Background: Self-medication is a serious danger in every health sector which potentially brings harmful side effects for the society. The aim of this research was to investigate self-medication and its contributing factors among residents of Yazd province in Iran in 2014. Methods: A descriptive, cross sectional study was conducted in 2014 using a self-constructed questionnaire. A total of 580 families living in Yazd in the time period of study were contributed to fill out the questions organized in two sections of demographic and self-medication factors. Data were analyzed by SPSS software version 16 through appropriate descriptive and analytical statistical tests. Results: Self-medication was reported in 53.4% of the cases. The most frequent self-prescribed medications were related to pain killer drugs (26.6%). There was a significant statistical relation between self-medication and households’ age, occupation and income, level of parents’ education, number of children and place of residence. Among different reasons for self-medication the most important one was reported to be accessibility (3.44+1.3). Conclusion: Due to the considerable prevalence of self-medication and its harmful effects on every society, such an issue should be appropriately controlled through legal regulations particularly in the area of selling dangerous drugs. Furthermore, provision of proper information and warning the population about harmful side effects can be helpful in this regard. 

Background: One of the fatal side effects of transfusion is transfusion reactions. The incidence of transfusion reaction in Sanglah Hospital is still relatively high and far from national target which is 0.01%. To achieve the target of quality, it is necessary to set up an active program so that the number of incidence of transfusion reactions can be decreased. Methods: Pre and posttest interventional study was conducted for 6 months in Sanglah Hospital Bali. All nurses in wards which is blood product frequently used was involved in this study. The intervention in this study was in the form of education and training programs on the application of the closed system and cold chain in the distribution of blood products as well as improved service system. Results: The results showed a decline in the incidence of transfusion reactions occurred every month during the study. The incidence of transfusion reactions occurred each month was 0.77%, 0.56%, 0.5%, 0.49%, 0.45% and 0.38% respectively. The average reduction in the incidence of transfusion reactions was 0.08% every month. The type of transfusion reaction that occurred was 59% urticaria, 29% fever, 7% shortness of breath, 4% fever and chills, and 1% shock. Conclusion: Education and training programs on the application of the cold chain system and closed system in the distribution of blood products as well as the improvement of service system helped reduce the number of the incidence of transfusion reactions in Sanglah Hospital Bali.

 

Background: Preterm labor is still become a serious health problem in Obstetric and Perinatology with no sensitive biomarker currently approved. Several studies show that decrease antioxidant activity may play significant role in preterm labor. However, only few studies had been conducted to evaluate blood catalase level in preterm labor and assess its role in preterm labor. Objective: The aim this study was to identify the differences of maternal serum catalase level in preterm labor compared with preterm pregnancy. Methods: An observational analytic cross sectional study was conducted from February to December 2014 using pregnant women with 28-36 weeks’ gestational age. Blood catalase level was evaluated by colorimetric method and the data was analyzed by SPPS for Windows 17.0 program. Results: 12 subjects were enrolled and divided into preterm and control group. No significant differences between mean age, gestational age, and parity between preterm and control group. However, blood catalase level was significantly lower in preterm group compared with control group (81.82 ± 20.38 vs 159.38 ± 35.79; p=0.001). Conclusion: Serum maternal catalase level were significantly lower in preterm labor compared with preterm normal pregnancy.

