The effect of tomato juice on the expression of matrix metalloproteinase-2 (MMP-2) and type-1 collagen on the vaginal wall of the menopausal rats

Background: Aging is a multifactorial phenomenon that is characterized by a decrease in physiological functions that increases with age. Free radicals cause oxidative stress, which plays a role in the aging process. The accumulation of reactive oxygen compounds increases matrix metalloproteinase-2. Collagen can be directly destroyed by reactive oxygen compounds or through the induction of MPPs. Tomato fruit is an antioxidant, which acts as a binder and damper of free radicals that activate collagen damage. This study aims to assess the effect of tomato juice on the expression of MMP-2 and type-1 collagen on the vaginal wall of the menopausal rat.

Methods: This was a true experimental study, using Sprague-Dawley rats and tomato juice (Solanum lycopersicum). Expression of MMP-2 and type-1 collagen was examined using immunohistochemistry staining. Twenty-four healthy female rats, aged 4 months weighing 150-200 grams, were divided into 4 groups, each group as many as 6 rats. The negative control group (NC) was a group of rats with a sham procedure, given aquades for 28 days. The positive control group (PC) was bilaterally ovariectomized rats, given aquades for 28 days. The first treatment group (P1) was bilaterally ovariectomized rats, given tomato juice with a dose of 11 g / 200 g BW / day. The second treatment group (P2) was bilaterally ovariectomized rats, given tomato juice with a dose of 15 g / 200 g BW / day. Data analysis used the One-way ANOVA statistical test (α = 0.05) and different tests between groups using Games-Howell and Tukey HSD. The association between tomato juice and the expression of MMP-2 and type-1 collagen used regression tests.

Results: This study found that the lowest expression of MMP-2 was NC group (2.07 ± 0.84), and the highest was the PC group (5.72 ± 1.91). The mean MMP-2 expression in the treatment groups was lower than the PC group but still higher than the NC group. There was a significant difference in MMP-2 expression between groups (p = 0,000). There was a negative correlation between tomato juice administration and MMP-2 expression (b = -0.592). The lowest type-1 collagen expression was PC group (3.83 ± 1.44), and the highest was the P2 group (7.27 ± 2.21). The mean type-1 collagen expression in the treatment groups was higher than the PC group. There were significant differences of type-1 collagen expression between groups (p = 0.012). There was a positive correlation between tomato juice administration and type-1 collagen expression (b = 0.682).

Conclusions: Tomato juice administration can reduce the expression of MMP-2 and increase the expression of type-1 collagen on the vaginal wall of the menopausal rat. The higher the dose of tomato juice, the higher the expression of type-1 collagen.

Profiles of IgM, IgG and IgE immune responses of mice against p14, p31 and p71 proteins following immunization with crude cystic fluid of Cysticercus bovis

Background: The presence of IgM, IgG and IgE antibodies has been widely used as important markers for the differentiation of acute and chronic infection in many infectious diseases, but limited studies reported on Cysticercus bovis infection are available. This study aimed to determine the IgM, IgG and IgE responses of mice against crude cystic fluid, p14, p31 and p71 antigens as the possible diagnosis of acute and chronic cysticercosis in hosts.

Methods: Six mice were immunized four times at 10 days interval with Cysticercus bovis. Individual p14, p31 and p71 proteins were separated by using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and elution of proteins from gel with elution buffer. The crude cystic fluid, p14, p31 and p71 were used as antigens for enzyme-linked immunosorbent assay (ELISA) to measure the IgM, IgG and IgE antibody titers in mice sera before and after the first, the second, the third and the fourth immunizations.

Results: No IgM, IgG and IgE against crude cystic fluid, p14, p31, and p71 was detected in sera samples collected before the first immunization. Moderate to high titers of IgM antibodies against crude cystic fluid, p14, p31 and p71 were identified following the first, the second, the third and the fourth immunizations. IgG titers against crude cystic fluid, p14, p31 and p71 was still at a low level following the first immunization and started to increase following the second, the third and the fourth immunization. Generally, low titers of IgE antibodies against crude cystic fluid, p14, p31 and p71 were detected after each immunization. IgE responses only increased slightly against crude cystic fluid and p71 antigens after the third and the fourth immunizations. The IgM, IgG and IgE responses of mice against crude cystic fluid and p71 antigens were higher than those against p31 and p14 antigens.

Association between expression of ALDH1 and TGFb2 genes, histological and clinical findings in breast cancer

Background: Breast cancer is one of the most common malignancies. The relationship between the pathogenesis of breast tumours and their invasive behaviour is an important issue that has been discussed recently. ALDH1 and TGFb2 genes can be mentioned among the most crucial signalling and molecular pathways that play an active role in tumour invasive behaviour. The aim of this study was to determine the expression level of ALDH1 and TGFb2 genes in breast cancer and its relationship with histology in breast cancer patients.

