Indonesian Journal of Biomedicine and Clinical Sciences

Chemopreventive effect of dayak onion [Eleutherine bulbosa, Mill. (Urb)] against 7,12-dimethylbenz [α] anthracene (DMBA)-induced breast cancer in rats: study on cancer antigen 15-3 (CA 15-3)

2024-08-26T10:21:13+07:00

Dayak onion [Eleutherine bulbosa, Mill. (Urb)] is herbal plant believed to have anticancer effects. It contains triterpenoids, flavonoids, anthraquinones, and naphthoquinones which have antioxidants and anticancer activities. This study aimed to investigate the effect of ethanolic extract of dayak onion bulb (EEDO) on serum cancer antigen 15-3 (CA 15-3) levels in rats induced with 7,12-dimethylbenz [a] anthracene (DMBA). Thirty female Sprague Dawley rats were randomly divided into six groups, namely Normal Group, Positive Control Group (tamoxifen), Negative Control Group (dimethyl sulfoxide/DMSO) 5%), Treatment Group I (EEDO 180 mg/kgBW), Treatment Group II (EEDO 360 mg/kgBW) and Treatment Group III (EEDO 720 mg/kgBW). All groups, except the normal group, were induced with DMBA 20 mg/kg body weight. Serum CA 15-3 levels were determined using enzyme-linked immunosorbent assay (ELISA) method. The results showed significantly lower (p< 0.05) CA 15-3 levels in the Treatment Groups compared to the Negative Control Group. The most significant reduction in serum CA 15-3 level was observed in the Treatment Group I receiving EEDO at a dose of 180 mg/kgBW. In conclusion, the EEDO possesses a chemopreventive effect on DMBA-induced breast cancer in rats.

EGFR mutation based on lung laterality in adenocarcinoma type of non-small cell lung cancer

2024-09-02T10:56:41+07:00

Targeted therapies have shown promise in improving survival rates for lung adenocarcinoma, a common and deadly malignancy. EGFR-targeting tyrosine kinase inhibitors (TKIs) are particularly effective among these therapies in cases with EGFR mutations. Detecting these mutations before TKI treatment is essential. Various radiological features have been linked to EGFR mutations. However, the relationship between tumor location and mutation types in Indonesian lung adenocarcinoma patients remains unexplored. This study aimed to identify the frequency of EGFR mutation in local lung adenocarcinoma cases based on the tumor location. Clinical data of lung adenocarcinoma patients (n = 272) diagnosed between 2018 and 2022 were retrospectively taken from the Department of Anatomical Pathology, Dr. Sardjito General Hospital, Yogyakarta. The qRT-PCR data of EGFR mutation status was obtained from the Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta. Descriptive analysis was performed using STATA version 14.0. EGFR mutations were found in 60.7% of patients, with 58.2% having exon 19 mutations and 21.2% exhibiting exon 21 L858R mutations. Mutation status was found to be significantly different based on the patient's gender (p = 0.022) and age (p = 0.029) but not with lung laterality (p = 0.093). The proportion of exon 19, exon 21 L858R, and uncommon mutations in the right and left lung adenocarcinoma was similar across all samples. This study found no difference between specific EGFR mutation types and tumor location in lung adenocarcinoma.

C-reactive protein (CRP) and lactate dehydrogenase (LDH) as functional outcome predictors in stroke patients

