 with p <0.05. The Psychical domain was 57.00 ± 9.41 and 65.66 ± 8.42 with p <0.05. The Social domain was 33.67 ± 9.15 and 41.67 ± 10.29 with p <0.05. The Environmental domain was 63.00 ± 1.93 and 69.33 ± 7.76 with p <0.05

Conclusions: Psychocurative decreases serum cortisol levels, decreases depression, anxiety, and stress scores and improves the quality of life of the physical, psychological, social and environmental domains.

The expression of TNF-α, IL-1β, and IL-10 in the diabetes mellitus condition induced by the combination of spirulina and chitosan

Background: Rapid wound healing is needed after tooth extraction treatment so that prosthodontics treatment can be done immediately. However, systemic diseases, such as diabetes mellitus, can inhibit the wound healing process. The state of hyperglycemia in people with diabetes mellitus can interfere with the function of macrophages and neutrophils. This condition can cause an imbalance in the cytokines IL-1β, TNF-α and IL-10 that are produced by macrophages and thus will affect the wound healing process. Spirulina and chitosan are two natural substances that have been proven to have anti-inflammatory properties. This study was aimed to determine whether the combination of 12% spirulina and 20% chitosan can accelerate wound healing through its intervention in cytokines IL-1β, TNF-α and IL-10.

Method: The samples used were 36 Wistar rats suffering from diabetes mellitus and divided into control groups induced by CMC Na base gel and treatment groups induced by the combination of 12% spirulina and 20% chitosan in the socket. These 2 groups were further divided into groups terminated on one day, three days and seven days post-extraction.

Results: The amount of IL-1β and TNF-α in the treatment groups is lower than that of the control group. Meanwhile, the treatment group of IL-10 showed an increase in IL-10 levels. 

Conclusion: The combination of 12% spirulina and 20% chitosan can accelerate wound healing. They are decreasing the amount of pro-inflammatory cytokines IL-1β and TNF-α as well as increasing the number of anti-inflammatory cytokines IL-10.

Transarterial Chemoembolization in Hepatocellular Carcinoma: A Clinical Efficacy Study of Ganoderma Lucidum Extract Polysaccharide Peptide β-Glucan

Background: Hepatocellular carcinoma (HCC) is a primary liver malignancy with high prevalence rate, associated primarily with the Hepatitis B Virus. HCC is the third leading cause of death worldwide. The prevalence in Indonesia is estimated at 100 per100,000 inhabitants. Treatment is generally ineffective as patients are already at advanced stages when diagnosed. Trans-arterial Chemoembolization (TACE) is a promising treatment, and β-Glucan combined therapy is expected to treat HCC more efficiently. This study evaluated the treatment response of TACE in HCC combined with β-Glucan orally.

Methods: A randomized clinical trial was conducted on 63 patients with HCC. The subjects of the study were randomly assigned into two groups: 32 administered TACE plus β-Glucan, and 31 with TACE plus placebo.

Results: In the β-Glucan group, there were four patients (12.50%) with complete response, 16 (50%) partial response, 3 (9.38%) no response, and 9 (28.12%) in deteriorated response. In the placebo group, there were 0 complete response, 11(35.48%) partial, 2(6.45%) no response, and 18 (58.07%) deteriorated response. The survival rate of the β-Glucan group was longer (median 39 weeks) than the placebo group (median 26 weeks). CD4, CD8 and IL-2 post-TACE increased significantly (p<0.05). The placebo group had 4.143 times, significantly higher hazard risk (p<0.05).

Conclusion: HCC therapy with a combination of TACE and β-Glucan is beneficial to increase the therapeutic response, immunity and survival rate.

A Randomised Controlled Trial: The effect of oral astaxanthin as an anti-inflammatory agent on serum level of e-selectin in acne vulgaris

Background: E-selectin plays a pivotal role in the inflammatory response of acne. Astaxanthin (AST), an supplement claimed having anti-inflammatory and antioxidant properties, has potential in inflammatory skin therapy. This study aims to determine the effect of oral AST as an anti-inflammatory agent on the serum level of e-selectin in acne vulgaris. 

Methods: This is a double-blind, randomized controlled trial study with a pretest and posttest control group design. The participants were 34 acne vulgaris patients with inflammatory lesions (papulopustular acne). The participants are randomly assigned to the treatment or control group to receive oral tablet of 4 mg of AST or placebo in addition to standard acne therapy of tretinoin cream 0.025% and clindamycin cream 1.2%. Each group was measured for the serum level of E-selectin before therapy (pretest) and after one month of therapy (posttest). 

Results: The pretest and posttest level of the mean serum e-selectin in the treatment  group were 50.21 ± 21.12 ng/ml and 50.04 ± 22.99 ng/ml, respectively. There is no significant difference between the pretest and posttest of the mean e-selectin level in the treatment group (p=0.943). While, the pretest and posttest of mean serum e-selectin level in control group were 57.84 ± 20.71 ng/ml and 55.87 ± 15.98 ng/ml, respectively. There is no significant difference between the pretest and posttest of the mean e-selectin level in the control group (p=0.453). There was a decrease in the mean serum e-selectin level of the treatment and control groups one month after therapy. However, the decrease of the mean e-selectin level between treatment and control group is not significantly different (p=0.547).