Method and material: This cross-sectional study was done on 65 breast cancer patients who had been referred to the Army 501 hospital during the years of 1992-1994. Data was collected using the patient records, and the results of immunohistochemically staining were obtained in the laboratory. Data were analyzed by SPSS software using t-test, Chi-square and Fisher tests. The level of significance was considered to be 0.05.

Results: In this study, we assessed the expression of these genes in tissue samples of 65 patients with breast cancer and its relation with the histology and clinical progress. The expression of ALDH1 in the malignant breast tissue was 83.5% (55 out of 65 samples) and the expression of TGFb2 gene showed 54 samples (83.1%) were positive. There was a significant relationship between lymphatic drainage and ALDH1 expression.

Optimising the effect of activated carbon on the microrheological properties of erythrocyte in rats with experimentally developed obesity

Background: Remains not fully clear the impact of intestinal chelators on microrheological violation of red blood cells during the early stages of obesity. It dictates the necessity of experimental investigations' fulfilment on laboratory animals with just developed obesity in them.

Method: Ninety-four of healthy male-rats of Vistar line at the age of 2.5-3 months took into investigation. Twenty-nine animals of them had experienced no impacts and composed the control group. In 65 rats after their putting into small cages (one specimen - in a cage) during 30 days there was developed OB as the result of giving them of high-caloric diet from combined feed (47%), sweet condensed milk (44%), vegetable oil (8%) and vegetable starch (1%). Of the 35 rats received a day for 60 days of activated carbon 25 mg/kg into a stomach. There used biochemical, haematological and statistical methods of investigation.

Results: At obesity development in rats, there found a steady decrease of erythrocytes-discocytes quantity in blood. It accompanied by increase of reversibly and irreversibly changed erythrocytes' quantity in examined animals' blood. At obesity development in rats there was found quick rise of erythrocytes' sum in aggregate and these aggregates' quantity at lowering of free erythrocytes' number. During experimental obesity modelling we noticed very early in rats' blood decrease of erythrocytes-discocytes' quantity, level rise of their reversibly and irreversibly varieties with strengthening of their aggregative ability. It takes place in the background of weakening of erythrocytes' antioxidant protection and activation of lipids' peroxidation in them.

Conclusion: Application of activated carbons capable of rats with experimental obesity resolve arisen they breach microrheological properties of erythrocytes. It is clear that in obesity treatment regimens must be intestinal chelators, capable of positively affect many broken with this pathology haematological indices.

The potential application of conditioned media-mesenchymal stem cells on human oocyte maturation in assisted reproductive technology: a quasi-experimental based-study at Dr. Sardjito General Hospital, Yogyakarta, Indonesia

Background: PCOS typically characterized by a decreased level of GDF9 and BMP15, which contribute to follicular arrest. Recent research related to stem cells showed that conditioned media-mesenchymal stem cell (CM-MSC) might have a positive role in folliculogenesis. Therefore, this study aimed to assess the effectiveness of CM-MSC towards oocyte maturity

Method: A quasi-experimental design was used to examine the outcome of 3 different interventions, namely group A (4-hour incubation in standard media), group B (24-hour incubation in standard media), and group C (24 hours incubation in conventional media with addition of CM-MSC). Nuclear and cytoplasmic maturity, along with GDF9 and BMP15 levels were measured and analyzed.

Results: Sixty-three patients at an infertility clinic, RSUP Dr. Sardjito, Yogyakarta was recruited and a total of 292 germinal vesicles were obtained to start in vitro maturation procedure. Multivariate analysis showed group C has OR 6.9 (3,3–14,41) to obtain metaphase II oocyte than group B (p <0,0001). Infertility causes, insulin resistance, and maternal age risk are other factors that significantly influence oocyte maturity outcome (p <0.001; p = 0.005; p = 0.017). For the oocyte morphology outcome, no significant effect was obtained from the intervention (p> 0.05). Group C has higher GDF9 levels (Δ mean = 3.31) and BMP15 (Δ mean = 1.52) compared with group B (p <0.001; p = 0.006).

Conclusion: It can be concluded that 24-hour incubation in CM-MSC was effective to induce oocyte maturation. However, other factors, such as infertility causes, insulin resistance, and maternal age, should also be considered.

The influence of maternal age and gestational age to urinary tract infection in Lempake Primary Health Care, East Kalimantan, Indonesia

Introduction: Urinary tract infection (UTI) is the second-largest of the world’s health burden just behind the respiratory tract infection. Pregnant women are at risk of suffering from urinary tract infection due to anatomical and physiological changes along the urinary tract. The study aims to find out the influence of maternal age and gestational age to UTI in Primary Health Care Center Lempake.

