Universa Medicina

3-12

Authors: Oentarini Tjandra, Linda J Wijayadi, Marcella E Rumawas

BACKGROUND Dry skin is a major skin health problem in elderly. Green tea, which has an antioxidant effect, has recently been used as an active ingredient in moisturizing creams; yet the effect has not been well studied. This study compares the skin hydration effect of green tea and vitamin E moisturizer among elderly. METHODS This quasi-experimental study involved 60 elderly living in Tresna Werda Budi Mulia 4 Social Institution, Jakarta. Using the Runve HL 611 skin analyzer, skin capacitance was measured prior to experiment and every following week during the 5-week application of green tea and vitamin E skin moisturizer on both forearms. The consecutive measurement data was analyzed using Generalized Estimating Equation to compare the relative changes in skin hydration between the two moisturizer groups over 5 weeks of intervention. RESULTS The green tea moisturizer showed more significant increases in skin hydration level than the vitamin E moisturizer at all measurement sites on right arm and proximal left arm (p= 0.021), and medial and distal left arm (p= 0.034). Skin hydration levels significantly changed over time at proximal (p=0.021), medial (p=0.006) and distal (p=0.006) right arm, and medial left arm (p=0.021). A parallel trend of skin hydration improvements for both moisturizer groups indicated no correlation between the moisturizer type and the duration of usage (p >0.05) in all measurement locations. No side effects were observed during application period in both groups. CONCLUSION Routine use of moisturizer containing green tea may improve skin hydration in elderly.

19-24

Authors: Nur Atik, Al Hadi Amrullah, Andri Reza Rahmadi

Background Dengue virus infection that most frequently occur in tropical and subtropical regions can cause many symptoms, one of which is a decrease in thrombocyte count. Recent studies showed that guava leaf extract can increase the thrombocyte count in rats. The present study aimed to determine the effect of guava leaf juice in increasing the number of megakaryocytes in the bone marrow of thrombocytopenic mice. Methods This study was of experimental design. The study subjects were 24 mice (Mus musculus). The mice were randomly divided into four groups that were subjected to intervention for 14 days. Group 1 was given guava leaf juice (56 mg/kg) and quinine (14 mg/kg), group 2 guava leaf juice (56 mg/kg) only, group 3 was given quinine (14 mg/kg) and group 4 distilled water. After 14 days, from the bone marrow of the femoral bones of each of the mice, hematoxylin eosin stained histologic preparations were made. Anova test was used to analyze the data. Results The mean megakaryocyte count per field of view in group 1 (2.83), group 2 (3.30), group 3 (2.24) and group 4 (2.93). Anova test results for all groups showed significant differences between groups (p<0.05). The mean megakaryocyte count was increased in group 1 compared to group 3, but the difference was statistically not significant (p=0.206). Conclusion Guava leaf juice can increase the megakaryocyte count in the bone marrow of thrombocytopenic mice. This suggests a potential role of guava leaf juice in improving the platelet count in thrombocytopenic disorders.

31-38

Authors: Titis Nurmasitoh, Shindy Yudha Utami, Endah Kusumawardani, Abdulhalim Ahmad Najmuddin, Ika Fidianingsih

Background Chronic and degenerative diseases are closely related to modern lifestyles that tend to be deficient in physical activity but excessive in food intake. One method used to overcome this problem is dietary restriction through intermittent fasting. Intermittent fasting decreases the risk of chronic and degenerative diseases, e.g. by lowering oxidative stress. Oxidative stress can be determined from the malondialdehyde (MDA) levels and lipid profile in the blood. The present study aimed to determine the effect of intermittent fasting on plasma MDA levels and lipid profile of Wistar rats (Rattus norvegicus). Methods This research was a laboratory experimental research using a post test control group design. Twenty four male Wistar rats (Rattus norvegicus) were randomly assigned to 4 groups, ie control group (C), fasting group (F), non-fasting obese group (NFO), and fasting obese group (FO). Fasting treatment given in this research was intermittent fasting, comprising one day of fasting for 12 hours alternating with one day of normal feed ad libitum in the span of 8 weeks. After completion of treatment, blood was taken transcardially for examination of MDA levels and lipid profiles using spectrophotometry. Results There were significant between-group differences in MDA levels and lipid profiles (p<0.05 for all parameters). Groups treated with intermittent fasting had lower levels of MDA, total cholesterol, triglycerides, and ow-density lipoprotein (LDL) than those without intermittent fasting. The high-density lipoprotein (HDL) levels were higher in the intermittent fasting group than the other groups. Conclusion Intermittent fasting has an effect on the oxidative stress parameters of Wistar rats (Rattus norvegicus).

50-56

Authors: Yuke Damayanti, Panji Fortuna Hadisoemarto, Irma Ruslina Defi

Background Flatfoot is a musculoskeletal abnormality commonly found in children that could result in a reduction of quality of life because of its related symptoms and functional abnormalities. This study aimed to determine the association between flatfoot and the quality of life among children 5-18 years of age. Methods A cross sectional design was used in this study of children aged 5-18 years. The diagnosis of flatfoot was made in accordance with the Chippaux-Smirak Index classification, whereas general and domain-specific quality of life were measured using the Indonesian version of PedsQL™ that has been previously validated. Mann Whitney test was used to compare quality of life between children with flatfoot and normal feet, along with other variables that potentially may influence a child’s quality of life. Results A total of 79 out of 120 subjects was used to analyze the data. There was a statistically significant difference in the quality of life score in the school functioning domain between children with flatfoot (64.46 ±18.22) and those with normal feet (75.90 ±17.29) in children <11 years of age (p=0.029). Apart from this, the study did not find any statistically significant differences in the total quality of life score or in other quality of life domains between the two groups. Conclusions Flatfoot significantly decreases children’s quality of life in the school functioning domain. Early detection and correction of flatfoot may be necessary to improve the educational attainment of children suffering from this condition.

65-74

Authors: Osaretin Godwin Igharo, John I Anetor, Oladele Osibanjo, Humphrey Benedo Osadolor, Emmanuel C Odazie, Zedech Chukwuemelie Uche

BACKGROUND Electronic waste (e-waste) is known to contain thousands of toxic chemicals and metals, many of which have identified endocrine disruption potentials even at low blood concentrations resulting from occupational and environmental exposures. E-waste crude reprocessing in Nigeria is massive and a growing number of Nigerians are occupationally exposed. The present study aimed to determine changes in gonadal hormone levels associated with occupational crude e-waste reprocessing in Nigerian male e-waste workers. METHODS This cross-sectional study which was carried out in Benin City, South-South Nigeria recruited male e-waste workers (n=63); and apparently healthy non e-waste workers (n=41), as exposed and unexposed participants respectively. Male fertility hormones which includes luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (TESTO) and prolactin (PROL); as well as progesterone (PROG), estrogen (EST) and inhibin (INH) were determined using enzyme linked immunosorbent assay (ELISA) methods; whole blood levels of chromium, cadmium, arsenic and mercury were determined using Inductively Coupled Plasma Mass Spectrometry. RESULTS Levels of TESTO, PROG, LH and FSH; as well as PROL and EST were significantly lower in e-waste workers compared with unexposed participants (p<0.05). In contrast, serum INH was significantly higher in e-waste exposed population compared with the unexposed. In addition, chromium correlated significantly and negatively with testosterone, progesterone and estrogen, while inhibin correlated positively with chromium. Similar correlation patterns were observed for cadmium, arsenic and mercury. CONCLUSION Nigerian e-waste workers experienced reduced levels of key gonadal hormones and this may be associated with occupational exposure to endocrine disrupting metals in e-waste.

85-87

Authors: Fransisca Chondro

The Sustainable Development Goals have prioritized ending the epidemic of tuberculosis by 2030.(1) Around one-third of the world population is infected with Mycobacterium tuberculosis (MTBC), but is asymptomatic, a conditon known as latent TB.According to the global tuberculosis report, in 2017 there were 5-15% of 1.7 billion persons infected with MTBC, who will develop TB in their lives. Around 10% of latent TB will develop into active TB disease, with a higher risk in patients with immunodeficiencies such as HIV, undernutrition, diabetes mellitus, smoking, and habitual alcohol consumption. As a result there are annually an estimated 8.8 million new TB cases, with a TB mortality of 1.1 million and deaths from TB and HIV coinfection of 350 thousand cases.The World Health Organization has planned a number of strategies for TB elimination in the year 2030, such as developing rapid and accurate diagnostic tests, new regimens for the treatment of drug-susceptible or drug-resistant TB, prevention of transmission of M. tuberculosis through infection control, new vaccine candidates to prevent the development of TB, and to help improve the outcomes of treatment for TB disease.

97-104

Authors: Ani Melani Maskoen, Lelani Reniarti, Nur Imaniati Sumantri, Edhyana Sahiratmadja

Background Ineffective erythropoiesis and multiple blood transfusions may cause iron overload, leading to high level of ferritin in β-thalassemia patients. Iron has the ability to catalyze the production of reactive oxygen species (ROS), which can be prevented by an adequate activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx). The aim of this study was to explore the association between high ferritin levels and oxidative stress among β-thalassemia patients by measuring SOD and GPx levels. Methods This was a cross sectional study among β-thalassemia major patients. Ferritin, SOD, and GPx were measured and compared between β-thalassemia patients with homozygous IVS1nt5 and heterozygous IVS1nt5/HbE mutations, which were the most prevalent mutations found in our previous study. The Spearman correlation test was used to analyze the data. Results The ferritin levels in all β-thalassemia major patients were very high (range: 791-12,340 µg/L). However, no significant differences were observed (p=0.318) between homozygous IVS1nt5 (n=45) compared to heterozygous IVS1nt5/HbE (n=13). The oxidative stress markers SOD and GPx were not significantly different between homozygous IVS1nt5 and heterozygous IVS1nt5/HbE (p=0.450 and p=0.323, respectively). The correlations between ferritin and SOD and GPx oxidative stress levels were not significant in both homozygous IVS1nt5 and heterozygous IVS1nt5/HbE mutations. Conclusion High ferritin levels in β-thalassemia patients tend to decrease the GPx level in all thalassemia patients and SOD level in half of the patients, indicating that GPx and SOD may play a role in the occurrence of oxidative stress among thalassemia patients. The mechanism of oxidative stress in thalassemia needs to be further explored.

115-126

Authors: Dwi Nur Ahsani, Ika Fidianingsih

Introduction Aging is characterized by gradual impairment in all physiological functions. Increases in free radicals and changes in organ morphology occur with aging. The purpose of this study was to determine age-related changes in serum free radicals, body weight, organ weights, and relative organ weights in male mice. Methods An experimental animal study was performed on 25 male mice (Mus musculus), which were randomized into 5 groups according to age at termination, i.e. 12 (group K1), 24 (K2), 32 (K3), 40 (K4) and 48 weeks (K5), respectively. Retro-orbital venous blood was taken for examination of malondialdehyde (MDA) levels. After termination, liver, heart, kidneys, testes, brain, thymus and spleen were weighed using an analytical balance. ANOVA and Kruskal Wallis tests were used to analyze the data, with p<0.05 being considered significant. Results Significant changes were found with age in serum MDA level (p=0.000), body weight (p=0.000), and weights of all organs except thymus (p>0.05) (liver p=0.023, heart p=0.000, kidneys p=0.002, testes p=0.000, brain p=0.012 and spleen p=0.006). Significant changes in relative weight of brain (p=0.001) and spleen (p=0.049) were also found with age. Conclusion This study demonstrated increases in serum MDA levels, body weight, and weights of the liver, heart, kidneys, testes, brain and spleen with age. Peak increases in weights of kidneys and thymus were found earlier than those in MDA levels and weights of other organs.

