Accreditation
SINTA 2Nationally Accredited Journal
Vol. 6 No. 9 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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Correlation of Malignancy in the Hepato-Pancreato-Biliary System with Serum Bilirubin Levels in Extrahepatic Cholestasis Patients
Views: 657Downloads: 486Background: The incidence of hepato-pancreato-biliary system cancer is increasing worldwide, which has been recognized as a disease that is difficult to diagnose early and has a poor prognosis. No research has yet been conducted in areas with limited resources and health facilities. There is an urgent need for diagnostic methods to recommend further diagnostic modalities in the selection of curative or palliative management.
Methods: Retrospective data from all cholestatic patients at Dr. M. Djamil General Hospital were collected during the period July 2020-May 2022. The data included demographic characteristics such as age, gender, preoperative, results of bilirubin fraction, and final diagnosis. Data analysis was done by bivariate and multivariate.
Results: A total of 132 patients were included in this study. 35.6% of them are HPB system malignancies, with Pancreatic Adenocarcinoma being the most common diagnosis (34.4%), more in males (51.06%), and in the age group, 50 years (61.71%) is the most. Only 52.27% of patients underwent preoperative radiological imaging. Bivariate analysis showed a significant relationship between HPB system malignancies with age >50 years (p=0.024) and all bilirubin fractions (p<0.001). Multivariate analysis showed that only the bilirubin fraction was significant for the diagnosis of malignant HPB (p<0.001).
Conclusion: The bilirubin fraction is a good initial indicator for predicting malignancy in the HPB system in order to increase the effectiveness of the diagnostic modality and reduce the referral duration.
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Diagnosis and Management of Refeeding Syndrome
Views: 1,596Downloads: 2,861Refeeding syndrome (RFS) is described as a syndrome of electrolyte abnormalities and changes in body fluids with metabolic abnormalities in malnourished patients who receive refeeding either orally, enteral, or parenterally. Patients at risk for RFS are patients who have lost 10% of their previous body weight in the last 3-6 months, cancer patients who are on chemotherapy, geriatric patients with malnutrition, and patients with anorexia. Clinical manifestations are caused by electrolyte changes that affect neurons, heart and muscle disorders with various symptoms, and even death. The specific characteristics of RFS are the presence of hypophosphatemia and accompanied by other symptoms of electrolyte imbalance such as changes in sodium levels, changes in glucose, protein, fat metabolism, vitamin B1 deficiency, hypokalemia, and hypomagnesemia. The principle of management of RFS is to correct biochemical abnormalities and electrolyte and fluid imbalances. Preventive steps that can be taken are identifying individuals at risk for RFS, monitoring refeeding and administering an appropriate diet regimen.
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The Role of Nutritional Status on SARS-CoV-2 IgG Levels After COVID-19 Vaccination in Palembang
Views: 1,064Downloads: 477Background: The elderly and geriatric population is the population most at risk for complications of COVID-19. Preliminary data show that individuals aged >59 years are estimated to experience five times more severe COVID-19 symptom onset than those aged 30 to 59 years. Nutritional status is believed to play a role in the body's ability to produce antibodies after COVID-19 vaccination.
Methods: A cross-sectional analytic observational study to determine the role of nutritional status on levels of IgG SARS-CoV-2 after COVID-19 Vaccination in Palembang. IgG levels were assessed by the ECLIA method. Data analysis was carried out univariate and bivariate.
Results: The mean quantitative IgG of SARS-CoV-2 in underweight nutritional status was higher with a value of 5757.42±2594.08 U/mL and with the lowest mean quantitative IgG SARS-CoV-2 in overweight nutritional status with a value of 2998.13±4386.95 U/mL.
Conclusion: Nutritional status did not play a role in SARS-CoV-2 IgG levels after the COVID-19 vaccination in Palembang.
