Universa Medicina

1-2

Authors: Richard Tjan

The global dementia epidemic now and in the future is mainly caused by the steady increase in the population of older persons, where around 2 billion people will be 60 years of age and older by 2050. As a consequence, in that year there will be 135 million people with dementia, particularly in low- and middle-income countries where 60% of the more than 47 million cases (2015 estimate) are living now.

13-18

Authors: Rokhima Lusiantari, Miranti Dewi Pramaningtyas, Titis Nurmasitoh, Rachmi Hidayati Pattimura, Anggita Dewanti

Background Shortening is widely used as raw material for bread and other foods. Hypercholesterolemia increases aortic arch foam cell formation and abdominal aortic wall thickness. This study aimed to determine the effect of shortening on the number of aortic arch foam cells and abdominal aortic wall thickness in rats. Methods This study was of experimental posttest control group design. Twenty four male Wistar rats were randomized into 4 groups. The negative control group (C-) received standard feed, the positive control group (C+) standard high-fat feed, group T1 shortening and standard feed at a ratio of 1:5 and group T2 shortening and standard feed at a ratio of 1:10. The interventions were given for 6 weeks through gavage. The foam cell count in the aortic arch and the thickness of the abdominal aortic wall were measured. One-way ANOVA test was used to analyze the data. Results There was no significant difference in the mean foam cell count of the aortic arch between the four groups C- (7.17 ± 4.17), C + (9.33 ± 7.01), T1 (11.83 ± 4.88) and T2 (9.33 ± 6.80) (p=0.598). The mean thickness of the abdominal aortic wall between the four groups C- (741.98 ± 60.67μm), C + (714.29 ± 90.59μm), T1 (838.90 ± 75.86 μm), and T2 (749.88 ± 99.37μm) also was not significantly different (p=0.110). Conclusion Shortening tends to increase the foam cell count of the aortic arch and the thickness of the abdominal aortic wall of rats.

25-30

Authors: Nendyah Roestijawati, Dwi Arini Ernawati, Diah Krisnansari

BACKGROUND Breast cancer in Indonesia ranks second as the most common cancer found in women after cervical cancer. Tumor cells express increased levels of antioxidant proteins to detoxify reactive oxygen species (ROS). Glutathione S-transferase (GST) is known to play a key role in the detoxification and reduction of ROS. Trace elements have nutritional benefits as essential cofactors for physiologic processes, but some can be toxic to humans. Accumulated evidence suggests that deficiency or excess of certain trace elements may be associated with risk of chronic diseases including cardiovascular diseases, diabetes and cancer. The aim of this research was to determine the correlation of the trace elements iron and zinc with the oxidative stress level of GST activity in women with breast cancer. METHODS An observational analytic study with cross sectional design was conducted involving 35 breast cancer women. Research subjects were women with breast cancer diagnosed by biopsy. Measurements of iron and zinc levels were performed using atomic absorption spectrometry, GST activity was measured using spectrophotometry. Data analysis was done with the Pearson correlation test. RESULTS The results showed that there was a significant relationship of serum iron with GST (r=-0.487; p<0.05) and serum zinc with GST (r=-0.409; p<0.01). CONCLUSION Our study demonstrated that the higher zinc and iron level, the lower GST level among breast cancer women. It is recommended to use zinc, iron and GST levels as biomarkers for breast cancer and its progression.