Method: The research method was cross sectional with total sampling and using secondary data from the register book of emergency unit in Primary Health Care Center Lempake including all UTI cases in pregnancy from all pregnant patients undergone urinalysis from January 2017 until October 2018 (48 patients). It was then analyzed using logistic regression with STATA version 14.

Result: Most of subjects distribution were maternal age group 26-35 years old (39.6%), third trimester of pregnancy (66.7%), and negative result of bacteriuria (81.3%). Maternal age group 26-35 years old was the the most one suffering from UTI/positive result of bacteriuria (55.6%) and had tendency 5.4 times to suffer from urinary tract infection (p=0.147; CI=0.56-51.71; OR=5.36) while gestational age in third trimester showed significant influence to urinary tract infection (p=0.05; CI=0.03-1.00; OR=0.18). The prevalence of urinary tract infection in this research was 18.7%. 

Conclusion: There were significant influences among maternal age and gestational age to UTI in Primary Health Care Center Lempake.

Management of urethral stricture due to prostate cancer and colorectal cancer radiotherapy: a systematic review

Background: Prostate and colorectal cancer are the second and third most common cancer in male. Radiotherapy is performed as treatment option for both cancers. Thus, lead to the increasing case of radiotherapy-induced urethral stricture. Recurrent stricture post-correction commonly occurs.

Methods: Six relevant English literatures were found throughout online database published between 2011-2017. PICO is used to identify components of clinical evidence to create systematic review. Subjects include 222 radiotherapy-induced urethral stricture patients due to prostate and colorectal cancer who undergone various treatment modality options.

Results: Radiotherapy modality performed in sample population were External Beam Radiotherapy (EBRT) (44.1%), Brachytherapy (BT) (31.5%), EBRT/BT (16.2%), Adjuvant EBRT (6.8%), salvage EBRT (0.9%), and proton beam (0.5%). Strictures were found in bulbomembranous-urethra (64.4%), bulbar-urethra (17.1%), posterior-urethra (10.8%), membranous-urethra (5.4%), vesico-urethra (1.4%), and pan-urethra (0.9%). Known mean onset for urethral-induced radiotherapy is 5.6 years. Treatment options include anastomosis urethroplasty (61.3%), Buccal Mucosa Graft Urethroplasty (23.4%), urolume stent (10.8%), penile island flap onlay (2.2%), Genital fasciocutaneous skin flap (1.4%), and perineal flap urethroplasty (0.9%). Known mean onset for urethral stricture recurrence is 10.8 months.

Conclusion: Urethral strictures commonly occur after radiation therapy for prostate and colorectal cancer. Urethroplasty is the preferable treatment option. The recurrence onset for urethral stricture post urethroplasty is shorter than urethral strictures in general.

Predisposing factors of kidney function recovery after postrenal obstruction

Background: Renal function recovery in postrenal acute kidney injury (AKI) patient is not always achieved and risk factor for chronic disease. Factors that affect of kidney function recovery include duration of symptoms, AKI stage and degree of hydronephrosis. The aim of the study is to determine the correlation of predisposing factors of renal function recovery in postrenal AKI patient.

Methods: A prospective observational analytic study with a cross-sectional study approach that involves postrenal AKI with urinary tract stones formers from August to November 2017. Renal function recovery was assessed by comparing creatinine levels before obstruction and after obstruction (3rd and 7th day) and be correlated by the duration of symptoms, AKI stage, and degree of hydronephrosis.

Results: 66 patients were included in the analysis of this study. Renal function recovery was found in 29 patients (43.9%) at 3rd day and 47 patients (71.2%) on the 7^th-day post obstruction. There was a significant difference in mean creatinine levels before and after obstruction (p <0.0001). Both duration of symptoms, AKI stage, and hydronephrosis showed correlation on renal function recovery on 3rd and 7th day after obstruction (p < 0.05). In logistic regression analysis, hydronephrosis was the most correlated predisposing factor for renal function recovery in 3rd and 7th day after obstruction (p = 0.0001).

Conclusion: Factors duration of symptoms, AKI stage, and degree of hydronephrosis significant correlated to renal function recovery after post-renal AKI. Degree of hydronephrosis was the most correlated predisposing factors.

