The Indonesian Biomedical Journal

288-303

Authors: Anna Meiliana, Andi Wijaya

BACKGROUND: Hormesis was initially defined as a phenomenon where a small dose of harmful agent exposure to living organisms gives beneficial effects. The dose and time of this ‘tress’ exposure has become the object of investigation across the broad range of biomedical studies. CONTENT: Hormesis characterized by the biphasic dose-effect or time-effect relationship for any substance. Some hormetic mechanisms performed biological plasticity, involve oxidative damage which instead induce antioxidant enzyme production in various cells. Early-life stress can increase resilience in later life and lack of stress can lead to vulnerability. Many stressors like dietary factors and natural environmental toxins can be occupied for healthy growth or homeostasis, which exemplifies how illness is the doorway to health. SUMMARY: Hormesis reconcile many paradoxical phenomena exert opposite effects of the same substance, either a xenobiotic or an endogenous substance, a hormone or a metabolite, a genetic manipulation or an epigenetic alteration, an experimental intervention or a natural event. Human bodies are highly adaptive. A resilient body would be resulted after the ‘training’. In this review, we will elucidate the hormesis’ definition, mechanisms and pathways, and also how hormesis impacts in human health and lifespan.

313-9

Authors: Selma Zein Syafira, Nabilla Ghina Zavitri, Su Yan, Yunia Sribudiani, Alexander Lezhava, Lidya Chaidir

BACKGROUND: Molecular techniques, which detect mutations associated with drug resistance tuberculosis (TB), are promising technologies for rapid diagnosis and monitoring of drug-resistant TB. Pyrosequencing is a potential rapid and robust molecular technique to detect drug resistance but its performance in clinical samples is less investigated. This study aimed to determine the positivity rate of pyrosequencing to diagnose drug-resistant TB directly from sputum samples with different grades of sputum smear microscopy results. METHODS: Thirty-five sputum specimens from drug-resistant TB suspects were submitted for acid-fast bacilli (AFB) microscopy. All specimens were cultured using microscopic observation drug susceptibility (MODS) culture. Pyrosequencing was performed to DNA extracted from sputum of culture-positive patients. RESULTS: MODS culture was positive in 19/35 subjects (54.29%) samples; 16 smear-positive and three smear-negative. Using pyrosequencing, Mycobacterium tuberculosis was identified in all culture-positive samples, including smear-negative samples. A complete resistance profile for 16 (82.35%) samples could be generated. Pyrosequencing failed to show results for eis or gyrA promoter in three samples. Nine of 19 patients were multidrug resistant-TB (MDR-TB), 1/19 was rifampicin-resistance TB (RR-TB), and 4/19 were pre-extensively drug-resistant TB (pre-XDR-TB). Two novel mutations in rpoB and rrs (associated with rifampicin and aminoglycoside, respectively) were found in this study. CONCLUSION: The results of this study demonstrates high positivity rates of pyrosequencing to detect drug-resistant TB directly from sputum samples with different grades of smear microscopy, as the surrogate of bacterial load. The assay can be used as a first prediction test of drug resistance prior to confirmation by phenotypic tests.

325-32

Authors: Mulyana Mulyana, Iwan Sugiarta, Lim Jen Fuk, Vani Nur Pratami, Dewi Yunia Fitriani, Nuri Purwito Adi, Dewi Sumaryani Soemarko

