Risk scoring in predicting preterm birth of women receiving cervical cerclage

Chro Najmaddin Fattah

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Background: Cervical incompetence is primarily a clinical diagnosis, which is characterized by recurrent painless dilation of cervix and spontaneous second trimester loss and preterm delivery. Despite recent advances, the indications and efficacy of cervical cerclage have been remained controversial. This study was performed with the aim of evaluating the risk factors of preterm birth among women who underwent cervical cerclage and establishing a scoring system to predict preterm labor in this group of women.

Material and Methods: This retrospective cohort study was performed on 95 women who had undergone cervical cerclage from January 2016 to January 2018 in Maternity Teaching Hospital of Sulaimaniyah, Iraq. A total of 66 women who delivered after 34 weeks were used as control group, compared to 29 cases who delivered before 34 weeks.

Results: According to the findings of the present study, there was a significant association between the preterm birth before the 34 weeks of pregnancy and the risk factors of pathological vaginal discharge, cervical length less than 25 mm prior to cerclage placement, and passive smoking. The positive predictive value was calculated using the prediction model was %99 with a risk score of 3, 47.6% with risk score 2 and 28.2 % with risk score 1.

Conclusion: The prediction model can be used as a tool to identify patients at a higher risk for PTD <34 weeks and to recognize those that could benefit from cerclage and deliver after 34 weeks. It could also be a useful tool for identifying those high risk women with cerclage who require increased surveillance.

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The functional and physical state of the anal sphincter complex in the patients with rectal prolapse in the post-surgery period

Solmaz Soltan Imanova

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Purpose: The work was aimed at comparative studying of the functional and physical state of the patients with rectal prolapse after surgical treatment with various surgical techniques and at identifying the most optimal procedure technique.

Patients and methods: The authors observed 49 patients (32 women, or 65.3 %) aged 22 — 83 years (the median age of women was 46.1 ± 1.3 years old, of men — 48.7 ± 1.4 years old) with the rectal prolapse of varying severity. The Delorme’s procedure was indicated for 28 patients (57.1 %). Perianal proctosigmoidectomy (the Altemeier’s surgery) was performed in 12 patients (24.5 %). In the young patients, preference was given to the Ripstein’s abdominal surgery (nine patients; 18.4 %). To objectively assess the physical state of the anal sphincter apparatus, traditional sphincterometry was performed using S4402 sphincterometer with a nonperfusing sensor (Pro Medika GmbH, Germany), and the functional state of the sphincter complex was subjectively assessed using the Wexner’s score scale.

Results: The best results were obtained after the Delorme’s procedure (p<0.05), while the worse results were obtained in the young patients after the Ripstein’s surgery (p<0.05).

Conclusion: The obtained results may be used for assessing the functional and physical state of the anal sphincter complex in the surgical treatment of the patients with the rectal prolapse syndrome, especially in those with ASFs of varying severity.

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IDH1 mutation in Balinese glioma patients and its relationship with clinicopatological parameters

Ni Putu Sriwidyani, Ida Ayu Ika Wahyuniari, Herman Saputra, I Gusti Kamasan Nyoman Arijana

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Purpose: Isocitrate dehydrogenase 1 (IDH1) mutation plays an important role in the carcinogenesis of gliomas. The most recent WHO classification of central nervous system tumors has added molecular genetic in addition to the histological features of the tumor, including status of IDH mutation in glial tumors. The purpose of this study was to determine the prevalence of IDH1 mutations in Balinese glioma patients and its association with clinicopathological features.

Patients and methods: This study was conducted from 30 glioma patients at Sanglah General Hospital during January 2018 until June 2019. DNA extractions were carried out from the FFPE of tumor tissue, followed by amplification of codon 132 in exon 4 of the IDH1 gene by allele specific PCR. Relationship between IDH1 mutation status and clinicopathological features was tested with X² with 0.05 significance.

Results: The age range of patients is 14-81 years with an average age of 43.4 years (SD±17.9 years). Most patients with astrocytic tumors (25/30; 83.3%), others were oligodendroglial tumor (2/30; 6.7%) and oligoastrocytic tumor (3/30; 10%). Most patients were found with grade IV glioblastoma (18/30; 60%).  Genotyping analysis showed IDH1 mutations in the majority of glioma patients (90%). Most cases (92.6%) of mutant IDH1 showed heterozygous mutations (GA genotype) while the rest showed homozygous mutations (AA genotype). There were no significant relationship between IDH1 status and age (p=0.09), sex (p=0.63) and histologic type (0.14), but there was significant relationship between IDH1 mutation status and tumor grade (p=0.01). All of IDH1 mutation were found in diffuse glioma (grade II and III gliomas and grade IV glioblastoma).

