Impaired cognitive function and its relationship with menopausal onset and exercise intensity of elderly women

Background: The success of development is the ideals of a nation that can be seen from the improvement in living standards and life expectancy. This also results in a shift in the composition of the population, which will increase the composition of the elderly population. Increased life expectancy must also be accompanied by a good quality of life. During this time the elderly are related with helplessness, dependence, with various health problems such as various cardiovascular diseases, osteoporosis, cognitive impairments such as dementia. This needs to be the concern of all parties. This study aims to determine: 1) the prevalence of elderly women who experience cognitive dysfunction in Buleleng Regency; 2) the relationship between cognitive impairment and the onset of menopause; and 3) and the relationship between cognitive impairment and the level of exercise activities of elderly women in Buleleng Regency.

Methods: This research is a descriptive correlational quantitative observational study with a cross sectional study approach. The study sites were in 5 sub-districts in Buleleng Regency with a total sample of 73 people. To find out the relationship between cognitive impairment and the onset of menopause and the pattern of exercise activities in older women, data were analyzed by contingency coefficient correlation test.

Results: The results showed that 18.4% of elderly women experience definite cognitive impairment, 23% probale cognitive impairment, and 58.6% normal cognitive function. The relationship between cognitive impairment and the onset of menopause was obtained p value 0.296 which indicates that the correlation between the onset of menopause and cognitive function was not statistically significant. The relationship between cognitive impairment in elderly and level of exercise activity obtained a p value of 0,000 which indicates that the correlation between exercise activity and cognitive function is statistically significant.

Characteristic gynaecology-oncology patients from Obstetrics and Gynaecology Outpatient Clinic Mangusada Regional Hospital Badung reffered to Sanglah Hospital from 1st January 2016 – 31st December 2018

Background: Every year, there is an increase in malignancy cases in the world. In women, malignancy is the second most cause of death. Gynecologic malignancy can be found in all women reproductive tract, including cervix, ovary, uterus, vagina and vulva. Most women death from gynecologic malignancy occurred in developing countries, and this is due to lack of access for early detection and treatment. The study aims to report characteristic of patients referred from Obstetrics and Gynaecology Outpatient Clinic Mangusada Hospital, Badung from January 2016 – December 2018.

Results: Total referred case were 451 gynaecology-oncology patients in obstetrics and gynaecology outpatient clinic Mangusada Hospital, Badung-Indonesia. Top three most referred case were cervical cancer, ovarian cyst with malignancy suspected and ovarian cancer. For Cervical cancer, most of the patients are in group age 41-50 years old (40,3%), in-stadium III (59,2%) and squamous cell type (71,7%). For ovarian cancer, most of the patients are in group age 41-50 years old (45,1%), in-stadium III (59,2%), and epithelial type cell (87,3%). For endometrial cancer, most of the patients are in group age 51-60 years old (53,9%), in-stadium III (46,1%) and adenocarcinoma cell type (100%).

Conclusion: The most common gynaecological referral cases are cervical cancer, suspicious malignant ovarian cysts, and ovarian cancer. All gynaecological cases referred to are suspected or diagnosed as gynaecological malignancies and require the handling of a gynaecology-oncology division and integrated oncology services.

The effects of meldonium on microrheological abnormalities of erythrocytes in rats with obesity : An experimental study

Background: The microrheological disorders of red blood cells in obesity is often missed by the researchers. This study aimed to report an experimental investigation on laboratory animals with developed obesity and to find out the effect of meldonium on the erythrocytes.

Methods: A total of 95 healthy male-rats of Vistar line were taken into the investigation, 29 animals had experienced no impacts and allocated as the control group, while 64 rats which had developed obesity induced by a cardioangionefopathogenic semisynthetic diet into the obesity group. These rats were casually divided into an experimental (34 rats) group and the control group (30 rats). The rats of the experimental group in the next ten days were intragastrically injected with meldonium for 80 mg/kg. The biochemical, hematological and statistical methods of investigation were used in this study.

Results: During the formation of obesity and the use of meldonium, the body weight of the rats were gradually decreased to the normal level. On the obese rat's group receiving meldonium, the content of the lipids peroxidation products in erythrocytes progressively decreased.  and reached the level of the healthy control rats group. Moreover, there was a decrease in the number of erythrocytes-discocytes accompanied by an increase in the reversible and irreversible changes. These values were returned to the level of the healthy control rats group at the end of the observation. This pattern was observed in the total number of erythrocytes aggregate and free erythrocytes.