BACKGROUND: The use of acetylcholinesterase (AChE) insecticides is still widely used by farmers in flower and agricultural centers. However, biological monitoring of farmers is still very rare in Indonesia. AChE inhibitors are reported to have toxic effects on various organs. METHODS: This study involved 120 subjects in Cihideung, Cikole and Pangalengan areas. All subjects have been interviewed, physically examined and biological sample taken by medical team. Descriptive analysis was performed to assess general conditions of the subjects and AChE erythrocyte activity enzyme at pseudo-baseline and the next 3 months from pseudo-baseline. Statistical analysis have been performed of the pseudo-baseline AChE erythrocyte activity with hypertension and history of exposures. RESULTS: The median value of pseudo-baseline AChE erythrocyte activity was 8.10 (1.3-14.25) U/g hematocrit. In the comparison between pseudo-baseline and 3 month from pseudo-baseline AChE activity, 7 respondents from 19 respondents (36.84%) had lower enzyme activity than 70% and the others subjects have higher activity value. AChE erythrocyte activity is associate with frequency of insecticide exposures. AChE erythrocyte activity (p=0.04; Exp (B)=2.937 CI 95%=1.049-8.224) and age (p=0.025; Exp (B)=3.872 CI 95%=1.180-12.703) are independent risk factors for hypertension in farmworker. CONCLUSION: AChE erythrocyte activity associated with frequency of insecticide exposures and hypertension among farmworkers.

340-8

Authors: Daniel Joko Wahyono, Anton Budhi Darmawan, Leader Alfason, Reinhard Simbolon, Siwi Pramatama Mars Wijayanti, Wisiva Tofriska Paramaiswari, Korrie Salsabila, Dodi Safari

BACKGROUND: Chronic Suppurative Otitis Media (CSOM) causes hearing impairment and frequently occurred in low-income country where medical care and personal hygiene are poor. Staphylococcus aureus and Pseudomonas aeruginosa are the most common cause of CSOM. We investigated prevalence and antimicrobial susceptibility of S. aureus and P. aeruginosa from tubotympanic CSOM patients in tertiary hospital, Purwokerto, Indonesia in 2016-2017. METHODS: Ear swab specimens were collected from patients with tubotympanic CSOM. S. aureus and P. aeruginosa were isolated and identified by culture, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and molecular tools. Antimicrobial susceptibility testing was performed using the disk diffusion method. RESULTS: Out of ear swabs from 34 patients with tubotympanic CSOM, P. aeruginosa and S. aureus were identified in 35%patients. No Methicillin-resistant S. aureus (MRSA) strain was found from the ear swabs of the patients with tubotympanic CSOM. Bacterial identification using the MALDI-TOF MS was concordantly with culture and molecular tools. All S. aureus isolates showed full susceptibility to cefoxitin and trimethoprim-sulphamethoxazole. Resistance to tetracycline was common with only 64% of S. aureus strains being susceptible. Meanwhile, all P. aeruginosa strains were susceptible to cefepime, cetazidime, meropenem, gentamicin, and tobramycin. CONCLUSION: S. aureus and P. aeruginosa are found in patients with tubotympanic CSOM and still susceptible to different antibiotic agents. MALDI-TOF MS demonstrate rapid, accurate and robust to detect S. aureus and P. aeruginosa.

355-60

Authors: Mulyadi Muhammad Djer, Emilda Osmardin, Badriul Hegar, Darmawan Budi Setyanto

BACKGROUND: There is a lack of local data about recurrent acute respiratory infections in children with congenital heart disease (CHD). This study aims to investigate the incidence and recurrence of acute respiratory infection (ARI) in left-to-right shunt CHD. METHODS: This prospective cohort study investigated children with left-to-right shunt CHD, aged three months to five years, at Dr. Cipto Mangunkusumo Hospital between September 2012 and April 2013. Age and sex-matched participants without CHD were recruited as reference. The occurrence of ARI was observed for six months. Acyanotic CHD patients from 2015 to 2019 were also evaluated to determine the proportion of ARI among this population. RESULTS: A total of 100 subjects were enrolled in the study, 50 in the CHD group and 50 in the non-CHD group, six of whom were later excluded. The monthly incidence of ARI in the CHD group ranged between 40-60% (p=0.027). Subjects with CHD had a cumulative increased risk of 10% for acquiring ARI (RR=1.1; 95% CI=1.02-1.2, p=0.027). The proportion of subjects with a high recurrence of ARI was also higher in the CHD compared to the non-CHD group (67% vs. 30 %, p<0.001). The mean frequency of and median duration of ARI episodes was also higher in CHD compared to the non-CHD group, 3 vs. 1.5 episodes (p<0.001), and 7 vs. 5 days, respectively. CONCLUSION: Children with CHD are at an increased risk of ARI, with more episodes and longer duration compared to children without CHD.

