The hepatoprotective effect of cacao beans whole extracts (Theobroma cacao L.) in oxidative stress mice

Background: Increased production of reactive oxygen species (ROS), causing accumulation of oxidative damage. Carbontetraclorida (CCl₄) is known as a toxic material and causing hepatocellular damage initiated by oxidative stress, which increased blood serum glutamic pyruvic transaminase (SGPT) concentration. Cacao beans (Theobroma cacao L.) extracts have antioxidant properties from flavonols, consisting of catechin, epicatechin, and procyanidin. This study aims to investigate the effect of hepatoprotective of cacao beans (Theobroma cacao L.) extracts in oxidative stress mice induced by CCL₄. 

Methods: The study was conducted at the Department of Biochemistry and Department of Pharmacology and Therapy, Faculty of Medicine Udayana University using the Pretest-Postest Control Group Design. About 20 male mice were divided into 4 groups, as control or placebo group (P0), intervention group by 15 mg extracts of cacao beans (P1), 30 mg (P2), and 60 mg (P3) for 7 days. On the eight-day induced by 0,55 mg/gram mice bodyweight of CCl₄. All groups were examined for blood SGPT concentration before and after the intervention. Data were analyzed using SPSS version 20 for Windows.

Results: The SGPT level prior to the administration of cacao bean extract and CCl4 was 18.56±0.19 µ/L in P0 group, followed by 18.41±0.28 µ/L (P1), 18.36±0.21 µ/L (P2), and 18.16±0.47 µ/L (P3), but statistically not significant (p=0.260). However, after CCl4 administration, the SGPT levels were 38.63±0.37 µ/L in P0 but significant decrease in the P1 (28.14±0.34 µ/L), P2 (20.72±0.35 µ/L), and P3 (18.68±0.25 µ/L) following cacao beans whole extracts administration (p=0.000).

Conclusion: This study concluded that cacao beans extracts administration could inhibit the oxidative stress and protect hepatocellular damage induced by CCl₄ by decreasing the blood SGPT concentration.

High serum interleukin-2 levels are associated with pruritus in chronic kidney disease undergoing regular hemodialysis

Background: Uremic pruritus or more accurately termed ‘chronic kidney disease-associated pruritus’ (CKD-aP) is chronic itch in patients with advanced or end-stage renal disease without evidence of any other active disease that could explain the pruritus. The pathogenesis of CKD-aP is complex and not fully clarified. Some preliminary studies indicate that CKD-aP is a systemic inflammatory disease with a deranged balance of T helper (TH) cell differentiation toward TH1 predominance especially IL-2. This study aimed to elucidate further the association of interleukin-2 serum levels with CKD-aP in patients undergoing regular hemodialysis (HD).

Methods: This was an analytical cross-sectional study. Sampling was taken with consecutive sampling technique. This study was carried out on 72 patients on regular HD consist of 36 patients with CKD-aP and 36 patients without CKD-aP after meeting the inclusion and exclusion criteria. Blood samples were obtained at Hemodialysis Unit Sanglah General Hospital and IL-2 serum levels were measured at Clinical Pathology Laboratory Sanglah General Hospital Denpasar between July 2019 and August 2019. Mann-Whitney U Test was used to compare IL-2 serum between CKD-aP and non-CKD-aP group.

Results: Results in this study we found higher median IL-2 level (17.1 ng/l) on pruritus group versus those without pruritus (13 ng/mL) (p<0.05).

Conclusion: IL-2 serum levels on CKD-aP patients are higher than those without CKD-aP in patients who undergo regular hemodialysis.

Overexpression of nuclear factor kappa B (NF-кB) protein as a risk factor for anthracyclin chemoresistance in luminal a subtype locally advanced breast cancer (LABC) at Sanglah General Hospital, Bali - Indonesia

Background: Around 68.6% of women who have breast cancer seek medical treatment at a locally advanced stage (LABC), where the neoadjuvant chemotherapy (NAC) modality is the initial choice therapy. Luminal A was recorded as the subtype with the chemotherapy response being the most resistant among others. The cause of chemoresistance is multi-factorial, and several studies correlate this condition with several anti-apoptotic agents expressed in the nucleus of cancer cells, especially nuclear factor-kappa B (NF-кB). The NF-κB transcription factor as an anti-apoptotic agent in some cancers blocks the apoptotic pathway through the extrinsic and intrinsic pathways. NF-κB plays a vital role in the development of chemoresistance. Understanding the NF-κB pathway and perceiving more about the cellular characteristics of LABC is very important to develop NF-κB inhibitors as therapy. NF-κB as a transcription factor can be considered a promising research target because it can affect oncogenes' transcription and play an essential role in prognostic and predictive biomarkers. This study was conducted to determine whether NF-κB overexpression is a risk factor for anthracycline-based neoadjuvant chemoresistance in Luminal A subtype LABC patients at Sanglah General Hospital.

