Medical Journal of Indonesia

Taking stance against the challenges of communicable diseases and antimicrobial resistance

Hans-Joachim Freisleben — 2019-10-04

[None]

Soybean extract increases telomerase reverse transcriptase protein expression in pancreatic β-cells of diabetes mellitus-induced rats

Muhammad Samsul Mustofa — 2019-10-04

BACKGROUND A number of studies on the benefits of soybean (Glycine max (L.) Merr) in the treatment of diabetes mellitus (DM) have already been conducted; however, the effects of soybean extracts on telomerase reverse transcriptase (TERT) expression in improving telomerase activity in pancreatic cells is currently unknown. This study was aimed to evaluate the effects of soybean extracts on TERT protein expression in the pancreatic β-cells of rats with DM.

METHODS Sixty male Sprague-Dawley rats were randomly divided into six groups: (1) negative control (N); (2) DM rats induced by alloxan (DMA); (3) DM rats with glibenclamide (DMG; positive control); (4) DM rats with 1 mg/kgBW/day soybean extract (DM1E); (5) DM rats with 5 mg/kgBW/day soybean extract (DM5E); (6) DM rats with 25 mg/kgBW/day soybean extract (DM25E). The treatments were carried out over 28 days. The measured variables included fasting blood glucose (FBG) level, TERT protein expression, and the number of pancreatic β-cells.

RESULTS All parameters were measured against the diabetes control group. The FBG levels in rats DM1E, DM5E, and DM25E were significantly reduced on the 28th day (p < 0.05). TERT protein expression and the number of pancreatic β-cells (DM25E) also showed significant improvements compared to DM rats (p < 0.05).

CONCLUSIONS Soybean extracts can increase TERT protein expression in pancreatic β-cells in diabetes-induced rats.

Comparison of intravitreal antifungal 100 μg voriconazole and 5 μg amphotericin B in experimental Aspergillus flavus endophthalmitis model in rabbits

Alia Arianti — 2019-10-04

BACKGROUND Fungal endophthalmitis is a sight-threatening disease associated with high morbidity and Aspergillus sp. is the most common causes. Voriconazole (VCZ) and Amphotericin B (AmB) are the most used antifungal drugs, while head-to-head comparison for in vivo intravitreal efficacy is still unknown. This study was aimed to compare the efficacy of both agents against Aspergillus flavus.

METHODS A randomized, masked, controlled-experimental study was conducted on 15 albino New Zealand white rabbits. Endophthalmitis was induced by intravitreal inoculation of Aspergillus flavus. Intravitreal injection was given 24 hours post-inoculation, the rabbits were divided into three groups; 100 μg/0.1 ml VCZ intravitreal injection, 5 μg/0.1 ml AmB, and control. Clinical evaluation of corneal opacity, aqueous cells and flare, and vitreous opacity using Yang’s method of quantification were performed at day 1, 3, 5, 7, and 10 after treatment. Mycology quantitative analysis and histopathological examination were performed at the final evaluation.

RESULTS Clinical evaluation showed improvement of inflammation in the VCZ and AmB treatment groups (Δ score −2.1 [2.8] and −1.0 [3.2]) compared with the control group (Δ score 0.8 [3.1]). Although the VCZ group demonstrated a better clinical response with less inflammation and relatively intact retina structures in the histopathology result. Number of fungal colony was significantly less in AmB group (CFU/0.1 ml, p < 0.05).

CONCLUSIONS Favorable clinical improvement was shown in VCZ group compared to AmB group. Intravitreal VCZ showed a better clinical response tendency for Aspergillus flavus-induced endophthalmitis in rabbits.

The effects of intensity and duration of aerobic exercise on spatial memory function in male Wistar rats

Neng Tine Kartinah — 2019-10-04

BACKGROUND Memory is a vital function of the brain. Aerobic exercise has a positive effect on memory’s function, but the appropriate combination of intensity and duration of aerobic exercise is still unknown. This study was aimed to investigate the effect of optimum combinations of intensity and duration of aerobic exercise on spatial memory function.

METHODS In this study, the authors performed in vivo experiment using 20 male Wistar rats (6-month-old). They were randomly divided into four groups: (1) low-intensity and short duration aerobic exercise group (L–S); (2) low-intensity and long duration aerobic exercise group (L–L); (3) high-intensity and short duration aerobic exercise group (H– S); and (4) high-intensity and long duration aerobic exercise group (H–L). The aerobic exercise treatment of each group was conducted for three weeks with a frequency of five days a week. The memory function was assessed with the help of water-E-maze on week 0, 1, 2, and 3 (a total of four times).