135-142

Authors: Aditya Nugraha, Agung Putra

Background Wounds are areas of physical or thermal damage of the epithelial layer of skin or mucosa. The wound healing process consists of hemostasis, inflammation, proliferation, and remodeling. Mesenchymal stem cells (MSCs) play a role in wound healing by suppressing potent pro-inflammatory molecules, such as tumor necrosis factor-α (TNF-α), leading to macrophage polarization from the pro-inflammatory type to the pro-regeneration type characterized by increasing vascular endothelial growth factor (VEGF) production. MSCs are able to increase VEGF level in-vivo correlated with collagen synthesis. The objective of this study was to assess the role of TNF-α-activated MSCs on VEGF in rat wounds. Methods An experimental animal study with post-test only control group design was performed involving 24 Wistar rats. The rats were randomized into four groups consisting of one control (K) and three treatment groups (P) (activated MSCs at doses of 3x105, 6x105, and 12x105 cells, respectively). The measurement of VEGF levels was done using ELISA assay while the collagen analysis was performed by light microscopy. One way ANOVA and Post Hoc LSD were used to analyze the data. Results The results showed a significant increase in VEGF levels (p <0.05) on day 3 and then a significant decrease on day 5 along with a significant increase in the amount of collagen on day 7 (p<0.05). Conclusion This study demonstrated that TNF-α-activated MSCs were able to regulate VEGF levels and collagen synthesis in wound healing in rats. The molecular mechanism by which TNF-α-activated MSCs stimulate cutaneous wound healing should be clarified further.

150-158

Authors: Parichehr Pooransari, Fatemeh Salehi, Maryam Afrakhteh, Masoumeh Mirzamoradi, Soraya Saleh Gargari, Omid Ghatreh Samani

Background Preterm birth (PTB) remains a global problem associated with perinatal morbidity, including low birth weight, growth retardation and irreversible damage to the nervous system. The objective of this study was to determine the predictive value of cervical consistency index (CCI) to indicate the occurrence of PTB in mid trimester screening of low risk pregnant women. Methods This was a prospective study conducted on low-risk pregnant women at 14-28 weeks of pregnancy. The cervical length (CL) and AP cervical diameter were measured and the CCI determined according to the formula AP2/AP1*100. The ROC curves were drawn according to gestational age and the sensitivity and the specificity were calculated for optimal cut-off for 1st, 5th, 10th, 21th, and 24th centiles of CCI. The inter-observer agreement was validated by interclass correlation coefficients (ICC). Results A total of 149 participants were enrolled in this study. Among them, 12.08% had PTB (<37weeks) and 87.92% had normal birth. Mean CCI for all subjects was 68.60%, but was lower in PTB (48.9%). The best cutoff for predicting PTB based on CCI was 59.46% with 99.18% sensitivity and 85% specificity. The AUC for CCI for prediction of PTB <37weeks was 0.936. There was no inter-observer difference in measurement of CCI and CL (ICC values for CCI and CL were 0.997 and 0.990 respectively). Conclusion In women with normal CL the CCI could predict PTB in the second trimester in low risk women. So, CCI is a valid predictor of PTB in low risk women.

165-166

Authors: Nugroho Abikusno

We have nearly reached the end of the second decade of the Millennium. Within 5 years we hope the Third Ageing Summit will be held to discuss lessons learned and future directions in the field of Ageing and Longevity. 1) I mention the word Longevity since many countries especially in the Asia Pacific region, the second Hub of Ageing after the Western world countries, have experienced this phenomenon since the early years of this Millennium.

173-180

Authors: Okeke Okechukwu Chizoba, Ajulu A Chibuogwu

Background Sexually transmitted infections and syphilis are a major public health concern. Hemodialysis patients are at an increased risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. The aim of this study was to determine the seroprevalence of HBV, HCV, syphilis, and the association between these infections and hemodialysis among hemodialysis patients. Methods A cross-sectional study was conducted involving 90 hemodialysis patients. Blood samples were collected and analysed for HBV, HCV and syphilis using immunochromatographic test kits. All subjects completed a questionnaire on demographic characteristics and other risk factors. A chi-square test was used to analyse the data. Results The prevalence of HBV, HCV and syphilis infections was 4.4%, 6.7% and 2.2% respectively. Highest prevalence of HBV, HCV and syphilis were found in patients whose duration of dialysis were >1 year, >1 year, and 4 months to 1 year, respectively. Similarly, those who had undergone dialysis for > 10 times had the highest prevalence of these infections. The major risk factor the patients was exposed to was blood transfusion (100%), with those who had been transfused for 5 times having the highest prevalence of HBV and HCV and those transfused twice for syphilis. A significant association was seen between duration of dialysis and HCV infection (p<0.05). Conclusion This study has demonstrated that duration of dialysis increased HCV infection in hemodialysis patients. The prevalence of HBV, HCV and syphilis in the hemodialysis unit is a warning that universal precautions will be the next challenge for decentralised hemodialysis services.

188-194

Authors: Sem Samuel Surja, Melyawati Hermawan, Meiliyana Wijaya, Pramanta Pramanta, Hanna Yolanda

Background The prevalence of type 2 diabetes mellitus (DM) is increasing. Diabetic patients have a higher risk of getting dermatomycosis. Dermatomycoses, although a common health problem amongst DM, is often misdiagnosed and consequently undertreated. Studies on the association between dermatomycosis and type 2 diabetes are lacking, especially in Indonesia. Therefore, the aim of this study was to determine the prevalence, etiology, and association of dermatomycosis with diabetic control of type 2 DM. Methods A cross-sectional study was performed involving 87 subjects with type 2 DM. Demographic and clinical data, including age, sex, and blood glucose level, were collected. If a dermatomycosis lesion was found, a specimen would be taken for identification. Determination of serum glucose level was conducted using Roche c111 analyzer®. Statistical analysis was performed with the chi-square test and Kolmogorov-Smirnov two-independent sample test. Results Seventeen (19.55%) subjects had dermatomycosis. The predominant age group affected was 51 - 60 years (42.4%). The number of clinically apparent dermatomycosis was greater in the uncontrolled than in the controlled blood sugar group, but the difference was statistically not significant (p > 0.05). The lesions were mostly found on the nails (74%) and the most common etiology was candida (50%) followed by dermatophyte (25%) and non-dermatophyte molds (25%). Conclusion Uncontrolled blood sugar tends to increase the risk of dermatomycosis in type 2 DM patients. Fungal skin infections are common in type-2 DM patients, especially in those with poor glycemic control.

203-208

Authors: Irmiya Rachmiyani, Lily Marliany Surjadi, Rully Ayu Nirmalasari, Yudhisman Imran

BACKGROUND Menopause is a condition in which the menstrual periods have stopped for the last 12 months due to cessation of ovarial functions causing estrogen hormones to decrease. Various studies find that many factors affect cognitive function at post-menopausal age among others the decrease in estrogens, age at menopause, duration of menopause, and education. However, the effects have been subject to controversy. The aim of this study was to determine the relationship of age, age at menopause, estradiol level, and education with cognitive function among healthy post-menopausal women. METHODS A cross-sectional study was conducted involving 31 post-menopausal women between 50 to 75 years old. Data on age, age at menopause, and education were collected using a questionnaire. The estradiol levels were measured using an electrochemiluminescent immunoassay (ECLIA). The Indonesian version of the Montreal Cognitive Assessment (MoCA INA) was used to assess the cognitive function. Multiple linear regression was used to analyze the data. A p<0.05 was considered statistically significant. RESULTS Age (b=-0.086; 95% C.I.=-0.263-0.090; p=324) and estradiol levels (b=0.106; 95% C.I.=-0.018 -0.230; p=0.092) were not significantly associated with cognitive function. However, education (b=1.537; 95% C.I.=0.176-2.898; p=0.028) and age at menopause (b=0.364;0.056-0.671; p=0.022) were significantly associated with cognitive function. Age at menopause was the most influential factor of cognitive function (Beta=0.402) compared to education (Beta=0.394). CONCLUSION Later age at menopause could increase cognitive function in post-menopausal women. Our findings are that modifiable factors that delay age at menopause should receive attention, in order to promote cognitive function.

216-221

Authors: Mohsen Eshraghi, Seyed Mojtaba Mousavi

Background Thyroid carcinoma is the most common endocrine malignancy. Chronic inflammation can be involved in tumorigenesis. It is estimated that more than 20% of all tumors are caused by persistent inflammatory conditions. The objective of the present study was to compare the inflammatory factor level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and thyroiditis between benign and malignant thyroid nodules. Methods A cross-sectional study was conducted involving 94 patients (47 patients with benign tumors as controls and 47 patients with malignant tumors as cases). ESR and CRP were measured and analyzed. Mean ESR and CRP in both groups was compared using independent t-test. The chi-square test was used to assess the risk of cancer in patients with Hashimoto’s thyroidits and with significance level at p<0.05. Results The mean age of the patients in the benign group was 42.28 ± 13.43 years and in the malignant group 42.20 ± 16.32 (20-85) years, which was not significantly different (p=0.350). Independent t-test results were not significantly different between mean ESR and CRP in both groups (p=0.800 and p=0.993 respectively). Hashimoto’s thyroiditis was not a risk factor for thyroid cancer (OR=1.58; 95% CI:0.63-4.01). Conclusion This study demonstrated that Hashimoto’s thyroiditis was not a risk factor for thyroid cancer. Factors such as ESR and CRP are acute phase reactants and their levels increase in cases of acute inflammation, but may not increase significantly in chronic inflammatory conditions and malignancies.

4-10

Authors: Galuh Chandra Irawan, Ani Margawati, Ali Rosidi

Background Tuberculosis (TB) is a leading cause of morbidity and mortality, especially in middle- and low-income countries. The risk of developing TB may be related to nutritional status. Socioeconomic and behavioral factors are also shown to increase the susceptibility to TB infection. The objective of this study was to determine nutritional factors as risk factors of pulmonary TB in adult. Methods This was an observational study of case control design. The study subjects were community members consisting of 19 adult cases of pulmonary tuberculosis and 38 controls. Data on nutritional intakes were obtained by semiquantitative food frequency questionnaire (FFQ), while smoking behavior, history of DM, body mass index, education, and income were obtained by structured interviews. The data were analyzed by independent t-test and logistic regression for calculation of the odds ratio (OR). Results The bivariate test showed that the adequacy levels for energy (OR=6.8; 95% CI: 1.51-30.54), protein (OR=5.1; 95% CI: 1.52-17.14), vitamin A (OR=4.2; 5% CI: 1.31-13.54), vitamin C (OR=3.8;95% CI: 1.21-12.36), selenium (OR=4.2; 95% CI: 1.34-13.58), body mass index (OR=4.4; 95% CI: 1.32-14.35) and smoking behavior (OR=3.7; 95% CI: 1.15-11.9), were significant risk factors for pulmonary tuberculosis. Multiple logistic regression test showed that low body mass index (<18.5 kg/m2) (OR=6.0; 95% CI: 1.32-27.18) was a the most influential risk factor of pulmonary tuberculosis. Conclusion Low body mass index is the most influential risk factor for pulmonary tuberculosis incidence in adult. Nutrition profile in adult is an important determinant of TB incidence.

