Urine neutrophil gelatinase-associated lipocalin (NGAL) as an initial biomarker of acute kidney injury (AKI) in an intensive care unit (ICU) patients: a preliminary study

Background: Acute kidney injury (AKI) is one of the complications in critical patients that can increase morbidity and mortality. The condition of AKI is reversible and must be detected as early as possible. One of a potential marker for early detection is urine Neutrophil gelatinase-associated lipocalin (NGAL). This study aims to evaluate urine NGAL as an early AKI detection marker among critically ill patients.

Methods: This is an observational prospective cohort study involving 39 patients who were admitted to the Intensive care unit (ICU) of Dr. Sardjito General Hospital Yogyakarta during June-August 2018. The inclusion criteria were ICU patients with age>19 years old, and exclusion criteria were chronic renal failure and kidney transplantation. The AKI established based on an increase in serum creatinine levels ≥0,3 mg/dl in 48 hours or urine volume <0.5 ml /kg/hour in 6 hours. Mann Whitney test, Spearman correlation, and Chi-Square were used for statistical analysis. Data were analyzed using SPSS version 17 for windows.

Results: The results showed that there were no significant differences between the urine NGAL levels of AKI and non-AKI patients (130 (85-177) ng/dL; 56.65 (2.8-1500) ng/dL, p=0.407). In this study, only 3 cases of AKI were obtained from 39 subjects. Further analysis was carried out by looking at the correlation between urine NGAL levels and urine leukocyte count. The results showed a moderate correlation between them (r=0.6, p=0.001). The proportion of patients with elevated urine NGAL levels was greater in the group of patients with elevated urine leukocyte counts compared to the group with normal urine leukocyte counts (86,7%; 13,3%, p=0,008).).

The comparison of ion exchange-high performance liquid chromatography (IE-HPLC) and capillary electrophoresis (CE) for HbA1C measurement

Background:HbA1c is a glycosylated hemoglobin that routinely performed in patient with Diabetes Mellitus. There are several methods for HbA1c measurement. One of them are based on the molecular charge such as High Performance Liquid Chromatography(HPLC) and Capillary Electrophoresis (CE). Each method has its own advantages and disadvantages. Thus, the selection of HbA1c measurement method is an important thing. This study was aimed to compare HbA1c measurement with HPLC and CE method.

Methods:HbA1c measurement was done by HPLC and CE methods in 110 patient samples which have data of average blood glucose level during three months. We investigate the correlation of HbA1c results with average blood glucose level during three months,precision, methods comparison and interference including Hb varian. This study was conducted in Central Laboratory of dr. Saiful Anwar  Hospital during March–August 2018. Correlation analysis were done by Pearson analysis while precision test and methods comparison were done by Bland Altman Plot and Passing-bablok Regression analysis.

Results:There were correlation between estimated Average Glucose from HbA1c (eAGHbA1c) calculation with average blood glucose level during 3 months in both methods.From precision test we found intra-assay coefficient of variation in normal level (HbA1c ±5%) by HPLC vs CE was 1,7% vs 0.63% and in high level (HbA1c ±11%) was 0,59% vs 0,61% and inter-assay coefficient of variation by HPLC vs CE was 2,47% vs 2,17%. Method comparation results showed strong correlation on both method. The results of HbA1c in group without Hb variant by CE method was slightly lower than HPLC. In Hb variant group, CE method was slightly higher than HPLC, but it was not significant for HbA1c interpretation.

Conclusion:HbA1c measurement by HPLC and CE method are comparable and there is no significant difference in the results obtained.

The incidence of Clostridium Difficile infection in diarrhea patients after receiving antibiotics at Dr. Soetomo Hospital Surabaya

Introduction: Improper use of antibiotics is a risk factor for C. difficile infection. The increasing incidence of C. difficile infection is one of the indications of failure in infection prevention and control in hospitals. The aim of this study was to analyze the incidence of C. difficile infection in diarrhea patients after receiving antibiotics in the ICU and internal medicine ward of Dr. Soetomo Hospital Surabaya.

Results: The average age of respondents was 48.94 (21 – 86) years old. In addition, based on demographic data, it was predominant by females (65%), diabetes mellitus and fever (16%), and ceftriazone usage (22%).  The results showed one sample (3%) with positive results and 30 samples (97%) with negative results for both A/B toxins and GDH enzyme.

The ability of earthworm Lumbricus rubellus extract in slowing down the activation of NFkB and TNF-α in lipopolysaccharide-induced Rattus norvegicus

Background: Earthworm (L. rubellus) contains many compounds such as Lumbricin I, G-90 glycoprotein, and polyphenols as antimicrobial, antioxidant, and hepatoprotective toward bacterial infections. Tumor necrosis factor (TNF-α) has been identified as a mediator for necrosis tumor inside animal serum treated by lipopolysaccharide (LPS). High concentrated LPS can cause tissue damage and death. The increasing number of Nuclear Factor Kappa Beta (NFkB) activation has been responded by macrophage to produce cytokines pro-inflammation TNF-α as an indicator of inflammation.

Methods: The research was conducted in the Animal Laboratory Pharmacology Unit, Biomolecular Laboratorium, Faculty of Medicine Udayana University and the Pathology Clinic Sanglah General Hospital with a post-test only control group design. Thirty-two experimental rats were made as samples and divided into four groups, which are negative control, positive control, treatment 1, and treatment 2. Treatment was performed for 14 days. The containment of NFkB and TNF-α was measured on the 16_th day using quantitative technique sandwich enzyme immunoassay (ELISA).