Conclusion: The addition of oral AST to standard acne therapy shows no significant difference in reducing the serum e-selectin level compared to placebo.

Physiological and morphological peculiarities of children with Down’s syndrome: A brief review

Background: There are several approaches to solve the problems of many pathological processes’ correction, such as clinical pathology and experiment in modern science. At the same time, genetically-conditioned diseases usually demand researchers’ attention and generalization of earlier information for making the correction foundation of their manifestations in the future. Down’s syndrome is considered to be one. Our objective was to review existing literature regarding physiological and morphological peculiarities of children with Down’s syndrome.

Methods: A total of 30 relevant literature were reviewed regarding physiological and morphological peculiarities of children with Down’s syndrome. The data collection for eligible articles were conducted from 1989-2017. Different database and manual search methods were used to find the topic-related articles.

Results: Abnormalities of heart, gastrointestinal tract and the system of urinary excretion are considered as the underlying congenital abnormalities for children with Down’s syndrome influencing their lifespan. People with Down’s syndrome have difficulties in their cognitive activity, such as lag in development, speaking, and reading. Limitation existence of ideas and scarcity of conclusions make studying different school subjects impossible for children with Down’s syndrome. They need more time to master new skills and remembering new material. On the other hand, children with Down’s syndrome possess positive personal qualities: they are tender, friendly and even-tempered. Conclusion: Down’s syndrome is considered as one of the most common genetic diseases occurred newborns. Children with Down’s syndrome have several physical abnormalities. It is important to understand children with Down’s syndrome as a whole, as they can be put into a well-adjusted system of rehabilitation.

Efficacy of revision urethroplasty in the treatment of recurrent urethral strictures at a tertiary hospital (Kenyatta National Hospital–KNH), in Nairobi Kenya: 2015-2018

Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.

Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.

Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.

Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.

The effectiveness of puzzle therapy on cognitive functions among elderly with dementia at Balai Pelayanan Sosial Tresna Werdha (BPSTW) Yogyakarta, Indonesia

Background: People with Alzheimer's dementia can experience a disruption in their daily activities, which can increase the burden of treatment costs. Puzzle therapy can encourage the release of the expression of the person living with Alzheimer's through artistic expression and creative processes. This study aims to determine the effectiveness of puzzle therapy on cognitive function of elderly dementia.

Methods: A quasi-experimental approach using pre-post with control group design was used in this study.  The number of respondents in the intervention group was 44 and in the control group was 27. The cognitive function on the elderly was assessed by the questionnaire of the Hopkins Verbal Learning Test (HVLT). Data were analyzed using SPSS version 17 for Windows. Bivariate paired T-test and Independent T-test were used in this study.

Results: There was a significant increase in the mean value of cognitive function among the intervention group (2.16±2.67; P=0.013) after puzzle therapy. The intervention group without dementia was also found significantly increase (2.10±2.19; 0.000). While in the control group who had dementia obtained a non-significant decrease in cognitive functions (0.29±0.75; 0.356). However, the control group without dementia was found to be significantly increased (0.5±0.7; 0.008) in the cognitive function.

Conclusion: Puzzle therapy intervention can improve cognitive scores significantly in all elderly people.

Surgery in foreign body ingestion and aspiration: descriptive study

Background: Foreign bodies in upper digestive tract, as well as respiratory tract, are common cases in daily life. This incident can occur in all age groups, ranging from children to elderly. Endoscopy and bronchoscopy are the first treatment option, nevertheless, case with complications which endoscopy or bronchoscopy cannot be done, it requires another extraction procedure specifically surgery.

Method: We conducted a retrospective review of patients who came to consult to Thoracic Cardiovascular Surgery Department by ENT Department. The data obtained are from 2009-2019.

Result: Out of 290 patients recorded, experiencing foreign body impaction in both digestive and respiratory tract for the last 10 years, the highest number was digestive tract with 243 cases (83.8%) and 47 respiratory tract cases (16.2%). From 17 patients who underwent surgery, 70.6% men and 29.4% women. The age group of children and adults had the same number as seven patients (41.2%) and elderly with three patients (17.6%). The highest number of surgical procedure was thoracotomy with 10 patients (58.8%) while cervical esophagotomy with seven patients (41.2%).

Conclusion: The failure of the extraction procedure using endoscopy or bronchoscopy in the case of a foreign body leads to surgery as a definitive therapy for patients. The age group of children and adults have same number. Cases of impaction in the esophagus are the most common. The most common surgical procedure performed is thoracotomy. In this study the success rate of extraction by surgery reached 100% without additional morbidity and mortality.

Correlation of neutrophils lymphocytes ratio with femur muscle damage due to acute limb ischemia in white Wistar rats

Background: Acute limb ischemia (ALI) is a sudden decrease in limb perfusion that threatens limb viability and requires urgent evaluation and management. Assessment determines whether the limb is viable or irreversibly damaged. Neutrophil-lymphocyte ratio (NLR) is a useful marker for cardiovascular disease to delineate the prognosis. Endothelial dysfunctions related to atherosclerotic plaques are usually associated with states of neutrophilia together with lymphopenia processes.