19-24

Authors: Suhendro Suwarto, Surya Ulhaq, Bing Widjaja

Introduction Skin hydration decreases with aging. Aquaporin-3 (AQP3) is a major protein that plays a role in skin hydration, therefore it is a novel target for skin moisturizing treatment. Retinoic acid (RA) as a well-known active agent in antiaging treatment increases AQP3 expression, but frequently causes harmful side effects. Asiaticoside, a saponin compound isolated from Centella asiatica (CA) is also known as an antiaging cosmetic and plays a role in wound healing. The aim of this study was to evaluate and compare the effect of asiaticoside isolated from CA and the effect of RA on the AQP3 expression in normal human epidermal keratinocytes (NHEKs). Methods An experimental laboratory study was performed using primary NHEKs that were derived from the foreskin of a boy. AQP3 expression in NHEKs was examined in vitro after the cells were incubated for 24 hours with asiaticoside or with RA at several concentrations. The AQP3 expression was evaluated by immunocytochemistry and quantitatively analyzed by Image-J software. Independent t-test and one-way ANOVA were used to analyze the data, followed by post-hoc Tukey test. Results There was an increasing trend of AQP3 expression upon exposure to asiaticoside at all concentrations compared to the control group. However, RA exposure seemed to induce a higher level of AQP3 expression. Asiaticoside effected a lower increase in AQP3 expression in NHEKs than did RA (p=0.042). Optimal results were achieved at 1 mg/ml concentration of asiaticoside. Conclusions Asiaticoside isolated from CA can enhance the AQP3 expression in NHEKs. Therefore it can be used as an active ingredient in cosmetic moisturizer formulation for dry skin treatment.

34-41

Authors: Wulan Christijanti, Aditya Marianti, Wiwi Isnaeni

Background Diabetes mellitus is a chronic disease caused by lack of insulin production in the pancreas or by insulin resistance, the disease being characterized by elevated blood glucose levels. Hyperglycemia in diabetes could lead to oxidative stress due to the rise in 8-oxo-2'-deoxyguanosine (8-oxo-dG) levels and the decrease in levels of total antioxidant status (TAS). The purpose of this study was to assess the effect Aloe vera extract on 8-oxo-dG level and total antioxidant status in diabetic rat testis. Methods This was an experimental laboratory study with 20 rat samples which were divided into 4 groups (1 control group and 3 treatment groups). Diabetes was induced in the rats by streptozotocin (STZ) at 65 mg/kgBW. The diabetic rats were then treated for 28 days with Aloe vera extract at 0 mg (P0), 200 mg rind (P1), 200 mg pulp (P2), respectively. The level of 8 -oxo-dG was measured by ELISA and total antioxidant status with 2,2' -azino-bis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS). Data were analyzed with ANOVA and Least Significant Difference Advanced Test at P<0.05. Results 8-Oxo-dG levels were significantly different between the control group and both P0 and P2, but not between the control group and P1. Among the treatment groups the 8-oxo-dG levels were significantly different. Mean total antioxidant status was significantly different between control and treatment groups, and also between treatment groups (p<0.05). Conclusions Aloe vera extract reduced free radicals (level of 8-oxo-dG) and increased the total antioxidant status in diabetic rat testis.

49-58

Authors: Lilik Maslachah, Rahmi Sugihartuti

Background Leukocytes play an important role in the elimination of malaria infection. The leukocyte profile upon elimination of the malaria parasites that have been exposed to antimalarials and are subsequently capable of faster growth has not been researched. The aim of this research was to evaluate the role of mouse leukocytes in the elimination of parasites as shown by the leukocyte profile. Methods An experimental research with post test only control group design was conducted involving 24 male mice of the Swiss Albino strain weighing 20 g -30 g, and 2.5 months old. They were randomized into four groups: two control groups (K1, KP) and two treatment groups (P1, P4). Artemisinin at a dose of 0.04 mg/g body weight was given to the mice for 3 days, starting 2 days after infection. The leukocyte profile was observed on the 2nd, 5th, 8th, and 10th day after infection. The results were analyzed by two-way Anova. Results As shown in treatment control group KP and treatment group P4, P. berghei that had been passaged in the mice and were still viable after repeated exposure to artemisinin, may cause changes in leukocyte profile. On the 10th day of infection, the neutrophil percentage in group P1 showed a significantly different decrease when compared with the other groups (K1, KP and P4) (p<0.05). Conclusion Repeated exposure to artemisinin of mice infected with P. berghei can cause changes in neutrophil profile in mice.

68-76

Authors: Rizaldy Taslim Pinzon, Fransiska Theresia Meivy Babang, Esdras Ardi Pramudita

Background The mortality rate after ischemic stoke is influenced by various factors. Prognosis after ischemic stroke can be predicted using a scoring system to help the doctor to evaluate patient’s condition, neurologic deficits, and possible prognosis as well as make appropriate management decisions. The objective of this study was to identify the factors which determine mortality rates in patients after ischemic stroke and to determine the prognosis of ischemic stroke patients using the predictive mortality score. Methods This was a nested case control study using data from the stroke registry and medical records of patients at the Neurology Clinic of Bethesda Hospital Yogyakarta between 2011-2015. Data was analysed using simple and multiple logistic regression analysis. The scoring was analyzed using receiver-operating characteristic (ROC) curve and the cut-off point using area under the curve (AUC). Results Multiple logistic regression analysis showed a significant association between mortality of ischemic stroke patients and age (OR: 4.539, 95% CI: 1.974-10.439, p<0.001), random blood glucose (OR: 2.692, 95% CI: 1.580-4.588, p<0.001), non-dyslipidemia (OR: 2.313, 95% CI: 1.395-3.833, p=0.001), complications (OR: 1.609, 95% CI: 1.019-2.540, p=0.041), risk of metabolic encephalopathy (OR: 2.499, 95% CI: 1.244-5.021, p=0.010) and use of ventilators (OR: 17.278, 95% CI: 2.015-148.195, p=0.009). Conclusions Age, high random blood glucose level, complications, metabolic encephalopathy risk and the use of ventilators are associated with mortality after ischemic stroke. The predictive mortality score can be used to assess the prognosis of patients with ischemic stroke.

80-87

Authors: Donna Adriani Kusumadewi Muhammad, Minarma Siagian, Dewi Irawati SS

Background Hypertension and myocardial infarction account for the high rate of mortality globally. Hibiscus sabdariffa (HS) Linn. is rich in antioxidants and previous studies have demonstrated its anti-hypertensive effects. Several studies show that regular physical activity is an important component to reduce cardiovascular mortality. The objective of this study was to evaluate the effects of a combination of aerobic exercise and HS extract on nitric oxide (NO) and endothelin-1 (ET-1) in rats. Methods An experimental study was conducted on 36 male Wistar rats, aged 4 weeks and 60-70 g in weight. The interventions were aerobic exercises and HS at 400 mg/kg BW/day administered for 4, 8 and 12 weeks. The rats were randomized into 12 groups: 3 control groups (C4, C8, C12), 3 aerobic exercise groups (A4, A8, A12), 3 HS groups (H4, H8, H12), and 3 combination groups [aerobic exercise and HS] (HA4, HA8, HA12). After 4, 8, and 12 weeks, the rats were sacrificed and their abdominal aorta was collected for determination of nitric oxide and ET-1 concentrations. One way ANOVA was used to analyze the data. Results There was a significant difference in NO levels between all groups, with the 4-week aerobic exercise group (A4) showing the highest NO levels compared to the other eleven groups (p<0.05). In contrast, the ET-1 levels were not significantly different between all groups. Conclusions This study demonstrated that the combination of HS supplementation and aerobic exercise increases NO in rats, and provided further evidence to the traditional use of the plant as an antioxidants agent.

94-101

Authors: Siti Aminah, Suparmo Suparmo, Sri Naruki, Hastari Wuryastuty

Background The decline in estrogens could lead to an imbalance of bone formation and absorption as well as bone mineralization. Phytoestrogens are known to have the potential to maintain bone health. Calcium and phosphorus are essential components for bone mineralization. This study aimed to investigate the effect of soybean sprout flour consumption on serum calcium and phosphorus levels in ovariectomized rats. Methods A randomized post-test-only control group design involving 25 female Sprague-Dawley rats aged 2 months, which were divided into five groups: (i) normal controls on standard feed diet AIN-93 (C-N), (ii) ovariectomy controls on standard feed diet (OVX -N); (iii) ovariectomized rats on standard feed diet + ethinylestradiol (OVX -E), (iv) ovariectomized rats on standard feed diet + soybean flour (OVX -S); (v) ovariectomized rats on standard feed diet + soybean sprout flour (OVX -SS). The rats were treated for 6 weeks, then on the last day of treatment blood sampling was conducted. Analysis of calcium and phosphorus in serum was performed using the Arsenazo III photometric method. Data were analyzed using one-way Anova. Results Mean serum calcium level was highest in the OVX-SS group (12.59 mg/dL ± 1.32), while mean serum phosphorus level was highest in the C-N group (1.708 mg/dL ± 0.28). Soybean sprout flour consumption had a significant effect on serum calcium levels (p=0.019), yet it had no effect on body weight and serum phosphorus levels of the rats. Conclusion Consumption of soybean sprout flour could positively affect serum calcium levels in rats.

110-122

Authors: Retty Ratnawati, Annisa Nurul Arofah, Anastasia Novitasari, Sartika Dewi Utami, Made Ayu Hariningsih, Masruroh Rahayu, Sri Budhi Rianawati, Hari Purnomo, Mochammad Dalhar

BACKGROUND Catechins inhibits apoptosis through anti oxidant and anti inflamation pathway. Catechins also increases brain-derived neurotrophic factor (BDNF). There was a few research that explained the role of catechins in traumatic brain injury (TBI). The objective of the study was to evaluate the effect of catechins administration on neurologic severity score (NSS) through apoptosis and neurotropic pathway in traumatic brain injury rat model. METHODS A post test only controlled group design was performed using traumatic brain injury rat (Rattus novergicus) model through weight drop models. It was devided into negative control group, positive control group, TBI+catechins 513 mg/kgBW, TBI+catechins 926 mg/kgBW, TBI+catechins 1113 mg/kgBW. NSS was measured in the first hours, day three, and day seven. The expressions of NFkB, TNFa, Bcl-2, Bax, caspase 3, caspase 8, BDNF, and the numbers of apoptosis cells were evaluated by imunohistochemystry method. One way Anova and Kruskal Wwallis were used to analyse the data. Results TNFa, caspase 8, number of apoptosis cells were significantly decreased on the seventh day administration compared to the third day administration (p<0.05). Catechins increased the expression of Bcl-2/Bax and BDNF significantly (p<0.05). Yet, there were no significant differences between expression of caspase 3, NSS, Bcl-2/Bax ratio, and BDNF toward third days administration of catechins compared with seven days administration (p>0.050). Conclusions Administration of catechins decreased NSS through inhibiting inflammation and apoptosis, as well as induced the neurotrophic factors in rat brain injury. Catechins may serve as a potential intervention for TBI.

