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Journal Medical Journal of Indonesia

1,199 articles
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Yuliana Yuliana, Yenny Djuardi, Taniawati Supali
Medical Journal of Indonesia, Volume 27, pp 304-9; doi:10.13181/mji.v27i4.1935

Abstract:Background: The mass administration of anthelmintic such as albendazole is one of the strategies for eliminating soil-transmitted helminth (STH) infection. The widespread and long-term use of anthelmintics can cause resistance. The research on animals shows that factor that the single-nucleotide polymorphism (SNP) codon 200 β-tubulin gene of the worms is one of the factors that can cause the decreased efficacy of anthelmintics. This study aimed to determine the bases of codon 200 in A. lumbricoides and T. trichiura, which infect the people in Nangapanda, East Nusa Tenggara.Methods: The worm samples were obtained from the intestinal helminth-infected patients from Nangapanda Sub-district. The DNA from the worm tissues were isolated, amplificated by polymerase chain reaction (PCR), and sequenced. The sequencing results were aligned to the reference sequence to obtain the codon bases in the 200 β-tubulin gene.Results: TTC constitute the codon bases in the 200 β-tubulin gene found in two A. lumbricoides and one T. trichiura.Conclusion: The SNP codon 200 β-tubulin gene was absent in A. lumbricoides or T. trichiura worms that were examined in this study.
Putu A. Sekarningrum, Dyah K. Wati, Ign Made Suwarba, I Nyoman B. Hartawan, Dewi S. Mahalini, Ib Gede Suparyatha
Medical Journal of Indonesia, Volume 27, pp 244-9; doi:10.13181/mji.v27i4.2377

Abstract:Background: Mannitol 20% is used to treat patients with decreased consciousness and as the first line of treatment to reduce intracranial pressure (ICP). However, its application in pediatric patients is still based on minimal evidence. This study was performed to determine the predictive factors of clinical outcomes in pediatric patients with brain edema in the pediatric intensive care unit (PICU).Methods: This prospective cohort study was conducted in the PICU, Sanglah Hospital Denpasar, Bali, Indonesia. The subjects were chosen by consecutive sampling from July 2016 to July 2017. The primary outcome variable was the patient’s clinical outcome. A chi-square test was used to evaluate the association between the timing of mannitol administration and the patient’s clinical outcome. Multivariate analysis was performed on all variables with p≤0.25.Results: Forty-one patients were included in the study, 65% of them were male, 65% had good nutritional status, 90% had non-traumatic brain injury, and 73% had confirmed intracranial infection. The risk of sequelae or death for patients in a coma was 1.8 times greater than that of non-comatose patients (p=0.018; CI 95% 1.119–3.047). Based on the timing of mannitol administration from the onset of decreased consciousness, the risk of sequelae or death in patients who received mannitol after 24 hours was 2.1 times higher than that in patients who received mannitol within 24 hours (p=0.006; CI 95% 1.167–3.779). Based on multivariate analysis, only two variables were associated with the patient’s clinical outcome: pediatric Glasgow coma scale (PGCS) ≤3 (p=0.03) and timing of mannitol administration >24 hours (p=0.01).Conclusion: Early administration (<24 hours) of mannitol and high PGCS are related to favorable outcomes in patients with brain edema in the PICU.
Lucky A. Bawazier, Ignatius Stanley, Wicensius Sianipar, Suhardjono Suhardjono
Medical Journal of Indonesia, Volume 27, pp 271-8; doi:10.13181/mji.v27i4.2999

Abstract:Background: In Indonesia, chronic kidney disease (CKD) is primarily managed by hemodialysis (HD) because limited resources rule out the possibility of renal transplantation. HD patients are commonly accompanied by caregivers. However, most studies have neglected the health of caregivers, who play an important role in the survival of HD patients. This study aimed to determine the proportion of caregivers who suffer from anxiety and depression and the factors involved.Methods: This was a cross-sectional study involving 100 caregivers in the HD unit of Cipto Mangunkusumo Hospital, Jakarta. This study used the hospital anxiety depression scale (HADS) to determine the extent of anxiety and depression among caregivers. All caregivers were asked to fill out the questionnaire without assistance.Results: A total of 28% and 18% of caregivers were found to be anxious and depressed respectively. The caregiver’s relationship with the patient, whether the caregiver was being paid or unpaid, the total duration of care, and income were not associated with levels of anxiety and depression. However, the proportion of each 24-hour period spent on care was significantly associated with anxiety (p=0.037) and depression (p=0.015). The time spent on care every 24 hours was also a significant predictor of anxiety (p=<0.001) and depression (p=0.021).Conclusion: One-third of caregivers were found to be anxious and/or depressed. The time spent on care every 24 hours was a strong predictor of both anxiety and depression.
Fitri Muslim, Ratna Sitompul, Lukman Edwar
Medical Journal of Indonesia, Volume 27, pp 299-303; doi:10.13181/mji.v27i4.2007