Results: The results of the Shapiro-Wilk test and Levene’s test showed that the data were normally distributed and homogeneous, with p > 0.05. As the data were normally distributed, the one way ANOVA was used to analyze the data, followed by the Least Significant Difference (LSD) test. There was a significant difference between the average amount of TNFα found in each treatment group p = 0.001 (< 0.05). There were also significant differences between the average amount of NFkB found in each treatment group p = 0.001 (< 0.05). Advanced test using LSD shows more significant differences by p < 0.05.

Conclusion: It can be concluded that earthworm extract (L.rubellus) raises the amount of NFkB and TNF-α in male experimental rats injected with LPS.

The relationship of lactic acid, neutrophil lymphocyte ratio and monocyte lymphocyte ratio with the outcomes of coronary arterial disease patients following coronary artery bypass surgery

Background: Coronary artery bypass surgery (CABG) is a surgical procedure for coronary arterial disease (CAD). It has a risk of postoperative complication, extending from a long length of stay in the intensive care unit (ICU) to death. CABG needs a long duration of perioperative time, which decreases tissue oxygenation. It causes increased lactic acid production and initiates the secretion of inflammatory factors. Neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) become inflammatory signs that are caused by the failure of heart microcirculation during the operative procedure. This study aimed to determine the relationship of lactic acid, NLR and MLR with the outcomes of CAD patients following CABG surgery.

Methods: This was a prospective study including 42 CAD patients who had undergone CABG procedure at Dr. Kariadi Hospital Semarang between December 2017 and July 2018. Lactic acid data were taken using the spectrophotometer method.  NLR and MLR were taken by the calculation index. The outcomes data were ICU length of stay (LoS), complications, and death, which were obtained from the medical record. The data were analyzed using bivariate analysis.

Results: There was a significant correlation between lactic acid with ICU LoS (p = 0.001), complication (p = 0.01), and mortality (p = 0.044). There was a significant correlation between NLR with ICU LoS (p = 0.003), complication (p = 0.009), and mortality (p = 0.014). There was a significant correlation between MLR with ICU LoS (p = 0.02), complication (p = 0.027), and mortality (p = 0.017).

Conclusion: There was a significant correlation between lactic acid, NLR dan MLR with the outcomes of CAD patients (ICU LoS, complication and mortality) that have undergone CABG procedure.

Administration of pismatom juice increasing of potassium serum levels and faster of recovery in middle run athletes PASI Denpasar, Bali-Indonesia

Introduction: Intense prolonged physical exercises such as athletic need more energy. It causes fatigue and sweat excretion which is possibly related to decreasing of electrolyte and recovery delay. This research aimed to prove that administration of mix juice of banana, honey, and tomato (pismatom) increasing of potassium serum levels and faster of recovery in middle run athletes.

Method: This research was an experimental design using randomized pre-test-post-test control group design using 28 middle run athletes. Selected samples divided into two groups using random allocation technique. Treatment group was given pismatom juice before and after physical activity with 240 of volume and control group was given mineral water before and after physical activity with 240 ccs of volume during 14 days. Blood-vein measurement was used to evaluate potassium serum levels and measure of pulse recovery rate. The statistical analysis using SPSS version 20.0 for windows, comparison of electrolyte level and recovery time using t-independent test and General Linear Model (GLM).

Result: The results showed that potassium serum levels increasing significantly (p<0.05) in the Treatment Group (4.90 + 0.17 mmol/L vs 3.69 + 0.15 mmol/L). Pulse rate indicate the recovery more faster in the Treatment Group to 3^rd minute recovery pulse (RPR3) (124.21+6.61 x/mnt vs 131.57+12.49 x/mnt), to 4^th minute recovery pulse (RPR4) (120.14+8.29 x/mnt vs 126.50+12.13 x/mnt) and to 5^th minute recovery pulse  (RPR5) (111.29+6.69 x/mnt vs 123.14+12.06 x/mnt) that was significantly different (p<0.05).

The comparison of erythrocyte sedimentation rate (ESR) modify Westergren Caretium Xc-A30 and Westergren Manual in Clinical Pathology Laboratory, Sanglah General Hospital, Denpasar, Bali

Background: The erythrocyte sedimentation rate (ESR) test is one of the most widely performed laboratory test to assess acute phase of inflammation, infection, autoimmune or malignancy. The reference method for ESR measurement was introduced by Westergren. This method is generally easy, un-expensive, yet, time consuming. Automatic instrument has been introduced to decrease the measurement time. Caretium XC-A30 is automatic instrument to measure ESR; it is used in Sanglah General Hospital Denpasar without previous research. Aim of this study was to assess comparison, correlation and agreement of Caretium XC- A30 to the reference method.

Methods: A total of 35 samples in consecutive sampling were taken during August 2018 at Sanglah General Hospital, Denpasar. The samples were examined for ESR with Caretium XC-A30 and manual Westergren. Comparison, correlation and agreement were tested for both methods used.