Methods: An unpaired case-control study was conducted at Sanglah General Hospital. The research subjects were 40 people, divided into case groups (chemoresistance) and control groups (chemosensitive). Hereafter the NF-κB H-Score was carried out by IHC examination. Data are presented in table form and analyzed by Chi-square test or Fischer exact.

Results: Samples of cases with NF-κB overexpression were obtained 13 (65%), compared with the control group 7 (35%) (p<0.05). Multivariate analysis has shown that NF-κB overexpression is an independent factor against anthracycline-based chemotherapy resistance in advanced LABC patients with local luminal subtypes with p=0.013; OR 3.45 (95% CI=2.94-12.65).

Conclusion: NF-κB expression in Luminal A subtype LABC can be used as a predictor for anthracycline-based neoadjuvant chemoresistance. NF-κB overexpression is a predictor factor for NAC chemoresistance in luminal A subtype LABC.

Patient characteristics of non-operative anterior cruciate ligament injury associated with poor knee functions on activities of daily living: a cross-sectional study

Introduction: The ACL injury has commonly occurred in a greater number of athletes, less publication is about poor knee function and ACL injury in the patient with non-operative treatment. This study aimed to describe the characteristics of patients with ACL injury non-operative, which are associated with poor knee function on daily living activities.

Methods: We included patients with ACL injury that has been diagnosed for ACL injury by an orthopedic surgeon or physiotherapist in a hospital or private clinic. All participants were recruited from February 2019 to April 2019. The inclusion criteria were patients who at least 18 years old. We used the KOOS ADL function cut-off score ≤80 to dichotomous the patient with knee problems, and score >80 have no statistical analysis problem. We calculated using binary logistic regression on the KOOS ADL function for each variable.

Results: The mean score of KOOS daily living was 72.8 points, of which 66 participants had poor scores, and 37 were acceptable. Women were 9.2 times more likely to had poor KOOS daily living scores than men in non-operative ACL injury patients (p=0.044), and non-elite athletes had a higher possibility by 8.5 times higher than those who were participated in sports only for leisure or recreation (p=0.002).

Conclusion: This study confirmed that patients who did not undergo the ACL reconstruction had a poor knee function in daily living. It was associated with women and non-elite athlete participants, yet the concomitant injuries were possibly confounder for the association.

A network meta-analysis on comparative efficacy and tolerability of on-demand therapy for premature ejaculation

Introduction: The use of pharmacotherapy as a first-line treatment for premature ejaculation (PE) is recommended by EAU guidelines. However, no study had analyzed multiple treatment comparisons among available on-demand therapy. Therefore, we aimed to perform a network meta-analysis (NMA) to characterize the comparative efficacy and tolerability of on-demand therapy for PE.

Methods: We systematically searched randomized controlled trials (RCTs) in several databases at any period up to November 2019. NMA was performed to estimate efficacy and tolerability outcomes using intravaginal ejaculation latency time (IELT) and overall adverse effects (AEs), respectively. We ranked each outcome using the surface under the cumulative ranking curve (SUCRA) and presented the two outcomes as a clustered ranking plot.

Results: A total of 19 RCTs comprising 5950 patients were included in this NMA. All active treatments showed significant improvement compared to placebo. Among the available on-demand treatment, the combination of SSRI plus PDE5i showed the highest efficacy (MD: 3.06; 95%CI 1.84-4.29) followed by tramadol 100 mg and vardenafil 10 mg (MD 2.9, 95%CI 1.63-4.16; MD 2.36, 95%CI 1.2-3.52; respectively). Based on the SUCRA, the combination of SSRI plus PDE5i had the highest score (91.7%) in efficacy, while dapoxetine 30 mg had the highest score (73.3%) in terms of tolerability.

Conclusion: The combination of SSRI plus PDE5i was the treatment of choice for individuals who prioritize efficacy. For those who prioritize tolerability, dapoxetine 30 mg and vardenafil 10 mg became alternative treatments. Various on-demand therapy options require careful discussion with patient expectations of treatment effects.

Quickert procedure for involutional lower eyelid entropion: a multi-centre study

Background: Involutional entropion is the inward turning of the eyelid margin and commonly happens in the inferior eyelids in elderly people. The prevalence is as high as 2.1% in people ≥ 60 years old and more common in women than men. This condition may cause ocular surface irritation and discomfort secondary to contact between cilia and the ocular surface. Several etiological factors are suspected to be important causes of involutional entropion. One of them was horizontal eyelid laxity. Quickert Procedure is one of the surgical interventions recommended to correct involutional lower eyelid entropion in the elderly Asian population with 0% of recurrent entropion in a recent study by Miyamoto et al.