Abstract:Acanthamoeba keratitis (AK) is a very rare, sight-threatening corneal disease caused by the infection of a free-living amoeba. The aim of this report was to demonstrate the challenges in the diagnosis of AK with an atypical presentation. Amniotic membrane transplantation (AMT) was done in this case to accelerate wound healing. A woman who frequently used contact lens came with redness and a whitish spot in her left eye 2 weeks before admission. There was a history of rinsing contact lens in tap water. The patient had already been on a topical steroid for 2 weeks. Visual acuity of the left eye was light perception with wrong projection. Examination of the left cornea showed a semi-circular central ulcer with a 5.8-mm area and 1/3 stromal depth. It is surrounded by a feathery-edge infiltrate with positive satellite lesions but without hypopyon. It was diagnosed as corneal ulcers due to mixed infection (bacteria and fungi). After 2 weeks of bacterial and fungal therapy, the size of the ulcer decreased, but the corneal infiltrate remained; therefore, an Acanthamoeba culture was done to determine the possibility of Acanthamoeba infection. Two weeks after the Acanthamoeba topical therapy, the visual acuity improved. AMT was performed to accelerate wound healing. Two months post-AMT, visual acuity improved to 1/60 with no conjunctival or ciliary vasodilation, and the ulcer was resolved. The patient was planned to undergo keratoplasty. The diagnosis of AK with an atypical presentation is challenging. AMT can be used as an alternative therapy to accelerate wound healing.
Iris Rengganis, Dirga S. Rambe, Cleopas M. Rumende, Murdani Abdullah
Medical Journal of Indonesia, Volume 27, pp 279-83; doi:10.13181/mji.v27i4.2910

Abstract:Background: Obesity with knee osteoarthritis (OA) is related to chronic pain causing physical inactivity that leads to decreased cardiorespiratory endurance and quality of life. Aquatic and land-based exercises are effective in improving physical activity. The aim of this study is to compare between aquatic and land-based exercise to improve cardiorespiratory endurance and quality of life in obese patients with knee osteoarthritis.Methods: A single-blind, randomized, controlled trial was conducted on thirty-three obese patients with knee OA who visited Obesity Clinic of Medical Rehabilitation Cipto Mangunkusumo Hospital, from October 2016 to January 2017, subjects were divided into aquatic or land-based exercise group. Aerobic and knee-strengthening exercises were given. Cardiorespiratory endurance was assessed using the Borg Scale, whereas both the BORG CR-10 and SF-36 questionnaires were used to assess quality of life.Results: After intervention, there were significant improvements in the land-based exercise group in the rating of perceived exertion (p=0.02), role limitations due to physical health (p=0.024), role limitations due to emotional problems (p=0.041), energy/fatigue (p=0.016), and the decline in pain (p=0.049) parameters. While in the aquatic exercise, there were significant improvements in leg fatigue (p=0.016), energy/fatigue (p=0.025), emotional well-being (p<0.001), and general health (p=0.045) parameters. Despite this, there were no significant differences between two groups regarding cardiorespiratory endurance and quality of life.Conclusion: This study found that patients could start aquatic exercise to reduce leg fatigue and enhance general health and energy. After that, exercise could be continued in land-based settings to improve cardiorespiratory endurance and quality of life.
Sultan A.M. Saghir, Amer A. Almaiman, Aishah K.A. Shatar, Norris Naim, Huda S. Baqir
Medical Journal of Indonesia, Volume 27, pp 250-5; doi:10.13181/mji.v27i4.2635