Results: The Westergren method was the reference method and Caretium XC-A30 was the tested method. Wilcoxon signed rank test showed no difference between two methods (p= 0.439). There was a very strong correlation and excellent agreement showed by Spearman coefficient correlation r= 0.989 and kappa coefficient 0.942.

Conclusion: This study showed no difference between Caretium XC-A30 and Westergren as the reference method for ESR measurement, with very strong correlation and excellent agreement. Thus, Caretium XC-A30 has a potential use in performing ESR measurement with high throughput and lesser time than manual Westergren method.

The role of serum albumin level within the first 24-hours of hospitalization to the mortality risk in burn patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Introduction: Serum albumin level may predict the mortality risk in burn patients. This study aimed to determine the mortality risk in burn patients based on serum albumin level within the first 24 hours of hospitalization.

Method: A cross sectional study was conducted reprostecively to the patient’s medical records. The subjects were burned patients who were hospitalized in Dr. Hasan Sadikin General Hospital Bandung during January-December 2017. The subjects were divided into two groups, which were dead and survived at the end of hospitalization. The mortality risk based on serum albumin level within the first 24 hours of admission was assessed using the odds ratio (OR) of two groups. Data were analyzed using SPSS version 17 for windows.

Result: The subjects were 47 patients, consisted of 9 dead subjects and 38 survived subjects. Males were predominant in both groups such as 12.8% in dead subjects and 70.2% in survived subjects. The OR value based on serum albumin level <2 g/dL within the first 24 hours of hospitalization was 14.40 (p=0.009; CI:2.1–100).

Conclusion: The subjects with serum albumin level <2 g/dL within 24 hours of hospitalization has 14 times higher mortality risk compared to the subjects with serum albumin level >2 g/dL. Therefore, burn patients need to be examined for serum albumin level within the first 24 hours of hospitalization.

Pregnant gymnastics, ANC, and IEC pregnancy lower the stress on pregnant women

Background: Psychosocial stress in pregnant women is one of the factors that cause the disorder of metabolism for pregnant women. Maintaining physical and mental health on a pregnant woman can be conducted by ANC, pregnant gymnastics, and IEC pregnancy to optimize health degrees while pregnant and expedited the process of childbirth.

Aim: This study aimed to analyze the relationship of the gymnastics, ANC, and the IEC pregnancy with stress rate on pregnant women.

Methods: This was an observational analytical with a case-control approach. The subject of this study was the mother of a toddler as many as 390, ages 2 to 2.5 years that live settled in Klaten Regency, Karanganyar and Sragen.

Results: Stress while pregnant is significantly associated with the gymnastics pregnant (p = 0.023; CI 0.38-0.93; OR 0.69), ANC (p = 0.001; CI 0.01-0.57; OR 0.75) and IEC of pregnancy (p = 0.049; CI 0.45-1.00; OR 0.69).

Conclusion: Stress during pregnancy can be reduced by doing pregnant gymnastics and the ANC. Granting education can also be used as an alternative to reduce stress during pregnancy.

Betel nut (Areca catechu L.) extract toxicity on the kidney and liver of white rats (Rattus norvegicus)

Background: Medication using herbal medicine is one of the alternatives chosen to reduce the adverse effects caused by synthetic drugs. Betel nut (Areca catechu L) usually used as an alternative drug such as anthelmintic and others.

Aim: The study aims to determine the chronic toxicity effect of betel nut.

Method: Five hundred grams of simplicial powder was macerated using 95% ethanol in a container, then sealed and let them for three days. They were protected from light while repeatedly stirred. Rat was given Betel nut extract for three weeks. The histopathological examination was observed under the microscope.

Result: The mean GOT serum, GPT serum, BUN, and creatinine serum levels between control (no extract given) and each dose, i.e., 0.2 ccs, 0.4 ccs, and 0.8 ccs, showed insignificant results (p > 0.05). According to the histopathological observation, there was no difference between control and treatment.

Conclusion: Various orally doses of betel nut extract did not cause toxicity in white rats (rattus novergicus). 

The effect of Sargassum duplicatum extract on SGPT level in Rattus norvegicus infected by Plasmodium berghei

Background: Malaria still becomes a major health problem in Indonesia, especially in the eastern part of Indonesia. The occurrence of Plasmodium resistance against antimalarial medications increases the difficulty of malaria wipe-out effort. As regard with such a great potential Sargassum production that Indonesia possesses, it is very likely to develop Sargassum as adjuvant therapy to prevent and even to stop the resistance.

Aim: This research aims to develop adjuvant therapy of Sargassum extract to avoid the resistance of malaria therapy on the SGPT level.

Method: There were 24 white rats (Rattus norvegicus) that had been infected by Plasmodium berghei and were given dihydroartemisinin-piperaquin (DHA-PPQ) therapy as antimalarial therapy at the dose of 3mg/KgBW for three consecutive days. The rats were later divided into three groups. Group 1 received only (DHA-PPQ), group 2 received Sargassum duplicatum extract as adjuvant therapy at  the dose of 100 mg/KgBW for ten consecutive days. Group 3 also received Sargassum duplicatum extract as adjuvant therapy but the dose was at 300 mg/KgBW for ten consecutive days.

Result: SGPT level decreased more significantly in groups in which the rats received dihydroartemisinin-piperaquine and 100 mg/kgBW Sargassum extract as adjuvant therapy and on the other hand only received Sargassum extract at the dose of 300 mg/kgBW. After ten days of therapy the blood SGPT level was examined from all rats. The data were analyzed using one-way ANOVA test.