High level of anti-helicobacter pylori-heat shock protein 60II3, interferon-γ, and neopterin are risk factors of cardiovascular events in acute coronary syndrome patients

Background: Chronic inflammatory process that may cause acute myocardial infarction (AMI) has been known to play an important role in the pathogenesis of atherosclerosis and atheroma plaque instability. Based on inflammation process, several previous studies showed contradictory results in finding a relationship between infection H. pylori with the formation of atherosclerosis through the establishment of immunoglobulin G (IgG) anti-H. pylori-HSP60II3 (IgG anti-Hp-HSP60II3), and neopterin level due to oxidative stress. This study aims to know whether IgG anti-Hp-HSP60II3, IFN-γ and neopterin are risk factors of cardiovascular events (CVE) in patients with ACS.

Methods: A prospective cohort study was conducted among 66 patients to determine the levels of IgG anti-Hp-HSP60II3, IFN-γ, and neopterin in patients with ACS as well as the levels of IgG anti-Hp-HSP60II3, IFN-γ, and neopterin. ACS patients were grouped into two groups: patients with ACS with positive prognostic factors (high levels of IgG anti-Hp-HSP60II3, IFN-γ, neopterin, and hs-CRP) and the group of patients with ACS without prognostic factor (low level of anti-IgG levels hp-HSP60II3, IFN-γ, neopterin, hs-CRP), and then were observed for 6 months while in the hospital. Data were analyzed using SPSS version 20 for Windows.

Results: In observations over a period of 6 months, found as many as 15 (22.7%) patients with CVE, which consisted of 11 (16.7%) patients’ vascular death, 3 (4.5%) patients had IMA and 1 (1.5%) patients experienced recurrent cardiac ischemia from 66 patients with ACS. Mean difference between the time of occurrence CVE subjects with high and low levels of neopterin are statistically significant (P<0.05). When confounding factors such as dyslipidemia, diabetes, hypertension, obesity, smoking, and age are controlled, only neopterin levels affect the incidence CVE with the incidence rate ratio of 6.46 (95% CI: 1.45-28.74; p = 0.014) and path analysis found the effect of neopterin on CVE incidence about 49,1%, p < 0.05. Kaplan-Meier analysis gives result that the average time of CVE on a group of subjects with high levels of neopterin is shorter (129.09 days) than the group of subjects with low levels of neopterin (168.33 days) (P=0.008).

Conclusion: This study found that the high level of anti-helicobacter pylori-heat shock protein 60II3, interferon-γ, and neopterin have a potential role in predicting risk factors of cardiovascular events in acute coronary syndrome patients

The histopathological features and bacterial counts after exposure to Streptococcus pneumoniae serotypes 2,3,4 and 19 F in the lung of Balb/c mice

Background: Pneumococci cause mild or severe infections that begin with colonization in the nasopharyngeal area. Intranasal transmission is a natural route of bacterial infection in the host. This study aims to determine the type of serotype that can infect and provide an overview of inflammation in the lungs of mice after exposure to 107 bacteria S. pneumoniae serotypes 2, 3, 4, 19F and ATCC 6030 intranasally in animals try Balb / c mice.

Methods: True experimental study was conducted using Randomized Posttest Only Control Group Design among 30 Balb/c mice divided into 3 groups. The intervention used in this study was carried out twice, namely at 24 hours and 48 hours with 50 μl suspension of Streptococcus pneumoniae bacterial inoculum via intranasal drop by drop. Lung histopathology and CFU analysis of infected mice were evaluated. TNF-α was examined using ELISA. Data were analyzed using SPSS software version 17 for windows.

Results: The results showed that S. pneumoniae serotype 3 could infect Balb / c mice and found about 5x104 CFU (SD ± 7x104 CFU) at 101 dilutions and was still detected at 104 dilutions i.e. 0.5 CFU (SD ± 0.7 CFU) at 24 hours post-infection as well at 48 hours post-infection, accompanied by infiltration of neutrophil cells in the lung tissue at the same time. The TNF-α levels did not significantly differ between the treatment group (P>0.05)

Conclusion: The results of this study indicate that not all S. pneumoniae serotypes can infect experimental animals.

EGFR nanovaccine in lung cancer treatment

Lung cancer is known as the most common malignancy in the world in terms of incidence and death rate. GLOBOCAN data in 2018 showed that its prevalence reaches 11.6% with mortality reaching 1.7 million annually. The prevalence of lung cancer in Indonesia is also considerably high; there were 25,332 cases in men and 9,374 cases in women with mortality reaching 308,660 people. In general lung cancer is classified as non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Although it is less common, SCLC has a worse prognosis with a 5 year survival rate of 6.4%. In addition, SCLC is also often diagnosed when it has metastasized or already reaced extensive stage (ES-SCLC). Although SCLC is classified as chemo-responsive cancer, the overall outcome of first-line and second-line therapy is still unsatisfactory with an ORR of 10-25%. One of characteristic of SCLC is genomic instability which relates to high level of mutations especially EGFR mutation that strongly correlate with therapeutic outcome. Therefore, targeting EGFR mutation is a sensible and potential field in developing SCLC therapy. EGFR-CpG-ODN nanovaccine is one of the potential therapeutic choices that exploit this mutation. EGFR CpG ODN nanovaccine could inhibit resistance to EGFR TKI, increased dendritic cell maturation, inhibit cancer cell proliferation and apoptosis, as well as enhance the anticancer immune response. Therefore, this therapeutic approach is a promising future therapy for SCLC petients that could improve patient’s survivability.