131-137

Authors: Soetrisno Soetrisno, Sri Sulistyowati, Anwar Sandi Wibowo

Background Preeclampsia is a major cause of maternal and fetal morbidity and mortality. The imbalance of anti-angiogenic and angiogenic factors plays a role in endothelial dysfunction in preeclampsia. L-arginine is expected to improve the process of spiral artery remodeling. This study aims to examine the use of L-arginine to repair endothelial damage by measuring the thickness of uterine spiral arteries in mouse (Mus musculus) models of preeclampsia. Methods The researchers carried out an experimental study using 30 sixteen-day old pregnant Swiss mice (in good health, weighing 20-25 grams), which were randomly divided into 3 groups (each consisting of 10 mice). The groups were as follows: 1) normal pregnancy K(-); 2) preeclampsia model K(+); and 3) preeclampsia model receiving L-arginine (P). The authors performed histopathological examination of the mouse placenta, which had been dissected, embedded in paraffin wax and subsequently stained with hematoxylin and eosin (HE). The results were analyzed in SPSS v. 21 for Windows using Anova with Tukey. Results The mean thickness of spiral arteries in group K(-) was 53.95 + 26.96 mm, in K(+) 96.50 + 16.66 mm, and in P 62.79 + 8.04 mm. Statistically, there were significant differences between groups K(-) and K(+) (p=0.001) and between K(+) and P (p=0.000), but non-significant differences between K(-) and P (p=1.000). Conclusions The treatment with L-arginine proved to be effective in repairing endothelial damage by reducing intimal hyperplasia and atherosis and, in turn, the thickness of uterine spiral arteries in mouse models of preeclampsia.

150-156

Authors: Natharina Yolanda, Irene

Background Pediatric nephrolithiasis is an important cause of morbidity worldwide. Even with low prevalence, nephrolithiasis can cause detrimental long-term effects on kidney function. Idiopathic hypercalciuria is the most common cause of renal stones in children. This case report presents a pediatric patient with bilateral nephrolithiasis and hydronephrosis associated with underlying idiopathic hypercalciuria. Case description We report on a 17-month-old boy presenting with two days of high fever, irritability, nausea, and poor feeding. The patient had been diagnosed with bilateral nephrolithiasis at the age of 6 months. On examination, the patient was febrile and hypertensive. Laboratory evaluation revealed anemia, leukocytosis, normokalemia, normocalcemia, and normal glomerular filtration rate. Blood gases were within normal limits. Urinalysis revealed pH 5.0, hematuria, pyuria, and bacteriuria. Urine culture was positive for Proteus mirabilis and Enterobacter gergoviae. Electrolyte analysis from urine samples revealed hypercalciuria. Ultrasonography found stones at the left ureteropelvic junction with corresponding grade I hydronephrosis and stones in the right lower calyx without hydronephrosis. The patient was treated with antibiotics, an antihypertensive agent, thiazide diuretics, and was referred to a pediatric urologist. Conclusion This case can be considered as idiopathic. Most children with renal stones have metabolic risk factors including enteric, endocrinologic, or renal sources. Metabolic evaluation is mandatory in pediatric renal stone patients and hypercalciuria is an important etiology to be evaluated. Ignorance of the underlying metabolic abnormality or failure in its identification in pediatric urolithiasis could lead to catastrophic long-term effects.

160-165

Authors: Gilbert WS Simanjuntak, Golda AM Simanjuntak, Reinne Natali Christine

Background Macular hole surgery can be done under general or local anesthesia, and general anesthesia is still the standard procedure. The objective of this study was to investigate the results of macular hole surgery under local anesthesia. Methods A retrospective study on medical records of patients who had undergone macular hole surgery under local anesthesia. Funduscopic examination of macular hole had been performed and all other diseases with deterioration of visual acuity eliminated. Surgery was performed under retrobulbar local anesthesia, using 2 ml of 2% lidocaine mixed with 3 ml bupivacaine in one syringe. Vitreous tamponade used 20% sulfur hexafluoride (SF6). Demographic and clinical characteristics, visual acuity before and after surgery, and improvements that occurred were assessed. Results No significant interruption occurred during surgery. Mean age of the patients was 53.89 ± 13.3 years (22-74 years), with mean duration of symptoms of 48.83 ± 100.51 weeks (1-560 weeks). The patients comprised 20 males (55.6%) and 16 females (44.4 5). There were improvements in visual acuity after surgery in 31 patients (86.1%), the rest (13.9%) had identical or lower visual acuity after surgery. A total of 20 patients (55.6%) had postoperative visual acuity of 6/18 or better. Initial mean preoperative visual acuity was 0.08 ± 0.08 (0.01 - 0.29) and improved after the surgery to 0.38 ± 0.26 (0.00 - 1.00), the improvement being statistically significant (p=0.000). Conclusion Retrobulbar anesthesia is an effective and safe method in macular hole surgery. Macular hole surgery can be done well under local anesthesia, and visual acuity improved significantly.

173-178

Authors: Mohammad Esmaeil Hejazi, Mohammadamin Rezazadehsaatlou, Leila Namvar, Armin Sadeghi, Veghar Hejazi, Yasin Hejazi, Katrin Buyuk Aghazadeh

BACKGROUND Tracheostomy is one of the most frequently performed procedures in intensive care units. The widespread attraction of percutaneous dilatational tracheostomy (PDT) is increasing in modern intensive care units (ICU). Bronchoscopic guidance seems to secure the safety of the technique. Multiple studies done to explain characterize differences in complications and cost-effectiveness of open and percutaneous tracheotomy. The objective of this study was to evaluate the benefits of percutaneous dilatational tracheostomy (PDT) using the Ciaglia technique with bronchoscopic guidance. METHODS A total of 100 elective percutaneous dilatational tracheostomies using the Ciaglia technique with a little modification were performed under flexible fiber optic bronchoscopic guide. The demographic variables were recorded, the underlying cause for patient’s referred to the center for PDT, and intraoperative as well as early postoperative complications. Patients followed for several days after tracheostomy for early complications. RESULTS No severe complications related to percutaneous dilatational tracheostomy were noticed during and after the procedure. Three patients had bleeding during incision and two led to subcutaneous hematoma. There were no other complications such as infection, emphysema and puncture of posterior wall. CONCLUSIONS We recommended the use of endoscopic guidance bedside percutaneous tracheostomy using the Ciaglia technique with a little modification because it is safe and simple to do without significant complications. PDT with bronchoscopic guidance is a safe and easy procedure that can be done at the bedside setting.

187-196

Authors: Surilena Hasan, Yovita Alviany, Cerellia Clarissa, Sonia Sudana

Background Family support and low discrimination perceptions are a factor in protecting against mental disorders and poor quality of life in male to female (MtF) gender dysphoric individuals. The aim of this study was to determine the role of family factors, peer support, self-esteem, perceived discrimination, depression, anxiety, and stress on the quality of life among MtF gender dysphoric individuals. Methods A cross-sectional study was conducted involving 106 MtF gender dysphoric individuals of Sanggar Swara Jakarta. Respondents filled out questionnaires on demographics, WHOQL-BREF, perceived discrimination, Rosenberg self-esteem, family support, social support (SSQ6), family relations (FACES III), and depression anxiety stress scale (DASS). Simple and multivariate logistic regression tests were used to analyze the data. Results Among the 106 MtF gender dysphoric individuals of Sanggar Swara Jakarta with an age range of 18-45 years, 78.3% had no family support, 64.1% no peer support, 62.3% high perception discrimination, 64.1% low self-esteem, 36% extreme family relations, 44.3% depression, 59.4% anxiety, 35.8% stress and 62.3% poor quality of life. Employment, perception of discrimination, self-esteem, family support, and anxiety were significantly associated with quality of life (p<0.05). Multiple logistic regression analysis showed that perceived discrimination (Odds Ratio=13.89; 95% CI: 5.89-11.99), and family support (Odds Ratio=29.11; 95% CI: 2.45-8.21) were significantly associated with quality of life. Conclusion High perceived discrimination and no family support increase the risk of poor quality of life in MtF gender dysphoric individuals. These findings suggest the need for prevention and intervention of stigmatization and discrimination that should have a special focus on families with MtF gender dysphoric individuals.

205-213

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

Background Vitamin D insufficiency is associated with obesity and central obesity, which is in turn associated with the accumulation of visceral fat. Visceral fat secretes adiponectin which has a role in the pathogenesis of the metabolic syndrome, diabetes mellitus and cerebrovascular disease. The aim of this study was to determine the relationship between serum 25-hydroxy vitamin D [25(OH)D] level and adiponectin level in adults with central obesity. Methods This study was a cross sectional study with 80 subjects with central obesity and 80 healthy subjects as controls. The age of the subjects ranged from 55 to 65 years. The data collection included anthropometry and blood biochemistry (lipid profile, fasting blood glucose, 25(OH)D, and adiponectin). The data were analyzed using independent t test with p <0.05. Results Mean waist circumference and 25(OH)D level in the central obesity group were 94.9 ± 7.8 cm and 14.3 ± 6.6 ng/mL, respectively, and in the control group 72.4 ± 5.0 cm and 19.2 ± 8.6 ng/mL respectively. There were significant differences in adiponectin level between the central obesity group and the control group at the 25(OH)D level of <20 ng/mL (p=0.001), but no significant differences between the two groups at the 25(OH)D level of ³20 ng/mL (p=0.538). Conclusion The central obesity subgroup with 25(OH)D level of <20 ng/mL have lower adiponectin levels compared with the control group. This study demonstrates the role of adiponectin as a link between insulin resistance and vitamin D status in adults.

221-227

Authors: Mirna Widiyanti, Reynold Ubra, Eva Fitriana

Background In acquired immunodeficiency syndrome (AIDS) cases, cytopenias of all major blood cell lines were increasingly recognized in patients with HIV infection. Anemia commonly occurs during HIV infection and has been associated with increased progression to AIDS and decreased survival. The aim of this study was to determine the prevalence of anemia and associated risk factors in adults with HIV-AIDS receiving antiretroviral therapy (ART). Methods A cross sectional study was conducted involving 90 adults with HIV-AIDS. Sociodemographic data were collected using a questionnaire. In all patients, CD4+ lymphocyte counts were performed by means of a PIMA analyzer, while hemoglobin was determined using a Sysmex hematology analyzer. The WHO cutoff value of hemoglobin was adjusted to altitude to define anemia. Mild to moderate anemia was defined as hemoglobin 8-13 g/dL for men and 8-12 g/dL for women. Severe anemia was defined as hemoglobin 8 g/dL. Data was analyzed by using logistic regression test. Results There were 90 subjects with HIV-AIDS in this study. Anemia was found in 50 subjects (55.6%), consisting of 12.2% with mild anemia and 43.4% with moderate to severe anemia. Multiple logistic regression showed that an important risk factor for anemia was low body mass index (BMI) between <17-18.5 (OR=4.20; 95% CI=1.23-14.36). However, the CD4 <350 cells/mm3 was not a significant risk factor for anemia (OR=1.03; 95% CI=0.21-5.04). Conclusions Low BMI increases the risk of anemia in subjects with HIV receiving ART. Better screening for anemia and infectious diseases, and modified harm reduction strategy for injection drug users are primary needs in HIV patients.

236-242

Authors: Verawati Sudarma, Lukman Halim

Background Low vitamin D has been associated with various health problems. Aging influences body composition, especially body fat and fat-free mass. Anthropometric measurements, such as body weight (BW), body mass index (BMI), body fat (BF), skeletal muscle mass (SMM), waist circumference (WC) and the waist-height ratio (WHtR) represent body composition which many studies proposed will influence serum vitamin D [25(OH)D]. The objective of the present study was to determine which anthropometric measurements were determinants of 25(OH)D levels in elderly. Methods A cross-sectional study was conducted involving 126 elderly (>60 years old) men and women at Pusat Santunan Dalam Keluarga (PUSAKA) Central Jakarta centers. Anthropometric measurements [body mass index (BMI), skeletal muscle mass (SMM), body fat (BF), and waist circumference (WC)] were determined by bioelectrical impedance analysis using the Omron body composition monitor with scales (HBF-375, Omron, Japan). Fasting blood samples were taken to measure 25(OH)D level by electrochemiluminescence immunoassay. Multivariate linear regression was used to analyze the data. Results The data showed that BMI, BF, and WC were higher than recommended, while SMM and serum 25(OH)D were lower. When the analysis was done based on sex, there were significant differences in BF, SMM, WHtR, and serum 25(OH)D. In the linear regression multivariate analysis of log 25(OH)D with age and body anthropometric measurements, only SMM reached significance level (β=0.019; p=0.025). Conclusions This study demonstrated a positive association between skeletal muscle mass and serum levels of vitamin D in elderly.