Methods: This study was a post-test only control group performed on Wistar strain white rats. Thirty rats were divided into 5 groups, Control group (K), treatment group one (P1) examined NLR and femoral muscle tissue after 3 hours of ALI, P2 after 4 hours of ALI, P3 after 5 hours of ALI and P4 after 6 hours of ALI. Muscle tissue was histologically examined.

 Results: The duration of ALI increases the NLR value in Wistar strain white rats, the NLR value examined 6 hours after the rats experienced ALI increased significantly compared with the NLR values examined in the control group, the group examined 3 hours, 4 hours and 5 hours after the rats had ALI (p = 0.004). Necrotic muscle tissue very strongly correlated with the duration of ALI (r = 0.860, p<0.001). NLR value is strongly correlated with muscle tissue damage (r = 0.634, p<0.001).

Conclusion: The duration of ALI increases the NLR value in wistar strain white rats, NLR values increased significantly after 6 hours of ALI. Necrotic muscle tissue occurs after six hours of ALI. NLR value is strongly correlated with muscle tissue damage. Revascularization must be done within 6 hours to prevent permanent damage.

Reincarnation-Balinese local wisdom as supportive therapy in the elderly with depression: a case study

Background: Reincarnation (reborn after death), is a Hindu belief in Bali where it is proven by 'ngaluwang' ritual. In this ritual, every person who has a newborn baby will ask the help of  'orang pintar' to find out whose atman (spirit) has manifested in the baby. By returning to the world, there is no more sadness or feeling of loss in the elderly who suffers from the death of a spouse or other family member. This case study aims to know the reincarnation as supportive therapy for the elderly with depression.

Case Description: A qualitative case study with in-depth interviews has been conducted by 2 (two) elderly people with a history of depressive disorders from the community. The first case came from a retired woman 72 years old and other case was derived from a female-farmer 80 years old. Face-to-face interview assessment has been evaluated to the cases and narrative synthesis about the findings has been written by qualitative approach.  From the case study, the elderly experienced improvement in depressive symptoms, where feelings of loss, sadness, loneliness, guilt and hopelessness disappeared after the return of dead family members’ spirits into the world. The reincarnation of a loved one makes sadness and loss cease to exist, so symptoms of depression are healed.

A rare case of penetrating lung and cardiac injury due to late migration of multiple Kirschner-wire after shoulder fracture fixation

Introduction: Penetrating foreign body through lung and cardiac is very uncommon case and may lead to life-threatening complication.

Case: We reported an unusual case of penetrating lung and cardiac injury as a complication of open reduction and internal fixation combined with transfixing wire of right glenohumeral procedure.

Conclusion: The Kirschner wires were successfully extracted by using heart-lung machine (HLM) through thoracotomy and sternotomy approach, consecutively.

Obstructive jaundice as manifestation of relapsing Hodgkin’s Lymphoma: the success of chemotherapy (case report)

Background: Hodgkin's lymphoma is a hematologic malignancy of lymphocyte cells. Intrahepatic or extrahepatic disorders can cause jaundice associated with lymphoma. An extrahepatic obstructive jaundice due to lymphoma is still rarely reported, the incidence is only 1.3% out of 370 patients.

Case Description: A male patient, 44 years old, admitted to the hospital because his eyes and all over his body became yellowish. He also felt itchy on his skin, and his stool color was pale. The patient was diagnosed with a post-chemotherapy relapse of Hodgkin's lymphoma twice with different regimens. The first chemotherapy was with the CHOP regimen. We evaluated the patient nine months after the chemotherapy with abdominal CT-scan, and we found paraaortic lymphadenopathy with infiltration to the spleen and gaster. Then, the patient was re-chemotherapy using Mesna's ICE regimen. Seven months after the second chemotherapy, the patient was re-admitted to the hospital with jaundice throughout his body. His laboratory results were 25.3 mg/dl for total bilirubin, 21.5 for direct bilirubin, 199 U/L for AST, 213 U/L for ALT, 469 mg/dl for ALP, and 6,400/mm3 for leukocytes. We found gall bladder hydrops and Intra-Hepatic Bile Duct Dilatation (IHBD) during an abdominal ultrasound examination. The results of the PET-scan showed multiple metastases to the peritoneal/omentum and diffuse lymphomatous infiltration in the gastric. After that, the patient was given the third chemotherapy with gemcitabine and vinorelbine regimens. His laboratory results in three weeks post-chemotherapy were, 6.4 mg/dl for total bilirubin, 5.87 mg/dl for direct bilirubin, 82 U/L for AST, and 36 U/L for ALT. We also found significant clinical improvement after the third chemotherapy.

Conclusion: The diagnosis is difficult to establish because many other things can also cause obstructive jaundice. Chemotherapy is one therapeutic choice in the management of obstructive jaundice related to Hodgkin's lymphoma.