The characteristics of neurocognitive function in farmers exposed to chronic pesticides at Banjar Tengah Kelod, Kerambitan, Tabanan, Bali, Indonesia

Purpose: This study aims to evaluate the characteristics of neurocognitive function in farmers exposed to chronic pesticides.

Material and Methods: This study uses a descriptive cross-sectional design with total sampling methods. The study was conducted from 1^st January 2019 until 31^st January 2019 located in Banjar Tengah Kelod, Kerambitan sub-district, Tabanan district, Bali, Indonesia.

Results: A total of 60 samples, consisted of 36 samples (60%) were women and 24 samples (40%) were men were obtained. The median age of the study sample was 55 year-old. Most of the samples who experienced neurocognitive impairment used organophosphate pesticides (60%), followed by organochlorine (20%), carbamate (13.3%), and pyrethroid (6.7%). Organophosphate users experienced neurocognitive impairment in both memory domain (mean score of 1.5 what scoring was used?) and visuospatial executive functions (mean score of 1, what scoring system?). The mean memory function score in the organochlorine user group was the highest compared to other groups of pesticide users while the average score of visuospatial function was 1. The samples of the study using carbamate pesticides had the same average score in both domains of neurocognitive function. The mean score of memory function in pyrethroid user was 2.5 and the average score of executive visuospatial function was 1.

Conclusion: Chronic exposure to the four types of pesticides provided a picture of neurocognitive function impairment, including memory, visuospatial and executive functions. This result did not show clinical significance. The addition of sample size and analytic method studies should be considered for further research.

The effect of intraarterial heparin flushing to autism symptoms when used to treat the concomitant cerebral venous thrombosis: a case series

Introduction. There are still no definite therapeutic strategies for Autism Spectrum Disorder (ASD) other than behavioural interventions and few FDA approved behaviour control drugs. In this study, we found a co-existence medical condition of ASD & Cerebral Vein Thrombosis (CVT) in the paediatric population. Based on these findings, a new therapeutic approach, a catheter-directed anticoagulant therapy termed as IAHF (Intra Arterial Heparin Flushing) was performed on this population of patients.

Methods. This paper aims to describe a series of 10 cases of IAHF procedure performed to treat CVT on children with ASD from 2018 through 2019 at Cerebrovascular Center RSPAD Gatot Soebroto Jakarta-Indonesia. The children diagnosed with ASD by the multidisciplinary team but also had CVT findings on their brain magnetic resonance imaging studies when performed as the series of comprehensive diagnostic examination. IAHF were conducted by delivering heparin through a modified DSA technique into the occluded vessels. Subject Autism status was assessed with the Childhood Autism Rating Scale (CARS) before and one month after IAHF procedures.

Results. The measurement of CARS Score after IAHF shows a relatively positive result. Eight patients showed a decreased in total CARS Score after the procedure, while only two patients had no improvement. One subject shows a decrease of nine points, the most significant changes, and improved the status from moderate to mild autism.

Conclusion. In children who have ASD and also accompanied by CVT findings in their imaging studies, IAHF treatment showed clinical improvement of the autism symptoms.

Physical rehabilitation of middle-aged women with vegeto-vascular dystonia in Russia

Introduction: Vegeto-vascular dystonia (VSD) resembles a common condition in women nowadays. Its manifestations exert a weakening effects constellation on the central nervous system (CNS) and the bodily process. With insufficient effect from medical efforts in VSD, the level of viability of the organism inevitably decreases. The purpose of the study was to assess the possibilities of the author's version of physiological rehabilitation of women with VSD.

Materials and methods: The study involved 2 groups of women aged 27-35 years (mean age 30.8 ± 2.1 years). Each group consisted of 25 women with a diagnosis confirmed at least 3 years ago by the VSD. In the first group of women, rehabilitation was carried out according to the author's method, whereas the traditional scheme of rehabilitation is applied in second group. Rehabilitation activities lasted for 6 months, evaluated by functional tests using Student's t-test.

Results: The author's complex of rehabilitation measures proved to be very effective in first group, including a rational diet, therapeutic gymnastics, electrostimulation, massage and hydrotherapy. The complex of rehabilitation measures developed by the authors was able to provide the most complete restoration of the physical condition of women with VSD by achieving a balance between the activator and inhibitory processes in CNS also the optimal tone of their vessels.