Diabetes mellitus (DM) is a metabolic disease characterized by increase of blood glucose levels or hyperglycemia. Hyperglycemia results in oxidative stress and increase of AGEs. Oxidative stress and metabolic stress lead to reduction of endogenous antioxidant activity resulted in various organs injury especially kidney. The complication is caused by the formation of advanced glycation end products (AGEs), and free radicals. Increase free radicals that occur in diabetics accompanied with decline in endogenous antioxidant activity, such as superoxide dismutase (SOD) and catalase. One way to overcome the complications due to oxidative stress is through utilize the foods which possess natural antioxidant such as purple sweet potato. It has been proven in animals that purple sweet potato had antioxidant properties to prevent various complications in DM. Balinese purple sweet potato tubers contain high anthocyanin and it had been researched as antioxidant in rats in vivo. The aims of this research are to determine the effect of aqueous extract of purple sweet potato tubers to decrease malondialdehyde (MDA) and increase SOD2 in kidney of diabetic rats. This experimental study was conducted with randomized posttest only control group design. Research subject is 38 diabetic rats that divided into 2 groups, controlled group and treatment group, with 18 diabetic rats in each group. Treatment was given for 60 days to each group. Treatment group (P1) is diabetic rats group that was given a standard diet and ad libitum drinks, and 4CC/day/rat of purple sweet potato tubers aqueous extract for 60 days. Controlled group (P0) is diabetic rats group as control that was given a standard diet and ad libitum drinks only. After 60 days of treatment, evaluation was performed. The results of this research found that mean MDA in kidney of control and treatment group was 8.40±0.17 and 1.47±0.15, respectively. There was a significant decreae of MDA (p<0.05). Relative expression of SOD2 gene before and after treatment was 0.317 and 6.586, respectively. There was a significant increase of SOD2 gene (p<0.05). It can be concluded that aqueous extract of purple sweet potato tubers decrease MDA and increase SOD2 gene in kidney of diabetic rats.

Background: Oxidative stress occurs due to an imbalance of the number of free radicals by the number of endogenous antioxidant produced by the body i.e. Superoxide Dismutase (SOD), Gluthathione Peroxidase (GPx), and Catalase. The imbalance between the number of free radicals and antioxidants can be overcome with the endogenous antioxidant intake that exogenous oxidative stress can be reduced. One of exogenous antioxidants is natural Gaharu leaf water extract. Objective: This research focus on the effect of Gaharu leaf water extract in reducing MDA and 8-OHdG and increase the activity of SOD and Catalase. Methods: This study was an experimental with post only controls group design. Experiment was divided  into 5 groups of wistar rats, each consisting of 5 animals, i.e. negative control group without extract [K (-)], treatment 1 treated 50 mg/kg BW/day of the extract (T1), treatment 2 treated 100 mg/kg BW/day of the extract (T2), treatment 3 treated 200 mg/ kg BW/day of the extract (T3), and positive control group [K (+)] treated with vitamin Cat a dose 50 mg/kg BW/day. All groups treated for 10 weeks. Every day, before treatment, each group was given a maximum swimming activity for 1.5 hours for 10 weeks. ELISA was used to measure MDA, 8-OHdG, SOD, and Catalase activities. Result: The research results showed that treatment of extract of  leaves of Gaharu with an higher dose from 50 mg/kg BW up to 200 mg/ kg BW significantly decline (p <0.05) levels of MDA with the average ranging from 6.37±0.23, 5,56±0.27 and 4.32±0.27, 8-OHdG with a mean of 1.64±0.11, 1.26±0.46, and 1.09±0.17. On the other hand the treatment also increase SOD activity with less ranging from 12.15±1.04, 15.70±2.02, and 18.84±1.51, and Catalase ranging from 6,68±0.63, 8.20±1.14 and 9.29±0,79 in the blood of Wistar rats were given a maximum activity compared to the negative control group. This is probably higher phenol compounds (bioflavonoids) quantity content of the extract. These compounds synergistically affect their activity through capture and neutralize the free radicals that oxidized the lipid to less that automatically MDA production as the end result of oxidation lipid levels down, 8-OHdG down, the activity of SOD and Catalase ride. Conclusion: Gaharu leaf water extract reduced oxidative stress of Wistar rats through reduction of MDA and 8-OhdG mechanism. On the other hand, the extract increases SOD and Catalase activity.

Background: High interleukin-6 (IL-6) serum level was responsible in inflammatory regulation through the interaction within macrophage, glial melatonin production and regulation of methyl CpG-binding protein 2 (MeCP2) and influenced neuro-inflammation process, thus, it increased the risk of depression. The aim of this study was to determine whether high interleukin-6 serum level increased the risk of depression in geriatrics. Methods: A case control was performed as the design of this study. Geriatric populations with depression enrolled as the case group and without depression as control group. Assessment of IL-6 serum level was conducted by the patient’s venous blood. The IL-6 serum> 10 pg/ml was categorized as high. Results: In this study, 30 cases and 30 controls who met the criteria included as samples. There were 20 males (66.7%) and 10 females (33.3%). Factors associated with an increased risk of depression in geriatric were a high level of serum interleukin-6 (OR=3.60; CI95%: 1.22-10.64, p=0.018) and a marital status (OR=3.50; CI95%: 1.11-11.02, p=0.028). High level of interleukin-6 was a significant and an independent risk factor of depression in geriatric (OR=3.60; CI95%: 1.22-10.64, p=0.021) in multivariate analysis. Conclusion: This study concluded that high IL-6 serum level increased the risk of depression in geriatric.