Conclusion: The application of meldonium eliminates the existing erythrocytes abnormal microrheological features in the rats with recently developed obesity.

Psychological comfort in patients with lumbar spine osteochondrosis treated with daily therapeutic-prophylactic clothes over 6 months

Background: Patients with second-degree lumbar osteochondrosis are observed to pay more attention to their health, have higher levels of anxiety, and a lower degree of life satisfaction. Daily wearing of therapeutic-prophylactic clothes by the subjects was applied for correction of osteochondrosis signs. Levels of life-satisfaction, anxiety levels, personal self-estimation, and attention paid to their health were observed in subjects with osteochondrosis who wore the garments daily for 6 months.

Methods: The study was conducted in Central Russia (Moscow City and Moscow region). Data were obtained from 37 healthy subjects as a control group and 43 subjects of second-degree lumbar spine osteochondrosis as a case group in both sexes of the second mature age (mean age – 43.5±2.5 years, 44.7±1.9 years, respectively). The doctor in the institutions diagnosed second-degree lumbar spine osteochondrosis.

Results: Our results revealed subjects with osteochondrosis who daily wore the author’s version of therapeutic-prophylactic clothes for six months, had persistent remission of osteochondrosis with reduction of painful and unpleasant sensations in the lumbar spine. Furthermore, the subjects also showed a significant decrease of anxiety level, an increase of personal self-estimation and satisfaction with life at the rise of motivation to wearing of therapeutic-prophylactic clothes.

Conclusion: Daily wearing of therapeutic-prophylacticclothes’ applied version for six months can ensure the correction of clinical osteochondrosis manifestations in people of mature age and the formation of psychological comfort what secures the achieved remission.

Relationship between Interleukin-18 (IL-18) level and Mean Platelet Volume (MPV) with ischemic stroke event in Sanglah General Hospital, Bali, Indonesia

Background: Long-term stroke risk factors may lead to inflammation of endothelial vessels characterized by migration of macrophages and T-lymphocytes in blood vessel walls by releasing Interleukin-18 (IL-18) cytokines and causing changes in Mean Platelet Volume (MPV) values. This study aims to determine the relationship between IL-18 and MPV levels with ischemic stroke event in Sanglah General Hospital Denpasar.

Methods: A matched-pair case-control study design was conducted in this study. The number of stroke and control samples were 33 people, respectively, and the dependent variable was an ischemic stroke, following MPV and IL-18 as dependent variables. Free T-2 sample test used to compare MPV in each group while the Mann-Whitney test used to compare the interleukin levels of the two groups. Data were analyzed using SPSS version 20 for Windows.

Results: The MPV value of ischemic stroke patients was significantly higher (8.5±1.19 fL), whereas the MPV value at control was 0.00±0.44 fL (p<0.05). The levels of IL-18 were statistically significantly higher in stroke patients (450.71±278.82 pg/ml) compared with controls (221.46 ± 127.83 pg/ml) (p<0.05). With the Spearman correlation test, there was a significant moderate negative correlation between MPV value and ischemic stroke (r=-0.357; p=0.003) as well as IL-18 and ischemic stroke (r=-0.492;p=0.000).

Conclusion: Our study suggests that there was a significant relationship between MPV and IL-18 value and ischemic stroke event at Sanglah General Hospital, Bali, Indonesia

Investigation of Astaxanthin effect on the formation of collagen fibers for periodontal tissue repair in bacteria infected periodontitis

Introduction: Periodontitis is an inflammation of periodontal tissue in which the attachment-forming ligament composed of collagen fibers is damaged. Inflammation is a scenario where oxidative stress is abundant which may worsen periodontitis. Antioxidant, such as astaxanthin, is needed to promote collagen fibers formation as a sign of healing.

Objective: To explore whether astaxanthin has a desirable effect in the formation of collagen fibers in bacteria-triggered periodontitis in rats.