Conclusion: The study proved that the author's version of rehabilitation of women with VSD was capable of completely eliminating somatic manifestations accompanying vegetative vascular dystonia and increasing the adaptive capabilities of the body in daily life.

Physiological peculiarities of thrombocyte activity of candidates into masters of sports in athletics of preadult age

Introduction: Physiologically, platelets are an important component of homeostasis of the whole body and blood system. However, not everything is clear with platelet activity of young healthy persons who have systematic exercises, particularly masters of sports’ candidate. Its in vitro and in vivo should be studied further.

Aim: The aims of this investigation are to find out the abnormalities of thrombocyte activity of master of sports’ candidate in athletics of young age and compare them with thrombocyte level of young people who avoided exercises during their lifetime.  Through modulation of their activity, they increase capillaries' perfusion and thereby metabolism in tissues.

Materials and methods: In our investigation group we took 125 candidates into masters of sports in athletics of preadult age regularly exercising and participating in competitions of different levels. Control group was consisted of 141 healthy youths having avoided exercises during their lifetime. Biochemical, hematological and statistical methods are applied.

Results: Athlete were found to have stable normal functional platelet activity. For subjects between 18 and 22 years, their platelets aggregation was on low level and had no reliable variations related to their stable low sensitivity to inductors. Decreased platelet activity causes conservation in athletes' blood of some quantity of circulating thrombocyte aggregates. It makes positive impact on microcirculation in organs of athlete having regular athletic exercises. Avoidance of exercise in young age promotes gradual rise of thrombocyte activity. Masters of sports’ in athletics candidate who had intensive muscle activities are characterized by persistence of stable low platelet activity. It provides low quantity of active platelets and their circulating aggregates in blood. Those young persons, who avoided exercises, are noted to have elevated platelet activity with a tendency increased aggregate formation.

Conclusion: Masters of sports in athletics’ candidate doing intensive muscle activity are characterized by preservation of stable not high platelet activity caused by low content of active platelets and their circulating aggregates. Avoiding exercises in young people are noted to have caused the increase of platelet activity with a tendency to cause platelet aggregation.

Clinical and plain x-ray findings of spinal metastases: a retrospective study of pathologically-confirmed cases

Background: Malignancy of breast, prostate, and lung contribute to metastatic bone disease, and the metastases are mostly located in the spine. Spinal metastases may involve the spinal cord, leptomeninges, epidural space and also the bone itself. Therefore, proper imaging is needed in early detection and diagnosis of spinal metastasis. This study aimed to perform the clinical and plain x-ray findings in patients with spinal metastasis.   

Method: A retrospective study was conducted on 28 spine pathological fracture patients with neurologic deficits who underwent surgical intervention in Sanglah General Hospital during a year. We evaluated the present symptoms, neurological status (Frankel score), pathological reports by plain x-ray findings, metastases cell type by histological assessment, and extension of mass expansion on MRI. A total of 20 cases that met the inclusion criteria were evaluated.

Result: Most patients suffer from pathologic fracture on thoracic spine level, followed by lumbosacral level and none on cervical spine level. The compressive fracture was a major finding on plain x-ray. The extradural lesions account for most of the MRI findings, followed by intradural/extramedullary and intramedullary lesion. Primary tumours that lead to bone metastases in this serial-cases are prostate, breast, cervix, kidney and lung cancer, respectively.

Conclusion: Thoracic spine is the most common spinal metastases manifestation. Conventional plain x-ray is the most initial modality to evaluate systemic neoplasia patients with spinal pain, although it is not a sensitive indicator to identify the presence and extent of metastatic involvement.

Association of serum interleukin-10 (IL-10) with the severity of acne vulgaris

Background: Acne vulgaris is a common inflammatory disorder in pilosebaceous gland units, which affected more than 90% of teenagers, and half of them settled until adulthood. Inflammation is one of the four critical factors in the pathogenesis of acne vulgaris, and it could be a primary process or secondary to Propionibacterium acnes. The immune system has a various anti-inflammatory mechanism to counter-balance inflammatory mediators. One of the potent cytokines that play a role in regulating the inflammatory state is Interleukin-10 (IL-10). This study conducted to determine the association of serum IL-10 with the severity of acne vulgaris.