Background: A common complication after Coronary Artery Bypass Grafting (CABG) is postoperative bleeding, which is considered as an important problem. Objective: The aim of this study is to study only patients who have never used drugs above so that it can assess postoperative bleeding in CABG with the absence of high-risk medications related to postoperative bleeding. Method: 50 patients who were candidates for CABG surgery participated in the study. Inclusions criteria included who were candidates for CABG surgery, avoiding the use of blood-clotting drugs before surgery, avoiding the use of immunosuppressant, and the absence of an underlying medical condition such as kidney diseases. Patients with inflammatory, platelet diseases, or any coagulation disorder were excluded. All patients initially tested for hemoglobin, platelets and hemoglobin and INR. In addition to testing for hemoglobin, the amount of bleeding and packed red cell; frozen plasma and platelets were recorded. Results: Fifty patients who were candidates for elective surgery, including 33 men (66%) and 17 women (34%) were enrolled in this study. The mean patient age was 8.70+57.9years old. Test showed that mean hemoglobin level of patients before surgery was pre-operative of 1.5 + 12.4 g/dL, mean platelet was equal to 54.14 + 250.8 thousand/µL and an average international normalized ratio (INR) was equal to 0.12+1.07. The results after surgery also showed that: The total units of given packed red cell; frozen plasma and platelets were (3.14 + 1.90; 2.34 + 2.36 and 0.06 + 0.42). Also, postoperative hemoglobin was 1.30 + 10.30 g/dL, which significantly decreased compared to pre-operative hemoglobin. Bleeding in patients was observed with an average of 537.5 + 973 mL. Of course, the amount of bleeding in any patient was not caused further surgery, Conclusion: that the use of some drugs surgery can be a good way to reduce the risk of bleeding after surgery or on-use of some drugs can reduce the risk of bleeding after surgery with a minimum of morbidity and mortality. It is suggested that other researchers after designing clinical trials and using lower doses for effective drugs such as Clopidogrel and compared to control groups, or different doses of the N-acetylcysteine drug be reported more documentation to improve the bleeding after surgery.

Background: The implantation rate of IVF remains low due to the adverse effect of ovarian stimulation on endometrial receptivity.  Integrin β3 is the best known marker for endometrial receptivity evaluation. In this study,  the impact of antagonist and agonist protocol on the expression of integrin β_3   during implantation window was investigated. Methods: Two ovarian stimulation protocols were used, involving FSH plus GnRH agonist and FSH plus GnRH antagonist. Uterus sample were collected 48 hr after ovarian stimulation and the expression of integrin β₃ detected by immunohistochemistry. Results: The GnRH antagonist treated mice showed significantly lower integrin β₃ expression in endometrium during window of implantation than GnRH agonist treated mice. Conclusions: Antagonist protocol has more adverse impact on endometrial receptivity of mice uterus than agonist protocol

Background: Severe malnutrition remains a major killer of children under five years old. On such condition, there is a lack of antioxidants, an increase in free radical agents and proinflammatory cytokine. They prolong a hypercatabolic state, hindering an increase in weight. Virgin coconut oil (VCO) contains medium chain triglyceride and antioxidants. It is expected to solve that problem compared to corn oil. There has been no published study about VCO usage for severe malnutrition. Objective: The aim of this study was to find out the influence of VCO compared to corn oil for severe malnutrition treatment in GSH level, TNF-α level, and weight gain. Methods: It was a laboratory experiment study, using a randomized post-test control group design, to compare the treatment effect of the VCO vs corn oil in Formula 75 and Formula 100 in the treatment of severe malnourished rat. Severe malnourished rats were divided randomly into 2 groups. One group was given F75 and F100 with VCO content (Group A) and another group was given F75 and F100 with corn oil content (group B). Both groups were treated for 28 days. Results: There were 19 rats in each group. One rat from group B died before the study ended. An analysis was done for the last 37 rats. There was no significant difference in the mean of weight gain, 73.45 g (SD 20.08)  and  68.97 g (SD 11.49) for group A and B respectively (p=0.41). There was no significant difference in the GSH levels (p=0.70), where group A is 1.35 pg/g (SD (0.74) and group B 1.27 pg/g (SD 0.48). TNF-α level in group A (1087.2 pg/g (320.00-2525.46)) was higher than group B (711.32 pg/g (403.19-2400.91)) but not statistically significant (p=0.08). Conclusion: There is no significant difference in GSH and TNF-α level in the liver and body weight gain for VCO and corn oil groups. Virgin coconut oil can be one of the alternative vegetable oils that can be utilized in treating severe malnourishment.

