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Abstract :
Background: Concomitant treatment with antimalaria and antiretroviral drug is a new challenge in the management of malaria and HIV co-infection. Primaquine is a substrate and also an inhibitor of CYP3A4, while ritonavir is a substrate, an inhibitor, and also an inducer for CYP3A4. The objective of this study is to measure the CYP3A4 mRNA expression in HepG2 cell culture induced by primaquine and ritonavir co-treatment.
Methods: For the initial study HepG2 cells were treated with 30, 40, 50 uM of primaquine; 2, 10, 20 uM ritonavir; DMSO ≤0.1 % for negative control; or 20 uM rifampicin for positive control. While for the co-treatment study the cells were treated with 40 uM primaquine+10 uM ritonavir; DMSO ≤0.1 %; or 20 uM rifampicin for 72 hours. The cells were harvested using trypsin–EDTA and total RNA was extracted using the Tripure isolation reagent. After determining the quantity of RNA spectrophotometrically, CYP3A4 mRNA expression was quantified using real-time reverse transcription polymerase chain reaction (RT-PCR).
Results: The expression of CYP3A4 mRNA was up-regulated (1.22 fold over control) in HepG2 cells co-treated with primaquine and ritonavir. These data suggest that the induction effect of ritonavir was more dominant than the inhibitory effect of primaquine.
Conclusion: Concomitant administration of primaquine and ritonavir result in up-regulation of CYP3A4 mRNA expression in vitro. (Med J Indones 2012;21:3-7)
Keywords: CYP450 induction, CYP3A4, drug interaction, primaquine, ritonavir

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Abstract :
Background: Many studies have reported the role of Mesenchymal Stem Cells (MSC) in treating fractures. In case with bone defect, fracture healing needs not only osteogenic but also osteoconductive component (scaffold). Hydroxyapatite calcium sulphate (HA-CaSO4) being widely used as bone void filler, may serve as scaffold for MSC. However, the effect of this scaffold to the viability of MSC has not been evaluated before.
Methods: MSC were isolated from the iliac marrow of a Giant Flamish rabbit, and expanded in DMEM using histogradient density. After one week, they were sub-cultured in a 25cc TC flask (passage 1) and have the medium replaced every 3 days. During the subculture, we embedded a HA-CaSO4 pellet into the flask. The cells were evaluated under inverted microscope at a weekly interval.
Results: At the first week, MSC are difficult to be identified in microscope due to the large number of HA-CaSO4 crystals. By the third week however MSC have grown and the HA-CaSO4 crystals can readily be washed off by medium replacement. By the fourth weeks, MSC can be still seen on microscope.
Conclusion: HA-CaSO4 could serve as a good scaffold due to its pellet shape and easily absorbed, thus providing revascularization which is essential for bone healing.In addition, HA-CaSO4 does not interfere with MSC survival.

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Abstract :
Background: Leptospirosis is an acute infectious disease in humans caused by Leptospira spp. and classified as a zoonosis. Clinical symptoms of leptospirosis are nonspecific and the current available laboratory method for detecting Leptospira spp. is difficult, which resulted to the misdiagnosis of this disease. Therefore, the rapid and accurate method is needed to diagnose the disease. This study was aimed to optimize molecular diagnostic test using real-time PCR assay as a rapid, sensitive and specific method for the detection of pathogenic Leptospira spp. in humans.
Methods: Bacterial DNA was extracted by DNA extraction kit according to the manufacturer’s instructions. Primers and probes used in this study was based on previous and published research. The assay is performed using PCR-IQTM5, iCycler Multicolor real-time PCR detection system. Specificity of the primer used was evaluated towards some bacterial pathogens.
Results: Limit detection of the DNA was 0.375 fg/ml and the primers used does not cross-react with the genomes of the pathogens tested. Limit detection of DNA in blood is 150 fg/μl, and in urine is 1470 fg/μl.
Conclusion: Real-time PCR test is a rapid and accurate method for detecting pathogenic Leptospira spp. in human specimens. Further research is needed to determine the sensitivity and specificity of real-time PCR tests compared with other diagnostic methods in clinical settings.

