Medical Journal of Indonesia

Effect of lycopene and metformin combination on phagocytosis, glycemic control, and oxidative stress in rats with type 2 diabetes

Medina Sianturi — 2023-07-24

BACKGROUND Hyperglycemia and oxidative stress cause phagocytosis dysfunction in patients with diabetes. A combination of lycopene and metformin can reduce oxidative stress and blood glucose. This study aimed to determine the effect of combined lycopene and metformin on phagocytosis function, glycated hemoglobin A1c (HbA1c), nitric oxide (NO), reactive oxygen species (ROS), and advanced glycation end products (AGEs).

METHODS A randomized controlled study was conducted in rats at the Center for Food and Nutrition Studies, Universitas Gadjah Mada, Yogyakarta, Indonesia, from August to September 2022. 30 rats were divided into control (n = 5) and type 2 diabetes mellitus (T2DM) (n = 25) groups. Rats in the T2DM group were induced by a high-fat diet combined with streptozotocin-nicotinamide. The 25 rats were then divided into five subgroups: 1 ml coconut oil (DM), 250 mg/kg metformin in 1 ml coconut oil (DMet), 250 mg/kg metformin + 10 mg/kg lycopene in 1 ml coconut oil (DML-10), 250 mg/kg metformin + 20 mg/kg lycopene in 1 ml coconut oil (DML-20), and 250 mg/kg metformin + 40 mg/kg lycopene in 1 ml coconut oil (DML-40). Treatments were administered daily for 4 weeks. The macrophage phagocytosis index (PI), HbA1c levels, ROS, NO, and AGEs serum were evaluated.

RESULTS There was a significant difference in the PI, HbA1c, NO, ROS, and AGEs between the groups (p<0.001). The DML-20 and DML-40 groups had significantly increased PI and decreased NO, ROS, and AGEs levels than metformin alone (p<0.05).

CONCLUSIONS Lycopene combined with metformin could improve phagocytosis function, glycemic control, and oxidative stress.

DNA quality from buccal swabs in neonates: comparison of different storage time

Klara Yuliarti — 2023-07-11

BACKGROUND Genomic medicine has great potential for diagnoses, disease prediction, and targeted treatment. Buccal swabs are a suitable non-invasive method for neonates to obtain DNA samples. Due to Indonesia's geographical conditions, samples require a prolonged time to reach the genetic laboratory. This study aimed to compare the DNA quality of buccal swabs in neonates between immediate and after-storage extraction.

METHODS This study was part of a study about the profile of human milk oligosaccharide and FUT2 genotype in Indonesian mother-infant dyads consisting of 20 neonates. 1 swab stick for each participant was taken using a standardized buccal swabbing protocol and divided into 2 isovolume aliquots, which were grouped into the immediate (extraction was performed within 3 days after sampling) and storage groups (extraction was performed on the 14^th day after storage in 4°C). DNA yield and purity A_260/280 ratio were measured by spectrophotometry. The PCR amplification and Sanger sequencing were performed to validate the DNA isolate quality for downstream application.

RESULTS The DNA yield for the immediate group was similar compared with the storage group (9.50 [4.89] versus 9.10 [5.05] µg), p = 0.659, as well as DNA purity A_260/280 (1.58 [0.24] versus 1.56 [0.28]), p = 0.785. PCR and sequencing of FUT2 results also showed similar quality between both groups.

CONCLUSIONS The similar DNA quality and sequencing results between immediate and storage extraction confirmed that buccal swabs could be stored for 2 weeks, allowing ample time for sample shipping from remote areas to the laboratory.

Αlpha-thalassemia genotypes in Vietnam: a report of 12,030 pregnant women and their husbands performing prenatal screening for alpha-thalassemia

Tran Danh Cuong — 2023-07-12

BACKGROUND Αlpha (α)-thalassemia is a global health concern, and improving screening methods is crucial for disease prevention. This study aimed to assess α-thalassemia genotypes and evaluate the effectiveness of various thresholds for mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) in prenatal screening for α-thalassemia.