Conclusion: Most of diffuse glioma (grade II-IV glioma) patients in Bali had IDH1 mutation and IDH1 mutation status has significant relationship with tumor grade. Further research about genetic abnormalities in order to improve therapeutic efficacy against IDH-mutated gliomas is needed.

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Relationship between body mass index, handgrip, and cognitive status on frailty status in elderly women

Dwi Ngestiningsih, Hermina Sukmaningtyas, Timothy G Susanto, Enny Probosari

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Background: Decreased health due to the aging process is characterized by a decrease in the function and work of the body's organs which triggers the risk of disability and frailty, especially in postmenopausal women prone to sarcopenia which can worsen the condition of the elderly. The aim of the study is to determine the relationship between body mass index, handgrip, and cognitive status on frailty status in elderly women at some elderly integrated health services (posyandu lansia), Semarang City, Indonesia.

Methods: This study used a cross sectional design with a consecutive sampling method of 70 subjects. Subjects measured vital signs, weight and height. Subjects were then assessed for handgrip strength, cognitive status and frailty status. Univariate and bivariate data analysis used SPSS 25.0 with the Spearman correlation test.

Results: A total of 70 elderly women followed this study with an average age of 65.96 years. As many as 67.1% of elderly women have hypertension. There are 70% of all elderly women with pre-frail status and 4.3% with frail status. There is no significant relationship between body mass index and frailty status (p=0.328). There is no significant relationship between handgrip and frailty status (p=0.476). There is no significant relationship between cognitive status and frailty status (p=0.664).

Conclusion: The elderly women at the some elderly integrated health services, Semarang City mostly have pre-frail status. There is no significant relationship between body mass index, handgrip, and cognitive status on frailty status in elderly women.

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The correlation between serum fibroblast growth factor-23 with urinary fractional excretion of phosphate in predialysis chronic kidney disease

Yenny Kandarini, Vika Wirdhani, Anak Agung Wira Dewi Lestari

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Purpose: To investigate the correlation of serum fibroblast growth factor-23 (FGF-23) with urinary fractional excretion of phosphate (FEPi) in predialysis chronic kidney disease (CKD).

Methods: This cross-sectional study involved 75 patients with CKD stage 2-4. Blood and 24-hour urine samples were taken from eligible participants to measure key variables using standard commercial assays. FGF-23 concentration was measured using enzyme-linked immunosorbent assay (ELISA). The correlation between FGF-23 serum level and urinary FEPi was analyzed using the Spearman correlation test.

Results: Of 75 eligible subjects, the majority had the characteristics of male gender, CKD stage 3, with mean age and body mass index of 50±10.8 and 23.51±3.3, respectively. The median FGF-23 level was 108.7 (13.6-1226.2) RU/ml, while the median urinary FEPi was 24.3% (4.04%-65.9%). There was a moderate positive correlation between FGF-23 and FEPi (r = 0.44, p<0.001).

Conclusion: The result confirmed the correlation between serum FGF-23 level with urinary FEPi in predialysis CKD.

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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

I Wayan Sugiritama, Ida Ayu Ika Wahyuniari, I Gusti Ayu Dewi Ratnayanti, Ni Made Linawati, I Gusti Nyoman Sri Wiryawan, Ni Luh Gede Yoni Komalasari, I Gusti Kamasan Nyoman Arijana

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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.

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

Ni Wayan Sucindra Dewi, Agung Nova Mahendra

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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.

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

Made Swastika Adiguna, Luh Made Mas Rusyati, Prima Sanjiwani Saraswati Sudarsa

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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.

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Correlation between malondialdehyde levels and disease activity in vitiligo

Prima Sanjiwani Saraswati Sudarsa, I Gusti Ayu Agung Praharsini, Ratih Vibriyanti Karna

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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.

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High c-reactive protein level as risk factors of complications in upper gastrointestinal bleeding

I Ketut Mariadi, Karismayusa Sudjana, I Dewa Nyoman Wibawa

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Purpose: Upper gastrointestinal bleeding is the major medical emergency case in the field of gastroenterology. The complications of UGI bleeding are recurrent bleeding and death. Identifying risk factors for the complications is expected to prevent or reduce recurrent bleeding complications and deaths from UGI bleeding. This study aims to know the risk of UGI bleeding complications in patients with a high level of C reactive protein (CRP).

Patients and methods: A prospective observational analytic study was performed, including all UGI bleeding patients (variceal and nonvariceal). CRP level was used to determine the high-risk cohort. High-risk cohort if the CRP level 5 mg/L and above, and low risk if CRP level less than 5 mg/L. The outcome of the study was the incidence of complication, both rebleeding and death during follow up for six weeks. 