39-49

Authors: Efosa Bolaji Odigie, Peter Uwadiegwu Achukwu

BACKGROUND Cervical lesions are abnormalities seen in tissues and cells examined from the uterine cervix. These abnormalities are on the increase and are ignored; thereby constituting major health problems in resident commercial sex workers (CSWs) who temporarily reside in brothels for sex business. Hence, we investigated the associations between behavioural risk factors and cervical lesions in resident commercial sex workers. METHODS We conducted a cross-sectional study among 119 resident commercial sex workers using questionnaires as the data gathering tool, liquid-based cytology for cervical lesions screening, and microscopy for examination of slides. Statistical analyses were conducted using Epi- Info™ version 6.4 and STATISTICA (StatSoft, version 5, 2009 Edition, Atlanta, GA 30329-4027 USA). Data were analysed using multivariate and simple logistic regression analyses, while the level of significance was set at p £0.05. RESULTS The behavioural risk factors, like smoking and hard drugs, alcohol intake, commercial sex duration, client’s daily patronage and sex frequency were not significant apart, but regular condom use tends to decrease the cervical lesions in CSWs (OR=0.91;95% C.I. 0.92-1.06), including anal and oral sex (OR = 0.99 (95% C.I. 0.29-3.60). The patterns of cervical lesions further showed acute and chronic cervicitis with a prevalence of 10.1%, including low-grade squamous intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASCUS). We recorded 8/12 (66.7%) for acute cervicitis, 4/12 (33.3%) chronic, and 82.4% negative. CONCLUSION We suggest that behavioural risk factors are associated with cervical lesions and that regular condom use tends to decrease cervical lesions among resident CSWs.

57-64

Authors: Budi Santosa, Henna Ria Sunoko, Andri Sukeksi

BACKGROUND Lead acetate may inhibit the enzyme aminolevulinate dehydratase (ALAD) resulting in decreased heme synthesis (and consequently in anemia) but in increased number of reticulocyte cells. IR Bagendit paddy leaf water extract has a high metallothionein protein content which acts to bind to lead. The study objective was to determine whether aqueous IR Bagendit rice leaf extract dosage variations prior to lead exposure decreases reticulocyte count in lead-exposed rats. METHODS The study was of randomized post test only control-group design involving a sample of 28 rats, that were randomized into 4 groups consisting of 1 control group and 3 treatment groups, daily administered with aqueous IR Bagendit rice leaf extract of respectively 0.2; 0.4; 0.8 mg using a feeding tube up to week 13. Lead exposure was also given using a feeding tube to both control and treatment groups at a dose of 0.5 g/kg BW/day, up to week 13. The reticulocyte count was then examined using supravital brilliant cresyl blue staining. The reticulocyte count was determined per 1000 erythrocytes and then converted into a percentage. Kruskal Wallis test followed with Bonferroni test was conducted to figure out the differences between groups. RESULTS Mean reticulocyte count decreased significantly, starting from the control group up to the third treatment group (15.48 ± 3.41; 12.25 ± 03.28; 10.45 ±1.47; 9.10 ± 2.35 average per unit) (p=0.02). The Bonferroni test showed that the reticulocyte count was significantly decreased in the third treatment group (p=0.004). CONCLUSION Aqueous rice leaf extract significantly decreases reticulocytes in rats exposed to lead.

75-84

Authors: Ida Effendi, Yeva Rosana, Andi Yasmon, Wresti Indriatmi

Background Syphilis is a multistage disease transmitted primarily through sexual intercourse. Nowadays, the polymerase chain reaction (PCR) test for Treponema pallidum has been widely used and is expected to overcome problems in diagnostic tests for syphilis. The Treponema pallidum PCR is influenced by type of specimens, PCR methods and target genes. This study aimed to assess the use of blood and serum in multiplex nested PCR for Treponema pallidum, targeting the 23S rRNA. Methods A cross-sectional study was conducted from April 2015 - April 2016. Sampling was carried out consecutively among patients with clinical features of secondary syphilis who came to Sexually Transmitted Disease (STD) clinics in Jakarta. All sera were also tested with Rapid Plasma Reagin (RPR) and Treponema pallidum Hemagglutination Assay (TPHA) assay, which was considered as the gold standard for this study. We determined the sensitivity and specificity of the multiplex nested PCR for Treponema pallidum using blood and serum. Results PCR test was performed on 122 clinical specimens (61 blood and 61 serum). The positive results of PCR test on blood was 22.95% and serum was 6.56%, while the positive results of serology was 68.85%. The sensitivity of Treponema pallidum multiplex nested PCR on blood was 30.95% compared to serum 9.52% (p=0.006). PCR test on blood is able to detect 3.25 times higher than serum. Conclusion The use of blood has a higher proportion of positives compared to serum in Treponema pallidum multiplex nested PCR using 23S rRNA target gene.