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Abstract :
Background: Some populations are more susceptible to atherosclerotic diseases than others. Indians had a higher mortality due to coronary heart disease (CHD) than Chinese and Malays. Antibodies to oxidized low density lipoprotein (Ab-oxLDL) are produced as an immune response to oxidized low density lipoprotein (oxLDL). The difference in prevalence of CHD among the ethnic groups may be related to the immune response. The objectives of this study were to determine the serum Ab-oxLDL levels and lipid profile among the three major Malaysian ethnic groups.
Methods: The participants of this study were 150 healthy subjects consisting of 50 Malays, 50 Chinese and 50 Indians. Serum Ab-oxLDL was measured by enzyme immunoassay method. Serum triglycerides and total cholesterol were measured by enzymatic methods. Serum high density lipoprotein cholesterol (HDL-C) was measured by precipitation method and low density lipoprotein cholesterol (LDL-C) was calculated using Friedewald formula.
Results: AboxLDL level [adjusted mean (95% of CI)] was highest in Malays [1404 (1202-1607) mU/mL] followed by Chinese [1026 (829-1223) mU/mL] and Indians [954 (744-1163) mU/mL] (P = 0.006) and HDL-C level was highest in Chinese [1.53 (1.44-1.61) mmol/L] followed by Malays [1.44 (1.35-1.53) mmol/L] and Indians [1.35 (1.26-1.45) mmol/L] (P = 0.035).
Conclusion: Our results indicate that Ab-oxLDL and HDL-C levels differed by ethnic and AboxLDL may have antiatherogenic properties among Malaysian ethnic groups.

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Abstract :
Background: Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme of folate and methionin metabolism, making it crucial for DNA synthesis and methylation. Variants of MTHFR C677T and A1298C gene result in reduced plasma folate levels and increase the susceptibility to spermatogenic arrest. This research aims to analyses MTHFR C677T and A1298C gene polymorphism in Indonesian infertile men with azoospermia and oligozoospermia.
Methods: This cross sectional study takes 3 mL of blood from 150 infertile men with oligozoospermia and azoospermia. MTHFR gene is analyzed using polymerase chain reaction technique (PCR) with specific primers. PCR-RFLP analysis of the MTHFR gene using restriction enzymes MboII and HinfI determines allotypes, both of SNP A1298C and C677T in oligozoospermia and azoospermia in Indonesian population.
Results: The results show that the distribution of allotypes of MTHFR gene SNP A1298C and A677T is not significantly different (p>0.05) between patient groups with oligozoospermia and azoospermia.
Conclusion: MTHFR gene polymorphisms, both of SNP A1298C and C677T are not associated with male infertility in Indonesian men including patients with severe oligozoospermia and azoospermia.

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Abstract :
Background: Buceng is a combination of plant of purwoceng (Pimpinella alpina Molk) and pasak bumi (Eurycomalongifolia Jack) that has been traditionally used to enhance adult male vitality. However, the mechanism of action of buceng has not been understood. This study was aimed to elucidate whether buceng could increasing Testosterone (Te), Luteinizing Hormone (LH), and Follicle Stimulating Hormone (FSH) level in rats.
Methods: 20 male Sprague Dawley rats were randomly assigned into two groups. After one week of acclimatization, control group was given aquadest 2 mL, while treated group B received 2 mL (containing 25 mg) buceng extract for seven successive days. The plasma concentration of Te, LH, and FSH were assesed by RIA and IRMA method respectively. Independent t-test was used to analyze the different concentration of Te, LH, FSH between the two groups.
Results: Testosterone level of treated group was significantly higher (3.55 pg/mL) compared to control group (1.00 pg/mL), p = 0.003. LH concentrations of treated group (0.12 pg/mL) was slightly but not significantly higher compared to control group (0.11 pg/mL), p = 0.810. Likewise, the FSH level was not significantly different between the two groups (0.15 vs 0.14 pg/mL, p = 0.088).
Conclusion: Administration of buceng extract increases testosteron level which might play a role in enhancing male vitality.