RESULTS This study indicates that the central nervous system responds to aerobic exercise as an external stimulus differently depending on the combinations of intensity and duration. Moreover, this study demonstrates that changes in memory functions are best observed in the group with low-intensity and long duration aerobic exercise.

CONCLUSIONS The combination of low-intensity and long duration of aerobic exercise for animal study can improve spatial memory functions better than any other combinations of intensity and duration of aerobic exercises in male Wistar rats.

Aerobic exercise combined with environmental enrichment improves spatial memory and enhances neuroligin 1 expression: an animal study

Faizah Abdullah Djawas — 2019-10-04

BACKGROUND Numerous studies have revealed that aerobic exercise (AE) or environmental enrichment (EE) exert positive effects on the molecular, cellular, and structural changes responsible for functional plasticity. Therefore, this study was aimed to investigate whether the combination of AE and EE yields a greater effect on spatial memory and increases the expression of the adhesion molecule neuroligin 1 compared with either of the therapies alone.

METHODS Twenty 6-month-old male Wistar rats were randomly divided into four groups: (1) the control group (C), (2) the AE group, (3) the EE group, and (4) the AE-EE group. Escape latency in a Water-E-maze (WEM) task was used as a parameter to assess spatial memory function. Neuroligin 1 protein expression was examined via the immunohistochemistry (IHC) technique followed by IHC optical density (OD) score analysis of the CA1 hippocampal region.

RESULTS Data acquired from the WEM task show that escape latency progressively decreased over time in all groups. However, animals in the AE-EE group required less time to complete the task compared with those in the control, AE, and EE groups. IHC OD scores revealed that the combination of AE and EE caused the highest expression of neuroligin 1 in the CA1 hippocampal region among the therapies studied. Statistical analysis indicated significant differences in OD score between the AE-EE and control, AE, and EE groups (p ≤ 0.001).

CONCLUSIONS The combination of AE and EE rats increased neuroligin 1 expression and improved the spatial memory of male Wistar rats compared with application of either therapy alone.

Gluthathione S-transferase-resuscitation-promoting factor B recombinant protein of Mycobacterium tuberculosis induces the production of interferon-γ and interleukin-12 in mice splenocytes

Andriansjah Rukmana — 2019-10-04

BACKGROUND As the only TB vaccine available, Bacillus Calmette-Guérin shows variable efficacy in adults and does not provide protection against the resuscitation of latent TB infections. Resuscitation-promoting factor B (RpfB) is a protein produced by Mycobacterium tuberculosis during the resuscitation phase and is promising as a novel TB vaccine. This study was aimed to analyze the immunogenicity of the gluthathione S-transferase (GST)-RpfB recombinant protein on mice splenocytes in vitro.

METHODS After induction with isopropyl β-D-1-thiogalactopyranoside, the protein was extracted by sonication followed by solubilization in 8 M urea buffer. Protein was then re-natured and purified with a GST chromatography column. The isolated protein was confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot using anti-GST antibodies, and its concentration was determined using the Bradford method. Each group of splenocytes was treated with 25 μg/ ml of the recombinant protein (GST-RpfB), GST, and phytohemagglutinin. Antigen induction was repeated twice at 24 and 72 hours. The supernatant was collected at 96 hours and interferon gamma (IFNγ), interleukin (IL-12, IL-4, and IL-10) levels were measured with enzyme-linked immunosorbent assays.

RESULTS GST-RpfB recombinant proteins were expressed in the form of inclusion bodies with a molecular weight of approximately 66 kDa. Based on the independent t-test, GST-RpfB stimulated IFNγ and IL-12 production but not IL-4 and IL-10.

CONCLUSIONS The GST-RpfB protein has been immunogenically proven and is a potential candidate as a novel subunit TB vaccine.

Acupoint-catgut embedment combined with medication does not decrease interleukin-6 levels serum in patients with gastroesophageal reflux disease: a randomized controlled clinical trial

Andalia Fitri — 2019-10-04

BACKGROUND Gastroesophageal reflux disease (GERD) is a pathological condition caused by the reflux of stomach contents into the esophagus. GERD is a multifactorial disorder with an increase in prevalence worldwide. Interleukin-6 (IL-6) is a proinflammatory cytokine that is commonly found in the esophageal mucosa of GERD patients and associated with esophageal motor disorders. Acupoint-catgut embedment has long been known as adjunctive therapy for GERD. This study was aimed to establish the effect of acupoint-catgut embedment combined with medication on the IL-6 serum levels of patients with GERD.