88-96

Authors: emuel Sandy, Antonius Oktavian, Hanna S Kawulur, Mirna Widiyanti, Iman HS Sasto, Yustinus Maladan

Background Cysticercosis is an infectious disease caused by the larval form of Taenia solium (cysticercus cellulosae) and has been ranked as the most important food-borne parasite of humans in terms of public health, socioeconomic and trade impact. Cysticercosis is still a health problem in Papua and is inseparable from socio-cultural factors, hygiene and environmental sanitation. The aim of this study was to investigate the seroprevalence of cysticercosis and the risk factors that contribute to cysticercosis. Methods A cross-sectional study was conducted in March-November 2016 involving 800 subjects. Demographic data and risk factors were collected using questionnaires. Cysticercosis serological examination was performed by means of the magnetic microsphere bead immunoassay technique coupled with rT24H recombinant protein to detect serum rT24H cysticercosis specific antibodies. The data obtained were analyzed by bivariate test (chi-square) and logistic regression. Results Cysticercosis seroprevalence in Papua was 3.6% (284/7 874). The logistic regression analysis found that the risk factors playing the role of predictor were cooking pork with hot stones [OR=3.06; 95%CI: 2.19-4.28; p=0.000], nail hygiene [OR=2.05; 95%CI: 1.57-2.67; p=0.000], consumption of raw vegetables or salads [OR=0.52; 95%CI: 0.30-0.91; p=0.022], use of river water for washing foods [OR= 1.92; 95%CI: 1.39-2.64; p=0.000]. Conclusions Cooking pork with hot stones was the main risk factor of cysticercosis. Suspected cases of T. solium in pigs should be confirmed by molecular methods. Both taeniasis and human cysticercosis should be notifiable and surveillance in animals should be improved.

105-114

Authors: Woro Riyadina Djoeworo, Dian Perwitasari Tasono Hadi, Sulistyowati Tuminah Darjoko

Background Injuries due to traffic accidents are the leading cause of death and disability, especially in developing countries. The proportion of injuries in Indonesia tends to increase. The cause of the injury is dominated by motorcycle accidents (70-85%). The aim of this study was to compare the severity of motorcycle injuries with that of other land transportation injuries in Indonesia. Methods A study of a cross-sectional design was performed involving 15,849 subjects from 33 provinces in Indonesia. The dependent variable was the severity of injury and the main independent variable was transportation mode (motorcycle and other vehicles). Other independent variables included were respondent characteristics (sex, age, education, occupation, economic status) and health status (stroke, hypertension, heart disease, impaired hearing and vision). Chi-square test and multiple logistic regression were used to analyze the data. Results The contribution of motorcycle transportation mode to the severity of the injury was 85.5%. The proportion of severity of injury due to motorcycle transportation was higher (9.0%) than to other land transportation modes (7.5%). The severity of injuries related to motorcycle transportation was 1.1 times greater (AOR=1.1 95% CI 1.0-1.3) than that other related to vehicles. The determinants of severity of injury due to motorcycle transportation were age and sex. Conclusion Motorcyclists are at higher risk of having injuries than persons using other modes of transportation. Motorcyclists need to increase the safety of riding and to be more discriminating in the selection of the safest mode of transportation, by taking age and sex into consideration.