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Botanical and Chemical Overview, Traditional Uses and Potential of Anticancer Activity from Several Costus Plants: A Narrative Review
Views: 1,552Downloads: 1,407Plants in the Costus genus are known to have various activities, starting from an antibacterial agent, anti-inflammatory, antioxidant, anticancer, antidiabetic, and so on. From some previous studies that have been conducted, it is stated that some Costus plants have a high potential to be a prospective anticancer candidate in the future. This review will discuss botanical and chemical overview, traditional uses, and potential anticancer activity of several Costus plants, namely C.speciosus, C.igneus, C.spiralis, and C.pictus. In conclusion, anticancer activity assay was carried out by several methods using various cell cultures resulting in an IC50 value ranging from strong and very strong, with the strongest potency belonging to C.speciosus with an IC50 value of 13.87 µg/ml. In addition, the active phytoconstituent, mainly diosgenin, contributes to the anticancer activity, which also strengthens the potential of Costus plants.
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Sperm DNA Fragmentation Index: A Comparison Study of Success Rates among Natural, Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF)-Intra Cytoplasmic Sperm Injection (ICSI) Pregnancy Programs
Views: 2,062Downloads: 753Background: Some studies have reported a relationship between the sperm DNA fragmentation index (DFI) and the rate of fertilization and pregnancy. This study was designed to assess the mean sperm DNA fragmentation in pregnancies that occur in infertile couples, whether in natural pregnancy, intrauterine insemination (IUI), and in vitro fertilization (IVF) – intra cytoplasmic injection (ICSI).
Methods: This research is an observational analytic study with a cross-sectional design. The sample taken in this study were infertile patients that underwent natural pregnancy or IUI or IVF-ICSI at Yasmin Infertility Clinic of Dr. Ciptomangunkusumo Hospital period 2018-2020 with a consecutive sampling technique. The research data was processed and analyzed by the Mann-Whitney test using the SPSS application.
Results: The mean DFI of sperm in men with infertile couples who successfully conceived naturally was 10.7% (mild), while IUI was 20.4% (moderate), and IVF-ICSI was 30.5% (poor). The mean DFI in semen samples of men from infertile couples who underwent a natural program was significantly lower in those who successfully conceived compared to those who did not. Similar results were also shown in the IUI and IVF-ICSI programs, which showed a significantly lower DFI compared to non-pregnant women.
Conclusion: DFI can be applied as a marker for selecting the type of pregnancy program in infertility management.
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Orbital Lymphoma: Clinical Features and Management at Dr. M. Djamil General Hospital in 2018
Views: 1,234Downloads: 639Background: Orbital lymphoma is found in 50-60% of ocular adnexal lymphomas, with approximately 90% of orbital lymphomas being Non-Hodgkin's lymphomas. Clinical features may include proptosis, ptosis, limitation of eye movement, and salmon patch lesions on the conjunctiva. If an orbital tumor is present, an accurate histopathological examination is important in the management of orbital lymphoma. Because of nonspecific clinical signs and symptoms, some diagnostic delays may occur. The purpose of the study was to evaluate the clinical features, diagnostic approach, and treatment choice in orbital lymphomas.
Methods: We identified patients diagnosed with orbital lymphoma in an outpatient clinic in Dr. M. Djamil General Hospital from January to December 2018. Patients’ medical records were reviewed retrospectively.
Results: The patient group consisted of 6 patients (five males and one female) with a median age of 58 years. Proptosis and orbital swelling were the leading clinical symptoms, mainly found unilateral (five cases). The diagnosis was confirmed by a surgical biopsy. One histology result showed lymph node hyperplasia, which didn't suit the clinical manifestation and got re-reviewed. All histology results then showed non-Hodgkin’s lymphoma with the small lymphocytic type (100%). Five patients received systemic chemotherapy with the CHOP regimen protocol, and one patient refused to get further chemotherapy treatment.