Developing Indonesian version of childbirth self-efficacy inventory (Cbsei)-C32

Introduction: Women readiness and self-efficacy for pregnancy and childbirth is an important issue which usually assessed by using CBSEI-32 but currently no evaluation is ever conducted nor Indonesian version of this instrument ever developed to enhance subject understanding. Therefore, this study aimed to develop the Indonesian Language version of CBSEI (childbirth self-efficacy inventory) instrument.

Method: A quantitative study was conducted by involving 73 pregnant mothers in their trimester III either as the primigravida or as multigravida. The selected respondents are those who lived in the working area or visited several health care centres in the area between July-August 2018. The content validity was tested by using Aiken V analysis and the construct validity was assessed using Kaiser-Meyer-Olkin (KMO) and Bartlett’s test. Finally, the reliability test was conducted using Alpha Cronbach.

Result:  Analysis revealed that the Aiken V value of the instrument was in the range of 0.67-1 for the outcome expectancy and 0.75-1 for efficacy expectancy. 16 items in outcome expectancy showed KMO value > 0.5 with MSA value between 0.648-0.957.  Meanwhile, 16 questions in efficacy expectancy also had KMO value > 0.5 with a MSA range between 0.798-0.937 respectively. The average values of the instrument validity for the outcome expectancy and efficacy expectancy were 0.740 and 0.726 respectively. Finally, Alpha Cronbach value for both outcome expectancy and efficacy expectancy was 0.94.

Conclusion: According to the analysis, it can be concluded that CBSEI-C32 in Indonesia language version was valid and reliable instrument to be applied in pregnant mother in Indonesia.

Validity and Reliability of the Disaster Preparedness Knowledge Instrument for Health Cadres in Volcanic Disaster-Prone Areas

Background: Public health cadres can play an important role in improving disaster response and recovery. However, a multidimensional instrument is needed to assess the levels of disaster knowledge for community health cadres. This instrument is important to develop a complete and effective educational program for disaster preparation for health cadres. Therefore, this study aimed to test validity and reliability of the disaster preparedness knowledge instrument for health cadres in areas prone to volcanic disasters.

Methods: A cross-sectional study was conducted by involving 300 respondents. The instrument was developed by conducting literature review followed by completing a qualitative study. We reduced the original instrument from 50 items to a final instrument comprising 41 items, classified into 6 categories: 1) early warning [16 items]; 2) disaster triage [4 items]; 3) basic life support [7 items]; 4) first aid [7 items]; 5) search and rescue [5 items]; and 6) logistic, communications and team organization [2 items].  Instrument validation was assessed by using Pearson Product moment and the reliability was estimated by using internal consistency reliability.

Results: 300 respondents were involved in this study with all respondents were women aged between 40-49 years old. All of them were either health cadre or high school students. In instrumental testing, all 41 items of the instrument were confirmed through content validity (Pearson Product Moment). Using internal consistency reliability, the study found reasonable inter-item reliability for all items (Cronbach’s α: 0.785-0.807).

Conclusion: Higher score on disaster triage aspect suggest that health cadres have pivotal role in emergency care during disaster. The finding revealed that disaster triage technique and skills for health cadres or lay man is very important.

Reproductive health promotion through traditional art media reduced the of premarital sex intention among adolescent population in Gianyar, Bali

Background: Sex education in adolescents is still considered taboo to be discussed in the community. Traditional arts as communicative and informative socialization media contain meaningful messages, it is expected that teenagers get a good understanding of reproductive health so that they become healthy and quality adolescents. Therefore, this study aimed to evaluate reproductive health promotion through traditional arts media on adolescent knowledge, attitudes and sexual intentions in Gianyar, Bali.

Methods: A quantitative study with a quasi-experimental design was conducted with nonequivalent (pretest and posttest) control group. Data on premarital sex knowledge, attitudes and intentions were collected before and after staging traditional arts in the intervention group (75 adolescents). Data were collected from self-filled questionnaires and analyzed using STATA (version 12.0). Data analysis was conducted using Wilcoxon rank test and Wilcoxon rank-sum.