Conclusion: Sargassum duplicatum (100 mg/kgBW) showed a more significant decrease of SGPT level in Rattus norvegicus (Wistar strain) inoculated by Plasmodium berghei as against those in the dose 300 mg/kgBW. 

The effect of lean six sigma toward maternal emergency lead time in penembahan senopati hospital, bantul, yogyakarta

Introduction : Indonesia is one of the countries with high Maternal Mortality Rate that result partially from in management inefficiency, causing in obstruction of flow, underutilized resources, and imbalance between the number of patients with the availability of care facilities and the alternative care strategies. One of the strategies that can be applied to reduce lead time is Lean Six Sigma (LSS). Therefore, the purpose of this study was to evaluate the impact of Lean Six Sigma (LSS) methodology on patient lead time in Maternal Emergency of district government hospital.

Methods: Researcher and the participants were involved in planning, gathering data, analyzing, and choosing the best solutions. The participants were trained on LSS methods, its implementation tools and procedures. Evaluations were conducted using lead time observation before and after implementation, and midwives were interviewed about their perceptions. The analysis was based on Value Stream Mapping tools.

Results: Patients’ lead time from being admitted in emergency unit definitive diagnosis was decreased by 26.04 minutes or 16.4% in Caesarean Section (CS) and 15.25 minutes or 21.7% in other maternal high risk. For emergency CS, the improvement was 33.06 minutes or 26% from decision until incision. The benefit of LSS implementation was primarily in accelerating service processes and improving communication and team work.

Conclusion: This study showed that the implementation of LSS had great potential benefit in a maternal emergency unit. Participation of the midwives is crucial for successful implementation of LSS to reduce patients lead time.

The mucin 5AC level in medical faculty students with Computer Vision Syndrome (CVS)

Introduction: Prolonged computer use will lead to a group of symptoms such as dryness of eyes, tired, headache and others called Computer Vision Syndrome (CVS). The decrease of Mucin 5 AC (MUC5AC) level could be one of the signs of dry eye disease on persons with CVS.

Objective: The purpose of this study is to describe the Mucin 5AC level in medical faculty students of Udayana University, Bali, Indonesia with CVS.

Method: It is an observational cross-sectional analytic study at Medical Faculty Udayana University on October 2018. Thirty four subject selected  by purposive sampling and examined with Schirmer I test, Tear Break Up time (TBUT) test, and Mucin 5AC test. All of the subject then divided into CVS group and non-CVS group. Mucin 5AC level which less than 186.33 ng/mL categorized as low mucin, while more than 186.33 ng/mL categorized as normal mucin level. Data was analyzed by crosstabulation table and chi-square test with significant value p < 0.05.

Result: Most of the students who diagnosed with CVS had lower mucin 5AC levels as much as 77,3% and 33,3% students with CVS had normal mucin 5AC level.  This study analyses found there is significant association between level of mucin 5AC with CVS. The students with low level of mucin 5AC had 6,8 higher risk tend to be CVS (OR=6,8; CI 95%= 1,42-32,37; p=0,012).

Conclusion: Low level of mucin 5AC has association with the risk of CVS in the medical students with prolonged computer use.

The surveillance of antibiotics resistance in Indonesia: a current reports

Background. Antimicrobial resistance (AMR) has become serious problem globally. Surveillance AMR is important to be part of quality indicator in antimicrobial stewardship program (ASP).

Method. Surveillance of microbial pattern and their antibiotics susceptibility in Indonesia 2017 were developed by Indonesian Association of Clinical Pathology and Laboratory Medicine. Data aggregation was sourced from 31 hospitals antibiogram report which were joined the system of national data collection in forlabinfeksi.or.id. with standardized inclusion criteria. Data was analyzed descriptively, based on hospital type-A-B-C.    

Result. There were 15.302 isolates included, 4.761 (31,1%) were positive Gram and 10.541 (68,9%) were negative Gram, 61,6% reported by type-A hospital, 16,4% by type-B and 22% by type-C. Positive and negative Gram patterns respectively were E. faecalis and E.coli  (blood and urine), Streptococcus spp and K. pneumoniae (sputum), S. aureus and E.coli (pus), E. faecalis and E.coli  (wound), coagulase negative Staphylococcus and Enterobacteriaceae (CSF). Antibiotic susceptibility pattern was slightly different among various types of hospital and among various clinical specimens. Positive Gram bacteria had good vancomycin susceptibility in all hospital types, except in sputum from Type-A and B hospital, also in blood and urine from Type-C hospital, similarly with linezolide susceptibility. Susceptibility pattern among Gram negative- bacteria for carbapenem and amikacin was good, in all hospital types, except on A. baumannii.  For A. baumannii, antibiotic carbapenem, amikacin and ceftazidime susceptibility were 20-66%, 35-80%, and up to 83%, respectively. For P. aeruginosa, antibiotic susceptibility pattern was equal among all hospital types. Their susceptibility against cephalosporin (ceftazidime), fluoroquinolone (ciprofloxacin) and aminoglycoside (amikacin) were better in higher type-hospital.

Conclusion. This result may become part of national epidemiological data for ASP program evaluation. This data may also be referred for local empirical antibiotic guideline among limited resources appropriate hospital. There will be improvement forward for more representative beneficial data.