2024-09-02T10:59:28+07:00

Stroke is a neurologic disorder with high mortality and disability. Its pathophysiology is associated with vascular inflammation. However, studies between vascular inflammatory markers and stroke outcomes are still limited. This study aimed to investigate the association between inflammatory markers and functional outcomes of stroke. This was a retrospective cohort study involving all stroke patients at the Dr. Sardjito General Hospital, Yogyakarta from October 2020 to August 2021 who meet the inclusion and exclusion criteria. Mann-Whitney was used for bivariate analysis, followed by multivariate analysis. A total of 269 subjects, with 213 infarcts (79.2%) and 56 hemorrhagic (20.8%) strokes. There were 83 subjects deceased (30.9%), with 66 infarct (31%) and 17 hemorrhagic (30.4%) strokes. High CRP levels had significant and independent associations with worse GCS, ADL, IADL, NIHSS, BI, SSGM, MRS, and higher mortality rates (p < 0.05). High LDH levels had a significant and independent association with worse GCS scores and higher mortality rates (p < 0.05). Sub-analysis showed high CRP and LDH had associations with high mortality rates in infarct (p < 0.001), but only CRP (p = 0.029) had associations with high mortality rates in hemorrhagic. There was no significant association between fibrinogen and procalcitonin with stroke outcomes (p > 0.05). Cox-regression analysis showed CRP>24.5 mg/dL and LDH >300U/L associated with hazard ratios of 3.2 (p < 0.001) and 1.65 (p = 0.026). In conclusion. high CRP and LDH levels are associated with mortality rates in stroke patients.

Health comorbidities in children with down syndrome (DS) at Dr. Sardjito General Hospital, Yogyakarta

2024-09-02T10:58:36+07:00

Down syndrome (DS) is a disease caused by trisomy of chromosome 21. The phenotype in DS leads to manifestations in several organ systems. This study aimed to identify the pattern of comorbidities in DS patients. It was a single-center, cross-sectional study at Dr. Sardjito General Hospital, Yogyakarta. Medical records of pediatric patients with DS from a period of January 2022 to May 2023 were included. Descriptive analysis was performed to demonstrate demographic and clinical characteristics. A total of 355 pediatric patients with DS were found at Dr. Sardjito General Hospital and the majority were male (196 children or 55.2%). As much as 339 children (95.49%) had comorbidities. The highest comorbidity was congenital heart disease (230 patients or 67.84%) in specifics were atrial septal defect (41 patients or 12.39%), atrioventricular septal defect (29 patients or 8.17%), and patent ductus arteriosus (28 patients or 7.88%). The second highest comorbidity was endocrine system disorders (102 patients or 30.09%), with 100 patients (28.16%) children suffering hypothyroidism. The number of children who had one comorbidity was 248 patients (69.86%), 74 patients (20.48%) had two comorbidities, and 17 patients (4.79%) had three or more comorbidities. The highest co-prevalence of the two comorbidities was congenital heart disease and endocrine system disorders (36 patients or 10.14%). The highest co-prevalence of 3 or more comorbidities was a combination of congenital heart disease, visual impairment, and hearing impairment (6 patients or 1.69%). In conclusion, 95.49% of children with DS have comorbidities. The most common comorbidity was heart defects. About 25.63% of patients had more than one comorbidity. Children with DS who have comorbidities require more attention to prevent complications and to reduce morbidity.

Effects of garlic tablet (GARLET) in combination with telmisartan on high blood pressure

2024-09-03T09:19:02+07:00

Hypertension (HTN) is a health problem worldwide affecting tens of millions of people. Giving modern antihypertensive alone is not enough to cure this disease. Garlic has been used to treat and cure various diseases, including high blood pressure (BP). This study aims to evaluate the effectiveness of administering telmisartan with garlic in reducing BP. In this study, 96 people with mild to moderate HTN were randomly selected and assigned to three groups consisting of 32 subjects; each participant in the garlic group received 400mg BD, the telmisartan group received 20mg OD, and the mixed group received 400 mg garlic BD and 20mg telmisartan OD for 8 wk of treatment. Blood pressure was measured at the beginning of each week, as well as on the closing day of the 8 wk. Combining telmisartan with garlic is more effective in reducing systolic blood pressure/SBP (113.0±22.9 mmHg) compared to telmisartan (147.7±4.6 mmHg; p=0.015) and diastolic blood pressure/DBP (71.0±21.2 mmHg vs 90.75±11.9 mmHg; p=0.038) during 8 wk of treatment in hypertensive patients. No significant side effects were identified during the treatment period. In conclusion, garlic, like other BP control pills, increases the effectiveness of chemical pills to lower SBP and DBP.