Methods: This is a descriptive retrospective study of 16 involutional lower eyelid entropion patients (18 eyelids) that needed surgical correction.  About ten males and six females were undergone Quickert procedure to correct the involutional entropion. Patients were assessed postoperatively for 24 months to evaluate the recurrence entropion, cosmetic, and functional improvement. Data were analyzed by SPSS version 20 for Windows.

Results: This study included 16 patients, with mean age was 69.8 years old which range from 62-85 years old. They consisted of 9 (56.0%) patients were male, and the rest was female (44.0%). Eleven (61.0%) patients were with left eye laterality, and 10 (63.0%) patients found without anticoagulant consumption. All patients (100.0%) had positive snapback test and achieved >6 mm in distraction test. After surgical intervention, no patients (0.0%) were found to experience recurrence of involutional entropion nor ocular discomfort due to prior surgery.

Conclusion: A detailed assessment of the etiology, accurate preoperative evaluation, and precision in addressing patients underlying eyelid anatomic abnormalities are needed in the selection of appropriate surgical procedures to correct entropion.

Bacterial identification of acne vulgaris

Background: Acne vulgaris (AV) is a chronic inflammation of the pilosebaceous unit with clinical polymorphic lesion consist of non-inflammatory (open and closed comedones) and inflammatory lesions (papules, pustules, and nodules) with varying degree of inflammation and depth. Earlier studies showed that other bacteria might also found and played a role in acne pathogenesis besides Cutibacterium acnes (C. acnes).

Patients and Methods:  This descriptive observational study used cross-sectional method. Samples were collected from 40 subjects with AV. We took the samples from non-inflammatory (closed comedones) and inflammatory lesions (pustule) in each subject, followed by Gram staining, aerobic and anaerobic bacterial culture, and bacterial identification. This research has been approved by the Ethical Committee, Faculty of Medicine, University of Sumatera Utara.

Results: There were 12 bacterial species that were identified from 80 samples. We identified Cutibacterium acnes (21,2%) in anaerobic culture. While in aerobic culture, we identified Staphylococcus epidermidis (47,5%), Staphylococcus hominis (17,5%), Staphylococcus aureus (8,7%), Staphylococcus haemolyticus (8,7%), Leuconostoc mesentroides (6,2%), Micrococcus luteus (3,7%), Kocuria varians (2,5%), Staphylococcus vitulinus (1,2%), Staphylococcus cohnii (1,2%), Staphylococcus arlettae (1,2%) and Dermacoccus nishinomyaensis (1,2%).

The quality of life in the treatment of maxillofacial fractures using open reduction: A prospective study

Purpose: To assess the impact of open reduction on quality of life in patients with maxillofacial fractures.

Methods: A prospective study of 15 patients admitted to a general hospital in Bandung for maxillofacial trauma from October 2017 through February 2018 was conducted. Trauma severity was assessed using facial injury severity scale (FISS) score, while the quality of life was assessed using Oral Health Impact Profile (OHIP) -14 questionnaires at one day before surgery (T₀) and 14 (T₁) and 60 days (T₂) after surgery.

Results: Male (3.92±1.89) and younger patients (3.89±1.69) had a greater mean FISS score than their respective counterparts. The most common areas involved in maxillofacial fractures were mandible body (80%) and dentoalveolar (46.67%). The overall quality of life was worse in younger patients as indicated with a higher mean OHIP-14 score. There was a disparity in the domain of interest where younger patients (17-30 years) had more concern over psychological discomfort, whereas older patients (31-50 years) were more concerned about physical disability. Both qualitative and quantitative improvement in quality of life was observed in the follow-up period. Consistent and statistically significant improvement in mean OHIP-14 score before intervention (20.80±5.94), 14 days post-intervention (17.93±4.68), and 60 days post-intervention (14.67±3.42) was observed.

Conclusion: Open surgery approach yielded a good outcome in quality of life improvement. Further study on demographic factors, timing, and quality of life domain affected in maxillofacial fractures is recommended.

Scoring predictor for successful of arteriovenous fistulas as vascular access in hemodialysis patients: PAVAS score

Introduction: The use of vascular access (AV-fistula) for long-term hemodialysis is still served as the primary choice. The fact that there is still a high rate of failure of arteriovenous fistulas procedure is one of the obstacles in the treatment of chronic kidney disease problems. This study aims to assess the risk factors for AV-fistula or AV-shunt failure and develop a risk scoring system for the failure of the AV-fistula procedure in patients with chronic kidney disease.

Methods: This study is a prospective study conducted at Dr. Soetomo Hospital, Surabaya, Indonesia. The analysis focuses on the risk factors for AV-fistula failure and performs a scoring order using multiple logistic regression methods.

Results: Based on this study, three variables were found to have significant values in determining the risk of AV-fistula failure scoring, namely local arterial condition (p<0.1), local venous condition (p<0.1), and arterial diameter (p<0.1). The scoring system for normal arteries, normal veins, and artery diameter >1.8 mm was scored 1. Scoring for veins and arteries with a history of puncture was 1. Arteries with stiff sensation with weak pulses and veins with a history of intravenous catheters scored 2.