Erythrocyte alloantibodies in chronic kidney disease patients receiving packed red cell transfusions in Sanglah General Hospital, Denpasar

Introduction: In Chronic kidney disease (CKD) patients, as the consequences of the pathogenesis, anemia due to the failure of erythropoietin production requires Packed Red Cell (PRC) transfusion. The presence of alloantibodies in CKD patients who routinely require transfusion in Bali has never been evaluated. This study aims to determine the erythrocyte alloantibodies of CKD patients who received PRC transfusions in Sanglah Hospital.

Methods: This study was a cross sectional descriptive study in adult CKD patients with history of PRC transfusion more than twice.

Results: A total of 50 patients with Chronic Kidney Disease consisting of 31 men and 19 women, mostly 46-65 years old (60%) and the most blood group were blood group O (44%). There were 3 patients with positive antibody screening and identification results, 2 male patients (66.67%) and 1 female (33.33%). Two patients 46-65 years (66.67%) while 1 person 18-45 years (33.33%), with 2 person with blood group A (66.67%) and one person with blood group O (33.37% ). These three patients presented multiple alloantibodies in the form of anti-K, anti-Kp^a, anti-Lu^a

Conclusion: From  the CKD patients who received PRC transfusions in Sanglah Hospital, ±6% formed alloantibodies. All of the alloantibodies formed were multiple alloantibodies, in the form of anti-K, anti-Kp^a and Lu^a.

Coagulation Defects in Βeta-Thalassemia Major Patients at Haji Adam Malik Hospital Medan

Background: The prognosis of patients with beta-thalassemia major has improved in the last few decades, but some complications occur in thalassemia patients such as the prolongation of blood coagulation time. This study aimed to determine the difference in prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT) between beta-thalassemia major patients and healthy children, frequent and infrequent transfusion, and ferritin levels ≥ 2,500 ng/ml and < 2,500 ng/ml.

Method: This was an analytical cross-sectional study performed at Haji Adam Malik Hospital from April to August 2018 including 20 thalassemia patients and 20 healthy children. Patient data consisted of full blood count, transfusion status, coagulation parameters, serum iron, and ferritin level. The difference between coagulation parameters was analyzed using the independent t test.

Result: There was a significant difference in PT and aPTT between patients with thalassemia and healthy children (15.7 ± 1.5 vs. 13.0 ± 1.0; 42.5 ± 4.8 vs. 36.3 ± 4.8 respectively). There was a significant difference in PT between frequent and infrequent transfusion (15.41 ± 1.30 vs. 17.16 ± 2.08). There was significant difference in PT and aPTT between ferritin levels ≥ 2,500 ng/ml and < 2,500 ng/ml (18.97 ± 0.57 vs 15.93 ± 1.18; 52.92 ± 1.17 vs 42.11 ± 3.88 respectively).

The relationship between Epidermal Growth Factor Receptor (EGFR) mutation and computed tomography findings in lung adenocarcinoma

Background: Adenocarcinoma is the highest histology subtype of lung cancer. Epidermal Growth Factor Receptor (EGFR) is a factor that can predict the prognosis or response to treatment in patients with lung adenocarcinoma. Adenocarcinomas with EGFR mutations generally have a component of Ground Glass Opacity (GGO), smaller size, oval shape, multiple nodal metastases, and distant metastases.  The aim of this study was to determine the relationship between EGFR mutations and CT scan images in pulmonary adenocarcinoma patients.

Methods: This was a retrospective analytical study consisting of 92 samples, which were categorized into the mutation group (n = 62) and wild group (n = 30). This study was conducted at Dr. Soetomo General Hospital from January 2015 – December 2017. The assessed CT-Scan findings were tumor size, shape, density, lymph node size, pleural effusion, and metastasis presence. The relationship was analyzed using the chi-square test and considered significant if the p-value was < 0.05.

Results: This study found a significant relationship between EGFR mutations status with tumor size ≤ 3 cm (p = 0.02), lymph node size < 1.5 cm (p = < 0.001) and metastasis (p = 0.026). However, tumor density, tumor form, and pleural effusion did not have significant relationship with EGFR mutation.

Conclusion: Tumor size ≤ 3 cm, lymph node size < 1.5 cm and presence of metastasis can be found in EGFR mutations pulmonary adenocarcinoma patients.

The correlation between caspase-9 and caspase-3 on sepsis case: an experimental study on the Balb/C Mice induced by lipopolysaccharide

Introduction: Sepsis mortality rate in Indonesia reaches over 50 %, hence, acknowledgement of its pathophysiology need to be elucidated, including the pathway of apoptotic. The objective of this study was to describe the lipopolysaccharide (LPS)-induced sepsis in which triggers intrinsic apoptotic pathways in terms of the expression of caspase-9 (Cas9) and caspase-3 (Cas3).

Method: By experimental with time series randomized post test-only control group design, 48 Balb/C mice divided into 2 groups (control and treatment). Each group was injected intra-peritoneally with saline 250 µL/mice and saline 250 µL + 0.1 mg E. coli LPS/mice. Each group divided into 4 termination time (12^th, 24^th, 36^th and 48^th hours), examined by immunohistochemistry (IHC) for Cas9 and Cas3 expression, and analyzed by mean difference test (Mann-Whitney and t test) and correlation test (Spearman’s test).