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Abstract :
Background: Hospital Acquired Infection (HAI)-Blood Stream infection (BSI) cause considerable morbidity, mortality and health care costs. This study aimed to assess the HAI-BSI in neonates with birth weight 1000-2000 g in Neonatal Unit Cipto Mangunkusumo National Hospital (RSUPNCM), Jakarta, during 4 months period (Oct 2010-Jan 2011), and to review the possibility of sources and transmission of environment microbes to the presence of HAI-BSI in the unit.
Methods: Subjects of this study were neonates (birth weight 1000-2000 g) with clinically sepsis and within 48 hours or more being hospitalized, no clearly focal infection detected, with catheter lines. Two blood specimens from two separate venipunctures, drawn simultaneously, were cultivated. Identification and antimicrobial susceptibility tests were performed for each isolates. Cultures from environment in the unit and other suspected clinical specimens were also examined.
Results: From 29 neonates with 39 episodes of sepsis, 5 positive isolates from blood cultures were obtained i.e. Enterobacter asburiae (2), Enterobacter cloacae (1), Pseudomonas aeruginosa (1) and Klebsiella oxytoca (1). The laboratory confirmed HAI-BSI was 12.8%, and HAI-BSI rate was 1.46 per 1000 catheter line days during 4 months period (Oct 2010-Jan 2011). Cultures performed for environment specimens gave yield some species which were as those from clinical specimens. Antibiogram analysis showed those of environment isolates i.e E. asburiae and P. aeruginosa shared similarity to those of neonates’ blood isolates.
Conclusion: Gram-negative bacteria were responsible to the occurrence of HAI-BSI in the Neonatal Unit RSUPNCM. Despite of low HAI-BSI rate found in this study, analysis of antibiogram profiles of the isolates originated from neonates’ blood and environment strongly suggested that cross infection was present in the unit.

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Abstract :
Background: To investigate the association between aircraft noise and blood pressure.
Methods: A nested case-control study was conducted on Indonesian Air Force pilots doing annual medical check-ups at the Saryanto Institute for Aviation and Aerospace Health (LAKESPRA) from 2003 – 2008. The data extracted from medical records were age, total flight hours, type of aircraft, fasting blood glucose and cholesterol levels, waist circumference, height and weight (Body Mass Index), and blood pressure.
Results: There were 549 pilots, 49 were found to be hypertensive, with SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg. Helicopters pilots were at an almost 2 fold risk of hypertension compared to pilots of the fixed wing aircrafts. Pilots with more than 1400 hours of flight had more than 2 fold risk of being hypertensive compared to those with 1400 flight hours or less.
Conclusion: The type of aircraft, which is related to the noise generated, may be a risk factor for developing hypertension in pilots. Increased total flight hours also increased the risk of hypertension.

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Abstract :
Background: The aim of this case study is to compare the effectiveness between cyclophosphamide and mycophenolate mofetil to achieve remission of lupus nephritis in an evidence-based case report from meta-analyses.
Methods: Method in this case study is evidence-based case report using meta-analyses. Clinical question used in this paper is; which immunosuppressant gives better result in achieving remission in lupus nephritis patient: cyclophosphamide or mycophenolate mofetil? To answer this question, we search the evidence from PubMed with the keywords: “lupus nephritis AND mycophenolate mofetil AND cyclophosphamide” with inclusion criteria of meta-analysis, written in English, and focused comparing cyclophosphamide and mycophenolate mofetil.
Results: From the searching method, we found 11 articles which is relevant. One has been excluded since it written in Hebrew, 4 articles excluded since are not focus answering the clinical question. At the end, 6 studies were included to the critical appraisal step.
Conclusion: Based on the evidences, mycophenolate mofetil is non-inferior to cyclophosphamide in achieving remission in lupus nephritis patients, but with the better safety profile. Patient in our case study get mycophenolate mofetil and shows better clinical condition towards remission as she are evaluated in the outpatient clinic.

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Abstract :
Heart failure becomes main problem in cardiology because of increasing of heart failure patients, rehospitalization rate, morbidity, and mortality rate. The main causes of increasing heart failure problems are: (1) Successful treatment of acute myocardial infarction can be life saving, but its sequelae can cause heart failure. (2) Increasing life expectancy rate grows along with incidences of ageing related heart failure. (3) High prevalence of infection in Indonesia can cause rheumatic heart disease post Streptococcal beta hemolyticus infection, viral myocarditis, infective endocartitis, and tuberculoid pericarditis. (4) Many risk factors for coronary heart disease are often found in heart failure patients, for examples smoking, diabetes, hypercholesterolemia, hypertension, and obesity. Indonesia joined international multicentered registry in 2006. Acute Decompensated HEart failure REgistry is a web based international registry to record patient with acute decompensated heart failure treated in emergency room. It was found that heart failure patients in 5 big hospitals in Java and Bali island that joined this registry are younger, sicker and late to seek treatment. The median hospital length of stay was 7 days and in hospital mortality rate was 6.7%. The aim of this article is to give summary about essential things in diagnosing and treating heart failure patients. 3D (accurate diagnoses, evidence based drugs, and new devices) are the most important but what to do and what not to do in dealing with heart failure is also useful for your daily practice.