Methods: An animal experimental study were conducted. There were 3 groups, each consisted of 8 rats: negative control, positive control, and treated group. The treated group received oral preparation of astaxanthin 0,54 mg/kg/day for 7 days. The rats were then sacrificed, and the periodontal tissue were made into paraffin-fixed 5 µm tick slides with hematoxylin eosin staining and trichromone masson to evaluate the collagen expression. The evaluation was carried out by a pathologist.

Results: There is a significant difference of collagen expression level between the T and PC groups (p-value<0.05)

Conclusion: There is a significant difference between the groups treated with astaxanthin and the group with periodontitis disease.

A Cohort Study: Caspase-3 As Prognostic Factor of Radiation Therapy in The Advanced Stage of Cervical Cancer (IIB-IIIB) Patients

Background: The treatment of the advanced stage of cervical cancer (stage IIB, IIIB) using internal (brachitherapy) and external radiation therapy raises question in how to determine the prognosis of the disease. The role of caspase 3 in predicting radiation response in the advanced stage of the cervical cancer (stage IIB-IIIB) is still unknown. This study aim to analyze the role of Caspase-3 expression as a prognostic factor of radiotherapy in patients with the advanced stage cervical cancer.

Methods: This study is an analytical cohort prospective study from June 2019 to February 2020 in the Department of Obstetrics and Gynecology in association with the Department of Anatomic Pathology of Dr. Moewardi General Hospital, Surakarta, Indonesia involving 40 patients diagnosed with cervical cancer. The staging of cervical cancer was determined using the FIGO 2019 staging system. The Caspase-3 expression level were determined using immunohistochemical examination. The association between the caspase 3 expression and changes of tumor volume is analyzed using chi square and fisher exact test for parametric and non-parametric test, respectively. A p-value of less than 0.05 is considered to be statistically significant.

Results: The analysis shows that there is a significant association between the Caspase -3 expression and the changes of tumor volume (p = 0.04). The odds of the changes of tumor volume in the score 3 of the caspase -3 expression is 22.67 times higher than the score 2 of the caspase-3 expression (95%CI, 1.56 - 328.95, p=0.04).

Conclusion: Caspase-3 expression has a significant association with the changes in the tumor volume of the advanced stage cervical cancer.

C-reactive protein levels as a predictor for anastomotic success in post-operative intestinal resection surgery

Background: C-reactive protein (CRP) is widely used as an early predictor of anastomotic complications such as anastomotic leakage (AL) after abdominal surgery. There are no data available regarding the AL in A.W.Sjahranie Regional General Hospital (RSUD AWS). This study analyzed the CRP values and their relationship with AL after bowel resection and anastomosis surgery at RSUD AWS Samarinda.

Methods: This is an observational analytic cross-sectional study. Sample data were collected from the medical records of 40 patients who underwent bowel resection between May and December 2019. Patients were between 18-75 years old and showed clinical signs of AL. CRP laboratory data were examined on the fifth-day post-operation. After tabulation, the data were analyzed using Chi-square (Fisher’s exact) test, t-test, and receiver operating characteristic curve analysis.

Results: The average sample age was 46.3 ± 1.31 years, with a 1:1 male and female ratio. The analysis showed that an increase in CRP values and white blood cell counts was not related to AL (p > 0.05). The mean CRP value of patients with AL (48.0±0.00 mg/L) was not significantly different if compared to non-AL patients (25.89 ± 18.93 mg/L) (p = 0.139). The CRP cut-off value of 36 mg/L had 100% sensitivity, 60.5% specificity, 71.7% positive predictive value and 100% negative predictive value with an area under the curve of 0.80 (p=0.153). These results showed that the CRP cut-off value of 36 mg/L couldn't be used as a predictor of AL.

Conclusion: CRP level of 36 mg/L can be used as a predictor of non-AL; therefore, it can be used as a criterion for patient discharge.