3-9

Authors: Endang Purwaningsih, Yulia Suciati, Etty Widayanti

Background Cancer cells have a relatively high telomerase activity compared to normal cells, so that cancer cells have the ability for continued proliferation and uncontrolled mitosis. Telomerase is an enzyme responsible for the length of telomeres, DNA segments located at the ends of eukaryotic chromosomes. Natural materials such as rodent tuber (Typhonium flagelliforme) have anticancer potential. The purpose of the present study was to determine the effects of Typhonium flagelliforme extract on telomerase expression in HeLa cervical cancer and T47D breast cancer cells. Methods This experimental laboratory study was conducted on cultured HeLa and T47D cancer cell lines, with normal Vero cells as controls, and using RPMI and M199 culture media. The study comprised three groups, i.e. controls, and groups receiving Typhonium flagelliforme extract at doses of ½ IC50 and IC50. Telomerase expression was measured by immunohistochemistry (IHC). Analysis of variance and LSD multiple comparison test were used to analyze the data. Results Telomerase expression in cancer cells showed significantly higher values compared to normal Vero cells. Typhonium flagelliforme extract was capable of significantly decreasing telomerase expression in cancer cells receiving the extract. Conclusion Typhonium flagelliforme extract at different doses is capable of decreasing telomerase expression more effectively in cervical cancer cells than in breast cancer cells. This study shows that Typhonium flagelliforme may have anti-cancer activity, necessitating further investigations.

19-25

Authors: Indah Maulidawati, Abdurrahim Rasyid Lubis, Dharma Lindarto

Background The number of people with diabetes mellitus (DM) is increasing due to population growth, aging, and increasing prevalence of obesity. Diabetic retinopathy and diabetic nephropathy are two main complications of DM. Some studies suggest a correlation between diabetic nephropathy and diabetic retinopathy. However, other studies found that renal cortex echogenicity is associated with chronicity of kidney disease and renal histopathology. The aim of this study was to determine whether there is a correlation between renal cortex echogenicity as determined by renal ultrasonography and degree of retinopathy as determined by funduscopy in subjects with DM. Methods A cross sectional study was conducted on 41 DM subjects from September to November 2014. Data obtained by anamnesis, physical examination, and examination of ureum, creatinine, urinalysis, glycated hemoglobin (HbA1c), renal and urinary tract ultrasonography and funduscopy, were collected from all subjects. Blood samples were taken from the median cubital vein for biochemical measurements using COBAS automated analyzers. Normality of data distribution was tested using the Shapiro-Wilk test. To determine the relationship between variables the Spearman correlation test was used. Results Using the Spearman correlation test, a strongly significant correlation was found between degree of renal cortex echogenicity and degree of retinopathy (r=0.773; p=0.0001). A significant relationship was also found for the degree of retinopathy with age (r=0.317; p=0.044), duration of diabetes mellitus (r=0.639; p=0.0001) and HbA1c (r=0.681; p=0.001). Conclusion This study found that renal cortex echogenicity increased the degree of diabetic retinopathy in diabetic subjects. Renal ultrasonography for patients with type 2 DM has a great role in diagnosing and grading diabetic retinopathy.

33-39

Authors: Sri Sulistyowati, Yuniarsih Zakia, Soetrisno Khasan

Introduction Preterm delivery is one of the causes of high perinatal morbidity and mortality. Matrix metalloproteinase 9 (MMP-9) is important for extracellular matrix (ECM) remodeling and may cause preterm labor and premature rupture of membranes (PROM). Tumor necrosis factor-α (TNF-α) as a pro-inflammatory cytokine plays a role in stimulating uterine activity and cervical ripening by degrading the ECM of the amniotic membranes through MMP-9. This study aimed to determine differences between MMP-9 and TNF-α expression of the membranes in preterm delivery with premature rupture of membranes (PPROM) and without PROM. Methods An analytic observational study with cross-sectional approach was conducted in 24 subjects, who were divided into 2 groups, with 12 subjects in the preterm delivery group with PROM and 12 subjects in the preterm delivery group without PROM. The expression of MMP-9 and TNF-α in the amniotic membrane was determined by immunohistochemistry. Data were analyzed using the t test. Results MMP-9 expression in the amniotic membrane of preterm delivery subjects with PROM (8.6 ± 3.1%/field) differed significantly with that of preterm delivery subjects without PROM (5.5 ± 2.3 %/ field) (p=0.001). TNF-α expression in the amniotic membrane of preterm delivery subjects with PROM (8.0 ±3.0%/field) also differed significantly with that of preterm delivery subjects without PROM (3,3 ± 1.5%/field) (p=0.000). Conclusion Expression of MMP-9 and TNF-α was higher in the amniotic membrane of preterm delivery subjects with PROM than in preterm delivery subjects without PROM and can thus be used as predictor to avoid PPROM.

46-55

Authors: Eva Sulistiowati, Marice Sihombing

Background Subjects with metabolic syndrome (MetS) have a greater risk for acquiring type 2 diabetes mellitus (type 2 DM). The MetS criteria usually used are those of the National Cholesterol Education Program Expert Panel (NCEP) and Adult Treatment Panel III (ATP III) and of the International Diabetes Federation (IDF). This study aimed to evaluate the modified NCEP-ATP III and IDF criteria as predictor of type 2 DM among subjects with MetS. Methods A cohort study was conducted among 4240 subjects with MetS. MetS was determined according to the modified NCEP-ATP III and IDF criteria. The study followed up 3324 non-diabetic subjects of the cohort study of non-communicable disease (NCD) risk factors (NCD study) during a 2-year period. Type 2 DM was determined from the diagnosis by health personnel or from fasting blood glucose of ≥126 mg/dL or blood glucose of ≥200 mg/dL, 2 hours after 75g glucose loading. Results The MetS prevalence based on modified NCEP ATP III and IDF criteria in non-DM subjects was 17.1% and 15.6%, respectively. The risk for DM in subjects with MetS using modified NCEP ATP III and IDF criteria was 4.7 (CI 95%: 3.4-6.5) and 4.1 (CI 95%: 3.0-5.7), respectively. Conclusions Both MetS criteria can be used as predictors of the occurrence of DM type 2, but the modified NCEP-ATP III is more properly applied than the IDF criteria in subjects with MetS. Screening programs and routine monitoring of MetS components are required for early detection of type 2 DM.

65-67

Authors: Adi Hidayat

Diabetes mellitus (DM) is an important global cause of mortality, morbidity, and health-system costs,(1,2) with significant increases in its prevalence and number of cases in the last 30 years. It constitutes one of the four non communicable diseases (NCDs) targeted for action by world leaders.According to WHO estimates, in 2014 there were 422 million adults with DM aged 18 years or older, with around half in the WHO South-East Asia and Western Pacific Regions.(3) The prevalence of DM and the number of adults with DM in low- and middle-income countries have over the last decade increased at a greater rate than in high-income countries. The global DM prevalence increased by more than 100% in men and by 60% in women, resulting in a predominance of males with DM in 2014 as compared with a higher DM female prevalence in 1980.

75-80

Authors: Ifael Yerosias Mauleti, Suhendro Suhendro, Leonard Nainggolan, Martin Rumende

BACKGROUND Dengue infection is an acute viral infection, in the natural history of which plasma leakage may occur, resulting in shock followed by tissue hypoxia, with death as the final outcome if not treated properly. The purpose of this study was to determine the correlation of the hematocrit, serum albumin concentration, and the presence of pleural effusion or ascites, with hyperlactatemia in adult dengue patients. METHODS A cross-sectional study was conducted on 62 subjects. The inclusion criteria were: diagnosed dengue viral infection, age >14 years, fever during three consecutive days, and hyperlactatemia. Serum albumin was measured on an Advia 1800 analyzer using the bromocresol green method. The lactate oxidase method was used to determine serum lactate levels. Pleural effusion and/or ascites was determined using an ultrasound scanner (Xario SSA-660 A, Toshiba, Japan). The Pearson correlation test was used to analyze the data. RESULTS There was no significant correlation between the hematocrit (r=0.11; p=0.301), serum albumin (r=0.003;p=0.981), and pleural effusion or ascites (r=0.75; p=0.692) with serum lactate levels. However, in patients aged >30 years there was a significant inverse correlation between serum albumin and lactate levels (r =- 0.663;p=0.026). CONCLUSION This study demonstrated a significant inverse correlation between albumin and serum lactate levels in dengue patients aged > 30 years. This can aid in the early recognition and prompt management of at-risk patients to reduce morbidity and mortality.

89-95

Authors: Safyudin, Subandrate

Background Smoking is the act of introducing toxic substances into the body. Cigarette smoke contains chemicals that may cause several disorders, including cardiovascular disease, cancer, and chronic obstructive pulmonary disease. Toxic substances in cigarette smoke have the potential to increase free radicals, malondialdehyde (MDA) levels and to decrease endogenous antioxidant (glutathione/GSH) levels. This study aims to determine the relationship of smoking with plasma GSH and MDA levels in medical students. Methods This study was analytical observational with cross-sectional approach. The study was conducted from April to December 2015. The subjects in this study were medical students, consisting of 20 smokers and 20 nonsmokers. Plasma GSH and MDA levels were determined biochemically using Sigma GSH Assay Kit and Sigma MDA Assay Kit. Data was analyzed using the independent t test. Results The results showed that there was no significant difference between mean GSH in smokers (1.74 ± 0.91 mmol/L) and nonsmokers (2.42 ± 1.19 µmol/L) (p=0.441). Mean smokers MDA level of 2.06 ± 1.39 nmol/mL was not significantly different compared with mean nonsmokers MDA level (1.32 ± 0.90 nmol/mL) (p=0.092). Conclusions Smoking tends to decrease plasma GSH levels and increase plasma MDA levels in medical students. Smoking history could be evidence of oxidative stress and an impaired oxidant defense system. In particular, young smokers should quit promptly before health problems arise, so as to have the optimal benefits of cessation.

105-109

Authors: Johnkennedy Nnodim, Obioma Elemba JE, Nwadike Constance, Edward Ukamaka, Njoku-Obi Treasure, Jimoh Raifu Folorunso, Nsonwu Magnus

Background One of the most important sight-threatening eye disorders in ophthalmology is glaucoma. Together with age related macular degeneration it is the most common cause of irreversible blindness. Magnesium (Mg) is considered to improve the ocular blood flow in glaucoma patients and could protect the retinal ganglion cell against oxidative stress. Membrane potential refers to the difference in electrical potential between the intracellular and the extracellular of a biological cell. The objective of this study was to determine the Mg serum level and membrane potential in glucoma subjects. Methods A case-control study was conducted in eighty confirmed glaucoma patients and eighty normal subjects between 50 to75 years were selected. The serum sodium, potassium and calcium were estimated using Randox Kit. While membrane potential was determined by calculation using Nerst Equation. Magnesium levels were determined by atomic absorption spectrophotometer technique. An independent t-test was used to analyze the data. Results The results obtained showed that the level of Magnesium serum (1.11 ± 0.14 mg/dL) and membrane potential (176.40 ± 42.00 J) was significantly decreased in glaucoma as compared to the controls (2.4 ± 0.68 mg/dL) and (251.76 ± 191.99) (p<0.05). The serum sodium, potassium and calcium were also significantly decreased among glaucoma subjects compared to control (p<0.005). Conclusion The result probably suggests, that decrease in magnesium aggravates glaucoma while decrease in membrane potential could cause poor energy transmission and hence affect ocular blood flow. Hence, decreased magnesium and membrane potential levels contributes greatly to glaucoma.