METHODS This cross-sectional study included pregnant women and their husbands who underwent prenatal screening for thalassemia at the National Hospital of Obstetrics and Gynecology, Vietnam from January 2012 to August 2021. Blood samples were collected and analyzed using the strip assay technique, which can detect 21 common mutations in the α-globin gene and 22 common mutations in the beta-globin gene.

RESULTS Of the 12,030 participants, 931 were identified as having α-thalassemia, with --SEA, -α^3.7, and -α^4.2 being the most common mutations. When examining different thresholds of MCV and MCH, MCV <85 fL and MCH <28 pg had a lower missing rate than MCV <80 fL and MCH <27 pg, respectively. MCH <28 pg showed the highest sensitivity in screening for α-thalassemia. MCV <85 fL showed the lowest positive predictive value (PPV). The combination of MCV <80 fL and MCH <27 pg showed the lowest sensitivity in screening for α-thalassemia but the highest PPV among all thresholds.

CONCLUSIONS Optimizing the screening methods for α-thalassemia is important for preventing and managing the disease in the community. These findings have important implications for thalassemia prevention and management programs and may contribute to reducing the burden of thalassemia in the global population.

Charlson comorbidity index to predict 28-day mortality in critically ill COVID-19 patients

Adhrie Sugiarto — 2023-06-26

BACKGROUND Severe COVID-19 patients may become critically ill and require treatment in the intensive care unit (ICU). As intensive care resources are limited, mortality predictors should be used to guide resource allocation. This study aimed to validate the Charlson comorbidity index (CCI) as the mortality predictor of critical COVID-19 patients in the ICU.

METHODS A retrospective cohort study was done in adult patients admitted to the ICU with severe COVID-19 at Cipto Mangunkusumo Hospital and Universitas Indonesia Hospital from March to August 2020. We extracted the subject’s CCI score from the medical records and the 28-day mortality after ICU admission. The CCI score was validated by the Hosmer–Lemeshow calibration test, determination of area under the curve (AUC), and optimal cut-off point for the critical patients in the ICU. We used the chi-square test to examine the association of comorbidities with mortality.

RESULTS Mortality was higher in CCI scores >4 (odds ratio [OR]: 8.83; 95% confidence interval [CI] = 1.81–43.01). The CCI score had moderate discrimination ability (AUC 76.1%; 95% CI = 0.661–0.881). Chronic kidney disease (CKD) (OR: 18.00, 95% CI = 2.19–147.51), congestive heart failure (CHF) (OR: 4.25, 95% CI = 1.23–14.75), and uncontrolled diabetes mellitus (DM) (OR: 18.429, 95% CI = 2.19–155.21) increased the risk of 28-day mortality.

CONCLUSIONS The CCI score could predict the 28-day mortality of critical COVID-19 patients. The coexistence of CKD, CHF, DM, peripheral vascular disease, and peptic ulcer in COVID-19 patients should be considered for patient management.

Photogrammetrics and clinical features of nasal siliconoma in Asians

Krista Ekaputri — 2023-06-15

BACKGROUND Nasal silicone injections have been a common procedure among Asians. However, this procedure can lead to severe complications. Unfortunately, there are limited data available on the distortive characteristics of nasal siliconoma in the Asian population. This study aimed to provide objective data on the distortive characteristics of nasal siliconoma to be a reference for a treatment outcome.

METHODS This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from June 2017 to March 2018. The study included 30 Asian females with nasal siliconoma, and nasal photogrammetric measurements were taken using a portable mirror stand device and analyzed to formulate the distortive characteristics.

RESULTS The mean (standard deviation) of intercanthal width was 3.33 (0.25) cm, nasal root width was 2.70 (0.30) cm, alar width was 4.48 (0.31) cm, two tip-defining points (TDP) distance was 2.09 (0.22) cm, nasofrontal angle was 141.10 (8.40)°, length of the nose was 3.10 (0.48) cm, nasofacial angle was 32.94 (4.51)°, nasion projection was 0.64 (0.36) cm, pronasion projection was 2.00 (0.25–2.46) cm, tip angle was 122.7 (4.52)°, nasolabial angle was 78.81 (15.93)°, columella length (n = 20) was 0.64 (0.20) cm, tip lobular portion length was 1.12 (0.20) cm, the extend of extended columella was 0.47 (0.31) cm, and base of the nasal width was 3.98 (0.25) cm.