Results: The LPS-induced sepsis in the treatment group revealed increasing number of caspase-9 compared to control group (2.34+0.24 vs 0.82+0.08; p<0.001. There were increasing trends in the treatment group compared to control group includes for: all groups Cas3 (1.54+0.10 vs 0.48+0.05; p<0.001), t12 Cas3 (3.25+0.22 vs 0.50+0.06; p<0.001), t24 Cas3 (1.37+0.27 vs 0.45+0.05; p=0,002), and t36 Cas3 (1.03+0.20 vs 0.52+0.22; p=0,002). Instead, there were no difference between treatment group and control group for t48 Cas3 (0.50+0.14 vs 0.43+0.10; p=0,485). There was decreasing pattern on serial time 12, 24, 36 and 48 hours for Cas9 (p<0,001) and Cas3 (p=0,002). There was a correlation between Cas9-Cas3 (r_s=0.835;p=0.001).

Conclusion: The LPS-induced sepsis caused an increase of caspase-9 and caspase-3, strongly correlated with decreasing pattern on time serial.

Analysis of nerve growth factor serum levels in psoriasis vulgaris patients

Background: Psoriasis is a complex chronic inflammatory skin disease with multifactorial mechanism affected by immunological, genetic, environmental and nervous system factors which its mechanism is still unknown. The involvement of nervous system in psoriasis is ruled by nerve growth factor (NGF). Increased levels of NGF serum are expected occurring in psoriasis vulgaris.

Aim: To determine the differences between NGF serum levels in psoriasis vulgaris patients and controls

Methods: This study is an analytic study with cross sectional design involving 30 psoriasis vulgaris patients and 30 healthy controls. Diagnosis of psoriasis vulgaris was made based on history and clinical examination; we conducted blood sampling and measurement of NGF serum level to the patients and controls. The differences between NGF serum levels in psoriasis vulgaris patients and controlled is analyzed by independent-t test. This research approved by the health research ethics committee of the Faculty of Medicine of Sumatra Utara University/ H. Adam Malik  Medan General Hospital.

Results: In this study, we found the mean NGF serum level of female psoriasis vulgaris patients (810.30 ± 299.97 pg/ml)  was higher compared to male (806.70 ± 256.04 pg/ml).  The mean NGF serum of psoriasis vulgaris patients were highest on ages group 15 – 23 years (930.14 ± 69.03 pg/ml). The mean NGF serum level of psoriasis vulgaris without family history (875.38 ± 203.91 pg/ml) was higher compared to patient with a maternal history (600.87 ± 387.45 pg/ml) and paternal history (477.88 ± 406.97 pg/ml). The mean NGF serum level in the psoriasis vulgaris group (808.38 ± 272.48 pg/ml) was higher compared to the control group (524.92 ± 281.22 pg/ml) dengan with p=0.0001.

Cytogenetic mutation in a family with sickle-cell beta-thalassemia in North Sumatera, Medan, Indonesia: A preliminary study

Background: The prevalence of  Hb S/β Thalassemia has not been widely reported, and until now, there is a lack of statistical data on the prevalence of the disease in Indonesia. In 1974, cases of β thalassemia with Hb S were found in one family in Jakarta. The aim of this study was to describe the cytogenetic mutation in a family with Hb S/β thalassemia in North Sumatera.

Methods: This was a descriptive study with a cross-sectional design conducted in one family of HbS patients with thalassemia trait, with a total of five samples. Complete blood count, hemoglobin electrophoresis examination, peripheral blood smear, PCR, and amplicon were performed to describe the hematology and cytogenetic profile of samples. Data were analyzed descriptively.

Results : The father (64 years old) suffered from HbS (HbA = 58.3%, HbS = 38.3%, HbA2 = 2.8%) with heterozygote HbS mutation type. The mother (36 years old) suffered from β-thalassemia trait (HbA = 93.8, HbF = 1.2%, HbA2 = 5%) with β-thalassemia heterozygote IVS1-nt5 mutation type. The first child (male, 18 years old) suffered from HbS/β thalassemia (HbA = 25.9%, HbF = 22.4%, HbS = 48.2%, HbF = HbA2 = 3.5%), the second child was normal (HbA = 97.4%, HbA2 = 2.6%) and the third child (female, 10 years old ) suffered from HbS β-thalassemia (HbA = 3.3%, HbF = 25.5%, HbS = 67.6%, HbA2 = 3.6%). The first and third child had β-thalassemia with double heterozygote HbS and IVS1-nt5 mutation type.

Conclusion: Population migration between nations followed by marriage could lead to cytogenetic mutations and cause sickle-cell beta-thalassemia. The finding of double heterozygous HbS mutation and beta thalassemia need to be explored further about the patient’s fathers family.

Measuring motor evoked-potentials in children with autism spectrum disorders accompanied with cerebral vein thrombosis following intraarterial heparin flushing

Background: The use of the term "Autism Spectrum Disorder" has led to confusion over this substance. Prior to DSM-V criteria, symptoms of Autism Spectrum Disorder (ASD) refers to the problems in brain vasculature and brain chemistry most likely affect the children behavior, whereas the authors' findings suggest such problems depicting a similar anomaly in cerebral vein thrombosis case (CVT). Recently, the evoked potentials, that demonstrated in CVT, have a possible prognostic value on patients suffering from ASD. This study purposes to measure the motor evoked potentials (MEPs) on patients following the intervention of intraarterial heparin flushing (IAHF).