119-127

Authors: Tutik Ida Rosanti, Sugeng Juwono Mardihusodo, Wayan T. Artama

Backgroud. Mass drug administration (MDA) has been one of the strategies for lymphatic filariasis elimination. Since the start of implementation in 2011 in Pekalongan, no study on MDA acceptability has yet been done. The objectives of the study were to determine the microfilaria rate (mf rate) and the risk factors of drug compliance in the MDA program. Methods A longitudinal study was conducted at Pabean region, Pekalongan City. There were 90 household heads as subjects, who were selected by proportional cluster random sampling. Microfilaria rate (mf rate) was determined by finger blood examination. Drug compliance was measured using questionnaires and observation sheets. Drug compliance observers, filariasis counseling participation, and presence of filariasis patients were factors influencing drug compliance. Results Mf rate in 2015 was 1.35% and drug compliance rate was 86.80%. Reasons for failing to take drugs were fear of side effects (50%), refusals (25%), laziness (16.7%), and perceiving the drug to be useless (8.3%). The chi-square test shows a significant difference between the presence of drug compliance observer and compliance (p=0.006). Filariasis counseling participation and presence of filariasis patients did not show a significant difference with drug compliance (p= 0.986). Conclusions Families as the source of observers was associated with increased filariasis drug compliance. It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.

135-142

Authors: Yudhisman Imran, Pukovisa Prawiroharjo, Martiem Mawi

Background Atherosclerosis is initiated by endothelial dysfunction, as a result of increasing degradation of nitrit oxide by reactive oxygen species, thereby increasing oxydative stress. Dyslipidemia is one of the risk factors of endothelial dysfunction. The aim of this study was to evaluate the relationship of blood pressure and serum lipid level with carotid intima-media thickness (CIMT) in subjects aged between 55-65 years. Methods A cross sectional study was carried out in 52 male and female subjects aged between 55-65 years. Age, gender, body mass index (BMI), blood pressure, lipid profile, and CIMT were assessed in all subjects. The independent t-test was used to to analyze the relationship between all variables and CIMT. The level of statistical significance was set at p<0.05 Results Mean age was 59.19 ± 3.68 years, prevalence of thickened CIMT was 66.5%, and plaques were found in 9 subjects. There wwre no significant differences in age, BMI, systolic and diastolic blood pressure, and lipid profile between normal and thickened CIMT (p>0.05). However, there was a significant difference in gender between the two groups (p=0.011). In females, mean systolic and diastolic blood pressure were higher in the thickened CIMT group than in the normal CIMT group, but the difference was not significant (p>0.05). Conclusions Our findings suggest that high blood pressure tends to increase CIMT in female adults. An increasing value of CIMT should be considered as a sign of cerebrovascular disease.

146-155

Authors: Hijra, Siti Fatimah-Muis, Martha Irene Kartasurya

Background In 2013, the prevalence of stunting in Central Sulawesi province was 41%, which was higher than the national prevalence of 37.2%. Complementary feeding practice, infectious disease, history of exclusive breastfeeding, birth weight and birth length were assumed to contribute to the prevalence of stunting. The objective of the present study was to identify the risk factors for stunting among children aged 12 to 24 months. Methods This study was conducted using a case control design. Subjects were children aged 12-24 months, consisting of 58 cases and 58 controls. Data were obtained with a body length infantometer. Data on complementary feeding practices, history of exclusive breastfeeding, and history of infectious diseases were obtained using questionnaires. Nutrient intakes were measured by semi quantitative food frequency questionnaires. Data on birth weight and birth length were obtained from the buku KIA (maternal and child health record). Data were analyzed by chi-square and logistic regression tests. Results There was no difference in sex, BMI, and parental education between cases and controls (p>0.05). After controlling for history of exclusive breastfeeding and birth weight, the risk factors for stunting were inappropriate complementary feeding practice in terms of quantity and quality (OR=8.26; 95% CI: 2.69-25.44), history of diarrhea (OR=4.73; 95% CI: 1.08-20.69), birth length (OR=5.11; 95% CI: 1.69-15.46) and respiratory tract infection (OR=5.30; 95% CI: 1.03-27.23). Inappropriate complementary feeding practice was the most dominant factor for stunting. Conclusion Inappropriate complementary feeding practice increased the risk of stunting in 12-24 months old children by 8.26. This study confirms the need to scale up interventions during the first 2 years of life, including appropriate infant feeding practices.

165-170

Authors: Afandi Charles, Birgitta M. Dewayani, Edhyana Sahiratmadja, Gatot N.A. Winarno, Herman Susanto

Background Epithelial ovarian cancer (EOC) is one of the most common cancers diagnosed in Indonesian women. A combination of paclitaxel and carboplatin is used to treat EOC as standard chemotherapy which is known to have hematologic toxicities. This study aimed to investigate the effect of combined paclitaxel-carboplatin chemotherapy on hematologic status in EOC patients managed at Dr. Hasan Sadikin General Hospital, Bandung, West Java. Methods All patients with confirmed pathological diagnosis of EOC at Dr. Hasan Sadikin General Hospital in the period of 2013 to 2014 were registered. Only patients with complete hematologic data before and after chemotherapy were collected and compared using the paired non-parametric Wilcoxon and McNemar tests. Results In total there were 147 patients with EOC (median age 46 ± 12 years), with the most dominant pathological diagnosis of mucinous (32.7%) and serous (29.3%) types. Only 33 patients had hematologic data before the initiation of chemotherapy. There was a significant decrease after chemotherapy including hemoglobin level (12.0 vs 10.9 g/dL, p=0.013), erythrocyte count (4.53 vs 3.74 million/mL, p<0.001), leukocyte count (7,700 vs 4,000/mm3 p<0.001) and platelet count (343,000 vs 215,000/mm3, p<0.001). Interestingly, anemia cases after chemotherapy were predominant (87.9%) compared with erythopenia, leukopenia, thrombocytopenia i.e. 39.4%, 57.6%, and 27.3% respectively. Conclusions This study confirmed the hematologic toxicities after paclitaxel-carboplatin chemotherapy in EOC patients treated in Hasan Sadikin General Hospital, West Java. The hemoglobin concentration may serve as prognostic factor. Further studies directed to other factors such as genetic factor for polymorphisms may be encouraged to explore the decrease of the hematologic indices.

181-191

Authors: Mulualem Endeshaw, Fantu Abebe, Melkamu Bedimo, Anemaw Asrat, Abebaw Gebeyehu, Alemayehu Keno

Background Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortalities worldwide. Despite extensive research, the underlying cause of preeclampsia remains poorly understood. This study aimed to offer compelling evidence on the important risk factors of preeclampsia in Amhara region, Ethiopia. Methods A case control study was conducted in public health facilities of Bahir Dar city from September 2014 to January 2015. A total of 453 (151 cases and 302 controls) pregnant women were enrolled in this study. Hemoglobin level and urinary tract infection (UTI) status were collected from clinical notes. Oral examination was performed by a dentist for detection of periodontal diseases. Univariate and multiple logistic regression analysis was conducted to determine the relationship of all the independent variables with the outcome variable. A p-value <0.05 was declared statistically significant. Result Advanced maternal age (AOR=4.79;95% CI 1.031-22.18), family history of hypertension (AOR=11.16;95% CI 5.41-41.43), history of diabetes mellitus (AOR=6.17;95% CI 2.11-20.33), UTI in the current pregnancy (AOR=6.58;95% CI 2.93-14.73), failure to comply with iron and folic acid supplement during pregnancy (AOR=8.32;95% CI 3.35-20.62), lack of exercise (AOR=3.33;95% CI 1.35-8.17), multiple pregnancy (AOR=4.05;95% CI 1.57-12.27), anemia (AOR=4.19;95% CI 1.27-13.92), and periodontal disease or gingivitis (AOR =3.51;95% CI 1.14-10.83) were associated with preeclampsia. Conclusion Family history of hypertension was the most dominant risk factor for preeclampsia in pregnant women. Encouraging pregnant women to have health seeking behavior during pregnancy would provide a chance to diagnose preeclampsia as early as possible.

199-205

Authors: Rizqi Arini Siregar, Leonardo Basa Dairi, Gontar Alamsyah Siregar

Background Rupture and bleeding from esophageal varices are major complications of portal hypertension and associated with a high mortality rate. Non-invasive serum markers of liver fibrosis could be used as predictors of esophageal varices in cirrhotic patients. The objective of this study was to assess the performance of Forns index as a noninvasive predictor in diagnosing esophageal varices. Methods A cross-sectional study was done in 51 cirrhotic patients who were admitted to Adam Malik hospital, Medan. Demographic and clinical data were recorded and laboratory tests were performed, so that Forns index could be calculated. The difference between Forns index and size of esophageal varices as determined by endoscopy was tested by independent-t and Mann-Whitney analysis. The diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, likelihood ratios and areas under the receiver operating characteristic curves (AUROC). Results Of the 51 patients with esophageal varices included in this study, the size of esophageal varices comprised F2 (37.3%), F3 (33.3), and F1 (29.4%). Most patients were of Child-Plug C type (52.6%). There was a significant difference between Forns index and grade of esophageal varices. The AUROC for Forns index was 0.717 (95% CI: 0.561 - 0.872) and the cut-off >7.92 was highly predictive to diagnose large esophageal varices with a sensitivity of 63.9%, specificity of 73.3%, PPV of 85.2%, NPV of 45.8% and accuracy of 71.7%. Conclusion Forns index was significantly increased in large esophageal varices. Forns index is a good noninvasive predictor of esophageal varices in cirrhotic patients.

213-221

Authors: Rika Bur, Suhendro Suwarto, Widayat Djoko Santoso, Kuntjoro Harimurti

Background Dengue fever (DF) and dengue hemorrhagic fever (DHF) are differentiated by the occurrence in DHF of plasma leakage into the interstitial space as shown by pleural and peritoneal effusion, hemoconcentration, and intravascular hypovolemia. Perfusion dysfunction causes anaerobic metabolism, which leads to increased serum lactate. This study was to determine serum lactate as prognostic predictor and diagnostic biomarker of plasma leakage in adult dengue patients. Methods A cross-sectional retrospective cohort study was conducted on 57 adult dengue patients hospitalized in the internal medicine ward of Cipto Mangunkusumo Hospital and Persahabatan Hospital in Jakarta. Serum lactate was examined to determine its mean difference between DF and DHF. The data was analyzed by independent t-test and the cut-off points were identified for presence as well as absence of plasma leakage, then the receiver operating characteristics (ROC) curve was used to determine sensitivity and specificity. Results Mean serum lactate was significantly higher in DHF than in DF. From the ROC curve, the cut-off point for serum lactate as prognostic predictor on day 3 of fever was 2.65 mmol/L with AUC of 0.626 (95% CI 0.480-0.772; p=0.108). The cut-off point for diagnostic biomarker of plasma leakage on day 5 of fever was ³2.55 mmol/L with sensitivity 66.6%, specificity 54.2%, and AUC 0.668 (95% CI 0.550-0.826; p=0.016). Conclusion There was a significant difference in serum lactate between DF and DHF. In the critical phase, serum lactate of 2.55 mmol/L could be used as plasma leakage diagnostic marker of low accuracy.