Results: The results showed an overall significant improvement in the knowledge and attitudes of adolescents about premarital sex and a decrease intention toward premarital sex after intervention (p value 0.00). The improvement in knowledge, premarital sex attitudes and intentions was more pronounced in the intervention group compared to control group. The control group that was not given an intervention showed a higher average value of premarital sex intention.

Conclusion: Reproductive health promotion program using traditional arts media was able to significantly reduce premarital sex intentions among teenagers.     

Three-weeks moderate aerobic exercise in increasing production of endogenous antioxidant enzyme and lowering oxidative stress level among sedentary men

Background: During exercise, there will be an increase of free radical due to the elevation of oxygen consumption to fulfill the increasing demand for energy. This free radical could produce by muscle and other tissue, especially from the leakage of mitochondria respiratory chain reaction. Moderate exercise training may provide adequate protection against exercise-induced oxidative stress by elevating the antioxidant level and healthier mitochondria that will produce less free radicals. This research will investigate the change of baseline level of MDA and superoxide dismutase (SOD) and also MDA and SOD level after a single bout of moderate exercise before and after three weeks of intervention.

Methods: Seven sedentary men with age average 17.2 + 0.2 years recruited for this study. They were meet the criteria of healthy sedentary men. Moderate aerobic exercise of 30 minutes running at 11 – 13 RPE Borg Scale, three times a week for three weeks in a row was applied to the subject. MDA and SOD examination was done by chromatographic assays for total plasma level. The collected data were analyzed using dependent student t-test. Data were normally distributed.

Results: The result of this research found a significant elevation of SOD production (p<0.01) after a single bout moderate exercise after three week training (19.98 + 15.52 vs 40.43 +19.64 mg/ml) and significant depression of MDA production (p>0.05) after training program (0.79 + 0.62 vs 1.97 + 0.94 nmol/ml).

Conclusion: There is no significant change in post-exercise MDA and SOD level before and after the training program. Initial fitness status, food intake, lifestyle could affect baseline level of MDA and SOD before and after exercise.

Protective effect of rotavirus immunization in acute diarrhea due to rotavirus infection: a prospective cohort study

Background: Diarrhea is a life-threatening disease for children. In Indonesia, the incidence of rotavirus infection was 67% of all cases of acute diarrhea. Immunization is an effort that can be done to prevent acute diarrhea due to rotavirus infection. Rotarix^® vaccine is expected to have protective effect against acute diarrhea due to rotavirus infection. This study aims to investigate the protective effect of immunization against rotavirus on the incidence of acute diarrhea in children due to rotavirus infection.

Methods: This was an analytical study using prospective cohort approach in private pediatric clinics in Denpasar, Bali, Indonesia. Participants include one-hundred children aged 6 months was divided into two groups, i.e. vaccinated and non-vaccinated groups, each consisting of 50 children. Incidence of acute diarrhea in both groups were measured and subsequent statistical analyses were conducted to determine contributing factors for the protective effect of rotavirus vaccine against acute diarrhea.

Results: The incidence of rotavirus infection in vaccinated children was 6%, compared to 24% in the non-vaccinated children. There was significant association between vaccination status and the incidence of acute diarrhea due to rotavirus infection (p value=0.012). The probability of acute diarrhea due to rotavirus infection in both groups were 15% and 52% for the vaccinated and non-vaccinated groups, respectively. The relative risk reduction of acute diarrhea due to rotavirus infection is 71% [RR=0.288; 95% CI (52% -82%)].

Conclusions: Immunization against rotavirus infection has a statistically significant protective effect against acute diarrhea due to rotavirus infection.

Diagnostic test of thorax computed tomography scanning in lung tumors against cytopathological results at Zainoel Abidin Hospital, Banda Aceh, Indonesia period June - August 2018

Introduction: Lung cancer which is a major cause of cancer deaths provides a perspective on the importance of the diagnosis of cancer since there is suspicion that influences the clinical diagnosis of lung cancer. Imaging modalities such as the use of contrast CT-Scan are very helpful in giving initial imaging before confirming cytopathological examination. The purpose of this study was to determine the value of the diagnostic tests possessed by CT-Scan compared to the gold standard cytopathological examination in patients with clinical diagnosis of lung cancer.

Methods: This study used a diagnostic study design with a retrospective approach at Zainoel Abidin General Hospital, Banda Aceh-Indonesia during the period June - August 2018. Analysis of diagnostic tests using cross-tabulation then calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive calculations value (NPV), positive likelihood ratio (LR +), negative likelihood ratio (LR-), and accuracy were performed.

Results: Most CT-scan findings were pulmonary mass (59.3%) and the most cytopathological findings were squamous cell carcinoma (47.5%). The CT-Scan diagnostic test value compared with the gold standard cytopathological examination in the form of sensitivity, specificity, PPV, NPV, LR +, LR-, and accuracy was 75%, 30.4%, 64.4%, 50%, 0.054, 0.822 and 61% respectively.