Conclusion: When unmatched orbital symptoms with histology results are present, re-reviewing the histology result is essential. Once the diagnosis is established, systemic chemotherapy is indicated and can proceed so there will be no delay in treatment
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Effect of Combination of Tamsulosin and Tadalafil in Benign Prostate Hyperplasia Patients on International Prostate Symptom Score
Views: 6,774Downloads: 907Background: Benign prostate hyperplasia (BPH) is the most common pathological condition that contributes to lower urinary tract symptoms (LUTS) in men. Alpha1-blockers are recommended as first-line therapy for LUTS due to BPH (LUTS-BPH). Phosphodiesterase 5 (PDE5-I) inhibitors, which have been used as first-line therapy for erectile dysfunction, have also been found to be effective in treating LUTS-BPH. However, the appropriate combination therapy strategy is still unclear until now.
Methods: This study used an experimental design on 17 BPH patients on medical therapy. The patient was given Tamsulosin 0.4 mg monotherapy for 7 days and then continued combination therapy with Tamsulosin 0.4 mg and Tadalafil 5 mg for the next 7 days. Total IPSS score, obstruction, irritation, and quality of life (QoL) were assessed before treatment, after monotherapy, and after combination therapy.
Results: The mean age of the research subjects was 62.12 years. Improvements in the total IPSS value, obstruction, irritation, and QoL showed significant changes in both types of therapy compared to the initial value. Combination therapy gave better results than monotherapy, with a mean difference in the decrease in the total IPSS value of 4.41 (p<0.001), obstruction of 3.18 (p<0.001), irritation of 1.41 (p<0.001), and QoL 0.6 (p<0.001).
Conclusion: The combination therapy of Tamsulosin 0.4 mg with Tadalafil 5 mg once a day showed clinically and significantly better results than monotherapy in total IPSS, obstruction, irritation, and QoL values in LUTS-BPH patients.
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Sodium Levels as a Predicting Factor for the Occurrence of Perforated Appendicitis in Children at Dr. M. Djamil General Hospital Padang
Views: 784Downloads: 528Background: Perforation of the appendix can lead to life-threatening complications. Early identification of a perforation before surgery has important clinical implications. Hyponatremia was previously proposed as a marker to differentiate between perforated and non-perforated acute appendicitis. This study aims to determine the role of sodium levels as a predictive factor in the incidence of perforated appendicitis in children at Dr. M. Djamil General Hospital Padang.
Methods: This research is an analytic observational study with a cross-sectional design. The research took place from March to May 2022 at Dr. M. Djamil General Hospital Padang. Samples were taken by consecutive sampling with criteria aged 0-18 years and diagnosed with acute appendicitis at Dr. M. Djamil General Hospital Padang.
Results: A total of 112 samples with most of the patients (52.7%) aged 6-11 years and found a greater proportion of men (57.1%). Most of the patients underwent laparotomy procedures (57.2%). Hyponatremia was found in 58% of patients. Perforation occurred in most (59.8%) patients. SPSS results showed a significant difference between the incidence of hyponatremia in perforated and non-perforated appendicitis with a p-value <0.001.
Conclusion: There is a significant relationship between sodium levels and the incidence of perforation, where the lower the sodium level, the higher the incidence of perforation.
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Atypical Chronic Myeloid Leukemia in Pregnancy
Views: 772Downloads: 863Background: Atypical chronic myeloid leukemia was first depicted as a subtype of myeloid neoplasm that closely resembles chronic myeloid leukemia but does not have the pathognomonic Philadelphia chromosome. Chronic myeloid leukemia can also be found in pregnant and fertile women, which means pregnancy can happen at the time of diagnosis or during the treatment of this disease.
Case presentation: A 32-year-old woman came to the hemato-oncology polyclinic at M. Djamil General Hospital Padang with the main complaint of weakness and fatigue. The patient was pregnant with a gestational age of 23-24 weeks. On physical examination, the conjunctiva was anemic, and the spleen was palpable S4 (18 cm). On routine blood laboratory examination, the results of anemia, leukocytosis, and on the peripheral blood picture, severe normochromic normocytic anemia was found with pathological cells of 3% myelocytes and 1% metamyelocytes. Conclusion bone marrow puncture (BMP) results follow the description of chronic myeloid leukemia in the chronic phase.