127-134

Authors: Gilbert WS Simanjuntak, Jannes F Tan, Reinne Natali Christine

Background Cataract is the leading cause of blindness in Indonesia, and poverty is a major barrier to having cataract surgery. Increasing the proportion of adults that have regular, comprehensive eye examinations for cataract and other common eye health problems is one of the National Health Insurance (JKN) objectives. The objective of this study was to determine the impact of vision insurance on eye care utilization of cataract patients in private hospitals with the JKN system as social intervention. Methods A cross-sectional study was conducted involving 230 cataract patients in a private hospital. Inclusion criteria were patients with cataract surgery, diagnosis and follow up visit minimally two months after surgery. A multiple logistic regression was used to analyse the data. Results Initial visual acuity (VA) was 0.13 ± 0.15 and final VA was 0.91 ± 0.15. Two patients had final VA of 0.2 and 0.15, respectively, in which the first was associated with persistent corneal edema and diabetes mellitus, and the other with corneal scar. Age, gender, and level of education were not associated with VA at the first visit (p>0.05). Further analysis using a multiple logistic regression model was found to be significant (p=0.0104), with gender being associated with preoperative vision, where males tend to come earlier to undergo cataract surgery/treatment. Conclusion Males tend to come earlier than females for cataract surgery with the National Health Insurance (JKN) programme, despite the social intervention of the programme.

143-149

Authors: Astri Handayani, Sophie Yolanda, Ria Kodariah

Background Synaptic plasticity, which primarily takes place in the hippocampus, is the molecular basis of long- term memory formation. Brain derived neurotrophic factor (BDNF), a member of the neurotrophin family, plays a significant role in synaptic plasticity and memory formation. When BDNF is released, it binds to its receptor and activates various intracellular signal transduction pathways leading to synaptic plasticity. Several methods to improve memory function in humans have been studied, one of which is the use of herbal compounds, such as Centella asiatica (CeA), an herbaceous plant that has been used for improving memory. This study aims to examine the effects of CeA ethanol extract on BDNF protein expression in the CA1 hippocampal region in adult male rats. Methods A randomized experimental design was performed involving 18 adult male Wistar rats. The rats were randomized into three groups: one control/distilled water group and two groups treated with doses of CeA ethanol extract of 300 mg/kgBW (CeA300) and 600 mg/kgBW (CeA600), respectively. CeA ethanol extract was administered orally for 28 consecutive days with weekly weight-adjusted dose. After 28 days, the rats were decapitated, and the hippocampus was isolated from the brain. BDNF protein expression was assessed using immunohistochemistry. Data was analyzed using Kruskal-Wallis test and continued with post-hoc analysis. Results There was a significant increase in BDNF protein expression in the CeA600 group compared to the control group (p<0.001). Conclusion Administration of CeA ethanol extract increased BDNF protein expression in the CA1 hippocampal region of adult male rats.

159-164

Authors: Mohammad Esmaeil Hejazi, Sepideh Tahsini Tekantapeh, Saeede Maddahi

Background This paper mainly focuses on patients with ruptured pulmonary Echinococcus granulosus infections (alveolar hydatid disease), who suffered from ruptured alveolar hydatid cyst. In this study we aimed to remove these ruptured central and peripheral pulmonary hydatid cysts by the bronchoscopic saline injection method (ME Hejazi method). Case description In this retrospective study, we evaluated eight patients from an endemic area who were non-surgically treated for ruptured pulmonary hydatid cysts at Imam Reza hospital between 2016-2017. By the bronchoscopic saline injection method (ME Hejazi method), we extracted the entire hydatid cysts of all patients by fiber optic bronchoscopy for the detachment of the underlying membrane from the cavity wall. There were three female and five male patients, with a mean age of 40 ± 23 years (range 17–63 years). Ruptured cysts were located in the peripheral (2) and central (6) parts of the lungs. All of our experiences have been successful without any complications and residual cyst membrane. During the follow-ups, clinical and radiological recovery were seen in these patients. Conclusions In the peripheral ruptured hydatid cysts, accurate recognition and location of the cyst is essential and the blind approach is not recommended because it needs several bronchoscopic interventions. Therefore the Hejazi method will be a beneficial and suitable alternative method for surgery in the treatment of patients with ruptured pulmonary hydatid cyst with cyst membrane adhesions.