3-9

Authors: Budi Santoso, Hertanto Wahyu Subagio, Lisyani Suromo, Henna Rya Sunomo

BACKGROUND Lead acetate (Pb) inhibits heme biosynthesis through inhibition of δ-aminolevulinic acid dehydrogenase (δ-ALAD), copro porphyrinogen oxidase, and ferro chelatase. Zinc supplementation increases lead-binding metallothionein proteins. The purpose of this study was to find evidence that zinc supplementation prior to lead exposure improves heme biosynthesis in rats METHODS This was a randomized post-test only control-group design study involving 28 rats assigned to 4 groups (1 control and 3 treatment groups). The treatment groups were supplemented with zinc at doses of 0.2, 0.4, and 0.8 mg daily by gavage for 3 weeks. From week 4 to 13, all groups were exposed to lead 0.5 g/kg BW/day by gavage. At the end of week 13, δ- ALAD, erythrocyte protoporphyrin (EPP), and heme concentrations were determined by means of ELISA. One-way ANOVA, followed by Bonferroni’s test was used to analyse the data. RESULTS Mean δ-ALAD concentrations decreased from the control group down to treatment group 3 (0.24 ± 0.20; 0.15 ± 0.15; 0.12 ± 0.11; 0.05 ± 0.06 ng/ mean per unit). Mean EPP concentrations decreased from the control group down to treatment group 3 (1.96 ± 0.50; 1.24 ± 0.24; 1.03 ± 0.05; 0.62 ± 0.16 ng/mL). Mean heme concentrations increased from the control group up to treatment group 3 (8.07 ± 2.64; 10.11 ± 2.27; 10.04 ± 1.65; 11.41 ± 2.58 μM). ANOVA followed by Bonferroni showed that EPP concentrations differed significantly between the control group and treatment group 3 (p=0.00). CONCLUSION Zinc supplementation prior to lead exposure improves heme biosynthesis in rats exposed to lead.

17-24

Authors: Ety Sri Handayani, Zainuri Sabta Nugraha, Prilly i Raleka Pahlevawati

BACKGROUND Soursop leaf contains annonaceous acetogenins and alkaloids. The acetogenins act as inhibitors of mitochondrial complex I, suppress ATP production and cause cell degeneration, whereas the alkaloids act as neurotoxins. Neuronal degeneration will be followed by an increase in neuroglia (gliosis). Hepatic clear cell foci represent the morphology of liver degeneration. The purpose of this study was to evaluate the effect of soursop leaf extract on number of neuroglia brain gliosis and hepatic clear cells in female rats. METHODS This study was an experimental study with a post-test only control group design. Ten female Sprague-Dawley strain rats were divided into one control and one treatment group. The control group was gavaged with distilled water, while the treatment group was gavaged with aqueous soursop leaf extract at a dose of 1000 mg/kgBW/day for 90 days. Rat brain tissue samples were taken at day 91 with a transcardial perfusion technique. The number of neuroglia in rat cerebral cortex, hippocampus, substantia nigra, and nucleus accumbens and the number of hepatic clear cells were determined. Independent t-test was used to examine the differences in the numbers of neuroglia and hepatic clear cells between control and treatment groups RESULTS The results of independent t-test analysis found a significant difference in the number of neuroglia in the cerebral cortex (p=0.015) and nucleus accumbens of the rats (p=0.030), and significant differences in the number of hepatic clear cells (p=0.029). CONCLUSIONS Aqueous soursop leaf extract orally increases neuroglia of the cerebral cortex and nucleus accumbens, and hepatic degeneration in female rats.

35-42

Authors: K Kartini, Ahmad A Jusuf, Sri Widia A Jusman, M Ekawati, Ani R Prijanti

BACKGROUND Prematurity refers to live births before 37 weeks of gestation, wherein the baby is born before the body and its organ systems achieve perfect maturity, and this disorder is still a global problem. The high incidence of prematurity is a problem in developing and also in developed countries. Certain conditions accompanying pregnancies like preeclampsia, infection, and placental insufficiency, may trigger uterine hypoxia, causing premature birth. The placental condition is related to the intra-uterine fetal condition. In prolonged placental hypoxia, there occurs a compensatory mechanism, i.e. an increase in placental angiogenesis. This study aimed to evaluate the effect of hypoxia on fetal blood vessel count as compensatory mechanism for tissue hypoxia. METHODS An observational-analytical cross-sectional design using paraffin blocks of conserved premature placentas, comprising 31 samples of hypoxic premature placentas and 28 samples of non-hypoxic premature placentas, selected using non-random consecutive sampling. The samples were made into slides and stained with hematoxylin-eosin for assessment of histological structure, including fetal blood vessel count and integrity, villus conditions, syncytiotrophoblastic nuclear changes, and syncytiotrophoblastic nuclear aggregation. Mann-Whitney test was used to compare the difference of blood vessel count between groups. RESULTS Assessment of histological structure showed a significant increase in fetal blood vessel count in the hypoxic group [8.00 (5-15)] as compared with the non-hypoxic group [7.50 (3-15)]. CONCLUSION The hypoxia in premature placentas caused an increase in the number of fetal blood vessels as a form of compensation for disturbed oxygen homeostasis.

52-60

Authors: Margaretha Vianny, Gunawan Santosa, Eddy Soedijanto

BACKGROUND Hepatocellular carcinoma (HCC) incidence is increasing in Asia and Africa. Locoregional minimally invasive transarterial chemoembolization (TACE) is the palliative therapy of choice, improving survival rate. Adequate lipiodol dose calculation in TACE is necessary to produce good therapeutic effect. Lipiodol retention pattern can predict TACE therapeutic effect. This study aimed to determine correlation of lipiodol volume/tumor volume (L/V) ratio and lipiodol volume/tumor diameter (L/D) ratio with lipiodol retention pattern in post-TACE CT-scans of HCC patients. METHODS This cohort prospective study was done from November 2013 to March 2014 on eighteen HCC patients with post-TACE therapy in Dr.Kariadi Hospital, Semarang, fullfilling inclusion and exclusion criteria. Lipiodol retention pattern was observed on 28 days post-TACE and classified as type I (lipiodol accumulation in tumor and surrounding area), type II (homogenous accumulation in tumor only), and type III (partial accumulation). The Spearman correlation test was used to determine any relationships between the various variables studied. RESULTS Spearman correlation test showed that lipiodol volume had significant moderate correlation with lipiodol retention pattern (r=-0.684; p=0.002). Both L/V and L/D ratios had moderately significant correlation with lipiodol retention pattern (r=0.511; p=0.030; and r=0.518; p=0.028, respectively). CONCLUSION Correlations of L/V ratio L/D ratio with lipiodol retention pattern were both moderately significant. Lipiodol dose calculation based on L/V ratio is suggested considering the irregular three-dimensional form of the tumor, making volumetric measurement more appropriate.

68-76

Authors: Magdalena Wartono, Herkutanto Herkutanto, Niken Lestari

BACKGROUND Few studies have investigated the impact on olfactory functioning of occupational exposure to toluene, an industrial solvent used in paints and cleaning fluids. The estimated olfactory dysfunction prevalence is 0.5–5%. Patients frequently do not complain about olfactory dysfunction. However, occupational exposure to chemicals may affect workers’ health and safety, because of their continuous inhalation. This study aimed to examine the relationship between toluene exposure and olfactory dysfunction in furniture workers. METHODS This was a cross-sectional study involving 65 workers. Data collection was by observation and interview on demographic characteristics, history of habits, and symptoms of chronic rhinitis. Risk of exposure scores were evaluated from potential hazard, exposure level, duration of employment, type of work, use of masks, ventilation of work space, and education and training. Olfactory function was tested using Sniffin’ Sticks, and determination of environmental toluene level was by personal sampling. The odds ratio was used to test correlations between variables. RESULTS Only 44 subjects could be analyzed, 37 (84.1%) of whom had olfactory dysfunction. Workers with high toluene exposure had a significantly 12.5- fold risk of olfactory dysfunction in comparison with those with low exposure (OR=12.5; CI 95% 1.35 – 115.79). CONCLUSIONS Toluene exposure increases risk of olfactory dysfunction in furniture workers. Olfactory function testing should be considered for initial screening or periodic testing of furniture workers. Low toluene levels with a high proportion of olfactory dysfunction indicate that olfactory dysfunction is an early negative impact of chemical inhalation.

79-86

Authors: Endang Purwaningsih, Etty Widayanti, Yulia Suciati

BACKGROUND Cancer cells have a relatively high telomerase activity and a lower p53 protein expression than normal cells, so that cancer cells have the ability to continue to proliferate and do not undergo apoptosis. One of the cancer treatments is chemotherapy using bioactive ingredients from synthesis or isolation of natural materials. One of the plants that have potential as anticancer agent is periwinkle (Catharanthus roseus L). The research objective was to evaluate the effect of ethanolic periwinkle leaf extract against p53 protein and telomerase expression in T47D cancer cells. METHODS An experimental study with controls was conducted involving T47D breast cancer cells. They were divided into 3 groups (control, ½ dose of IC50/26.849 µg/mL, and one dose of IC50/53.699 µg/mL) at a cell density of 1 x 104 cells/well. Expression of p53 and telomerase was measured by the immunohistochemistry method. Data were analyzed using one-way ANOVA followed by a multiple comparison test. RESULTS Periwinkle leaf extract significantly increased p53 protein expression (p<0.05) at both treatment doses, ½ IC50 and IC50, compared to the control group and it highly significantly reduced telomerase expression (p<0.01), in comparison with the control group at both treatment doses. CONCLUSION Periwinkle leaf extract has potential as an anti-breast cancer agent by increasing p53 protein expression and inhibiting telomerase expression.

96-103

Authors: Linda Yuliati, Etik Mardliyati, Kusmarinah Bramono, Hans Joachim Freisleben

Background Asiatiocoside, a saponin component isolated from Centella asiatica can improve wound healing by promoting the proliferation of human dermal fibroblasts (HDF) and synthesis of collagen. The skin-renewing cells and type I and III collagen synthesis decrease with aging, resulting in the reduction of skin elasticity and delayed wound healing. Usage of natural active compounds from plants in wound healing should be evaluated and compared to retinoic acid as an active agent that regulates wound healing. The aim of this study was to compare and evaluate the effect of asiaticoside and retinoic acid to induce greater cell proliferation and type I and III collagen synthesis in human dermal fibroblast. Methods Laboratory experiments were conducted using human dermal fibroblasts (HDF) isolated from human foreskin explants. Seven passages of HDF were treated with asiaticoside and retinoic acid at several doses and incubated for 24 and 48 hours. Cell viability in all groups was tested with the MTT assay to assess HDF proliferation. Type I and III collagen synthesis was examined using the respective ELISA kits. Analysis of variance was performed to compare the treatment groups. Results Asiaticoside had significantly stronger effects on HDF proliferation than retinoic acid (p<0.05). The type III collagen production was significantly greater induction with asiaticoside compared to retinoic acid (p<0.05). Conclusion Asiaticoside induces HDF proliferation and type I and III collagen synthesis in a time- and dose-dependent pattern. Asiaticoside has a similar effect as retinoic acid on type I and type III collagen synthesis.