The profile of bacteria isolated from urine culture of adults with urinary tract infection in Yogyakarta 2007-2022

2024-09-02T11:08:09+07:00

Local data regarding antimicrobial susceptibility patterns of bacteria from urine culture is limited in Indonesia, particularly in Yogyakarta. This study was conducted to provide epidemiology data of bacteria and their resistance profile, including the profile of bacteria that producing extended-spectrum beta-lactamase (ESBL) and carbapenemase in the urine of patients with urinary tract infection (UTI) in Yogyakarta. A descriptive retrospective study was conducted by assessing laboratory records of urine culture from adult patients at the Microbiology Laboratory, Department of Microbiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta between 2007 and 2022. Of the 842 urine cultures, 464 (55.11%) isolates were recovered. Among thisolates, 50 (10.78%) were fungi, 67 (14.44%) were Gram-positive bacteria, and 347 (74.78%) were Gram-negative bacteria. Enterococcus sp. (41 (61.19%)) was the most bacteria found in the Gram-positive bacteria group, while Escherichia coli (38.90%) were the most bacteria found in the Gram-negative bacteria group. This study also identified Gram-negative bacteria producing ESBL enzymes (58.70%) and carbapenemases (27.94%). Gram-negative bacteria are the most common bacteria found in urine cultures of adult UTI patients in Yogyakarta, and the resistance profile of these bacteria is concerning.

Characteristics, management, and major adverse cardiac events of ST-elevation myocardial infarction (STEMI) patients in rural area: a Jember acute coronary syndrome medical records study

2024-09-02T11:12:21+07:00

The mortality and morbidity of ST-elevation myocardial infarction (STEMI) remain high, and it is still the leading cause of death worldwide. Timely reperfusion lowers the risk of MACE and improves survival. However, reperfusion delay is still a significant issue in developing countries, particularly rural area. This study aimed to determine the characteristics, management, and major adverse cardiac events of STEMI patients in Jember Distric to enhance reperfusion therapy in rural areas. It was an analytical observational cross-sectional study with a quantitative method. A total of 108 medical records of STEMI patients of the Dr. Soebandi District Hospital, Jember in period of 2019 to 2020 were included using the consecutive sampling technique. As much as 78 (62%) of the patients did not receive reperfusion therapy while the remaining patients (41 or 38%) received the therapy, namely percutaneous coronary intervention (20 or 18.5%), fibrinolytic therapy (19 or 17.6%), and both (2 or 1.9%). Multivariate analysis for reperfusion was statistically significant (p=0.016; OR 3.688 95% CI: 1.274-10.679). The level of education, health funding, and distance to the hospital did not affect the delay of the reperfusion therapy. Reperfusion was highly associated with the incidence of MACE and this study discovered a threefold benefit of reperfusion in lowering the occurrence of MACE (p=0.016). In conclusion, the majority of STEMI patients does not get reperfusion therapy. Delays in reperfusion treatment are not related to the patient's level of education, health funding, or distance to the hospital. Nonetheless, the delay my be attributed to the Jember community's lack of awareness of STEMI symptoms.

The development and use of artificial intelligence (AI) in dermatology: a narrative review

2024-08-29T11:07:05+07:00

Artificial intelligence (AI) is defined as a computer science involving program development aiming to reproduce human cognition to analyze complex data. Artificial intelligence has rapidly developed in the medical field. In dermatology, its development is relatively new and is generally used in the diagnostic, especially for skin imaging analysis and classification, and also for risk assessment. The greatest advances have been primarily in the diagnosis of melanoma, followed by the assessment of psoriasis, ulcers, and various other skin diseases. The use of AI has shown good accuracy and is comparable to dermatologists in various studies, especially related to melanoma and skin tumors. However, several obstacles exist in the application of AI to daily clinical practice, including generalizability, image standardization, the need for large data quantities, and legal and privacy aspects. In current developments, AI should be aimed at helping enhance the decision-making of clinicians.

