The Indonesian Biomedical Journal

19-26

Authors: Miftakh Nur Rahman, Ajeng Diantini, Miswar Fattah, Melisa Intan Barliana

BACKGROUND: There is a continuous rise in the prevalence of central obesity and become a pressing health problem in the world. Central obesity followed by many metabolic disorders especially Type 2 Diabetes Mellitus (T2DM). The pathogenesis started from overnutrition signal that force pancreatic beta cells to produce a large number of insulin. Low-grade chronic inflammation that occurred also affects the organs sensitivity against insulin and caused beta cells to compensated this situation and at the end become exhausted and loss its function. CONTENT: Along compensation mechanism, certain nutrients were support the beta cells to maintain their mass and function to produce insulin. Short chain fatty acids (SCFAs) are gut microbiota fermentation product that act as nutrient and give an advantage to the proliferation and survivability of the beta cells. Zinc (Zn) also plays an important role in every step of insulin production. Moreover, these nutrients protecting pancreas against inflammation and oxidative stress through certain mechanism. Most of patients with central obesity are unaware of the presence of this disturbance at early stage. Whereas, at molecular level there is a magnitude of SCFAs and Zn level in the blood that would become an early signal and predict the damage of beta cells. SUMMARY: Quantification of these two nutrients in the blood expected to provide an early warning tool to maintain insulin adequacy and predict the possibility of beta cell failure in central obesity with promising performance.

34-9

Authors: Aileen Clarissa Dauhan, Aridamuriany Dwiputri Lubis, Munar Lubis

BACKGROUND: Early detection and treatment of sepsis can prevent septic shock and reduce mortality rate. Troponin can become a prognostic factor in sepsis. However, not all health facilities are equipped to assess troponin levels. Vasoactive-inotropic score (VIS) is a simpler and more accessible method to describe hemodynamic status. The aim of this study was to assess the suitability of VIS score as early prognosis and mortality predictor of sepsis METHODS: A retrospective study was conducted to determine the correlation between VIS and troponin levels for sepsis cases in Pediatric Intensive Care Unity (PICU) Haji Adam Malik Hospital, Medan from January 2018 to December 2019. VIS score at 48 hours, maximum VIS score, pediatric logistic organ dysfunction-2 (PELOD-2) score, cardiac troponin levels at 48 hours were taken from medical records. RESULTS: There were 54 samples analyzed. VIS scores were positively correlated (p<0.001) to troponin T and troponin I levels at 48 hours (r=0.670 and r=0.606, respectively). VIS at 48 hours and maximum VIS were related to mortality (p=0.001 and p<0.001, respectively). VIS score at 48 hours could be used as a predictive factor for mortality (area under the curve (AUC): 79.7%, p<0.001) with a cut-off point at 11 (74.4% sensitivity and 80% specificity). High VIS at 48 hours indicated poor outcomes of sepsis in children with odd ratio (OR) value: 1.99 (95% confidence interval (CI): 1.25-3.19). CONCLUSION: Vasoactive-inotropic score was suitable as an alternative to cardiac troponin T and troponin I levels at 48 hours to early detect myocardial dysfunctions and mortality in children.

48-54

Authors: Mardiah Suci Hardianti, Syahru Agung Setiawan, Nungki Anggorowati, Wiwiek Probowati

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with dysregulation of somatic hypermutation (SHM) and class switch recombination (CSR) have been known to contribute for its lymphomagenesis. Activation-induced cytidine deaminase (AID) enzyme plays a vital role for both processes. Multiple myeloma oncogene 1 (MUM1) is known to upregulate the AID expression in normal and pathological conditions. However, both AID and MUM1 expression association in DLBCL is still unexplored using immunohistochemistry method. We examined DLBCL samples and then retrospectively tested its correlation with clinical findings. METHODS: A retrospective cohort study with 20 cases of DLBCL biopsy tissue with AID and MUM1 antibody was conducted. The samples were then classified into concordant (AID+/MUM1+ or AID-/MUM1-) and discordant group (AID-/MUM1+). The clinicopathological comparison was performed to observe any association between immunohistochemistry expression and clinical findings. RESULTS: Among 20 samples of DLBCL, concordant expression rate of AID and MUM1 was 80% with kappa Cohen’s of 0.578 (p=0.004). A significant association was observed between AID and MUM1 expression with a prevalence ratio of 2.25 (95% CI: 1.08-4.67; p=0.008). Clinical characteristics were not significantly different between each group. Restricted mean survival time was shorter in the concordant group compared with the discordant group but statistically insignificant (21.16 vs. 22.5 months; p=0.531). CONCLUSION: The result of this study showed the association between AID and MUM1 expression in DLBCL. However, whether the association may add further molecular heterogeneity of DLBCL is still to be confirmed by expanding the study.