Methods: This is a cross-sectional analytic study involving 33 subjects with acne vulgaris and 31 normal-healthy volunteers as a control. Both groups had their serum IL-10 measured. Acne vulgaris severity was assessed with Lehmann criteria. Anova was used to determine the statistical difference of IL-10 among different groups of acne severity. This study has been approved by the Ethical Committee Faculty of Medicine, Universitas Sumatera Utara.

Results: The mean serum IL-10 of normal-healthy and acne vulgaris subjects were 5,79 ± 1,23 pg/ml and 5,25 ± 1,55 pg/ml, respectively. Mann-Whitney test showed a significant difference (p=0,029). The mean IL-10 serum levels according to acne vulgaris severity were 6,63 ± 1,94 pg/ml in the mild category; 4,89 ± 0,95 pg/ml in the moderate category and 4,38 ± 0,61 pg/ml in the severe group. ANOVA showed significant difference with p=0,001.

A network meta-analysis on comparative efficacy of statins focusing for prevention of contrast-induced acute kidney injury in chronic kidney disease patients undergoing percutaneus coronary intervention

Background: The use of interventional diagnostic and therapeutic procedures required intravascular iodinated contrast are performed in millions of patients worldwide and are steadily increasing the risks of contrast-induced acute kidney injury (CI-AKI). Statins are primarily used in cardiovascular medicine for their lipid-lowering effects but they possess remarkable pleiotropic effects such as improving endothelial function as well as decreasing oxidative stress and inflammation. A network meta-analysis was carried out to evaluate the effect of different statins in prevention of CI-AKI and also to investigate which type and dose of statins maybe the best choice specifically in CKD patients who have higher risk. 

Methods: We performed a pairwise and network meta analysis of 14 randomized studies (9847 patients) comparing a total of 6 different statins: rosuvastatin high dose, atorvastatin high dose, simvastatin high dose, rosuvastatin regular dose, atorvastatin regular dose, pravastatin regular dose versus each other and versus placebo in CKD patients undergoing PCI with iodinated contrast for prevention of CIAKI. Google Scholar, Pubmed, Science Direct databases were searched up to May 2019. The data were pooled using STATA, and R version statistics calculating odds ratios (ORs) with 95% confidence intervals.

Results: Statin loading before contrast administration was associated with a significantly reduced risk of CI-AKI in patients with CKD undergoing cardiac catheterization (pooled OR= 0.51; P=0.0001). Regular dose pravastatin comprised the best effect size for a reduction in CIAKI risk (OR = 0.32, 95% CI 0.14-0.72, p=0.006). Regular dose pravastatin and high dose atorvastatin were ranked as the highest probability to be the best treatment (Pbest) with 44% and 31% respectively for effect on CIAKI prevention.

Conclusion: Preloading with statins is associated with significantly reduced risk of CI-AKI in patients with CKD undergoing cardiac catheterization. Regular dose pravastatin and high dose atorvastatin have the highest probability to be the most effective prevention strategy.

The erection conundrum: risk factors for erectile dysfunction among middle-aged and elderly men in Lamongan, East Java, Indonesia

Background: The most common sexual problem affecting the general population of men is Erectile Dysfunction (ED) with a global estimated number of over 100 million. It affects the biological, psychological, and social aspect of life which can cause frustration, depression, and anxiety. Unfortunately, the attention towards the disease in Indonesia is often overlooked as evidenced by the lack of studies regarding the prevalence and risk factors for the disease. This study aims to evaluate possible risk factors of Erectile Dysfunction among elderly males in Lamongan, East Java.

Methods: This is a quantitative study with an analytical observational design, performed using a case-control approach. Respondents consisted of male inpatients as well as outpatients aged 40 years or more in Ngimbang General Hospital evaluated using the International Index of Erectile Function (IIEF) questionnaire. The patient’s comorbid data are taken from the Medical Record to ensure proper diagnosis. The acquired data are then analysed using the ordinal logistic regression method.

Results: A total of 174 men were evaluated. There are 62 people with no ED (35.6%), 39 people with mild ED (22.4%), 35 people with mild to moderate ED (20.1%), 16 people with moderate ED (9.2%), and 22 people with severe ED (12.6%). Significant risk factors are older age (OR: 1.29; CI: 1.23-1.37), Diabetes (OR: 6.56; CI: 2.77-15.56), and hypertension (OR: 5.19; CI: 2.27-11.88) (all, p < 0.05); whereas dyslipidemia and smoking habit are insignificant (p>0.05).