Autoimmune manifestation in splenic atrophy presented with toxic shock syndrome: a case report

2024-09-02T15:07:23+07:00

Splenic atrophy is an uncommon diagnosis, associated with autoimmune gastrointestinal disorders and other well-characterized connective tissue diseases. We would like to contribute a case report to support the association evidence of the real-world data. To our best knowledge, there is no similar case of splenic atrophy with the presentation of streptococcal toxic shock syndrome reported. Our patient was initially detected with atrophic spleen via CT scan and subsequently diagnosed with systemic sclerosis. Hyposplenism should be suspected in patients with adult-onset infections caused by encapsulated bacteria, especially if autoantibodies are present. Our patient received her pneumococcal vaccination before discharge and was followed in the clinic for further vaccination education and health check-up. Learning points: 1) Acquired splenic atrophy is a rare condition that may be suspected from persistent isolated thrombocytosis after the resolution of sepsis and Howell-Jolly bodies from peripheral blood film; 2) The pathophysiological mechanism of splenic atrophy in the context of autoimmune disorders remains unknown; 3) A high index of suspicion towards the evaluation of splenic function is required if a patient presented with community-acquired encapsulated organism bacteraemia; 4) Vaccination against encapsulated bacterial agents should be performed in patients with hyposplenism.

Juvenile ossifying fibroma accompanied with low-grade central osteosarcoma in sinonasal: a rare case report

2024-09-02T11:13:41+07:00

Sinonasal osteosarcoma is comparatively rare and accounts for 6.5% of all osteosarcomas. The five-year survival rate is less than 25% and may be improved to 60% when chemotherapy is initiated earlier. The diagnosis of low-grade central osteosarcoma requires a meticulous histopathological examination because histopathologically the tumor may mimic fibro-osseus neoplasm. We report a 12 y.o. male patient who complained of a lump on the face for 4 yr with symptoms of nasal discharge, congestion, epistaxis, and a feeling of fullness in the ears. Sinonasal biopsy was later performed and revealed an inverted papilloma. Two months after the biopsy procedure, mass extirpation and medial maxillectomy were performed. Histopathology examination confirms the diagnosis of ossifying fibroma accompanied by low-grade central osteosarcoma. Low-grade central osteosarcoma is an exceptionally rare variant, and the diagnosis is occasionally difficult. It can be misdiagnosed as a benign lesion, especially fibrous dysplasia or ossifying fibroma. Histomorphological, the discovery of atypical tumor cells producing osteoid matrix can be used to confirm that the lesion is a malignant lesion of low-grade central osteosarcoma. As demonstrated in our case, the tumor can consist of a trabecular and curvilinear arrangement of immature bone, at the edges of which there is an osteoblastic rimming appearance with a background of connective tissue stroma which is a histopathological feature of ossifying fibroma.

Differences in the clinical presentations of anti-NMDAR (anti-N-methyl-D-aspartate receptor) encephalitis with status epilepticus: a retrospective case series

2024-09-02T11:14:08+07:00

Literature on anti-NMDAR (anti-N-methyl-D-aspartate receptor) encephalitis is limited in developing countries, including Indonesia. This retrospective observational case series explored the impact of early diagnosis and treatment on patient outcomes in four distinct cases of anti-NMDAR encephalitis with status epilepticus, and other related conditions, of patients referred to Dr. Sardjito General Hospital, Yogyakarta. Clinical data from May 2021 to August 2023 were collected through the review of medical records, encompassing demographic information, clinical presentation, history, laboratory results, imaging studies, EEG reports, interventions, and the progression of the disease. Four cases were reported, three of whom were diagnosed with anti-NMDAR and one with bacterial encephalitis, each presenting a variety of neuropsychiatric clinical symptoms, leading to hospitalization, extensive testing, and interventions to establish the definitive diagnosis. Cases 1 and 4 have a childhood history of seizures. The cases analyzed factors including the impact of childhood versus adulthood onset and the adherence to taking medicine regularly leading to exacerbation symptoms and relapses. Distinguishing anti-NMDAR encephalitis from related conditions, such as bacterial encephalitis, was further complicated in patients with varied neuropsychiatric presentations (seizures, hallucinations, irritable behavior, headaches) and responses to the treatment. Supporting investigation finds positive NMDAR testing and abnormal CT, MRI, and EEG results, contributed to definitive diagnoses. It could be concluded that comprehensive diagnostic investigations are important for prompt recognition of clinical characteristics, and early initiation of immunomodulatory therapy in managing anti-NMDAR encephalitis and related conditions in Yogyakarta, Indonesia.