Conclusion: The use of scoring based on parameters of arterial diameter, local venous condition, and local arterial condition becomes a scoring system for predictors of the risk of failure of the AV-shunt procedure, with three scoring categories, namely low risk (score 0-1), medium risk (score 2 -3), and high risk (score 4-5). This study is only a preliminary study for arteriovenous fistula scoring (PAVAS Score) due to the limited sample size so that a large-scale follow-up study is needed to assess the validity of the proposed PAVAS score.

Clinical presentation and outcome of COVID-19 infection in Type 2 Diabetes Mellitus: a preliminary data from a tertiary hospital in Jakarta during the early days of the pandemic

Introduction. This study aimed to review the clinical characteristics and outcomes of COVID-19 patients presented with in-hospital hyperglycemia or pre-existing type 2 diabetes (T2DM).

Methods. This is a retrospective study conducted in Fatmawati General Hospital, Indonesia, from March 18th-Apr 30th, 2020. We reviewed medical records of 27 COVID-19 patients presented with either in-hospital hyperglycemia (11, 12.2%) or pre-existing T2DM (16, 17.8%) from a total of 90 confirmed COVID-19 cases admitted in our hospital.

Results. Critical conditions occurred in 50% of T2DM and 54.55% of the in-hospital hyperglycemia group. Mortality was documented in 68.75% of T2DM and 81.82% of in-hospital hyperglycemia group. Hypoglycemia, diabetic ketoacidosis, lactic acidosis and ketosis were found in 12.5%, 25%, 18.75%, and 25% of individuals with T2DM, respectively, resulting in a high mortality rate. Meanwhile, diabetes-related complications were rare among the in-hospital hyperglycemia group. However, respiratory failure (45.45% vs. 6.25%) and septic shock (27.27% vs. 6.25%) were more frequent than in the T2DM group.

Conclusion. In this preliminary study, a high mortality rate was documented among COVID-19 patients with preexisting T2DM and in-hospital hyperglycemia. In T2DM subjects, diabetes related-complications contributed to a higher mortality rate, while in-hospital hyperglycemia group, respiratory failure and septic shock were more frequent.

Lipid and cardiac profile assessment following the co-administration of Cisplatin and methanolic extract of Portulaca oleracea in adult Wistar rats: an experimental study

Introduction. There is a need for continual evaluation of the effective use of plant-based medicine as combination therapies as more therapeutic potentials are being associated with phytomedicine. The changes in the lipid and cardiac profile of adult Wistar rats following the co-administration of Cisplatin and methanolic extract of Portulaca oleracea (MEPO) were investigated.

Methods. Twenty-four (24) rats with an average weight of 154 kg were randomly divided into six (6) groups (A-F). Group A was given no treatment and served as the normal control group. Group B received only a cisplatin injection and served as the cisplatin control group. Group C and D were given 400mg/kg and 800 mg/kg MEPO six hours after cisplatin injection. Group E and F were administered 400mg/kg and 800 mg/kg MEPO 6 hours before cisplatin injection. All cisplatin injections were single-dose intraperitoneal injection (2 ml/kg) and MEPO administration lasted for 7 days. Animals were euthanized under diethyl ether anesthesia at the end of the experiment and blood collected for serum lipid profile investigations. Some cardiac and lipid parameters were estimated from standard formulae.

Results. There was a significant increase in the serum levels of TG and TC (p=0.01 and p < 0.001) and some estimated parameters – LDL, VLDL, CRR, HDL-LDL and TG-HDL (p<0.001, p=0.049, p<0.001, p<0.001 and p=0.001 respectively) while HTR was significantly decreased (p<0.001) due to cisplatin treatment. HDL and AI levels were unchanged by cisplatin treatment. MEPO significantly reversed (p<0.05) the cisplatin-induced changes in the serum lipid parameters (TG and TC) and estimated parameters (VLDL, CRR and TG-HDL) across all MEPO-treated groups.

IDH1 mutation in Balinese glioma patients and its relationship with clinicopatological parameters

Purpose: Isocitrate dehydrogenase 1 (IDH1) mutation plays an important role in the carcinogenesis of gliomas. The most recent WHO classification of central nervous system tumors has added molecular genetic in addition to the histological features of the tumor, including status of IDH mutation in glial tumors. The purpose of this study was to determine the prevalence of IDH1 mutations in Balinese glioma patients and its association with clinicopathological features.

Patients and methods: This study was conducted from 30 glioma patients at Sanglah General Hospital during January 2018 until June 2019. DNA extractions were carried out from the FFPE of tumor tissue, followed by amplification of codon 132 in exon 4 of the IDH1 gene by allele specific PCR. Relationship between IDH1 mutation status and clinicopathological features was tested with X² with 0.05 significance.