Methods: A descriptive study was conducted on 17 patients admitted in Cerebrovascular Center of RSPAD Gatot Soebroto, Jakarta, diagnosed with ASD presenting CVT. The MEPs value was measured by conforming the IAHF procedure.

Results: The MEPs value (amplitude, latency, CMCT) pre and post-IAHF showed an increasing value. Meanwhile, there was a lowering value of latency and CMCT in left cortical participants after IAHF.

Conclusion: The group tends to perform more expected positive MEPs changes after IAHF.

The 1st International Conference on Global Health and Innovation: Multiple Burden of Diseases in the Developing Countries

Welcome remark The Chairman of GHI Conference

Dear all participants and invited speakers,

It is my privilege and pleasure, on behalf of Dean of Faculty of Medicine and Rector University of Mataram, to welcome you all to the 1st International Conference on Global Health and Innovation. This conference is held by the Faculty of Medicine Universitas Mataram with the support of Chungnam National University, Indonesian Doctor Association of West Nusa Tenggara, and Indonesia Pharmacist Association. This conference is in conjunction with the 57th Dies Natalis of Universitas Mataram and 16th Dies Natalis of the Faculty of Medicine Universitas Mataram.

The theme of the conference this year, “Multiple Burden of Diseases in the Developing Countries” reflects the current health situation faced by Indonesia and other developing countries, where due to the demographic and socio-economic transition and the increasing trend of non-communicable diseases, more constraints are imposed to our health systems in dealing with the pre-existing burden of communicable diseases. This is a challenge that calls out further action and innovation.

This conference is presenting you with internationally recognized, multidisciplinary expert speakers from Indonesia and abroad to share their knowledge in regards to the current global health concerns of the multiple burdens of diseases in developing countries. We have 100 participants with 53 abstract.

To further disseminate the scientific endeavors of researchers who have submitted their study to be presented in this conference, we are partnering with Bali Medical Journal, an experienced and internationally-indexed journal in Indonesia.

Conferences such as this provide a valuable opportunity for health professionals, researchers and students to share knowledge, ideas, and experiences. It is also a forum for young and senior researcher to connect and explore potential future collaboration.

We would like to thank the provincial government of West Nusa Tenggara, Indonesian Doctor Association, Indonesia Pharmacist Association and all sponsors for the supports.

I am sure you will have fruitful and rewarding exchanges during this conference. I wish you every success with this important conference and I look forward to learning about the outcome. We once again welcome you to Lombok and we hope that you are enjoying this conference.

Thank you.

Anti-Mullerian Hormone (AMH) as a Novel Marker for Ovarian Function: A Review

Background: Anti-Mullerian Hormone (AMH) is a homodimeric glycoprotein linked by disulfide bonds which belongs to the Transforming Growth Factor (TGF) beta superfamily. AMH is produced by gonadal tissue namely testicular Sertoli cells and ovarian granulosa cells especially pre-antral and antral follicles. AMH involved in embryonic sexual differentiation in male, while it has an inhibitory effect on primordial follicle recruitment and responsiveness of the growing follicles to FSH, in female. Current studies show promising clinical utilities of AMH measurement in predicting ovarian function.

Objective: This review aims to explore further about the physiology of AMH and its role as a novel marker for ovarian function.

Method: A review of relevant literature was performed to elaborate AMH involvement in ovarian function. A total of 14 qualified published literature of all years until 2018 were collected from several electronic database and manual search and included in this review.

Results: AMH level reflected ovarian follicular reserve, an important indicator in infertility treatment (assisted reproduction technique) and a sensitive marker for ovarian aging. AMH is also a valuable tool in diagnosis and recognition of recurrence granulosa cell tumors, and a marker of ovarian dysfunction particularly polycystic ovary syndrome. A low circulating AMH level is observed in obesity and male with fertility problems.

Short insight of pediatric cerebral venous thrombosis and the safety of intra-arterial heparin flushing as a new therapeutic method

Introduction. The incidence rate of Cerebral Venous Thrombosis (CVT) in children has been increased quite significantly due to the availability of advanced imaging technology and the trends of increasing awareness about health-related problem. Systemic anticoagulant was mainstay treatment for CVT. The author proposed a method of heparin deliveries through existing Digital Subtraction Angiography (DSA) procedure called Intra-arterial Heparin Flushing (IAHF). The safety of this procedure in children was still few known and reported. The purpose of this study is to provide insights on CVT and the potential complication of IAHF as the primary therapeutic modality.

Methods. This was a descriptive longitudinal study involving all patients with age 0-18 years diagnosed with Cerebral Venous Thrombosis whom admitted in RSPAD Gatot Soebroto from 2016 to 2018 through MRI examination and will undergo IAHF Procedure as the primary treatment. All subject had signed informed consent regarding the nature of the study. The descriptive data were presented in tables and narratives.

Results. The study found that the highest age group found in this study was between 6-12 years old (46,6%) with male-predominant (70,6%). The origins of the patients were mostly from Indonesia (88%) and several from Vietnam (12%). The most common symptoms of CVT in this study was the speech/communication problem (12%). The most common complication after IAHF procedure was wound swelling at the puncture site (2,6%).