Conclusion: Lung cancer could manifest as a wide spectrum of radiological presentations. CT-Scan provide a high sensitivity and accuracy of diagnostic in person with clinical presentation of lung cancer.

Red guava juice (Psidium guajava linn.) suppress TGF-β protein expression in secondary hyperuricemia mice (Mus musculus) model

Background: Secondary hyperuricemia can increase the risk of renal dysfunction in the form of fibrosis and glomerulosclerosis mediated by TGF-β signalling. Non-pharmacological therapy through high dietary antioxidant intakes can help in controlling and preventing renal dysfunction by suppressing TGF-β expression. This study aimed to analyse the effect of red guava juice (Psidium Guava Linn.) on TGF-β protein expression in mice (Mus Musculus) kidneys with secondary hyperuricemia model.

Method: This was an experimental study with a post-test only design. Forty-eight mice (Mus Musculus) were choosen as samples, which were distributed into six different treatment groups. The mice were induced with potassium oxonate for 14 days and given red guava juice for 21 days. TGF-β protein expression in mice (Mus Musculus) kidneys was identified through immunohistochemistry using TGF-β antibodies. The preparation was observed in the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Sebelas Maret using the Olympus XC10 light microscope. Data were statistically analysed using the Kruskal Wallis test, followed by the Post-Hoc Mann Whitney test.

Results: The results of this study showed that the administration of red guava juice had a significant effect on TGF-β expression (p = 0.001). There was a significant difference between the negative control treatment and treatment of red guava juice at a dosage of 5 ml/kg/day (p = 0.043).

Conclusion: It can be concluded that the administration of red guava juice in mice (Mus Musculus) with secondary hyperuricemia model can suppress TGF-β expression, and therefore, can be used as non-pharmacological therapy.

Comparing the effect of Angiotensin-Converting Enzyme Inhibitors versus Angiotensin Receptor Blockers in heart failure patients with type 2 diabetes mellitus: a systematic review

Abstract:

Introduction: Heart failure is a prevalent world wide. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are widely prescribed. The aim of this study was to determine the effect of the two drugs in heart failure patients with type 2 diabetes mellitus.

Methods: This meta-analysis was performed on research articles on the drugs of heart failure patients in PubMed, ProQuest and EBSCO database published between 2008-2018. Pooled odds ratio (OR) are calculated using fixed and random effects models. Data were processed using Review Manager 5.3 (RevMan 5.3).

Results: From total 209 articles, 10 studies met the criteria for systematic review. Meta-analysis result showed that there were no difference effect of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in heart failure patients with type 2 diabetes mellitus (RR = 1.73 [95% CI 0.88-3.40], p=0.11). Heterogeneity test for studies (Pheterogeneity = <0.00001) showed variation of heterogeneous research. There is no publication bias on this study Egger’s test (p = 0.334) and Begg’s test (p = 0.180).

Introducing the tolerogenic macrophage therapy as an alternative approach to manage systemic lupus erythematosus: a case series

Introduction: Systemic Lupus Erythematosus (SLE) has been quite an enigma in medicine. The possibility of the host own defense mechanism attacking itself is still quite difficult to understand. Patients who suffer from this disease tend to have a problem in their qualities of life, especially as the majority affect female in their productive ages. Conservative therapy to manage this disease is widely developed and implemented. Since the known therapies have several side effects and limitation, a need to develop a new strategy that can re-establish the “tolerance” mechanism of our immune system is increasingly needed. Immunotherapy is already a promising field in the strategy against autoimmune cases. In our facility, we developed immunotherapy called ToM (Tolerogenic Macrophage) which similar to Mreg (Regulatory Macrophage) in order to utilise the “tolerance” ability of this immune apparatus.

Case: In this study, we present 2 cases of female patients who suffer from SLE, which underwent ToM Therapy in our Cellcure facility in RSPAD Gatot Soebroto Jakarta-Indonesia. After the procedure the patient was monitored one month and one year. Clinical and control parameter such as ANA (IF) and ANA profile was examined again in both patients to measure the effect of this therapy. The ANA titer and the titer of specific antibodies such as dsDNA, Nucleosomes and Histones results show significant reduction, accompanied by the improvement of the symptoms.

Conclusion: ToM Therapy seems to have a good efficacy as immunotherapy for SLE. Further study needed to establish this approach.