Results: Based on the characteristic data of the sample, the high-risk group appears to have a slightly older age, higher leucocyte count, lower hemoglobin levels, and higher serum creatinine than the low-risk group. The incidence rate of complication in the high-risk group was 85.3% while in the low-risk group was 37.5%, and the relative risk (RR) was 2.27 (95% CI: 1.43-3.67). There were significant differences in the incidence of complications between the group, X²: 16; p <0.001. The RR for rebleeding in the high-risk to low-risk cohort was 2.68 (95% CI: 1.31-5.47); this difference is statistically significant (X²:9.3; p=0.02). The RR for death complication was 1.70 (95% CI: 0.63-4.53), and the difference is not statistically significant (X²: 1.2; p=0.28).

Conclusion: In this study, we found the CRP level ≥ 5 mg/L as a significant risk factor for rebleeding complications but not mortality in a patient with UGI bleeding.

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In vitro study comparison of purple leaf extract as denture cleanser at different concentration towards S. mutans growth on flexible denture

Tri Purnami Dewi

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Background: The denture usage should be accompanied by good denture cleansing to prevent denture damage and oral disease due to bacterial on the denture. Research on purple leaves (Graptophyllum pictum) showed that purple leaves have anti-bacterial and antimicrobial activity. So it is essential to study the effectiveness of purple leaves as denture cleanser towards the growth of S. mutans on flexible denture plates.

Objective: The objective of the study was to compare the effectiveness of purple leaf extract at different concentrations: 1.25%; 2.5%; 10% and 40%, fittident^Ò and aquadest towards S. mutans growth on flexible denture plates.

Methods: This study was in vitro study that used S. mutans from local isolates of the microbiological laboratory faculty of medicine, Universitas Udayana. The isolates were incubated for 24 hours with temperature 37^oC on 18 plates (10x10x2mm). The concentration of purple leaf extract was 1.25%; 2.5%; 10% and 40%. The effectiveness of purple leaf extract, fittident^Ò and aquadest towards the growth of S. mutans can be evaluated from the number of S. mutans colonies on flexible denture base plate (CFU/ml). Data were analyzed using the One Way Anova test with 95% confidence level (α = 0,05%). LSD (Least Significant Different) was tested to determine the significance of differences in the treatment group. 

Result: The lowest mean of colonies' growth was found in 10% concentration (21.0000). There was significant difference in colony count between the extract concentration groups (p=0.000). LSD-multi comparisons test on the Post Hoc analysis showed a significant difference between the extract concentrations of 1.25% to 10% (p=0.037), and the 2.5% extract to 10% (p=0.012) and 40% (p=0.027). Graptophylum pictum extract showed with highest flavonoid content (4340,30 mg/100 QE wb).

Conclusion: All extract concentrations are effective in suppressing bacterial growth. The optimum concentration to the growth of S. mutans was the extract with 10% concentration but did not differ significantly with the 40% concentration extract.  

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Investigating the relationship between accountability and job satisfaction: A case study in hospitals affiliated to Yazd University of Medical Sciences 2017

Askari Roohollah, Hatami Hanza Maryam

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Introduction: high accountability of employees, the organization can be helped to achieve the goals. In general, this research is to investigate the relationship between accountability and job satisfaction in nurses in an educational hospital affiliated to Yazd University of Medical Sciences

Method: This study was a descriptive study of correlation type that has been conducted a cross-sectional study in 2017. We involved 190 nurses from selected educational hospitals affiliated to the Yazd University of Medical Sciences in the city of Yazd that have been chosen by stratified random sampling method. The data collection tool was Costa and M Care Accountability Questionnaire concerning 12 items, and Kendall and Smith Job Satisfaction Questionnaire were 37 items. Likert's 5 scales were used to determine the score of accountability and job satisfaction. The data was analyzed by descriptive-analytical statistical tests and Pearson correlation coefficient, a significance level of 0.05, and in the SPSS software version 20.

Results: there was no significant relationship between accountability and job satisfaction except one of job satisfaction (nature of work) (p=0.009). Also, a significant association was observed between three demographic variables of the age group (31-35) years (p=0.047) and work experience between (11-15) years (p=0.03) and the gender of women (p = 0.005) and two variables of accountability and satisfaction.

Conclusion: According to the results, it is better to pay more attention to work nature to implement responsibilities more efficiently and increase job satisfaction.