Results: The age range of patients is 14-81 years with an average age of 43.4 years (SD±17.9 years). Most patients with astrocytic tumors (25/30; 83.3%), others were oligodendroglial tumor (2/30; 6.7%) and oligoastrocytic tumor (3/30; 10%). Most patients were found with grade IV glioblastoma (18/30; 60%).  Genotyping analysis showed IDH1 mutations in the majority of glioma patients (90%). Most cases (92.6%) of mutant IDH1 showed heterozygous mutations (GA genotype) while the rest showed homozygous mutations (AA genotype). There were no significant relationship between IDH1 status and age (p=0.09), sex (p=0.63) and histologic type (0.14), but there was significant relationship between IDH1 mutation status and tumor grade (p=0.01). All of IDH1 mutation were found in diffuse glioma (grade II and III gliomas and grade IV glioblastoma).

Conclusion: Most of diffuse glioma (grade II-IV glioma) patients in Bali had IDH1 mutation and IDH1 mutation status has significant relationship with tumor grade. Further research about genetic abnormalities in order to improve therapeutic efficacy against IDH-mutated gliomas is needed.

Seizure free status as a good predictor for quality of life of temporal lobe epilepsy patients after amygdalohippocampectomy

Background:  The aim of epilepsy surgery is to improve the quality of life of people with epilepsy. Temporal lobe epilepsy (TLE) is the most common form of intractable epilepsy with a risk of low quality of life due to uncontrolled seizures. In this study, we evaluated the quality of life among TLE patients who underwent amygdalohippocampectomy between those who were free from seizure and those who were not.

Methods: This was a cross-sectional observational study. The postoperative quality of life was measured by QOLIE-31 questionnaire followed-up at least 12 months since the surgery.

Results: Among 31 patients, 21 patients (67.7%) were free from seizures after 12 months of follow-up. We observed significantly higher quality of life of those seizure-free patients either as overall quality of life (p=0.001) or among domains such as seizure anxiety (p=0.003), emotional well-being (p<0.001), fatigue (p<0.001), cognition (p=0.002), medication effects (p=0.01) and social function (p<0.001).

Conclusion:  TLE patients who were seizure-free had better quality of life compared to those who were not after amygdalohippocampectomy.

Differences of maternal leukocyte count in premature rupture of membranes and preterm premature rupture of membranes

Background: Premature rupture of membranes (PROM) is rupture of membranes amniotic membrane prior to the labor. PROM is associated with an increased incidence of preterm labor and infection.

Aim: To compare maternal leukocyte count in premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM)

Methods: This cross-sectional design was conducted at Dr. Kariadi General Hospital Medical Center and Kartini General Hospital Jepara from September 2019 to January 2020. The study sample was pregnant women with premature rupture of membranes that came to Emergency Department. Samples were divided into two groups, PROM and PPROM. All samples were subjected to leukocyte count examination.

Results: This study has a total of 40 samples, with 20 samples each. In PROM, 8 (40%) leukocytosis and 12 (60%) were normal, while in PPROM 7 (35%) leukocytosis and 13 (65%) were normal. There were no significant differences in maternal leukocyte levels in PROM and PPROM (p=0.229).

Conclusion: There were no significant differences in maternal leukocyte levels in PROM and PPROM.

The correlation between serum fibroblast growth factor-23 with urinary fractional excretion of phosphate in predialysis chronic kidney disease

Purpose: To investigate the correlation of serum fibroblast growth factor-23 (FGF-23) with urinary fractional excretion of phosphate (FEPi) in predialysis chronic kidney disease (CKD).

Methods: This cross-sectional study involved 75 patients with CKD stage 2-4. Blood and 24-hour urine samples were taken from eligible participants to measure key variables using standard commercial assays. FGF-23 concentration was measured using enzyme-linked immunosorbent assay (ELISA). The correlation between FGF-23 serum level and urinary FEPi was analyzed using the Spearman correlation test.

Results: Of 75 eligible subjects, the majority had the characteristics of male gender, CKD stage 3, with mean age and body mass index of 50±10.8 and 23.51±3.3, respectively. The median FGF-23 level was 108.7 (13.6-1226.2) RU/ml, while the median urinary FEPi was 24.3% (4.04%-65.9%). There was a moderate positive correlation between FGF-23 and FEPi (r = 0.44, p<0.001).

Conclusion: The result confirmed the correlation between serum FGF-23 level with urinary FEPi in predialysis CKD.

The effect of purple sweet potato (Ipomea batatas L) ethanol extract on Estrogen Receptor Alpha (ERα) and SOD mRNA expression in the menopause-liver animal model

Background: Aging and estrogen deficiency in menopause women increase susceptibility to liver diseases. In postmenopausal women, the change of ERα expressions and oxidative stress is related to liver diseases' pathogenesis. Phytoestrogens have been shown to protect and repair the liver organ due to estrogen deficiency. Purple Sweet Potatoes contain anthocyanins, a subgroup of flavonoids that have been shown to have antioxidant and phytoestrogen activity. This study aims to evaluate the phytoestrogen and antioxidant activities of purple sweet potato in a liver animal model of menopause through Superoxide Dismutase (SOD) and ERα expressions.