Conclusion: Age, diabetes, and hypertension are significant risk factors for Erectile Dysfunction.

High incidence of varicocele among young men in Public Police Hospital Denpasar, Bali, Indonesia: a descriptive study

Background: Varicocele is a progressive disease which possibly starts from puberty. When left untreated, it could progress and causes complications such as infertility. Determination on the representative national incidence and characteristic of varicocele has been a hard challenge due to the lack of data on varicocele epidemiological studies, especially in Bali. This study aims to know the characteristic of varicocele patients undergoing varicocelectomy in Bhayangkara Denpasar Hospital from January 2017 to December 2018. 

Methods: This research is a descriptive retrospective study with cross sectional approach. The population of the study consists of patients who were diagnosed with varicocele and underwent varicocelectomy in Bhayangkara Denpasar Hospital from January 2017 to December 2018. Total sampling method was used. Research data were retrieved by taking the patient’s entire medical record with varicocele in Bhayangkara Denpasar Hospital from January 2017 to December 2018.

Results: Ninty five samples were diagnosed with varicocele and underwent varicocelectomy. The highest percentage among age groups is 15 to 24 years (89.5%), with normal stature (94%), normal weight (86%), asymptomatic (90.5%), left unilateral varicocele (86.%), grade III varicocele (82,1%) and without comorbid (93.8%). The samples underwent varicocelectomy with Ivanissevich procedure (72.8%), operation time of ≤ 60 minutes (95.8%) and length of stay of ≤ 2 days (95.8%).

Conclusion: The high incidence of varicocele in young adulthood is due to a majority of the samples being young police recruitment participants who were accidentally diagnosed during general medical check-up. Early screening on varicocele in the age group of 15 to 24 years is recommended to consider the need of sperm analysis examination and further deciding on the treatment options. One of the options is surgery.

The out of pocket payments in low and middle-income countries and the affecting factors: a systematic review and meta-analysis

Introduction: The out of pocket (OOP) payment is the most important source of health system financial support in low and middle-income countries (LMICs); therefore, considering and controlling health expenses are pivotal issues. The present study aimed to determine the households OOP payments in LMICs.

Method: Electronic databases, including Web of Science, Scopus, and PubMed were searched systematically in September 2015. Relevant papers on OOP payment in LMICs were included in the study. OOP payment was estimated as a percentage of Gross Domestic Product (GDP) per capita and household final consumption expenditure per capita in every country.

Results: Seventeen papers out of 3714 were included in the study. Eight studies were conducted in low-income countries, eight in middle-income countries, and one in both low and middle-income countries. The mean OOP payment as a percentage of households final consumption expenditure in LMICs was 0.67(α= 0.000, CI: 0.35-1.003) and the mean of OOP payment as a percentage of GDP in these countries was 1.65(α=0.000, CI: 1.57-1.72).

Conclusion: The households in LMICs face high levels of OOP payment. Therefore, many challenges must be overcome in financial support of health sectors. Health system policies and strategies are necessary to reform interventions in financing resources and purchasing health care services.

Graft procedure on urethroplasty, in comparison with flap procedure: a literature review

Urethroplasty is a surgical procedure to reconstruct urethral patency on urethral stricture. There are several options for repairing urethral stricture in general, one of the examples is using graft or flap for augmentation urethroplasty. The indications of augmentation urethroplasty with graft are bulbar or penile urethral stricture, risk of tension on urethral anastomosis, and stricture more than 1 cm. Graft is less reliable because it has to be revascularized, easier to harvest, on the other hand flap has generous blood supply, but it was time-consuming to collect and to dissect. In case of bulbar urethral stricture with intact corpus spongiosum, graft had more advantages rather than flap because the anatomy of the urethra moves proximally giving thicker and more robust ventrally, and makes the graft suitable on vascular bed. Plenty of sites can be used to harvest graft for urethroplasty, there are buccal mucosa, genital skin, extragenital skin, lingual mucosa, bladder mucosa, and colonic mucosal graft. Although the treatment of urethroplasty depends on the length and location of stricture until today the comparison between the use of graft and flap in urethroplasty is still controversy and under debate.Some studies reported higher success rates in grafts than flaps procedure, but only few studies showed statistically significant difference. However, grafts procedure is easier, less operative time, and less morbidity, therefore leading to satisfaction in most of the patients.