METHODS This single-blind randomized controlled trial involved 40 GERD patients from the Gastroenterology Outpatient Clinic of Cipto Mangunkusumo Hospital that were randomly allocated to either catgut-embedding therapy plus medication or sham acupuncture with medication. Catgut-embedding therapy was given two times at CV12 (Zhongwan), ST36 (Zusanli), and BL21 (Weishu) every 15 days. Serum levels of IL-6 were measured by enzyme-linked immunosorbent assay as research output.

RESULTS There were no significant differences in the baseline levels of proinflammatory (IL-6) mediators between the groups. After 1-month treatment, the median levels of IL-6 were statistically insignificant decreased in catgut-embedding therapy plus medication versus sham acupuncture with medication (0.15 versus -0.16 pg/ml, respectively; p = 0.14).

CONCLUSIONS The results suggest that catgut-embedding therapy has not been proven to statistically influence the levels of IL-6 in patients with GERD.

Role of platelet-rich fibrin in enhancing the viability of autologous microlobular fat graft: an animal-based experimental study

Trimartani Koento — 2019-10-04

BACKGROUND Tissue fat has been used as a fat graft in plastic reconstructive surgery since ancient times by surgeons. However, an issue with this usage is that fat gets absorbed by up to 30–50%, especially centrifuged fats. The aim of this study was to compare the survival of microlobular fat, centrifuged fat, microlobular fat with plateletrich fibrin (PRF), and centrifuged fat with PRF.

METHODS Subcutaneous fat was taken from the stomach area and divided into two parts, microlobular fat and centrifuged fat, and processed by adding PRF as follows: 1) microlobular fat without PRF; 2) microlobular fat with PRF; 3) centrifuged fat without PRF; and 4) centrifuged with PRF. These fat grafts were implanted into rabbit earlobes. Each procedure was performed repeatedly nine times for a total of 36 repetitions for all groups.

RESULTS Microscopic evaluation revealed the highest number of adipocytes in the microlobular fat with PRF group (mean = 1,932) and the highest number of fibroblasts (mean = 600.5) compared to those in other treatment groups, although the difference was not statistically significant. There was more neovascularization in the microlobular fat group (mean = 228.5), but it was not statistically significant.

CONCLUSIONS Addition of PRF to microlobular fat graft enhances the number of adipocytes and fibroblasts, including the enhancement of neovascularization.

Prevalence of methicillin-resistant Staphylococcus aureus and other pathogens in pus samples of orthopedic department at a tertiary care hospital in Pakistan

Ashfaq Ahmed — 2019-10-04

BACKGROUND Orthopedic infections are difficult to manage. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most dangerous and harmful bacteria and is difficult to eradicate because of its changing strains as well as sensitivity to different antibiotics. The main aim of this study was to determine the prevalence of pathogens, especially MRSA, associated with orthopedic wounds and their sensitivity to different antibiotics.

METHODS A prospective study was conducted from September 2015 to August 2016. Pus samples of 1,350 patients who presented at the out-patient department or admitted with a wound infection after an orthopedic intervention were taken with the help of culture swab and were sent for culture and sensitivity according to hospital protocol. Data analyses were made using the SPSS software, version 17 (IBM).

RESULTS Adults aged between 15 and 30 years were most affected, with 444 (32.9%) cases. Of the patients, 268 (19.9%) had negative cultures. Among the patients with positive cultures, the gram-positive cocci and gram-negative rods were 497 (36.8%) and 377 (27.9%), respectively. The most common pathogen was MRSA (240; 17.8%), followed by Escherichia coli and methicillin-sensitive S. aureus.

CONCLUSIONS Multiple pathogens are involved in patients having an orthopedic surgical intervention. The high occurrence of MRSA and E. coli has an increasing economic burden on patients because of these pathogens high resistance to antibiotics. Thus, proper preventive measures should be done to decrease the occurrence of such infections as well as their associated morbidity.

Intravitreal anti-vascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study

Widya Artini — 2019-10-04

BACKGROUND The aim of this study was to determine the levels of vascular endothelial growth factor (VEGF) in the aqueous humor and the effect of intravitreal anti-VEGF injection combined with panretinal photocoagulation (PRP) on the management in diabetes mellitus (DM) patients with neovascular glaucoma (NVG).