368-75

Authors: Tjahjadi Robert Tedjasaputra, Mochammad Hatta, Muhammad Nasrum Massi, Rosdiana Natzir, Ilhamjaya Patellongi, Marcellus Simadibrata, Ibrahim Labeda, Rina Masadah, Muhammad Luthfi Parewangi, Prihantono Prihantono, Andi Asadul Islam, Agussalim Bukhari, Budu Budu, Rinda Nariswati

BACKGROUND: Some of colorectal cancers (CRCs) are familial, however, heterozygote relatives have approximately 80% lifetime risk of cancer. Risk assessment of CRC’s family could be calculated by direct measurement of mRNA gene expression and Bayesian theorem which is modifying initial background of pedigree risk with additional conditional information. This application has not been reported. METHODS: The cross-sectional translational sequential studies were performed: (1) adenomatous polyposis coli (APC) and MutS homolog (MSH)2 mRNA quantitative RT PCR gene expressions in tissue and whole blood CRC patients; (2) gene expression was determined in matched controls; and (3) pedigree and Bayesian analysis was calculated in the patient’s family of Proband. RESULTS: Fourty CRC and 31 control subjects were enrolled. The mean blood APC level control’s group was 13,261±670 fold-change (fc) and blood MSH2 level was 12,219±756 fc. The cut-off points for hereditary APC was 12,195 fc and MSH2 was 11,059 fc. The mean APC blood level in CRC subject was 11,578±2,638 fc and MSH2 blood level was 11,411±2,912 fc. There were significant differences APC and MSH level between tissue and blood level in CRC. Eight of 40 CRC subjects had a history of familial CRC. Four patients and 10 Probands were available for recurrence risk evaluation of pedigree analysis, RNA PCR quantitative and Bayesian calculation. CONCLUSION: There was determined a cut-off point of hereditary mRNA quantitative expression. The APC and MSH2 levels in CRC subjects were significantly lower than controls. Bayesian analysis allowed for the calculation of relative risk in CRC family members and considered in clinical practice.

384-9

Authors: Ardian Rizal, Ferry Sandra, Muhamad Rizki Fadlan, Djanggan Sargowo

BACKGROUND: Atrial fibrillation (AF) could be triggered by inflammation and oxidative stress. Ganoderma lucidum has an active substance in the form of β-glucan that can reduce inflammatory process and oxidative stress in rats. The objective of this study was to evaluate the effect of Ganoderma lucidum polysaccharide peptide (GLPP) in paroxysmal AF subjects with parameters of anti-inflammatory antioxidant, electrocardiography and health-related quality of life (HRQoL). METHODS: A randomized closed-label clinical trial with pre- and post-test design was conducted. After AF subjects selection, the subjects were randomized, interviewed and veni-punctured to isolate blood plasma. AF Subjects were then treated with placebo or GLPP for 90 days. Post-test blood plasma was collected on the following day after the 90th day. Then anti-inflammatory and antioxidant parameters were measured. After that, echocardiographic and HRQoL assessments were performed. RESULTS: A total of 38 subjects, 11 males and 27 females, completed the study with no significant changes in diets, physical activities, or medications. Comparing to control, the 90-days GLPP-treated subject characteristics were significant difference in systolic blood pressure, heart rate, malondialdehyde, high-sensitivity C-reactive protein, tumor necrosis factor-a, interleukin (IL)-1b, IL-6, primary (P)-wave dispersion, P-max, physical functioning, limitation to physical health, energy/fatigue, pain, and physical limitation. CONCLUSION: GLPP has several potential effects in AF subjects, including anti-inflammatory, antioxidant, and atrial remodelling, so that HRQoL of AF subjects could be improved. Hence, GLPP could suggested as a potential supplementing agent for AF management.