112-120

Authors: Yanuarita Tursinawati, Serene Thain, Christina Choi, George Heong Yeo Seow

Backgound Invasive prenatal diagnosis (PND) through amniocentesis and chorionic villus sampling (CVS) can detect Down syndrome. Pregnant women usually experience a variety of psychological responses associated with invasive PND. This study is intended to assess depression, anxiety and stress levels and the factors related to their psychological responses in pregnant women with invasive prenatal diagnosis of Down syndrome. Methods A cross sectional study was conducted at Kandang Kerbau Women’s and Children’s Hospital, Singapore. The psychological responses of 70 women undergoing PND were assessed by Depression Anxiety Stress Scale 21 (DASS 21) questionnaire. A multiple linear regression analysis was used to analyze association between knowledge and perceived risk with psychological responses (CI 95% and significance value p<0.05). Results More than half of the participants had normal anxiety (55.7%), stress (72.8%), depression levels (65.8%). The results revealed significantly higher level of anxiety in women with gestational age >13 weeks who had pursued amniocentesis. Women with no previous children had higher levels of depression and stress. Women who pursued amniocentesis had significantly higher anxiety scores compared to women undergoing CVS (p=0.015). Conclusions Women’s psychological responses are associated with gestational age, type of procedure and parity. The level of anxiety increased in women who underwent amniocentesis for diagnosis of Down syndrome. Knowledge and perceived risk of having a baby with Down syndrome do not seem to have psychological effects to women.

129-137

Authors: Surilena, Jean Valeria

Background Antiretroviral therapy adherence (ART adherence) is a factor significantly extending life expectancy of people living with HIV/AIDS. The objective of this study was determine several factors on ART adherence in women infected with HIV/AIDS. Methods A cross-sectional study involving 99 women with HIV/AIDS who were infected through their sexual partner or spouse was conducted in Dharmais Hospital between March and August 2014. The instruments used were demographic and self-esteem questionnaires, Hamilton rating scale for depression, Hamilton rating scale for anxiety, knowledge, perception of ART benefits and limitations, family support, peer support as well as assessment of ART adherence. The knowledge questionnaire has been validated with Cronbach’s alpha = 0.823. Data were analyzed using Chi-Square test and multivariate logistic regression. Results A total of 99 women with HIV/AIDS participated in the study, with an age range of 30- 60 years and mean age of 36 ± 3.72 years. A total of 57.58% of participants showed poor ART adherence. Multivariate logistic regression analysis showed that knowledge, ART side effects, depression, peer support and ARV availability significantly affected ART adherence (p<0.05). The most dominant factor affecting ART adherence was knowledge, with OR = 64.02 (95% CI 4.99-670.12). Conclusion With good knowledge about HIV/AIDS infection, ART benefits, and possible ARV side effects, women living with HIV/AIDS are expected to carry out ART adherence according to the recommended rules.

149-158

Authors: Sulistyowati Tuminah, Marice Sihombing

Background Coconut milk is an essential ingredient of the Indonesian cuisine. In view of its saturated fatty acid content, coconut milk has frequently been blamed as a cause of cardiovascular disease. The objective of this study was to determine any association between coconut milk intake and vascular disease among adults. Methods A cross-sectional study was conducted in 2011-2012 on adults aged 25-65 years. Self-reported health and nutritional data were collected by means of questionnaire-based interviews, with the aid of 3-D food models. Medical data comprised blood pressure and anthropometry (waist circumference and body mass index), neurological status, ECG, blood glucose and lipid profile. Data analysis was done using multiple logistic regression. Results A total of 4,187 respondents fullfilled the inclusion criteria. Frequent coconut milk intake (>3 times/week) significantly increased the risk of vascular disease by 1.3-fold compared with infrequent coconut milk intake (<2 times/week) (OR=1.33; 95% CI: 1.11-1.60; p=0.002) after controlling for age, gender, hypertension, diabetes mellitus and stress. The influence of coconut milk intake on vascular disease risk was lower than that of age, gender, hypertension and diabetes mellitus. Conclusion Frequent coconut milk intake increased the risk of vascular disease in adults. Further investigations are needed about the effect of coconut milk intake on noncommunicable diseases.

161-167

Authors: Prastiya Indra Gunawan, Darto Saharso

Background Tuberculous meningitis (TBM) is a severe intracranial infection with fatal outcomes, permanent disabilities, and electroencephalographic (EEG) abnormalities. Seizures may occur in TBM. The EEG findings in TBM vary according to the site of the inflammatory process. There are few studies describing the EEG patterns and clinical manifestations of TBM. The objective of this study was to investigate the correlation between clinical findings and EEG patterns in children with TBM. Methods A study of cross-sectional design using medical records was conducted on 12 children with TBM, with their EEG patterns classified as abnormal and normal. Clinical manifestations such as seizures, altered consciousness, headache or fever were collected. A positive cerebrospinal fluids Mycobacterium tuberculosis culture was considered to indicate definitive TBM. Abnormal EEG descriptions were classified into abnormal I, II or III. Correlation between EEG pattern and clinical manifestation were analyzed with Fisher’s exact test. Results The study found cases of 12 children with TBM, the majority presenting with seizures, decreased consciousness and fever. Abnormal EEGs were found in 75% of children and 77% of them showed epileptogenic activities. The EEG results mostly described epileptogenic potentials in the frontotemporal region. There was a significant correlation between EEG abnormality and seizures in children with TBM (p<0.05). Conclusions The EEG pattern in children with TBM varies, and EEG abnormalities were more frequently localized in the frontotemporal region. Seizures were associated with EEG abnormalities in children with TBM. EEG abnormalities occurring simultaneously with seizures may predict the occurrence of seizures.

177-186

Authors: Titis Nurmasitoh, Miranti Dewi Pramaningtyas

Background Coronary heart disease (CHD) is a major cause of morbidity and mortality throughout the world, including Indonesia. One of the risk factors for CHD is hypercholesterolemia. One of the natural products that has been developed for the treatment of hypercholesterolemia is honey. Honey contains fructooligosaccharides, various vitamins, minerals, and enzymes which are supposedly able to lower blood cholesterol levels. This research aimed to study the influence of honey on the levels of blood total cholesterol, triglyceride, and low density lipoprotein (LDL) levels in Wistar rats. Methods This study was of experimental post test control group design. Twenty-four male Wistar rats (Rattus norvegicus) were randomly divided into 4 groups. K1 was the negative control group (with normal diet), K2 was the positive control group (with high-fat diet), P1 was fed a high-fat diet for 7 days, followed by high-fat diet plus honey for the next 7 days. P2 was fed a high-fat diet for 7 days, followed by regular diet plus honey for the next 7 days. After completion of this treatment, total cholesterol, triglycerides, and LDL levels were measured by the cholesterol oxidase phenol+aminophenazone (CHOD-PAP) method using enzymatic spectrophotometry principles. Results There were significant differences in total cholesterol, triglyceride, and LDL levels between all groups after day 15 (p<0.05). Conclusion Honey supplementation was able to reduce the blood levels of total cholesterol, triglycerides, and LDL. Honey supplementation accompanied by non-cholesterol feeds could more effectively lower total cholesterol, triglycerides, and LDL serum levels in Wistar rats.

197-204

Authors: Hanif Nasiatul Baroroh, Esti Dyah Utami, Anisyah Achmad

BACKGROUND Guava is an herbal with proven antioxidant and anti-inflammatory properties. The aim of this study was to investigate the anti-arthritic activity of the ethanol extract of Psidium gujava leaves (EEPG) against complete Freund’s adjuvant (CFA) induced arthritis in rats. METHODS An experimental study was conducted on 40 male Wistar Sprague Dawley rats, which were divided into 5 groups. Each group was induced with 0.2 mL CFA (1 mg/mL) on day 1 and 0.1 CFA mL booster injection on day 5. Group I served as an arthritic control, group II received dexamethasone (6.75 mg.kg-1 orally), group III, IV and V received EEPG at oral doses of 250, 500, and 750 mg/kg BW, respectively, on days 14 to 28. Anti-arthritic activity was observed from the arthritis score, the paw circumference was measured on days 0, 1, 4, 8, 12, 16, 20, 24, and 28, the mobility score was determined on days 12 and 28, and the histolopathology of the knee joint was examined on day 29. RESULTS Ethanol extract of Psidium guajava leaves significantly suppressed the swelling of the paws in chronic phase based on increasing of edema (%), while starting on day 20. EEPG at 250 mg/kg was most effective in significantly reducing arthritis scores (p<0.05). Histopathological examination showed repair of the knee joint synovial membrane and cartilage. CONCLUSIONS Psidium guajava leaf extract is effective in decreasing the inflammatory response and arthritic symptoms in rats with adjuvant-induced arthritis. Psidium guajava leaves can be developed into an alternative anti-arthritis treatment.

213-219

Authors: Yvonne Suzy Handajani, Nelly Tina Widjaja, Yuda Turana

BACKGROUND Approximately 10-27% of the population aged >65 years suffers from frailty. The percentage increases with age so that the prevalence of frailty in the population aged >85 years reaches 45%. The objective of this study was to determine the relationship between frailty and quality of life (QOL) in nursing home elderly. METHODS This was a cross-sectional study of 138 subjects aged >60 years who were recruited from 4 nursing homes in West Jakarta. Participants with frailty status were evaluated by the Survey of Health, Ageing and Retirement in Europe (SHARE) instrument and QOL was evaluated by the WHOQOL-BREF questionnaire. One-way ANOVA and chi-square tests were used to find relations between the frailty syndrome and QOL. RESULTS The percentages of respondents with pre-frail, frail, and non-frail status were 30.4%, 52.2%, and 17.4%, respectively. A decline in QOL scores of pre-frail and frail respondents was found for almost all QOL domains (physical, psychological and environment domains), except social relationships. The subdomains most influenced were “energy and fatigue” in the physical health domain, “thinking, learning, memory and concentration” in psychological health, and “opportunities for acquiring new information and skills” in the environment domain. CONCLUSIONS More than half of the nursing home elderly were frail and one-third were pre-frail. The main factor of frailty was weakness. The frailty syndrome in the elderly has a negative impact on QOL, especially in the physical health, psychological and environment domains in nursing home elderly.

229-237

Authors: Nawanto Agung Prastowo, Samuel Kristanto, Poppy Kristina Sasmita

Background Flavonoids have positive effects on health, including the nervous system. High flavonoid content can be found in chocolate, especially dark chocolate. Verbal working memory is important for reasoning, language comprehension, planning, and spatial processing. The purpose of this study was to evaluate the effect of a single dose of dark and white chocolate administration on verbal working memory in medical students. Methods A study of experimental pre-post test design with controls was conducted on 60 students. These were simply randomized into two groups: the first group was supplemented with white chocolate as control, and the second group received dark chocolate, at an identical single dose of 100 g. Working memory was measured with the digit span forwards (DSF) and the digit span backwards (DSB) tests, before, at 1 hour, and at 3 hours after intervention. Independent t and Mann-Whitney tests were used for data analysis. Results Scores for DSF and DSB in control and treatment groups were similar at baseline. At 1 hour after dark and white chocolate administration, DSF and DSB scores were not significantly different between the two groups (p=0.832; p=0.683). Supplementation of dark chocolate at 3 hours after intervention significantly increased DSB scores compared to white chocolate (p=0.041), but DSF scores were not significantly different between the two groups (p=0.204). Conclusions Dark chocolate as a single dose is capable of improving verbal working memory in students, 3 hours after its consumption. Since cocoa contains multiple bioactive compounds, one approach might be to examine the neurocognitive effects of combinations of potential functional ingredients.