Conclusion. CVT predominantly affect male aged 6-12 years old with speech problem was the most common symptoms. IAHF procedure shown minimal side effects in pediatric with CVT.

Spontaneous recovery of Medial Prefrontal Syndrome following Giant Olfactory Groove Meningioma resection: A case report

Introduction: Anterior skull base meningiomas are frequently associated with changes in personality and behavior. Olfactory groove meningiomas take their origin from the cribriform plate and frontoethmoidal suture in the floor of the anterior cranial base. The cardinal clinical features usually observed are mental changes, visual deterioration, and headaches as a result of olfactory or optic nerve and frontal lobe compression. However, several authors have reported minimal changes in cognition or behavior following surgical resection, and many patients do not return to their premorbid level of function.

Case presentation: A 42-year-old male with four months history of changes in behavior, apathy, and lack of motivation. Over the course of two months, his vision progressively worsened in both eyes, and he developed a diffuse, mild headache. On examination, he was fully alert and cooperative. He only had light perception and could see faint silhouettes of people. All other neurological examinations were normal. Head Computed Tomography (CT) demonstrated a large, extra-axial mass consistent with an anterior skull base mass extending to the sellar and suprasellar region, which suggests an olfactory groove meningioma. The patient underwent a bifrontal approach craniotomy tumor resection and subsequently recovered from medial prefrontal syndrome following tumor resection. Surgical tissue pathology confirmed the diagnosis as an olfactory groove meningioma.

Discussion: The anatomical location of the olfactory groove meningioma may cause prolonged psychiatric symptoms before the onset of more overt neurological deficits. Personality changes that occur may be subtle, so patients may avoid seeking treatment for their headaches and delay ophthalmic care until their complaints become severe. Anterior skull base meningiomas often involve the ventromedial prefrontal cortex (vmPFC) that is associated with elevated levels of apathy.

Conclusion: Olfactory groove meningiomas are treatable. Reversal of cognitive impairments and changes in behavior can be expected after surgical resection.

A rare case of Hb H disease caused by compound heterozygous for α thalasemia and Hb Quong Sze in Chinese Indonesian proband: a case report

Background: Hemoglobin H (HbH) disease is alpha thalassemia characterized by inactivation of three of four α-globin genes due to deletions with or without non-deletional α-thalassemia. Hb Quong Sze (Hb QS) is a very rare non-deletional α-thalassemia in Indonesia caused by a CTG^Leu>CCG^Pronucleotide substitution at codon 125 of α₂ globin gene generating highly unstable hemoglobin. Compound heterozygosity for Hb QS and Southeast Asian double α-globin gene deletion (--^SEA) result in accumulation of b-globin tetramers, causing hemolytic anemia.

Case Report: A 49 years old Chinese Indonesian female was assessed for thalassemia screening. The phenotype of the proband was normal and only mild anemia was noticeable. She experienced blood transfusion five years ago due to a sudden fall of hemoglobin level after malarial infection. Complete blood count found hemoglobin 8.3 g/dL, Mean Corpuscular Volume (MCV) 65.7 fl and Mean Corpuscular Hemoglobin (MCH) 17.1 pg. HbH disease suggested by abundant Hb H inclusion bodies in the red blood cells. Microcapillary hemoglobin electrophoresis result showed HbH 31.8 %, Hb Bart 0.4%, HbA 67.3% and HbA₂ 0.5%. Molecular studies were carried out using multiplex polymerase chain reaction (PCR) method, and the common a⁰-thalassemia(--^SEA) was detected in one allele. Direct sequencing analysis of the α₁ and α₂ globin genes revealed Hb QS in the other allele.

Conclusion: Non-deletional Hb H disease due to compound heterozygous of  Hb QS with Southeast Asian double α-globin gene deletion (--^SEA) has a very low incidence in Indonesia. An advanced molecular analysis should be performed to determine this rare mutation.

Testicular carcinoma in a female with 46-XY karyotype: a case report

Background: Testicular cancer is now the most common malignancy in young males. Markers available in the management of patients with testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). Female patients with androgen insensitivity syndrome (AIS) and pure gonadal dysgenesis have a pure XY karyotype and an increased risk of developing a gonadal malignancy.

Case Description: A 26-year-old female presented with a hardened stomach and primary amenorrhoea. Physical examination revealed Tanner Stage I for both the right and left breast and no pubic or axillary hair. On local examination, there was a large firm non-tender mass extending across the abdominopelvic region. Gynecological examinations revealed normal labia; however there was clitoromegaly, the vagina was blind (5 cm) with the absent cervix. Laboratory tests with increased abnormal results were as follows: LDH 3,448 U/L, AFP 1,842.6 ng/mL, Cortisol 22.41 ug/dL and Testosterone 128.7 ng/dL. An MSCT of the abdomen showed a solid mass with no signs of a vagina or uterus. Blood karyotyping results were 46 XY with the presence of the SRY gene. Due to an increase in LDH, AFP, Cortisol and Testosterone, with 46 XY karyotyping, Tanner stage 1 breasts, pubic and axillary hair, female genitalia phenotype and abdominal MSCT showing a solid mass with no signs of vagina and uterus, this patient was diagnosed with non seminoma testicular cancer with widespread disease and 46, XY karyotype (male).