 

Background: Estrogen deficiency condition can degrade the quality of life, decline in cognitive function will be more severe trough age. Phytoestrogen compounds can be found in pegaga leaf extract, tomatoes and papaya is an easy and inexpensive way to increase estrogen levels in post menopause women through extra gonadal estrogen induction. Therefore, the aims of this study were to examine the effect of tomato juice, physical exercise, and combination of these treatments on promoting neurons and ERβ expression in somatosensory cortex that contribute to cognitive function of post-ovariectomy rats. Method: Twenty-eight female healthy Wistar rats (Rattus novergicus), 8-10 weeks old, from Laboratory of Biochemistry, Faculty of Medicine Airlangga University include in this experiment. The animals were housed in the animal-care facility with ad libitum food and water. The temperatur was maintained at 18°C-24°C.  The treatments were done 2 weeks after ovariectomy. Tomato were made in Laboratory of  Pharmacognocy  and Phytochemistry, Faculty of  Pharmacy, Airlangga University, from inner part of the tomato fruits (mucous like substance) with freeze dry method (-40°C). Results: The weight of white rat Rattus norvegicus post ovariectomy in this study was between 133-170 gram with a mean weight 154.32 ± 9.72 gram. Hematoxylin/eosin staining showed neuronal deficit in the control rats brain. In figure 1, the tomato group showed the largest of neurons number (145.43 ± 17.728), followed the combination group (140.57 ± 22.449), the exercise group (136.86 ± 23.104) and the smallest number in the control group (96.43± 28.965). Four weeks after treatments the number of neurons increased significant in the tomato group (p=0.001), exercise group (p=0.004) and combination group (p=0.002) from the control group.  This study showed no significant different between tomato and exercise group (p=0.500), tomato and combination group (p=0.701) and between exercise and combination group (p=0.769). Conclusions: In conclusion, our data demonstrated that post ovariectomy rats showed deficit numbers of neurons and decreased ERβ in the somatosensory cortex. Treatment with physical exercise, tomato juice, and combination of these treatments increased the number of neurons and ERβ expression in the somatosensory cortex.

Background: Physical fitness determines the level of human health. A good physical fitness can be achieved if conducted with a balance and active physical fitness. The aims of this study was to elucidate the effect of balanced physical exercise on physical fitness, endorphin levels, and malondialdehyde (MDA) levels. Methods: This study was a true experimental with pretest-posttest control group design using 24 students of IKIP PGRI Denpasar. Selected samples divided into two groups: the control group given conventional physical training (P0) and the treatment group given balanced physical training (P1). Physical fitness tests was performed using Cooper method and blood sampling was done to evaluate the level of endorphins and MDA before (pre test) and after (post test) treatment of 8 weeks. The data of endorphin and MDA levels were analyzed using independent T test. Whereas, the physical fitness was analyzed using Mann-Whitney U test. Results: Physical fitness of the group given a balanced physical training was significantly higher compare to the group given a conventional physical training (p < 0.05). Balanced physical training was proven to enhance physical fitness as measured by the Cooper method better than conventional physical training. In contrast, the levels of endorphins of the balanced physical training group did not different with the conventional physical training group (p > 0.05). Levels of MDA of balanced physical training group also did not different with the conventional physical training group (p > 0.05). Conclusions: balanced physical training can maintain physical fitness of people and improve the health and quality of life.