Method: A true experimental study by randomized post-test-only control group design was conducted among 28 female Wistar rats-aged 10-12 weeks with a bodyweight of 180-220 gram, which underwent bilateral ovariectomies. These animals were divided into 4 groups, with 7 rats in each group. On day 7, Group T0, as control was given aquadest, ethanol extract of purple sweet potato was assigned to Group T1, T2, and T3 with doses 1, 2, and 4 mL/day, respectively, during 30 days. The SOD and ERα mRNA expressions were evaluated by qRT-PCR with specific primers. Data were analyzed using SPSS version 20 for Windows.

Results: The mRNA expressions of ERα were not significantly different among groups (p>0.05), while SOD expressions were significantly different among groups (p<0.05). The expression of SOD in Group T1 (504.39±231.4 pg/μL), T2 (2,147.92±417.1 pg/μL), and T3 (405.30±224.1 pg/μL) showed a significantly higher than Group T0 (15.34±15.27) (p<0.05)

Conclusion: Oxidative stress could be prevented by purple sweet potato in the liver through the SOD mRNA expression but not ERα.

The problem of prevention and correction of posture disorders with the help of orderly muscle activity: a literature review

Background: One of the frequent manifestations of decreased motor activity and a decrease in the strength of skeletal muscles is a violation of posture. Under these conditions, the deformation of the posture is the result of a violation of the vertical position of the spine and the weakening of its adaptive reactions aimed at maintaining the vertical posture. The redistribution of the load in the spine is accompanied by a change in its configuration. In this regard, the only way to combat the violation of posture can be considered increased muscle activity.

Objective: This article provides a review of the literature regarding the problem of prevention and correction of posture disorders with the help of orderly muscle activity.

Method: The writing methodology used was the literature review. The source of study consists of relevant journals from the search engines www.pubmed.com, scholar.google.com, and proquest.com.

Conclusion: In this regard, exercise is a powerful biological stimulant for most of the physiological functions of the body. This allows them to purposefully increase the volume of various muscle structures, change the functional state of the body and solve the problems of short-term and long-term recovery.

Role of PRP (platelet-rich plasma) in alopecia areata: A literature review

Alopecia areata (AA) is an autoimmune disease that causes hair loss, and its specific cause is not  fully determined. This disease affects the patients physically, psychologically, and cosmetically. Treatment of AA is not curative, but controls or limits the disease course. Most treatment modalities are an immunosuppressive or immunomodulatory agent, which are associated with increased side effects. PRP has been used in aesthetics and dermatology, especially for wound repair. Improvement characterized by hair growth has been reported in several studies. Hair growth improvement with PRP is an effective procedure for AA without any allergic reaction. Epidermal proliferation, induction of angiogenesis, and stimulation of the growth of follicular bulge cells were also reported. Despite showing the efficacy of PRP in AA, it is necessary to carry out randomized clinical trials and long-term evaluations to support the efficacy of therapy.

Spontaneous conversion to sinus rhythm in atrial fibrillation after dual antiplatelet and anticoagulant therapy in patients with unstable angina

Introduction: Atrial fibrillation (AF) is a common arrhythmia and often becomes persistent with a high risk of thromboembolism event. Spontaneous conversion to sinus rhythm can occur in 50% of cases with new-onset AF. In this case report we report the spontaneous conversion of AF to sinus rhythm in patients with Unstable Angina without any thromboembolic complications.

Case description: A 65-year-old man with unstable angina pectoris (UA) with new-onset atrial fibrillation normal ventricular rate (AF-NVR) came to the Emergency Department Bali Mandara General Hospital. Patients have a history of uncontrolled hypertension and active smokers. Standard management of UA using dual antiplatelet, nitrates, and anticoagulants was given to this patient. There were no anti-arrhythmia drugs given to seek for AF cardioversion. Within 6 hours after initial therapy, spontaneous conversion of AF to sinus rhythm occurs. The patient was treated for five days in a stable condition without thromboembolic complications. Long-term anticoagulants were not given to patients because the CHA₂DS₂-Vasc score is less than two indicating a low risk of thromboembolism.

Conclusion: New-onset AF has the chance of spontaneous conversion to sinus rhythm within 48 hours, proper management of the trigger factors of AF and optimal rate control are determinants of prognosis. Provision of long-term anticoagulants must be based on the CHA₂DS₂-Vasc score.

Management of von willebrand disease in pregnancy in resource-limited settings: a case report

Background: Von Willebrand's disease (VWD) is the most common autosomal dominant bleeding disorder. Pregnancy and delivery in patient with VWD possess significant clinical challenges.