61-7

Authors: Novalia Chumaladewi Guntarno, Anny Setijo Rahaju, Nila Kurniasari

BACKGROUND: Bladder cancer is the tenth-most common cancer in worldwide and the majority are urothelial carcinomas. The depth of invasion plays important role in the prognostic and therapeutic factor in urothelial carcinomas. The expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) may associated with the progression of bladder carcinoma, such as depth of invasion. In this study, the correlation between these two markers in urothelial bladder carcinoma invasion will be analyzed. METHODS: An analytical observational research with cross-sectional were conducted on 54 formalin fixed paraffin-embedded tissue from radical cystectomy (RC) which were diagnosed as bladder urothelial carcinoma at the Anatomical Pathology Laboratory of Dr. Soetomo Academic Hospital, Surabaya and divided based on the T stage were immunostained using VEGF and MMP-9 monoclonal antibodies. The difference of VEGF and MMP-9 expression in T stage of bladder urothelial carcinoma were analyzed using Kruskal-Wallis and Anova test, the correlation between VEGF and MMP-9 expression in various T stage of bladder urothelial carcinoma were analyzed using Spearman test. RESULTS: This study showed no significant difference of VEGF expression among T stage of bladder urothelial carcinoma (p>0.05) but there was significant difference of MMP-9 expression in T stage of bladder urothelial carcinoma (p=0.043). There was a correlation between VEGF and MMP-9 in various T stage of bladder urothelial carcinoma (rs= 0.50, p=0.001). CONCLUSION: The significant correlation of VEGF and MMP-9 expression in bladder urothelial carcinoma may prove the synergistically role of both proteins in tumor invasion by MMP-9 degradation extracellular matrix.

75-83

Authors: Erwin Astha Triyono, Sarah Firdausa, Heru Prasetyo, Joni Susanto, James Hutagalung, Lilis Masyfufah, Budiono Budiono, Ivan Hoesada

BACKGROUND: Human Immunodeficiency Virus (HIV) is an infectious disease that targets the human immune system by attacking cluster of differentiation (CD)4 cells. The use of propolis in HIV patients is expected to be safe and beneficial in terms of increasing endurance and immunity by its role in increasing CD4 level. This study aimed to analyze the influence of propolis supplementation in increasing the CD4 level in anti-retroviral (ARV)-treated HIV patients. METHODS: Double-blind randomized controlled clinical trial was conducted in 50 HIV patients who took regular ARV therapy. The subjects were divided into two groups, one group was treated with ARV and propolis, while another one was given ARV and placebo. The CD4 cell count was measured during pre-treatment, in the 3rd month, in the 6th month after treatment. The level of hemoglobin, leukocyte, and platelets were also measured. The SF-12 questionnaire was used to evaluate quality of life of the subject. RESULTS: Out of 50 subjects, 43 subjects completed the study, which were 19 subjects from the propolis group and 24 subjects from the placebo group. After 3-month of treatment, there was a statistically significant difference in the increase of CD 44 level in propolis group, while the increment was not significant in the placebo group. After 6-month treatment, the increase of CD4 level was occurred in both groups, propolis and placebo, however the increment was not statistically significant. The levels of hemoglobin, leukocyte, and platelets were not altered by the treatment and remained normal throughout the study. The quality of life was improved during the study; however, it was also not statistically significant. Mild adverse events occurred in 3 subjects which were relieved after the treatment stopped. CONCLUSION: Based on the result of this study, the administration of propolis on HIV patients receiving ARV bring significant difference in the increase of CD4 in propolis group from baseline to 3 month after the treatment. While in placebo group, this increment was not significant. At the end of study, CD4 count continued to rise up, however the increase was not statistically significant. There are no hemoglobin, leukocyte, platelets, and quality of life abnormalities. Therefore, it is necesary to do further research with a spesific CD4 count. However, it may be beneficial in relieving the clinical symptoms and quality of life of patient living with HIV.

91-6

Authors: Diana Nur Afifah, Fauzia Purnamasari, Luthfiatul Khusna, Noviasti Rahma Utami, Aida Fitri Nazillah, Syafira Noor Pratiwi, Fillah Fithra Dieny, Aryu Candra, Ayu Rahadiyanti, Rachma Purwanti, Enny Probosari, Martha Ardiaria, Nyoman Suci Widiastiti, Ferry Sandra

BACKGROUND: Administration of resistant starch (RS) influences the diversity and the composition of microbiota as well as inhibits the growth of cancer cell. Banana as a potential source of RS has been reported. Although Musa paradisiaca has been reported to induce apoptosis in colon cancer cells, Musa balbisiana, which has low glycemic index and suitable for particular patients, has not been investigated yet. METHODS: Starches of M. balbisiana and M. paradisiaca were prepared and mixed with other components to make 3 types of mouse pellets. Mouse model for colon cancer was prepared and fed with different types of mouse pellets. Blood was collected and processed for measuring β-glucuronidase and malondialdehyde (MDA) with Enzyme-linked Immunosorbent Assay (ELISA) method. Resected ceca were incised to collect the inner part for short-chain fatty acid (SCFA) measurement with gas chromatography analysis. Resected colas were fixed and processed for immunohistochemistry to detect Caspase-3. RESULTS: Colon-cancer-mice fed with the M. balbisiana and M. paradisiaca starches-contained pellets had significant higher concentrations of total SCFA (p=0.003), acetic acid (p=0.000), propionic acid (p=0.000) and butyric acid (p=0.000); lower concentration of β-glucuronidase (p<0.001); higher Caspase-3 score (p=0.040); and lower MDA concentration (p<0.001) than colon-cancer-mice fed with standard pellet (control). CONCLUSION: M. balbisiana and M. paradisiaca starches could be suggested as potential anti-colon cancer RS. Further research should be carried out to disclose the starches mechanisms in colon cancer cell.