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Growth parameters in children with atopic dermatitis in Erbil City, Kurdistan Region-Iraq

Ahang Mohammed Hamid, Dindar Sharif Qurtas

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Background: Atopic dermatitis is a chronic inflammatory skin condition that significantly impacts patients' quality of life. A disturbed sleep pattern, frequent potent topical and sometimes systemic corticosteroid use, and diet restriction, all of which could affect child's growth.

Objective: This study determined height and weight impairment in children with atopic dermatitis.

Patients and Methods: A cross-sectional study took children with atopic dermatitis ≤18 years, which was conducted in the "Erbil Dermatology Teaching Center." The patients' data included sociodemographic information, family history, drug history, and present complaints. The severity of the disease evaluated using SCORAD score. The weight was recorded using a medical electronic weighing machine, and standing height was recorded using a stadiometer.  

Results: Among 100 children with atopic dermatitis, their mean of age was 6.84±1.8 years.  Males and Females frequencies were 54 and 46, respectively. The family history of atopic dermatitis was positive in 73%. Generally disturbed sleep pattern was dominant, and almost all severe AD patients had disturbed sleep (87.5%). The severity of AD was classified by SCORAD score to mild (23%), moderate (69%), and severe (8%). Patients having their growth percentile for weight and height for age below 3^rd percentile were 10% and 3%, respectively. Patients' weight and height for age below 25^th percentile were 15% and 9%, respectively.

Conclusions: Atopic dermatitis can affect the height and weight of the children inversely. The study sample's most dominant character was sleep pattern disturbances, which can affect both weight and height.

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Bacterial identification of acne vulgaris

Lovena Sari, Nelva Karmila Jusuf, Imam Budi Putra

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Background: Acne vulgaris (AV) is a chronic inflammation of the pilosebaceous unit with clinical polymorphic lesion consist of non-inflammatory (open and closed comedones) and inflammatory lesions (papules, pustules, and nodules) with varying degree of inflammation and depth. Earlier studies showed that other bacteria might also found and played a role in acne pathogenesis besides Cutibacterium acnes (C. acnes).

Patients and Methods:  This descriptive observational study used cross-sectional method. Samples were collected from 40 subjects with AV. We took the samples from non-inflammatory (closed comedones) and inflammatory lesions (pustule) in each subject, followed by Gram staining, aerobic and anaerobic bacterial culture, and bacterial identification. This research has been approved by the Ethical Committee, Faculty of Medicine, University of Sumatera Utara.

Results: There were 12 bacterial species that were identified from 80 samples. We identified Cutibacterium acnes (21,2%) in anaerobic culture. While in aerobic culture, we identified Staphylococcus epidermidis (47,5%), Staphylococcus hominis (17,5%), Staphylococcus aureus (8,7%), Staphylococcus haemolyticus (8,7%), Leuconostoc mesentroides (6,2%), Micrococcus luteus (3,7%), Kocuria varians (2,5%), Staphylococcus vitulinus (1,2%), Staphylococcus cohnii (1,2%), Staphylococcus arlettae (1,2%) and Dermacoccus nishinomyaensis (1,2%).

Conclusion: The two most common bacteria in acne vulgaris are Staphylococcus epidermidis and Cutibacterium acnes

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Correlation between body mass index with striae in female adolescent

Imam Budi Putra, Nelva K. Jusuf, Chyntia Giska Aryunisari

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Background: Striae has been reported as a skin problem often experienced by a woman and becomes an aesthetic problem. This skin problem can occur at any age, including adolescents, even though it is more common in younger women. Some conditions increase the risk of striae, such as weight, pregnancy, puberty, and hormonal drugs. Women with higher body mass index (BMI) tend to have more striae. With a limited study on striae, it is quite interesting to evaluate the high incidence of striae in the population.

Patients and Methods:  This was a cross-sectional study using a total sampling method. The study was conducted after approval from the Ethics Committee Faculty of Medicine, Universitas Sumatera Utara. Samples are 155 female students aged 18-25 years old from the Medical Faculty of Universitas Sumatera Utara. All samples were physically examined to diagnose the striae, and the BMI was calculated.  All the collected data were analyzed statistically with ETA statistical tests to see the relationship between BMI and striae. P-value <0.05 considered statistically significant.

Results: The dominant age of the subject is 19 years old (62.5%), followed by 20 years old (30.3%), 21 years old (3.8%), and 18 and 23 years old (0.6%). Out of 155 subjects, there are 117 have striae (75.5%). None of the striae subjects is underweight, normal weight was 113, 3 obese and one overweight. The 38 subjects without striae are in normal BMI. An analysis using ETA proved that BMI is not significantly associated with striae (p>0.05).