Case description: a 24-year-old woman who will undergo labor with a history of VWD.  The patient was planned for induction of vaginal delivery and has been given intranasal desmopressin, cryoprecipitate, and factor VIII from before delivery to 5 days after delivery. Labor occurs without excess bleeding. The patient was monitored for 6 days after delivery, and there is no complication of excessive bleeding.

Conclusion: This case emphasizes how to manage Von Willebrand's disease in pregnancy with limitation in the examination and therapeutic option, also the importance of joint management from the hematologist, obstetrician, starting from the antepartum, delivery, and postpartum phases.

Uterine cervix mixed adenoneuroendocrine carcinoma: case report of a rare, high grade and aggressive tumor

Introduction: Neuroendocrine carcinoma of the uterine cervix is a rare type of cancer in the female reproductive system, accounting for only about 1% of all malignancies in the uterine cervix. Mixed Adenoneuroendocrine Carcinoma (MANEC) is a combination of neuroendocrine components and non-neuroendocrine components, with each component contribute >30% of the tumor cells. This rare type of tumor is aggressive, high recurrence rates, and early distant metastases.

Case description: A 37-year-old female patient referred for evaluation after a previous finding of a cervix mass and a clinical diagnosis of cervical carcinoma IB2. Ultrasonography examination concluded a cervical mass, suspicious of malignancy. On macroscopic examination, it was found white-grey colored, huddle, and brittle mass filled the entire cervix with a size of 5x4 and 5x1 cm. Routine histopathological examination shows neoplastic cells forming a trabecular pattern, organoid, part with rosette formation, infiltrative between the connective tissue and a large area of necrosis. These cells conform to a uniform morphology, small oval to round nucleus, partially composed of molding, narrow cytoplasm, salt and pepper chromatin, and mitotic figure > 25/10 HPF. At some other focus, neoplastic cells appear cribriform, solid, and tubular, with a round to oval hyperchromatic nuclei, increased N/C ratio, severe nuclear pleomorphism, eosinophilic cytoplasm, mitotic figure 5/10 HPF. The metastatic cell was found in four right pelvic lymph nodes, and five left pelvic lymph nodes. Immunohistochemistry examination of chromogranin-A and CEA shows positive, focal distribution on tumor cells cytoplasms. Synaptophysin shows positive, diffuse distribution on tumors cell cytoplasm. Ki-67 was positive in 90% malignant cell nuclei.

Coronavirus disease 2019 (COVID-19): A case report in a patient with diabetic ketoacidosis and hypertension

Background: Until May 2020, Indonesia is still on COVID-19 emergency status. South Jakarta is part of the Special Capital Region of Jakarta that has applied large-scale social restrictions. The Indonesian government has extended Jakarta's large-scale social restrictions to Friday, May 22^nd, 2020 to curb the spread of the corona-virus that causes COVID-19.

Case report: Patients with diabetic ketoacidosis and hypertension were infected with SARS-CoV-2. He had traveled from Saudi Arabia a week before and already has a fever. Arriving in Indonesia, the patient showed symptoms of worsening disease, experienced coughing, shortness of breath, and sore throat. The patient does not inject insulin due to loss of appetite. On March 30^th, 2020, a laboratory examination showed high blood sugar levels (369 mg/dL) followed by positive ketones bodies. On April 2^nd, 2020, the patient was designated as a confirmed case of COVID-19 after a positive polymerase chain reaction test. The rapid diagnostic test also showed a positive IgM.  Management of patient includes giving O₂ through the non-rebreathing oxygen mask, infusion of sodium chloride, 20 IU Apidra®, 12 IU Lantus® injection, Oseltamivir orally, Levofloxacin, Paracetamol, Vitamin C, Candesartan, Concor. This therapy was continued until April 5^th, 2020. On April 5^th, the patient complained about a cold sensation all over his body. The patient died on the afternoon of April 6^th, (8 days of hospitalization) due to sudden cardiac arrest and acute respiratory distress syndrome. Cardiopulmonary resuscitation was done with standardized protocol with no avail.

Conclusion: Diabetic ketoacidosis and hypertension worsen the condition of COVID-19 patients. There are many unknown disease progression outcomes in these patients.

Ruptured ectopic pregnancy management in the COVID-19 pandemic era: a case report

Introduction. COVID-19 protocol and the unavailability of proper instruments in the isolation room had complicated the usual protocol to diagnose and manage the medical and surgical conditions.  This article is about the first ruptured ectopic pregnancy cases encountered during the COVID-19 pandemic in Sanglah General Hospital. Considering the unique circumstances and the difficulty during establishing the diagnosis and conducting the management, we ought to present our experience through this article.