Type IA urethral duplication: a case report

Background: Urethral duplication is a rare congenital malformation mainly affecting men and boys. Although a number of theories have been proposed to describe this condition, the actual mechanism of this disorder is still not clear. The most frequent anomaly occurs in the sagittal plane, in which the duplicated urethra is in either dorsal or ventral position in relation to the orthotopic urethra. The therapeutic management of these conditions is complicated and depends on the presence of symptoms as well as the type of anomaly.

Case Description: We present a case of urethral duplication in a 2 years old male child. The malformation was characterised by the presence of the meatus in the dorsal penoscrotal and accompanied by the sign of infection in it. Urethrography showed contrast stopped filling 2 cm from the meatus in the dorsal penoscrotal with a total dead-end impression as an accessory urethra and there was no abnormalities in the principal urethra looked from the contrast filled the penile urethra, bulbous urethra, prostatic urethra, and bladder. That was the form of Effmann Type IA urethral duplication. The dorsal accessory urethra was excised entirely without complication and he remains symptom-free eight months after surgery.

Conclusion: In summary, urethral duplication is a rare clinical condition. It has many variants that were classified by Effman. Management depends on the anatomy of the duplication involved and the patient’s clinical symptoms.

Rhabdoid adrenocortical carcinoma with brain metastasis: a case report

Introduction: Adrenocortical carcinoma (ACC) is a rare disease with the incidence about 0,02-0,2% from all case of malignancies. The number of malignancies cases reported annually being about 0,7-2 cases per million people. ACC can be functional or nonfunctional tumors, being diagnosed incidentally because of loco-regional symptoms or distant metastases. The overall 5-year survival rate after diagnosis was 15% to 47% and there are no significant differences in survival based on patient age, gender or tumor functional status.

Case Report: A 47 years old male came into emergency room with nauseous, vomiting, headache and weakness for 4 weeks. From the physical examination, there were slight hypertension and tenderness on left hypochondric region. Abdominal ultrasound showed a solid mass with central necrotic on upper left abdominal cavity. Then, contrast abdominal CT revealed a well defined heterogeneous solid mass, contrast enhancement with necrotic area that attached on the upper pole of left kidney suspicious on left adrenal organ. He was performed left radical adrenalectomy as initial treatment to determine the histopathology result and tumor staging. After surgery complains of his headache remained, thus head CT was performed and it concluded an intracranial metastatic process at right parietal region, left temporal brain parenchymal and cerebellum which pressing ventricle IV. Steroid and neurotrophic treatment were given by neurologic division. This patient was also consulted to neurology, hemato-oncology, neurosurgery and radiotherapy for further treatment.

Conclusion: ACC is a progressive disease with a poor prognosis because of its initial presentation with advance disease (tumor burden or distant metastases), high incidence of local recurrence, and systemic therapy still controversial. The patient has to do a complete physical examination, imaging and laboratory work-up. Multimodality treatment with a multidisciplinary approach is needed to manage the patient for optimal outcome.

PKB XXVII Ilmu Penyakit Dalam: Comprehensive Management in Internal Medicine

Foreword

Internal Medicine is quickly developing in all lines, from basic theories, pathophysiology, diagnostic procedures and therapy. The challenges of new cases and the re-emergence of re-emerging diseases in the era of globalization, modernization and industrialization require clinicians to constantly renew their knowledge and expertise and possess global standard quality to improve medical services. Information on medical science and technology is now easily accessible to anyone, produce an increasingly critical society and bring up challenges for clinicians.

The advancement of Indonesian doctors must be supported by access to regional, national and international scientific communication in the form of scientific forums that present the latest research information and results, as well as a forum for discussion with experts in addition to establishing family bond for doctors.

Pendidikan Kedokteran Berkelanjutan (PKB) Internal Medicine Department, Faculty of Medicine of Udayana University / Sanglah Hospital 2019 is a scientific activity in Internal Medicine topics held annually. In the series of activities of PKB XXVII in Internal Medicine Faculty of Medicine Universitas Udayana / Sanglah Hospital 2019, the update in the field of Internal Medicine will be presented in the form of training (workshops), symposiums, and expert discussions hence the opportunities for interaction between participants and experts are optimal. Development in the field of research is also a concern and we give appreciation in the form of opportunities to compete in oral papers and posters.

Dr. I Wayan Losen Adnyana, SpPD-KHOM

Chairman

The 3rd Aceh Surgery Update 2019 in Conjugation with The 1st Indonesian General Surgeon Society (PABI) Aceh Chapter Meeting and The 1st Ikatan Alumni Bedah Unsyiah (IABU) Meeting

Praise and gratitude we pray the presence of Allah SWT for all His mercy and guidance we can still work and work to help in the field of education and humanity. With our greetings and prayers, we are praised to the Holy Prophet Rahmatan lil alamin Rasulullah Muhammad SAW who has brought us from the realm of darkness to a world full of knowledge.