Conclusion: There is no significant relationship between BMI and striae.

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Clinical presentation and outcome of COVID-19 infection in Type 2 Diabetes Mellitus: a preliminary data from a tertiary hospital in Jakarta during the early days of the pandemic

Ida Ayu Kshanti, Giri Aji, Marina Epriliawati, Md Ikhsan Mokoagow, Jerry Nasarudin, Nadya Magfira, Anggraini Permata Sari, Annela Manurung, Aryan Yohanes Djojo, Elizabeth Yasmine Wardoyo, Martha Iskandar, Nikko Darnindro, Radhiyatam Mardiyah

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Introduction. This study aimed to review the clinical characteristics and outcomes of COVID-19 patients presented with in-hospital hyperglycemia or pre-existing type 2 diabetes (T2DM).

Methods. This is a retrospective study conducted in Fatmawati General Hospital, Indonesia, from March 18th-Apr 30th, 2020. We reviewed medical records of 27 COVID-19 patients presented with either in-hospital hyperglycemia (11, 12.2%) or pre-existing T2DM (16, 17.8%) from a total of 90 confirmed COVID-19 cases admitted in our hospital.

Results. Critical conditions occurred in 50% of T2DM and 54.55% of the in-hospital hyperglycemia group. Mortality was documented in 68.75% of T2DM and 81.82% of in-hospital hyperglycemia group. Hypoglycemia, diabetic ketoacidosis, lactic acidosis and ketosis were found in 12.5%, 25%, 18.75%, and 25% of individuals with T2DM, respectively, resulting in a high mortality rate. Meanwhile, diabetes-related complications were rare among the in-hospital hyperglycemia group. However, respiratory failure (45.45% vs. 6.25%) and septic shock (27.27% vs. 6.25%) were more frequent than in the T2DM group.

Conclusion. In this preliminary study, a high mortality rate was documented among COVID-19 patients with preexisting T2DM and in-hospital hyperglycemia. In T2DM subjects, diabetes related-complications contributed to a higher mortality rate, while in-hospital hyperglycemia group, respiratory failure and septic shock were more frequent.

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Lipid and cardiac profile assessment following the co-administration of Cisplatin and methanolic extract of Portulaca oleracea in adult Wistar rats: an experimental study

Izuchukwu Azuka Okafor, Uchenna Somtochukwu Nnamah, Jude Nnaka

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Introduction. There is a need for continual evaluation of the effective use of plant-based medicine as combination therapies as more therapeutic potentials are being associated with phytomedicine. The changes in the lipid and cardiac profile of adult Wistar rats following the co-administration of Cisplatin and methanolic extract of Portulaca oleracea (MEPO) were investigated.

Methods. Twenty-four (24) rats with an average weight of 154 kg were randomly divided into six (6) groups (A-F). Group A was given no treatment and served as the normal control group. Group B received only a cisplatin injection and served as the cisplatin control group. Group C and D were given 400mg/kg and 800 mg/kg MEPO six hours after cisplatin injection. Group E and F were administered 400mg/kg and 800 mg/kg MEPO 6 hours before cisplatin injection. All cisplatin injections were single-dose intraperitoneal injection (2 ml/kg) and MEPO administration lasted for 7 days. Animals were euthanized under diethyl ether anesthesia at the end of the experiment and blood collected for serum lipid profile investigations. Some cardiac and lipid parameters were estimated from standard formulae.

Results. There was a significant increase in the serum levels of TG and TC (p=0.01 and p < 0.001) and some estimated parameters – LDL, VLDL, CRR, HDL-LDL and TG-HDL (p<0.001, p=0.049, p<0.001, p<0.001 and p=0.001 respectively) while HTR was significantly decreased (p<0.001) due to cisplatin treatment. HDL and AI levels were unchanged by cisplatin treatment. MEPO significantly reversed (p<0.05) the cisplatin-induced changes in the serum lipid parameters (TG and TC) and estimated parameters (VLDL, CRR and TG-HDL) across all MEPO-treated groups.

Conclusion. MEPO shows evidence of attenuating cisplatin-induced hyperlipidemia and cardiac risk.