Case Description. This case report reviews a 24-years-old female, an asymptomatic COVID-19 case, who was diagnosed with ruptured ectopic pregnancy during appendectomy surgery in Sanglah General Hospital, Denpasar, Bali-Indonesia. The patient complained about mild lower right abdominal pain, with a clinical picture that supports acute appendicitis. However, the history taking revealed a history of post-curettage 15 days prior to admission due to vaginal bleeding suspected for incomplete abortion. Except for a positive pregnancy test, the clinical picture did not support a pregnancy nor a ruptured ectopic pregnancy. We still consider an ectopic pregnancy as no histopathological examination result was available to supports the previous vaginal bleeding was an intrauterine pregnancy. Further to complicate the problem, the patient was reactive for the COVID-19 screening test, thus requiring a COVID-19 protocol. As an ultrasound device was unavailable at the time in the isolation room, we could not assess for extrauterine pregnancy. Only during the surgical procedure for appendectomy, our surgical college notified us of the accompanying presence of sign of ruptured right ampullary pregnancy.

Conclusion. The COVID-19 isolation protocol and the unavailability of essential equipment and diagnostic tools in the isolation room could hinder the usual protocol used to diagnose and manage various medical and surgical problems. We hope this article could illustrate how COVID-19 had complicated unusual cases, thus reflect how important clinical judgment and infrastructure in our health care system.

Recombinant tissue plasminogen activator (rTPA) in young adult patient with acute ischemic stroke: a case report

Background: Stroke is one of the highest causes of morbidity and mortality in the world. The incidence rate of ischemic stroke is about 80% of all stroke incidents. The use of recombinant tissue plasminogen activator (rtPA) is recommended under 4.5 hours of stroke onset. Stroke in young adults are reported as being uncommon, compromising 10% -15% of all stroke patients. Many studies were reported the most common risk factor in young adults were obesity and dyslipidemia. This case report will discuss a 33-year-old men with ischemic stroke with obesity and dyslipidemia treated at dr. Kariadi Hospital Semarang.

Case presentation: A 33-year old obese man with left-sided hemiparesis and central facial nerve palsy with an onset of 1 hour. On laboratory examination, it was obtained total cholesterol 179mg/dL, LDL level 123mg/dL, and HDL level 39mg/dL. The protocol code stroke was performed in emergency room with alteplase (r-TPA) 0.6 mg/kgBW, after his head MSCT shows there was no sign of blood in the brain parenchym.

Conclusion: The increased risk of ischemic stroke in young patients is due to dyslipidemia, hypertension, obesity, physical inactivity, and smoking. Treatment of the hyperacute phase of ischemic stroke with thrombolysis can reduce the outcome of stroke due to the disability.

The 4th International Conference on Translational Medicine and Health Sciences

All praises to Allah, the most merciful, beneficent and compassionate, for His blessing that this conference could be organized today. I would like to express my greatest gratitude to Prof. Dr. Yos Johan Utama, S.H., M.Hum; Rector of Universitas Diponegoro, Dr. dr. Dwi Pudjonarko, M.Kes, Sp.S (K); Dean of Faculty of Medicine Universitas Diponegoro, Prof. Dr. Jamari, S.T., M.T.; Director of LPPM, Dr. dr. Hermina Sukmaningtyas, M.Kes., Sp.Rad and Dr. dr. Udadi Sadhana, M.Kes, Sp.PA, Vice Deans of Faculty of Medicine for all of their kind supervision during the preparation of this event. I would like to express my sincere gratitude to all of the committee members for all of your hard work, kind help, and best effort as a solid team work, by which this event can be held successfully even during the COVID-19 pandemics. I would like to thank all of the honorable speakers for your willingness to give lectures and all of participants from various institutions in the world. Welcome to the 4^th International Conference on Translational Medicine and Health Sciences (ICTMHS) 2020.  It is a great pleasure to announce that this is the first virtual ICTMHS, which is traditionally held in Semarang, Indonesia. ICTMHS is an annual routine program that began in 2017 initiated by the faculty to support the university's vision of becoming a world class university. The theme of this conference is "Unraveling the New Normal Guideline Treatment of Diseases in COVID-19 Pandemic". This difficult time has pushed us to strengthen our collaborative practices in the health sectors including Interprofessional Education and Research, Collaborative Practice, Translational Medicine, and Nutrition, Dietetic and Food. This is an interesting theme that invites all health workers to unite to increase collaboration in various aspects to tackle the pandemics affecting our country and beyong. Through this conference, we hope to contribute in introducing and educating the scientific community on the recent advances in the medical, dentistry, nursing, pharmaceutical, and nutrition sciences field. As a major goal of this event, we hope that it can be an excellent chance to discuss interesting ideas and develop fruitful project in the future, network opportunities with old and new colleagues, coordination new partnerships which advance collaboration either about the research field or not, as well as the careers of all participants. Please enjoy your participation in ICTMHS 2020.

dr. Muhamad Thohar Arifin, PhD, Sp.BS(K), PA

Chief of Organizing Committee