 

Background: It is necessary that various aspects of health information and statistics are identified and measured since health problems are getting more complex day by day. Objective: This study is aimed to investigate the distribution of health services in the health care system in Iran and the case of study is East Azerbaijan province. Methods: This research was a retrospective, descriptive, cross-sectional study. The statistical population included all health service providers in East Azerbaijan Province in the public, private, charity, military, social security, and NGO sectors. In this study, the data from all functional health sectors, including hospitals, health centers, and clinical, rehabilitation centers and all clinics and private offices were studied during 2014. The data relevant to performance were collected according to a pre-determined format (researcher- built checklist) which was approved by five professionals and experts Health Services Management (content validity). Results: The study findings showed that the public sector by 45.28% accounted for the highest share of provided services and the private sector, social security, military institutions, charities and NGOs institutions by 25.47%, 18.92%, 4.37%, 3.3%, and 2.66% next rank in providing health services in East Azerbaijan province have been allocated. Conclusion: The results show that most of the health services in East Azerbaijan Province belongs to the public sector and the private sector has managed to develop its services in some parts surpassed the public sector. According to the study findings, Policies should be aimed to create balance and harmony in the provision of services among all service providers.

Background: The presence of various animals, such as: ducks, chickens and pigs in households increases the potential risks of zoonosis from animal to human. One of the diseases is Japanese encephalitis (JE).  The seroepidemiological studies on the presence JE among animals especially those raised in household is very important for emerging and reemerging disease control program. Ducks, chickens and pigs have long been considered as carrier and even the amplifier hosts of Japanese encephalitis virus (JEV) replication. The presence of the animal hosts and mosquitoes as vector could result in transmission of the JEV to humans. Methods: A seroepidemiological study of the presence of Japanese encephalitis virus (JEV) was conducted by collecting sera and detecting the antibody against JEV in ducks, chickens and pigs in Bali. As pig is the amplifying animal of JEV, comparison JEV antibody between ducks reared in households with pig nearby and with no pig were also determined the presence of antibody against JEV was examined by using indirect enzyme-linked immunosorbent assay (ELISA).  The serum samples with over cut off value (COV) of optical density were considered as those containing Ab against JEV. Results: Antibody against JEV was demonstrated in ducks (20.6%), chickens (36.7%) and pigs (32.2%) evaluated in this study. Moreover, there was no significant difference (p>0.05) in the prevalence of antibody against JEV in ducks kept closely with pigs compared to the antibody in the ducks reared without pigs around. Conclusion: This study convinced that antibody against JEV is found in ducks, chickens and pigs in Bali. Indicating that these animals was infected or previously infected by the virus.

Background: Helicobacter pylori (H. pylori) causes continuous inflammation of the stomach. It is suspected that H. pylori infection is associated with an inflammatory response in acute myocardial infarction (AMI). This research was aimed at analyzing the association of Helicobacter pylori infection and the degree of reduction in left ventricular ejection fraction (LVEF) in patients with AMI, the number of coronary heart disease (CHD) risk factors with H. pylori on AMI incident, and association of type of AMI and H. pylori on AMI incident. Method: This is a prospective cohort study with observational-analytic method in AMI patients at ICCU of Prof. Dr. R. D. Kandou General Hospital Manado in 2015-2016. Data retrieval was done by filling out questionnaires, examination of blood samples, serology test to examine the presence of H. pylori, and echocardiography examination in patients with AMI. Results: Statistical analysis showed no significant association between H. pylori with the degree of reduction in LVEF in AMI patients (p=0.713), and the number of CHD risk factors (p=0.087). There was a significant association between H. pylori and types of IMA (p=0.017). There were more ST-Elevation Myocardial Infarction (STEMI) patients infected with H. pylori. Conclusion: There is no significant association between H. pylori infection and the degree of reduction in LVEF in AMI patients, and also the number of CHD risk factors. However, there is a significant association between AMI type and H. pylori on AMI, to wit there are more STEMI patients with H. pylori infections.