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The potential role of exosome on cytokine storm and treatment of severe COVID-19 infection

Hamsu Kadriyan, Eka Sunarwidhi Prasedya, Nova Audrey L Pieter, Masyita Gaffar, Abdul Qadar Punagi, Agussalim Bukhari

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The symptoms of COVID-19 varies from mild to severe. The risk of severe infection occurs about 10% of cases, while the risk of death occurs about 0-14.6% of cases. One of the suspected pathophysiology in cases of severe infection and death of COVID-19 is due to cytokine storms. Exosome plays a vital role in the pathogenesis of several diseases, including severe disease such as sepsis due to cytokine storm. Exosome has been proven as a nanomaterial carrier that can tackle cytokine storm in the treatment of severe COVID-19 infection. Several studies have been conducted for this purpose, and its clinical application continually increases. This review will explore the role of exosomes in cytokine storms that occur in patients with COVID-19 and seek the opportunity to use exosomes in their management

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Virtual patient simulation method for learning and assessment in cardiology field

Ida Bagus Amertha Putra Manuaba, Ni Gusti Ayu Putu Lestari Santika Dewi, I Putu Yuda Prabawa, Agha Bhargah, Chien-Chih Wu

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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. 

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Role of PRP (platelet-rich plasma) in alopecia areata: A literature review

Ni Wayan Eka Ciptasari

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Alopecia areata (AA) is an autoimmune disease that causes hair loss, and its specific cause is not  fully determined. This disease affects the patients physically, psychologically, and cosmetically. Treatment of AA is not curative, but controls or limits the disease course. Most treatment modalities are an immunosuppressive or immunomodulatory agent, which are associated with increased side effects. PRP has been used in aesthetics and dermatology, especially for wound repair. Improvement characterized by hair growth has been reported in several studies. Hair growth improvement with PRP is an effective procedure for AA without any allergic reaction. Epidermal proliferation, induction of angiogenesis, and stimulation of the growth of follicular bulge cells were also reported. Despite showing the efficacy of PRP in AA, it is necessary to carry out randomized clinical trials and long-term evaluations to support the efficacy of therapy.

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Pregnancy with seropositive toxoplasmosis: a case report

Natassa Zefanya Darsana, Anak Agung Ngurah Jaya Kusuma

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Introduction: Toxoplasmosis is present in every country and seropositive rates vary between regions from less than 10% to more than 90%. Toxoplasmosis in pregnancy can result in severe sequelae to the fetus. Primary infection in pregnancy may cause spontaneous abortion or fetal death in utero. Congenital ocular and neurological abnormalities may also occur. We present a case involving toxoplasmosis infection in early pregnancy and an overview of the management and the clinical outcomes for both mother and fetus.

Case report: A 26-year-old pregnant woman (G1P0A0) showed a high concentration of IgG anti-toxoplasmosis in early pregnancy with a concentration of 1200. Throughout the pregnancy, an increase in the concentration of IgG anti-toxoplasma was found. At 14 weeks gestation, concentration increased four-fold to 9068. During the ultrasound observation no hydrocephalus, ocular, and neurological abnormalities were found. Amniocentesis was performed for PCR examination and the result turned out negative. The patient was given spiramycin 1 gram daily for the remaining of her pregnancy. At 40 weeks gestation, the patient gave birth vaginally to a healthy term 3700 grams baby boy. There were no signs of major anomalies found in the baby.

Conclusions: Diagnosis and screening of toxoplasmosis require proper understanding of serological examination, as well as the specificity and sensitivity of the diagnostic tools. Ultrasound monitoring for the detection of congenital toxoplasmosis can also help with diagnosis.

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Recombinant tissue plasminogen activator (rTPA) in young adult patient with acute ischemic stroke: a case report

Dodik Tugasworo, Aditya Kurnianto, Retnaningsih Retnaningsih, Yovita Andhitara, Rahmi Ardhini, Runy Dyaksani, Jethro Budiman

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Background: Stroke is one of the highest causes of morbidity and mortality in the world. The incidence rate of ischemic stroke is about 80% of all stroke incidents. The use of recombinant tissue plasminogen activator (rtPA) is recommended under 4.5 hours of stroke onset. Stroke in young adults are reported as being uncommon, compromising 10% -15% of all stroke patients. Many studies were reported the most common risk factor in young adults were obesity and dyslipidemia. This case report will discuss a 33-year-old men with ischemic stroke with obesity and dyslipidemia treated at dr. Kariadi Hospital Semarang.

Case presentation: A 33-year old obese man with left-sided hemiparesis and central facial nerve palsy with an onset of 1 hour. On laboratory examination, it was obtained total cholesterol 179mg/dL, LDL level 123mg/dL, and HDL level 39mg/dL. The protocol code stroke was performed in emergency room with alteplase (r-TPA) 0.6 mg/kgBW, after his head MSCT shows there was no sign of blood in the brain parenchym.

Conclusion: The increased risk of ischemic stroke in young patients is due to dyslipidemia, hypertension, obesity, physical inactivity, and smoking. Treatment of the hyperacute phase of ischemic stroke with thrombolysis can reduce the outcome of stroke due to the disability.

