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

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

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

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

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

The in-vivo anti-inflammatory effect of red earthworm (Lumbricus rubellus) ethanolic extract from organic farmland in Bali, Indonesia

Background: One of the typical responses to the protection of the body is inflammation. Extensive and severe inflammation can result in tissue damage. Earthworms have been used empirically for years to treat diseases that are based on inflammatory events. This study evaluates the anti-inflammatory properties of red earthworm (Lumbricus rubellus) ethanolic extract from organic farmland in Bali, Indonesia.

Methods: An experimental study by post-test only control group design was conducted among 30 adult male Wistar rats, divided into 6 groups. Each group was given 0.5% NaCMC (negative control), Diclofenac sodium 9 mg/kgBW (positive control), Red earthworm ethanolic extracts of 50 mg/kgBW (P1) and 100 mg/kgBW (P2) at 1 hour before carrageenan injection. In addition, the ethanolic extracts of Red earthworms, respectively 50 mg/kgBW (P3) and 100 mg/kgBW (P4), which had been given once a day, during 1 week before and at the eighth day 1 hour before carrageenan injection. The measurements of edema were performed 4 hours after the administration of the test material. Data were analyzed using SPSS version 20 for Windows.

Results: The median score of Rats Hind Paw Edema was 0.3 (0.2-0.4) ml in negative control, 0.1 (0.0-0.2) ml in positive control, 0.2 (0.1-0.2) ml in P1, 0.2 (0.1-0.3) ml in P2, 0.2 (0.1-0.2) ml in P3, and 0.1 (0.1-0.2) ml in P4 groups. There was a significant differences between the NaCMC group (negative control) with the Diclofenac sodium group (positive control), P1, P3, and P4 groups (p<0.05), but not with P2 group (p>0.05).

Conclusion:  We conclude that red earthworm (Lumbricus rubellus) ethanolic extract from Bali's organic farmland exhibits an anti-inflammatory effect.

Correlation of plasma vitamin d receptors with the severity of psoriasis vulgaris

Introduction: Psoriasis vulgaris is still a major problem in the field of dermatology. Until recently, the exact cause of psoriasis is still being debated. In recent years research has been carried out on vitamin D and its role in the immune system, especially in psoriasis. Vitamin D cannot be separated from the role of VDR. The study aims to evaluate correlation between VDR plasma levels and the severity of psoriasis vulgaris.

Method: Study design using a cross-sectional design to determine the correlation of vitamin D levels in plasma with the severity of psoriasis vulgaris calculated using the Psoriasis Area and Severity Index (PASI) score.

Result: This study included 47 study participants who had psoriasis vulgaris, consisting of 30 (63.8%) men and 17 (36.2%) women with a mean age of 44.66 years. The mean PASI score was 6.904, while the mean plasma VDR level was 30.328 ng/ml. Spearman correlation shows a strong negative correlation (r = - 0.979; p <0.001) between plasma VDR levels and PASI scores in psoriasis vulgaris patients.

Conclusion: Vitamin D plays a role in regulating the growth and differentiation of keratinocytes and influences dendritic cells and T lymphocytes' immune function so that low vitamin D levels have essential implications in the pathogenesis of psoriasis vulgaris. In performing its function, vitamin D must bind to VDR and form a complex. In this study, it was found that there was a strong negative correlation between plasma VDR levels and PASI scores, so it can be concluded that low plasma VDR levels correlate with high degrees of psoriasis vulgaris severity and vice versa.

Correlation between malondialdehyde levels and disease activity in vitiligo

Background: Vitiligo is an acquired depigmented skin disease that occurs due to the death of melanocytes. There are various presumed theories about the cause of melanocyte death in vitiligo; one of them is oxidative stress theory. Lipid peroxidation is the primary manifestation of oxidative stress, producing malondialdehyde (MDA) as its end product. Malondialdehyde is a stable marker to assess the occurrence of oxidative stress. This study aims to prove the differences in serum MDA levels in the active vitiligo, stable vitiligo, and normal control groups.

Method: This research is an analytical cross-sectional study involving 64 vitiligo patients with active and stable lesions and 20 normal controls. The study was conducted at Sanglah General Hospital Denpasar in February - November 2019. Serum MDA levels were measured to assess oxidative stress. The measurement of MDA levels was carried out by a spectrophotometer instrument using Competitive-ELISA method.

Results: In this study, there were significant differences in MDA levels between active, stable vitiligo patients, and control group (p=0.000) with active vitiligo type have the highest MDA mean, followed by stable type and control group respectively.

Conclusion: Increased serum MDA levels are an indicator of oxidative stress in vitiligo, which leads to melanocyte death and manifests as increased vitiligo disease activity. The results of this study support the role of oxidative stress in vitiligo pathogenesis and the use of oxidative stress indicators like serum MDA levels as biomarker in evaluating vitiligo disease activity.

Virtual patient simulation method for learning and assessment in cardiology field

Virtual patient simulation (VPS) is an online computer simulation system that contains patients' clinical situation to train and realistically assess clinical abilities with supplemental animation, demonstration of anatomy, ECG tracing, etc. It can be used for teaching, learning, and assessment supports learning. Until now, it is difficult to ascertain how many VPS systems have been used today in the world, both for learning and assessment, especially in cardiology medicine field. We searched for all research using the term "virtual patient in medical education, virtual patient in cardiology & virtual patient simulation in cardiology" in the title or research abstract from 2014 until 2019. In this current review, we will describe the use of VPS for learning and assessment purposes in cardiology medicine field. 

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

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

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

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