Spine injury: how to recognize and stabilize patient in golden hours periods

An acute spinal cord injury (SCI) early management is one of the most challenging tasks in trauma cases. The outcome of its cases depends upon the accuracy, adequacy, and speed of first aid management, diagnosis, and treatment within the “Golden Hours Periods.” Rapid and safe transport of the spinal injury patient allows for early medical stabilization designed to preserve and potentially improve the neurological outcome. The complications that arise from spinal instability or neurological must be prevented immediately and involves all members of the multidisciplinary team. Specialized assessment of people with new spinal cord injuries must take place immediately after an injury. The diagnosis of SCI should include the level and severity of the damage of the spinal cord, type of fracture or/and dislocation of the injured vertebrae, and the stability of the spinal column. Imaging begins from plain radiograph and should include a multi-slice CT protocol of the entire spine to delineate the known injury and to exclude non-contiguous damages. The outcome SCI treatment depends on the number of axons that survived – the higher the number of surviving axons, the restoration of neurological functions might be higher. The management of SCI begins before the patient admitted to the hospital. The principles of treatments include early reduction and fixation, combined extramedullary and intramedullary decompression, cell transplantation, early rehabilitation treatment, and complication prevention. The surgical treatment sometimes needed to evaluate, stabilize the spine, decompress the area that injured, and managed any other injuries that may have been associated with the accident. Once a patient was stabilized, care, and treatment focus on supportive care and rehabilitation.

Hemodynamic changes in patients undergoing cemented total hip replacement surgery: a literature review

Cemented total hip arthroplasty is believed to offer adequate pain relief, satisfactory walking ability, and activities of daily living as one of the most widely used techniques for treating hip fragility fractures. However, some complications may occur perioperatively, not to mention the catastrophic bone cement implantation syndrome. Thorough assessment, perioperative monitoring, early detection, and treatment plays an essential role to maximalize the result of this procedure, as well as minimalizing morbidity and mortality. Some anesthetic measures that can be done in order to keep the stability of intraoperative conditions are avoiding volatile anesthetic agents in high-risk patients, administering 100% inspired oxygen throughout the procedure, invasive hemodynamic monitoring, and maintenance of normovolemia.

A central line placement also provides a rapid route of drug administration if resuscitation becomes necessary. Orthopaedic surgeons should also consider thorough lavage of the femoral medullary canal, especially pulsatile jet lavage, removal of tissues before cementation to minimize the formation of microemboli during the procedure, and using cement restrictor to compartmentalize the bone marrow tissue and blood separately from the cement. Therefore, it can be concluded that understanding hemodynamic changes during this procedure is essential, not only for the operator but also for the anaesthesiologists.

Osseous choristoma of the tongue: A rare disease

Choristoma is described as the growth of normal tissue in an unusual location. Intraoral choristoma may be comprised of various tissue types such as cartilage, bone, gastric mucosa and, even glial tissue. Osseous choristoma is a rare, benign normal bony tissue in an abnormal location, commonly over the dorsum of the tongue though cases at maxillofacial region have been reported. This entity should be kept in mind because it can be confused with other tumor and tumor-like lesions of the tongue. We report a case of lingual osseous choristoma along with discussion regarding its epidemiology, pathogenesis, clinical features, and treatment.

Multifaceted rehabilitation strategies for ramsay hunt syndrome: a case report and a review of literature

Background: Ramsay Hunt Syndrome (RHS) is a scarce diagnosis involving unilateral facial paralysis resulting from the reactivation of Varicella-Zoster Virus (VZV) infection in the past, which causes pain, asymmetrical facial expressions, and difficulty in speaking, eating and drinking. The most effective treatment is still debatable, and limited research is available. Rehabilitation program is considered as the core treatment that gives functional improvement. The aim of this case study is to present clinical findings in RHS and the rehabilitation program to maximize facial expression recovery.

Case Description: A 59-year-old man came to rehabilitation medicine outpatient clinic two weeks after diagnosed as RHS, with complaints of fever; severe pain and rashes on the left side of the face; and ear discomfort on the same side. Physical examination revealed peripheral facial nerve palsy on the left side with drooping of the left eyelid, left end of the mouth, and difficulty in oral communication. Electroneuromyography (ENMG) examination showed axonal facial nerve paralysis on the left side. The patient was referred to the physiatrist and got rehabilitation program with neuromuscular electrical stimulation (NMES), facial massage and biofeedback exercise for facial muscle 3 times a week for 4 weeks.

Discussion: After 4 weeks rehabilitation program, the patient showed improvement as House-Brackmann grades improved from a grade IV to a grade II; improvements in communication, facial symmetry at both rest and motion; significant improvement in experiencing pain.

Conclusions: This study suggested that rehabilitation program with NMES, facial massage and biofeedback exercise are safe, efficacious and provide good outcomes in the treatment of Ramsay Hunt Syndrome.