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Delayed reconstruction of soft tissue defects in mangled lower extremities: A report of three cases

Agus Roy Rusly Hariantana Hamid, I Gusti Putu Hendra Sanjaya, I Made Suka Adnyana, I Gusti Ayu Putri Purwanthi, Grace Inriani Ronge, Gede Wara Samsarga

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Background: The best timing for the soft tissue reconstruction procedure in the mangled lower extremity is still controversial. Despite the advantages of acute treatment, delayed soft tissue reconstruction are often inevitable for various reasons. This case report aims to present three cases of delayed reconstruction to treat lower extremities soft-tissue defects in mangled lower extremity following high-energy trauma.

Case Series: This study included three cases that underwent delayed reconstruction for the mangled lower extremity. The definitive reconstructions were done in 15, 30, and 60 days after injury and all cases underwent serial debridement before the definitive procedure. The reconstruction methods used were skin graft and free flap. There was no graft/flap loss observed in this study.

Conclusion: We believe that soft tissue reconstruction of mangled lower extremities following high-energy trauma may also be safely done in a delayed setting if the wound debridement is adequately done, and the basic reconstructive principles are fulfilled.

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Unilateral pedicle screw fixation as a less invasive surgical procedure: a case series and literature review

Tjokorda Gde Bagus Mahadewa

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Introduction: The principle of treatment for degenerative spinal diseases when conservative modality failed is surgery. Unilateral pedicle screw fixation is a less invasive methods with clinical outcomes that were similar to a bilateral fixation, especially for lumbar degenerative disease. Improvement of symptoms, neurological outcome and spinal stability is the utmost priority. This was a case series study with five patients with degenerative spine disease from January 2019 - January 2020. The aims are to evaluate unilateral pedicle screw surgery outcomes and elucidate the effectiveness of this method clinically.

Case Description: Five patients aged 40-64 years old involved in this series. Four patients presented with lumbar radiculopathy and one patient with cervical radiculopathy. All experienced weakness (MMT score 2-4) and pain along the affected extremities. Three patients diagnosed with concomitant Herniated Nucleus Pulposus (HNP) and Foraminal Stenosis (FS) based on clinical examination and Magnetic Resonance Imaging result. The rest of two patients each diagnosed with FS and HNP. Surgery initiated with a midline incision. Muscle ipsilateral to the symptomatic side was dissected and retracted to expose the facet joint and the vertebral lamina. Screws were inserted into the vertebral body and the rod used to connect the screws was bent following the vertebral curvature. Facetectomy or Hemilaminectomy was done to expose and decompress the ipsilateral side's nerve root and intervertebral space. The incision site is then irrigated and closed. All operation was done by the same surgeon. Postoperative clinical outcomes were evaluated for six months after surgery. All patients showed a complete motor improvement and fully relieved from pain.

Conclusion: Unilateral pedicle screw fixation is considered as a less invasive instrumentation system with clinical outcome comparable to bilateral screw fixation.

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Ruptured ectopic pregnancy management in the COVID-19 pandemic era: a case report

I Gde Sastra Winata, Anton Supono

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Introduction. COVID-19 protocol and the unavailability of proper instruments in the isolation room had complicated the usual protocol to diagnose and manage the medical and surgical conditions.  This article is about the first ruptured ectopic pregnancy cases encountered during the COVID-19 pandemic in Sanglah General Hospital. Considering the unique circumstances and the difficulty during establishing the diagnosis and conducting the management, we ought to present our experience through this article.

Case Description. This case report reviews a 24-years-old female, an asymptomatic COVID-19 case, who was diagnosed with ruptured ectopic pregnancy during appendectomy surgery in Sanglah General Hospital, Denpasar, Bali-Indonesia. The patient complained about mild lower right abdominal pain, with a clinical picture that supports acute appendicitis. However, the history taking revealed a history of post-curettage 15 days prior to admission due to vaginal bleeding suspected for incomplete abortion. Except for a positive pregnancy test, the clinical picture did not support a pregnancy nor a ruptured ectopic pregnancy. We still consider an ectopic pregnancy as no histopathological examination result was available to supports the previous vaginal bleeding was an intrauterine pregnancy. Further to complicate the problem, the patient was reactive for the COVID-19 screening test, thus requiring a COVID-19 protocol. As an ultrasound device was unavailable at the time in the isolation room, we could not assess for extrauterine pregnancy. Only during the surgical procedure for appendectomy, our surgical college notified us of the accompanying presence of sign of ruptured right ampullary pregnancy.