167-172

Authors: Manouchehr Mazdapour, Mahmood Dehghani Ashkezari, Seyed Morteza Seifati

BACKGROUND Recurrent spontaneous abortion is defined as the occurrence of three or more clinical miscarriages in one woman. Several factors, including genetics and environmental factors, are involved in this kind of infertility, in which WNT7A (rs104893832) polymorphism plays a major role. The aim of the present study was to determine the association between a common polymorphism of WNT7A (rs104893832) with recurrent spontaneous abortion in females. METHODS In the present case-control study, the WNT7A (rs104893832) polymorphism was investigated in 70 women with recurrent spontaneous abortion as cases and 100 women with at least one child and no history of infertility or abortion as controls. Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) was used to investigate the WNT7A (rs104893832) polymorphism in both case and control groups. The data were subsequently analyzed using the chi-square and logistic regression tests by SPSS software (version 18.0). RESULTS A significant association was found between the WNT7A (rs104893832) polymorphism and recurrent spontaneous abortion (OR=25.00, 95% CI=5.52-157.09; p<0.0001). Our finding showed that G allele frequency in women with recurrent spontaneous abortion was significantly different compared to the control group. (OR=6.42, 95% CI=2.82-15.16; p<0.0001).Therefore, genetic variation in WNT7A (rs104893832) polymorphism may play a role in recurrent spontaneous abortion. Conclusion This study revealed that WNT7A (rs104893832) polymorphism increased the risk of recurrent spontaneous abortion. Knowledge of these mutations and polymorphisms can provide an insight into the prognosis for individual patients. Therefore, further studies are necessary to establish the association of WNT7A (rs104893832) polymorphism with recurrent spontaneous abortion in a larger population.

181-187

Authors: Evarista Odaburhine Osime, Catherine Obar

BACKGROUND Various studies have examined optimal methods for Prevention of Mother to Child Transmission (PMTCT) of human immunodeficiency virus (HIV) and subsequent outcome of response to highly active antiretroviral therapy (HAART) as well as the impact of pregnancy on outcomes of HIV in the Pre-HAART era. Little is known of the impact of pregnancy in response to HAART in Africa. This study is aimed to evaluate euglobulin lysis time (ELT), protein C and protein S in HIV-positive pregnant women on HAART. METHODS This was a cross-sectional study comprised of 150 participants attending Ante-Natal Clinic (ANC) in Central Hospital, Benin City. Pregnant women on HAART (Test subjects) (n=50, mean age 34 years), 50 pregnant newly diagnosed HIV-positive women that had not yet commenced HAART (n=50, mean age 31 years) and 50 pregnant HIV-negative women (n=50, mean age 30 years) which served as controls. The ELT was determined by methods described by Bain, protein C and protein S were determined using Enzyme Linked Immunosorbent Assay (ELISA). RESULTS There was a significant increase in ELT in both pregnant women on HAART and not on HAART) when compared to HIV-negative pregnant women (p<0.05). There was a significant decrease in protein C in test subjects when compared with controls (p<0.05) and protein S increased significantly in HIV-positive pregnant women on HAART when compared to those not on HAART and HIV-negative pregnant women (p<0.05). CONCLUSION There are changes in ELT, protein C and protein S parameters with the introduction of HAART in pregnancy.