Background: Mitral valve prolapse (MVP) is a valvular heart disease in which the two valve flaps of the mitral valve do not close equally, and part of the mitral valve slips backward loosely into the left atrium during systole. In general, MVP is associated with low body mass index (BMI), as confirmed by several studies. However, the reason for the higher prevalence of MVP in patients with low BMI remains unknown. Objectives: There is no reliable evidence on the role of genetics or pathophysiological factors in this correlation, and the hypothesis that the size of BMI may lead to MVP or vice versa has not yet been established. Materials and Methods: In this study, all the articles were evaluated in terms of the inclusion criteria. In total, we found 546 articles via PubMed and Google scholar, out of which 30 articles were mainly focusing on MVP, MVR as the major complication of MVP, and BMI, which were included in this systematic review. Results: Among these reviewed studies, patients with MVP had a lower BMI score compared to the subjects without MVP. The low and high BMI score were 28±5 kg/m and 31±6 kg/m, respectively. Conclusions: In the present study, we concluded that low BMI is directly associated with the occurrence of MVP.

Traumatic Brain Injury (TBI) case is commonly found in the emergency room.  TBI accompanied by increased intracranial pressure (ICP) is a neurological emergency that requires prompt and appropriate management. Hyperosmolar fluid is the main treatment in the initial management of increased ICP. Mannitol and hypertonic saline are hyperosmolar fluids which are generally used. There is no specific recommendation regarding the choice between the two fluids. From the current studies indicate that both fluids are equally effective in reducing ICP. Regarding the superiority between the two fluids, it is difficult to determine because of the heterogeneity of the studies that exist. Therefore, clinicians should choose between hyperosmolar fluids based on indications and contraindications exist in TBI patients.

Background: Streeter dysplasia is a term to describe fetal congenital syndrome which mainly characterized by constriction band on appendages, prenatal amputations of extremities, and acrosyndactyly. This syndrome has wide range of clinical manifestation between patients, as reflected by many other terms to describe this syndrome. Case: The author reported five cases of Streeter dysplasia with constriction band on different locations of the body, with a patient having a constriction band around pelvic and other multiple anomalies, patient with constriction around leg and caused acute limb ischemic, and several cases of acrosyndactyly around hand and foot. Result and Conclusion: Constriction band release surgery, as well as correction surgery for other abnormality was performed, either by direct closure or Z-plasty with satisfactory result in functional and aesthetic.

Background: Fetal cardiac rhabdomyoma is a rare condition. Case: We report a case with cardiac mass discovered in utero by prenatal ultrasonography at 33 weeks of gestational age. An echogenic round-oval shape mass at the interventricular septum protrudes to left ventricle was observed. Results: After birth, the baby was followed up for 7 months with echocardiography, physical examination, and computerized tomography scan, to rule out anything related to tuberous sclerosis. The prognosis depends on the size, site, number of tumors, and co-existing congenital abnormalities. Management highly depends on the presence of outflow tract obstruction of the heart. However, some cases may regress after birth. 

Background: Neonatal hypocalcemia is a metabolic abnormality commonly reported. Late onset hypocalcemia usually manifests after 7 days and requires a long-term therapy. Neonatal hypocalcemia due to hypoparathyroidism can manifest as life-threatening seizures or tetany. Initial management is important to prevent any complication due to this condition. However, the initial management to correct hypocalcemia with the administration of calcitriol, high dose intravenous and oral calcium may take longer to achieve because of hypoparathyroidism. Case summary: We report a case of late onset neonatal hypocalcemia in a nine-days-old baby. He was born on the 35-36 week of gestational age by Caesarean section, without asphyxia nor neonatal infection. The baby had a refractory seizure with low serum calcium and magnesium, high phosphate, normal alkaline phosphatase (ALP) and low calcium creatinine urine ratio. His 25-hidroxy vitamin D (25-OHD) total was as low as 12.9 ng/mL. And, he has a low level of parathyroid hormone (PTH). Adequate correction for hypocalcemia and hypomagnesemia failed to maintain calcium and magnesium to their normal value. Oral calcium gluconolactate and carbonate were added after calcitriol supplementation, but seizure still noticed. After magnesium oxide supplementation was given, another seizure had never occurred. A long-term follow-up on vitamin D and calcium level were required. Conclusion: In a hypocalcemic newborn patient, assessment of the magnesium, vitamin D, and PTH status are needed.