CONCLUSIONS Nasal siliconoma in Asians had certain characteristics such as a wider nasal root, wider two TDP distance, wider nasion projection, acute nasolabial angle, hanging columella, and a long lobular portion of the tip.

Characteristics of neurogenic lower urinary tract dysfunction patients at Cipto Mangunkusumo Hospital

Fina Widia — 2023-06-15

BACKGROUND Neurogenic lower urinary tract dysfunction (NLUTD) is an abnormal function of the bladder, urethra (and/or prostate in males) in patients with a clinically confirmed relevant neurologic disorder. Hence, accurate diagnosis and management of NLUTD is crucial. This study aimed to recognize the characteristics of NLUTD to identify, manage, and prevent the associated complications.

METHODS This retrospective study was conducted at the Outpatient Clinic of the Department of Urology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2011 to December 2021. The study analyzed data collected from voiding dysfunction patients with upper motor neurological disorders who underwent urodynamic studies during the study period. Incomplete data in the medical records were excluded.

RESULTS Mean age of the participants was 50.7 (18–95) years old. The most common cause of NLUTD was stroke (26.6%), followed by unspecified groups and spinal cord injury. Patients under 20 years old were affected by trauma and congenital defects. Of the patients, 34.0% had urinary retention, and 18.1% had incontinence. Small bladder capacity occurred in patients with stroke, Parkinson’s disease, and spinal/cerebral tumors, leading to decreased bladder compliance.

CONCLUSIONS NLUTD was associated with aging, with upper motor neurological lesions such as trauma, stroke, and spinal/cerebral injury being the most common etiologies. Most patients with NLUTD had small bladder capacity and decreased compliance based on urodynamic result.

Factors associated with the uncorrectable congenital heart disease in children with pulmonary arterial hypertension

Handoyo — 2023-07-17

BACKGROUND Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a common complication of uncorrected left-to-right shunt defects in acyanotic CHD and a frequent type of pulmonary hypertension in youth. The standards for operability in left-to-right shunts with increased pulmonary vascular resistance are not universally agreed upon. This study aimed to identify variables associated with uncorrectable lesion in children with PAH-CHD.

METHODS This retrospective study used a database of all children who underwent cardiac catheterization at Sanglah Hospital, Bali, from May 2009 to April 2021. Pulmonary hypertension was defined as pulmonary artery pressure of >25 mmHg, while correctability was a fall of >20% in the pulmonary arterial resistance index (PARI) with final value of <6 WU/m2 when doing an acute vasoreactivity test using 100% oxygen. The analyses were carried out using SPSS software version 22.0 (IBM Corp., USA).

RESULTS A total of 104 children were included. Cardiac catheterization showed that the uncorrectable group had a higher PARI (14.4 [8.88] WU/m² versus 8.43 [3.85] WU/m²) and lower flow ratio (1.27 [0.83] versus 1.47 [0.77]) at baseline. In terms of correctability, pre-tricuspid lesions (OR = 0.05; 95% CI = 0.01–0.47; p = 0.01) and younger age group (OR = 0.32; 95% CI = 0.12–0.85; p = 0.01) were protective variables, whilst high baseline PARI (OR = 4.54; 95% CI = 1.64–12.57; p = 0.01) was unfavorable.

CONCLUSIONS High baseline PARI was the most significant variable in predicting uncorrectable left-to-right shunt defects in PAH-CHD.

Comparative efficacy of intravenous levetiracetam and phenytoin in status epilepticus: a systematic review and meta-analysis of randomized controlled trials

Galuh Anis Tasya — 2023-07-18

BACKGROUND Status epilepticus (SE) is a neurological emergency, with the current guidelines for second-line anticonvulsants may include phenytoin, levetiracetam, valproic acid, and phenobarbital. However, some studies suggest that levetiracetam may be better at stopping seizures in SE. This study aimed to compare the efficacy of intravenous (IV) levetiracetam and phenytoin in SE.