Mitogen-activated protein kinase 3 (MAPK3) and human epidermal growth factor receptor 2 (HER2) on recurrent intracranial meningiomas: a case report

Introduction. Meningiomas accounts for one-third of all adult central nervous system tumors and by far the most common primary intracranial tumor in adults. Despite their high prevalence, it remains challenging to predict their biological and clinical behavior. To date, it has been accepted that the extent of surgical resection and histological grade are the most reliable factors to predict the recurrence of meningiomas. HER2 and MAPK3 represent a well-known prognostic factor in various tumors, however only a few studies on the relationship between meningioma recurrence, HER2, and MAPK3 expression. This report presents additional data that support the relationship between the expression HER2 and MAPK3 with recurrent of meningioma.

Case: We report 39 years-old-female with recurrent meningioma. The patient had tumor removal a year ago. After the first resection, the tumor demonstrated rapid growth with significant invasion to neighboring dural tissue and brain parenchyma, which resulted in impaired brain function and intracranial hypertension manifested as severe headache, vomiting, and coma. Histopathological examination confirms a malignant meningioma (WHO grade I). The patient had the second craniotomy for tumor removal, and we performed immunohistochemical staining. The result was positive for HER2 and MAPK3

Conclusion: HER2 and MAPK3 might be a reliable predictor of recurrent meningiomas.

Management of 14 hours penile fracture: a case report

Introduction: Penile fracture is a rare urological emergency that needs immediate repair. It is usually caused by trauma in its origin, whether during sexual intercourse, exotic self-inflicted, fall, or vehicle-related. Tunica albuginea and/or corpus cavernosa are severed, it can sometimes be accompanied by rupture of the urethra. Immediate surgical repair should be done as soon as possible to prevent further complication.

Case Presentation: A 52 years old male comes with swelling and severe pain on his penis 14 hours following sexual intercourse with his partner. No blood in the external meatal nor hematuria was present, and there were no abnormal passing of urine complained. Immediate repair of the corpus cavernosum was performed. The penis was degloved and the corporal tear was closed using absorbable suture. 8 hours following surgery, the patient had a morning erection and no early signs of complication observed.

Conclusion: Immediate surgical repair should be presented after penile fracture was diagnosed. Emergency surgical repair can preserve voiding and sexual function.

The 3rd Live Surgery Workshop International Society of Reconstructive Urology (ISORU), 2nd International Live Surgery Workshop Indonesia Genitourinary Reconstructive Society (InaGURS), and 12th Malang Continuing Urology Education (MCUE)

Dear colleagues and friends,

It is truly a pleasure to invite you to actively participate in the upcoming meeting, The 3rd Live Surgery Workshop International Society of Reconstructive Urology (ISORU), 2nd International Live Surgery Workshop Indonesia Genitourinary Reconstructive Society (InaGURS), in conjunction with 12^th Malang Continuing Urology Education (MCUE), which will be held on September 5^th-7^th, 2019, in Bali Nusa Dua Convention Center (BNDCC), Bali, Indonesia.

The theme chosen is Reconstructive Urology.

These three important meetings that held in conjunctionally will provide a wonderful forum for you to refresh your knowledge and explore new techniques and innovation in urology field from well-known experts. The symposia will be held on the first day and on the 2^nd and 3^rd day, they are going to be the highlight of live surgeries on various cases of reconstructive urology.

Additionally, we would like to also invite you to submit your recent achievement in scientific writing in various field of Urology. The scientific committee will prepare the prestigious oral presentation and poster presentation awards.

The island of the gods, Bali, awaits you!

Undisputable world well-known meeting destination is easily reach with direct flights from most major cities in the world. Since March 2016 Indonesian government has granted 169 countries for FREE Visitor Visa. Please check the list of countries and further details in visa section at the congress website www.mcue.org

Please make sure you have blocked this important dates and visit the congress website for further program update.

See you soon in Bali……

Paksi Satyagraha

Congress Chairman