METHODS This study was a prospective, interventional study in DM patients with NVG. Paracentesis followed by intravitreal bevacizumab (IVB) injection was performed in all eyes. The concentration of VEGF obtained from paracentesis was measured. In week-1, the intraocular pressure (IOP), sectorial iris neovascularization (NVI), and visual acuity were documented, and management was continued with PRP laser over a period of 1 week. All parameters and additional interventions performed after PRP were also recorded.

RESULTS A total of 18 eyes from 17 patients were studied. The mean (SD) level of VEGF in the aqueous humor was 3,864 (1,468) pg/ml, and the mean (SD) of initial IOP was 39 (10.2) mmHg. There was a significant reduction in IOP in week-1 after the first intervention to 24.4 (8.0) mmHg (p = 0.001); however, at 2 weeks the IOP increased to 30.4 (6.7) mmHg. NVI showed significant regression in week-1 after IVB combined with PRP laser (p < 0.05). All eyes required additional glaucoma implants (14 eyes) and cyclocryotheraphy (4 eyes).

CONCLUSIONS In the eyes of diabetes patients with NVG, VEGF levels were high. With the use of IVB, the IOP was reduced, and NVI regressed; however, due to the severe stages of disease, all eyes required glaucoma surgery.

Cranberries for women with recurrent urinary tract infection: a meta-analysis

Made Parulian Tambunan — 2019-10-04

BACKGROUND Cranberries are the most widely used nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI) in women; however, their efficacy still remains uncertain. Hence, this meta-analysis was aimed to assess the effectiveness, safety, and adherence of cranberry as a prophylactic drug for treating rUTI.

METHODS Literature search was conducted using PubMed, EBSCO, Science Direct, Scopus, Cochrane, and Google Scholar. Studies were screened for duplication, inclusion and exclusion criteria, and then reviewed by two authors independently. This included all randomized controlled trials of cranberry derivatives versus placebo and antibiotic prophylaxis. Cochrane risk-of-bias assessment tools were used to evaluate the quality of the study. Quantitative analysis was performed using the Review Manager 5.0 software.

RESULTS Nine studies were included. Among 1,542 participants, cranberry consumption reduced incidence of rUTI in women compared with placebo (p = 0.02). The subgroup analysis revealed that only cranberry capsules were superior to placebo (relative risk [RR] = 0.67, 95% confidence interval [CI] = 0.45–0.98), but not for cranberry juice (RR = 0.85, 95% CI: 0.7–1.04). Antibiotics had better outcome than cranberry for rUTI (RR = 0.83, 95% CI = 0.70–0.98). Most of the participants experienced minor adverse events such as rash and gastrointestinal symptoms. There was also a good adherence rate, ranging from 90.3–99% monthly dose.

CONCLUSIONS Cranberry, especially cranberry capsule consumption, had a significant effect in reducing the incidence of rUTI compared with placebo, with good adherence rates, and minor adverse events. In contrast, although antibiotic use had a greater efficacy, it was associated with a higher risk of severe adverse events.

A case of nonalcoholic Wernicke’s encephalopathy due to an extreme diet based on magnetic resonance imaging features

Julius July — 2019-10-04

Wernicke’s encephalopathy is a rare occurrence in Indonesia because alcohol consumption is very low. However, in Indonesia, Wernicke’s encephalopathy could be triggered by an inadequate intake of thiamine (vitamin B1) due to an extreme diet for several months. It is a case of a 31-year-old male, who presented to the emergency room with a decreased level of consciousness. According to the family, for the last few weeks, he has become less responsive and less attentive. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) revealed a unique picture with symmetrical lesions in the bilateral medial thalamus, mammillary bodies, periaqueductal gray matter, and the dorsal surface of the medulla oblongata. Clinically, there is no neck stiffness and no fever. The laboratory results from the blood and cerebrospinal fluid have ruled out meningitis. Treatment with thiamine 200 mg t.i.d. has shown an excellent response and significant clinical improvement. The earlier thiamine substitution treatment is started, the better the outcome because thiamine will prevent further injury to the brain and enhance recovery.