Conclusion. The COVID-19 isolation protocol and the unavailability of essential equipment and diagnostic tools in the isolation room could hinder the usual protocol used to diagnose and manage various medical and surgical problems. We hope this article could illustrate how COVID-19 had complicated unusual cases, thus reflect how important clinical judgment and infrastructure in our health care system.

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Tracheostomy in upper airway obstruction on a COVID-19 patient

Rohaizam bin Japar Jaafar, Zakinah Binti Yahaya, Mohd Razif Bin Mohamad Yunus, Marina Binti Mat Baki

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Background:  Stridor due to upper airway obstruction in a COVID-19 positive patient is a big challenge to the medical team especially to anaesthetists and otolaryngologists. In this condition, performing aerosol generating procedures (AGP) are time-sensitive and this increased the risk of virus transmission.  

 

Case Report: A 66-year-old male, chronic smoker, completed 6 days in-patient treatment for community acquired pneumonia when the RT-PCR for COVID-19 was found to be negative. He was seen in the otorhinolaryngology (ORL) clinic 2 weeks later due to hoarseness for two months that was associated with worsening shortness of breath and cough. He had soft stridor at rest and was mildly tachypnoeic. Flexible endoscopy revealed mass on the right immobile vocal cord with small glottic airway. Repeat nasopharyngeal swab for COVID-19 on the same day was positive. A meticulous discussion involving multidisciplinary team lead to the decision to secure the patient’s airway by first intubating him with a small endotracheal tube and followed by tracheostomy in the same setting. Here, the experience in managing upper airway obstruction due to laryngeal carcinoma (at least T3) in a patient with stage 4 COVID-19 is presented and discussed. The challenges emerged due to inevitable series of AGPs that need to be performed. Multidisciplinary team involvement comprises ORL surgeon, anaesthetist, infectious disease and respiratory physician is pertinent. 

 

Conclusion:  This is the first case in the literature on a stridorous COVID-19 positive patient with laryngeal carcinoma that requires emergency tracheostomy. The case highlights the challenges and decision making in managing such case that supposed to be straightforward before the COVID-19 pandemic era. This shall be the new normal for otorhinolaryngologists, anaesthetists and may be any other specialities that deal with AGPs. 

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The 4th International Conference on Translational Medicine and Health Sciences

Muhamad Thohar Arifin

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All praises to Allah, the most merciful, beneficent and compassionate, for His blessing that this conference could be organized today. I would like to express my greatest gratitude to Prof. Dr. Yos Johan Utama, S.H., M.Hum; Rector of Universitas Diponegoro, Dr. dr. Dwi Pudjonarko, M.Kes, Sp.S (K); Dean of Faculty of Medicine Universitas Diponegoro, Prof. Dr. Jamari, S.T., M.T.; Director of LPPM, Dr. dr. Hermina Sukmaningtyas, M.Kes., Sp.Rad and Dr. dr. Udadi Sadhana, M.Kes, Sp.PA, Vice Deans of Faculty of Medicine for all of their kind supervision during the preparation of this event. I would like to express my sincere gratitude to all of the committee members for all of your hard work, kind help, and best effort as a solid team work, by which this event can be held successfully even during the COVID-19 pandemics. I would like to thank all of the honorable speakers for your willingness to give lectures and all of participants from various institutions in the world. Welcome to the 4^th International Conference on Translational Medicine and Health Sciences (ICTMHS) 2020.  It is a great pleasure to announce that this is the first virtual ICTMHS, which is traditionally held in Semarang, Indonesia. ICTMHS is an annual routine program that began in 2017 initiated by the faculty to support the university's vision of becoming a world class university. The theme of this conference is "Unraveling the New Normal Guideline Treatment of Diseases in COVID-19 Pandemic". This difficult time has pushed us to strengthen our collaborative practices in the health sectors including Interprofessional Education and Research, Collaborative Practice, Translational Medicine, and Nutrition, Dietetic and Food. This is an interesting theme that invites all health workers to unite to increase collaboration in various aspects to tackle the pandemics affecting our country and beyong. Through this conference, we hope to contribute in introducing and educating the scientific community on the recent advances in the medical, dentistry, nursing, pharmaceutical, and nutrition sciences field. As a major goal of this event, we hope that it can be an excellent chance to discuss interesting ideas and develop fruitful project in the future, network opportunities with old and new colleagues, coordination new partnerships which advance collaboration either about the research field or not, as well as the careers of all participants. Please enjoy your participation in ICTMHS 2020.

 

 

 

dr. Muhamad Thohar Arifin, PhD, Sp.BS(K), PA

Chief of Organizing Committee

 

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