Abstract:Background: The fast and outpatient setting for a determination of the hemoglobin (Hb) level is a well-recognized prerequisite to detect anemia in blood donors. This study aimed to evaluate the performance of the HemoCue methods (HemoCue B-Hb and HemoCue-301) against Coulter LH-750 as a reference method for Hb determination.Methods: This study was an experimental cross-sectional study. It includes 455 blood samples that were collected from volunteer blood donors between January 15, 2010 and February 15, 2011. The performance of the three methods and their comparisons were assessed using the analysis of coefficients of variation (CV), linear regression, and mean difference. Correlation coefficient and Bland–Altman plots were drawn to compare the two HemoCue measurements and the automated cell analyzer against each other and to evaluate their results. The Hb concentrations were compared using the concordance correlation coefficient.Results: The findings exhibited that the CV for the three methods Coulter LH-750, HemoCue B-Hb, and HemoCue-301 were 0.60%, 0.72%, and 0.92%, respectively. A statistically significant difference was observed between the means of the Hb measurements for the three methods (p<0.001). The HemoCue B-Hb and HemoCue-301 methods showed the best agreement, and the Coulter LH-750 method gave a lower Hb value compared with the two HemoCue methods. The results showed a positive correlation of HemoCue Hb results compared with the reference method.Conclusion: All three methods provide a good agreement for Hb determination. The new device HemoCue-301 was found to be more accurate compared with HemoCue B-Hb and Coulter LH-750.
Citra Praditi, Ani R. Prijanti, Sri W.A. Jusman, Mohamad Sadikin
Medical Journal of Indonesia, Volume 27, pp 223-8; doi:10.13181/mji.v27i4.2152

Abstract:Background: Lymphocytes activated by immunization must increase their metabolism to meet the energy requirements for mitosis, differentiation, and protein synthesis, which may subject the cell to conditions of relative hypoxia and oxidative stress. This study was conducted to investigate the increase in the levels of transcription factors involved in both conditions.Methods: Male Balb/c mice were divided into the following four groups, each consisting of six animals: the control and three experimental groups. The experimental groups were immunized by injection of 0.2 ml of 2% sheep red blood cells (SRBC) suspended in phosphate-buffered saline (PBS). Lymphocytes were harvested from the spleens of each group at time intervals of 24-, 48-, and 72-h post-immunization. The buffy coat from splenocytes was separated using Ficoll Histopaque as the medium. The lymphocytes were separated from adherent cells by incubating the purified splenocytes in microtubes for 2-h. Cells were lysed by three freeze–thaw cycles (−80°C and 37°C) and used to analyze the levels of HIF-1α and HIF-2α (mRNA and protein), Nrf2 (protein), and glutathione peroxidase (GPx) activity.Results: The treatment caused an increase in GPx activity and HIF-1α protein concentration 24-h post-immunization, whereas the HIF-1α mRNA levels remained static. Elevated Nrf2 protein levels were detected within 48-h after treatment. Meanwhile, the HIF-2α mRNA and protein levels increased within72-h after immunization.Conclusion: Immunization with SRBC suspension induced relative hypoxia, elevated reactive oxygen species (ROS), and oxidative stress in the lymphocytes as indicated by the increase in both HIF-1α and HIF-2α protein and mRNA levels, GPx activity, and Nrf2 protein levels.
Nafrialdi Nafrialdi, Novita M. Handini, Instiaty Instiaty, Ika P. Wijaya
Medical Journal of Indonesia, Volume 27, pp 262-70; doi:10.13181/mji.v27i4.3024

Abstract:Background: Dual antiplatelet therapy (DAPT) using either an aspirin–clopidogrel (A–C) combination or aspirin–ticagrelor (A–T) combination has become the standard therapy for acute coronary syndrome (ACS). Ticagrelor shows better pharmacokinetic profiles but is more expensive. This study aimed to compare cost-effectiveness and safety profiles of A–C versus A–T in patients with ACS.Methods: This was a retrospective cohort study of ACS patient at the Cipto Mangunkusumo Hospital between 2014 and 2016. ACS patients treated for the first time with A–T or A–C were included. Occurrence of major adverse cardiovascular events (MACE) within 3, 6, 9, and 12 months were used as effectiveness outcomes, while safety outcomes were measured based on the incidence of adverse drug reactions (major and minor bleeding, dyspnea, and hyperuricemia). Cost-effectiveness analysis was presented as incremental cost-effectiveness ratio (ICER).Results: Data records obtained from 123 ACS patients treated with A–C and 57 ACS patients treated with A–T were evaluated. Within the first three months, the MACE rate was 15.8% in the A–T group and 31.7% in the A–C group (RR: 0.498, 95% CI: 0.259–0.957, p=0.039). There was no statistically significant difference observed in the number of MACE between groups after 6, 9, and 12 months. The A–T group had a higher incidence of major bleeding (melena) than the A–C group (5.3% vs 1.62%, p=0.681), especially in geriatric patients. Minor bleeding was observed in three patients of the A–C group, but in none of the patients in the A–T group. The cost of ICER was IDR 279,438, indicating the additional cost needed for avoiding MACE within 3 months, if A–T was used.Conclusion: The aspirin–ticagrelor combination is a clinically superior and cost-effective option for MACE prevention among ACS patients, especially during the first three months of DAPT, with a slight but not significantly higher major bleeding risk when compared to the aspirin–clopidogrel combination.
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