Double-J stents forgotten for four years: a case report

Johannes Cansius Prihadi — 2019-10-04

Placement of double-J ureteral stents after endourologic procedures and some open urological surgeries are practical and safe. However, when neglected in situ, undesired problems may occur, leading to serious medical and legal issues. Complications from ureteral stents with protracted indwelling durations include urosepsis, renal failure, encrustation, and spontaneous fractures which may be retained or voided in the urine (stenturia). We report a 40-year-old woman of forgotten double-J ureteral stents, inserted 4 years prior to this study during a gynecologic operation. The patient had pulled out the double-J stents from her urethra herself and presented with impending sepsis. Then, she underwent ureterorenoscopic lithotripsy, but it failed to remove the remaining encrusted double-J stent. As a result, percutaneous nephrolithotomy was performed successfully and she had symptom-free thereafter.

A recent update of the diagnostic methods for tuberculosis and their applicability in Indonesia: a narrative review

Tri Nugraha Susilawati — 2019-10-04

Tuberculosis (TB) is a major global problem, especially with the high prevalence of HIV-TB co-infection. Delayed diagnosis and continual transmission contribute to high mortality in Indonesia, which has the third highest incidence of TB in the world, after China and India. Therefore, early diagnosis is needed to reduce the number of cases and to administer therapy to prevent the transmission of bacteria. The diagnosis of TB remains a challenge in clinical practice due to poor sensitivity and the requirement of skilled staff in microscopic tests, the slow growth Mycobacterium in culture, and the low number of bacilli present in extrapulmonary TB. Despite being the golden standard for TB diagnosis, cultures require 2–8 weeks to grow. Other methods for diagnosing TB include interferon-gamma release assays and serologic tests such as the tuberculin skin test. Recently, the World Health Organization recommended the GeneXpert MTB/RIF assay for diagnosing TB. This review presents the current state of TB epidemiology and various methods for TB diagnosis. In particular, the paper provides an in-depth discussion about the GeneXpert MTB/RIF assay that has been made available recently in selected tertiary hospitals in Indonesia.

A glance at molecular mechanisms underlying cisplatin-induced nephrotoxicity and possible renoprotective strategies: a narrative review

Bashar Adi Wahyu Pandhita — 2019-10-04

Cisplatin is a platinum-based drug that is usually used for the treatment of many carcinomas. However, it comes with several devastating side effects, including nephrotoxicity. Cisplatin toxicity is a very complex process, which is exacerbated by the accumulation of cisplatin in renal tubular cells via passive diffusion and transporter-mediated processes. Once cisplatin enters these cells, it induces the formation of reactive oxygen species that cause cellular damage, including DNA damage, inflammation, and eventually cell death. On a small scale, these damages can be mitigated by cellular antioxidant defense mechanism. However, on a large scale, such as in chemotherapy, this defense mechanism may fail, resulting in nephrotoxicity. The current article reviews the molecular mechanisms underlying cisplatin-induced nephrotoxicity and possible renoprotective strategies to determine novel therapeutic interventions for alleviating this toxicity.

Voxel-wise analysis of 18F-fluorodeoxyglucose metabolism in correlation with variations in the presentation of Alzheimer’s disease: a clinician’s guide

Siti Aishah Abdul Aziz — 2019-10-04

BACKGROUND Diagnostic imaging can be applied in the management of Alzheimer’s disease as it provides structural and functional information to exclude possible secondary causes and offers additional information, especially in atypical cases of Alzheimer’s disease. The utility of positron emission tomography/computed tomography (PET/CT) can help in the noninvasive diagnosis of Alzheimer’s disease by voxel-wise quantification of cerebral 18F-fluorodeoxyglucose (FDG) metabolism.

METHODS This prospective study was conducted among 10 subjects with Alzheimer’s disease and 10 healthy control subjects who underwent neuropsychological testing and 18F-FDG PET/CT scans. Images of the brain were postprocessed using voxel-wise analysis and segmented into 20 regions of interest. The standardized uptake value (SUV)_max/SUV_mean/standard deviation of SUV_mean results were analyzed accordingly and correlated with the subjects’ Montreal cognitive assessment (MoCA) results that were adjusted for age and education level.

RESULTS Hypometabolism at the right parietal lobe significantly correlated with increasing age and lower MoCA scores. Global hypometabolism was observed in subjects who had advanced Alzheimer’s disease but preserved primary somatosensory cortices (S1) region metabolism. Predominance of frontal lobe hypometabolism was a feature of subjects with Alzheimer’s disease having associated depressive symptoms.

CONCLUSIONS 18F-FDG PET/CT voxel-wise analysis can be used for quantitative assessment and can assist clinicians in the diagnosis of Alzheimer’s disease and other variations of the disease spectrum.

Front & Back Matter

Medical Journal of Indonesia — 2019-10-04