METHODS We searched PubMed, ScienceDirect, Cochrane, and Google Scholar for randomized controlled trials (RCTs) on administering IV levetiracetam or phenytoin in patients with SE. RCTs were screened using eligibility criteria, and their quality was assessed using the Cochrane risk of bias tool. Heterogeneity was assessed using the I² test, and publication bias was evaluated using Egger’s test. All analyses were performed using Review Manager version 5.4 (The Cochrane Collaboration, UK) and Stata 17 (StataCorp LLC, USA).

RESULTS 12 RCTs involving 2,137 patients (1,099 receiving levetiracetam) met the inclusion criteria. Pooled analysis showed that levetiracetam therapy had a significantly higher rate of seizure cessation than phenytoin (RR: 1.10, 95% CI = 1.05−1.14, p = 0.02, I² = 51%). Less adverse events were observed in the levetiracetam group (9.34%) than in the phenytoin group (11.62%; RR: 0.82, 95% CI = 0.66–1.02, p = 0.07). However, there was no significant difference regarding IV levetiracetam or phenytoin administration with the incidence of admission to critical care (RR: 1.01; 95% CI = 0.93–1.10, p = 0.80) and mortality (RR: 1.08; 95% CI = 0.54–2.15; p = 0.82).

CONCLUSIONS IV levetiracetam was significantly better in the cessation of seizures in SE patients than phenytoin.

Association of perceived male sexual dysfunction and sexually transmitted disease to female sexual function among Indonesian women

Mega Anara Manurung — 2023-07-18

BACKGROUND Male sexual dysfunction (MSD)’s impact on female partners is challenging to understand. Male erectile dysfunction (ED) and ejaculation disorder likely affect female sexual function. This study aimed to examine the prevalence of female sexual dysfunction and disorder as well as the relationship between perceived MSD and female sexual function using the validated Indonesian short version of the 6-item Female Sexual Function Index (FSFI-6).

METHODS This cross-sectional study was conducted at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from February 2018 to February 2019. About 702 Indonesian married women, including patients, visitors, and medical and nonmedical staff, provided the sociodemographic, FSFI-6, quality of life, and sexual function (ED, ejaculation disorder, and desire problems), and sexually transmitted disease (STD) data. The association between categorical variables was evaluated using Fisher’s test. Logistic regression was used for multivariate analysis, and a p-value of 0.05 was considered statistically significant.

RESULTS Among 702 women, about 242 had sexual dysfunction (34.5%), 20 had sexual disorder (2.8%), 172 had low desire (24.5%), 72 had low arousal (10.3%), 253 had orgasmic function (36.0%), and 575 had sexual pain (81.9%). The respondents reported their partners’ STD, desire problems, ED, and ejaculation disorder. Female sexual disorder and low desire were associated with perceived ED. Female sexual disorder was associated with STD (Wald = 10.3, p = 0.001) and desire problems (Wald = 6.89, p = 0.008). No other MSD was associated with female sexual function.

CONCLUSIONS Perceived STD and male desire problems affected female sexual disorder.

Split cornea transplantation in anterior lamellar keratoplasty for limbal dermoid surgery: a case report

Dewinta Retno Kurniawardhani — 2023-08-04

Limbal dermoid is a rare congenital lesion that can impair vision and raise aesthetic concerns. Surgery is frequently required to reduce discomfort and enhance visual outcomes. A 20-year-old woman presented with a limbal dermoid measuring 4.5 mm in diameter and half the depth of the stroma. Excision was performed with anterior lamellar keratoplasty (ALK) using a post-Descemet's membrane endothelial keratoplasty graft, which resulted in signs of graft failure. Re-surgery was then performed with post-Descemet's stripping endothelial keratoplasty graft. It yielded a clear graft with good visual acuity. The first corneal graft utilized 95% of the graft thickness to cover 55% of the defect, leading to poor host-donor apposition. The second graft employed 55–65% to cover the same portion of the defect. The proportional thickness of the graft is crucial for a successful ALK. Split cornea transplantation produces respectable results; however, the corneal thickness must be carefully considered.

Erratum: Subgingival chlorhexidine irrigation for scaling and root planing adjunctive therapy in chronic periodontitis: a systematic review

Agus Susanto — 2023-08-04

[This corrects the article DOI: 10.13181/mji.rev.236337]

Front & Back Matter

Medical Journal of Indonesia — 2023-08-04