195-202

Authors: Meiyanti, Eveline Margo, Pusparini, Lie Tanu Merijanti, Alvina Lesmana

Background The prevalence of diabetes in Indonesia continues to increase and causes many complications. Fruits of Phaleria macrocarpa (Scheff.) Boerl. (PM) are used in the traditional health system of the Indonesians, as effective remedy in the management of diabetes mellitus. The aim of this study was to evaluate the effect and magnitude of doses of PM dry fruit extract (PME) on blood glucose levels in healthy adults. Methods This research was of pre-posttest design involving 30 healthy volunteer subjects aged 20-55 years receiving glucose loads. At pre-test the subjects were given orally 75 g glucose, and at post-test they were given PME at doses of 125 mg and 250 mg. Data collection included anthropometric examination and blood glucose level. The area under the curve (AUC) of blood glucose levels was measured at 0, 15, 30, 60, 120 and 180 minutes. Data analysis was performed using paired t-test with p <0.05. Results The percentage of reduction in AUC between pre- and post-test after administration of PME 125 mg was 12.1% and significant (p=0.000). But the percentage of reduction in AUC between pre- and post-test after administration of PME 250 mg was 4.07% and not significant (p=0.06). The reduction in AUC between post-test PME 125 mg vs PME 250 mg showed significant results (p=0.011). Conclusion This study demonstrated that a dose of 125 mg Phaleria macrocarpa (Scheff.) Boerl. dry extract has a hypoglycemic effect in healthy adults, and may therefore be suitable for use as traditional anti-diabetic drug.

209-215

Authors: Reza Ranjbar, Maryam Zeynali, Nooshin Sohrabi, Asghar Ali Kamboh, Arman Moshaveri

BACKGROUND Hospital wastewaters may contain antibiotic resistant bacteria such as Escherichia coli. These E. coli harbor integron genes that are responsible for antibiotic resistance. The purpose of the current study was to evaluate the frequency of class 1 and 2 integrons in environmental antibiotic resistant E. coli strains isolated from the hospital wastewaters in Tehran, Iran. METHODS As a descriptive cross-sectional study, this research was performed from April to September 2015 on hospital wastewaters in Tehran. Bacterial isolation and identification was performed by standard biochemical and bacteriological procedures. Susceptibility testing was done by employing the disk diffusion method using different antibiotics. Total DNAs were extracted to evaluate the presence of class 1 and 2 integrons by using the polymerase chain reaction (PCR) method with specific primers. RESULTS Fifty E. coli strains were isolated and identified from the wastewaters of 25 hospitals in Tehran. The phenotype results showed that 46 isolates (92%) were resistant to at least one antibiotic and 27 isolates (54%) were multidrug resistant. PCR showed that 35 (70%) and 20 (40%) of the isolates had class 1 and 2 integrons respectively and 14 isolates (28%) had both class 1 and class 2 integrons. CONCLUSION This study has shown a considerable presence of class 1 and class 2 integrons in E. coli strains isolated from hospital wastewaters in Tehran. Proper antibiotics prescription and appropriate hospital wastewater treatment can prevent resistance genes in E. coli from circulating in the environment.

222-226

Authors: Marcellinus Uchechukwu Nwagu

Background Drug-induced thrombocytopenia (DITP), which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for haematologists. Drug-induced thrombocytopenia is often misdiagnosed as immune thrombocytopenic purpura with resulting inappropriate treatment. Immune thrombocytopenic purpura (ITP) is a clinical disorder that leads to easy bruising (purpura), excessive bleeding or extravasation of blood from capillaries into skin and mucous membranes (petechiae). The bleeding tendency is due to decreased number of circulating platelets (thrombocytopenia). There is production of antibodies against the platelets by the patient’s immune system. This case report was conducted to introduce the effectiveness of freshly donated blood and steroids on patients with immune thrombocytopenic purpura (ITP) after ingestion of herbal drugs. Case description DT was a 30-year old female who presented with bleeding per vagina, gum bleeding and weakness. The patient did not have any systemic disease that would cause any spontaneous hemorrhage. The patient was referred to a hematologist urgently and her thrombocyte count was found to be 2000/ìL. Other test results were in normal range. Full blood count revealed severe thrombocytopenia. Freshly donated whole blood was given to the patient and then the changes in her general condition were analyzed, as well as the blood test results. Conclusion In the absence of platelet concentrate especially in rural settings and resource-poor countries, freshly donated whole blood can be used in the management of a case of severe thrombocytopenia from ITP.