Conclusion: During pregnancy, chronic myeloid leukemia has a better prognosis compared to acute leukemia. However, atypical chronic myeloid leukemia still has the potential of leukostasis, causing uteroplacental deficiency and eventually leading to fetal growth restriction, premature birth, and an increase in perinatal mortality.
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Factors Related to the Incidence of Dysphagia in Patients Using Tracheal Cannula at Dr. Mohammad Hoesin General Hospital Palembang
Views: 1,144Downloads: 701Background: The need for tracheostomy increases during the coronavirus diseases 2019 (COVID-19) pandemic. However, some studies suggest that tracheostomy causes dysphagia which can lead to other health problems such as pneumonia, choking, weight loss, malnutrition, and dehydration with serious side effects. This study aims to determine the factors associated with the incidence of dysphagia in patients using a tracheal cannula.
Methods: This study is an observational study using a cross-sectional design. Data collection was carried out using medical record data on 58 patients who used a tracheal cannula recorded in the medical record data for the FEES examination at Dr. Mohammad Hoesin General Hospital Palembang from January 2019 to September 2021. The data were analyzed by descriptive statistics, chi-square, and multiple logistic regression.
Results: Of 58 patients who used a tracheal cannula, it was found that 75.9% had dysphagia. The results of the comparison test showed that the factors associated with the incidence of dysphagia were gender (p=0.001), nutritional status (p=0.013), incision location (p=0.043), and primary disease (p=0.021). Factors that were not associated with the incidence of dysphagia were age (p=0.933), tracheostomy indication (p=0.741), and the type of tracheal cannula (p=1,000). Patients are male, with low and high tracheal cannula incision locations, and have a primary neurological disease. The probability or chance of dysphagia is 79.8%.
Conclusion: Tracheostomy can cause dysphagia which is influenced by gender, location of tracheal cannula incision, and primary disease.
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Resveratrol as a Chemopreventive Agent in Lung Cancer Therapy
Views: 1,043Downloads: 532For decades, lung cancer has been the most widespread cancer in the world and the leading cause of cancer death. Lung malignancy is the superior cause of death in Indonesia, accompanying the second topmost number of new cases. The low survival rate of lung cancer patients reflects the therapy's low success rate due to side effects and cancer cells' resistance to chemotherapy and radiotherapy. Combination therapy, which includes the use of chemopreventive agents, can reduce the risk of side effects and resistance. Natural product-based chemopreventive agents used together with accompanying chemical anti-cancer drugs and/or actinotherapy can overcome cancer cell resistance, improve therapy effectiveness, and reduce side effects. Resveratrol is a compound belonging to the non-flavonoid polyphenolic group contained, particularly in vine fruits, berries, and some nuts. Resveratrol exhibits anti-cancer activity, according to considerable in vitro and in vivo studies, and hence has what it takes to be reasonably applied as a chemopreventive compound. The discovery of resveratrol's chemopreventive mechanism against lung cancer is expected to enable the development of a chemopreventive compound that can be used together with accompanying chemical anti-cancer drugs and/or actinotherapy.
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The Effect of Combination of Green Tea and Roselle Extract on Morphology and Motility of Spermatozoa in Rats Induced by Monosodium Glutamate
Views: 804Downloads: 440Background: Infertility is a reproductive system problem and has been increasing recently. One of the reasons is the poor quality of spermatozoa, which can be assessed through its morphology and motility. Excessive consumption of MSG can affect the quality of spermatozoa. The provision of a combination of green tea and roselle extract, which is an antioxidant and is expected to be able to counteract the effects of MSG’s free radicals on spermatozoa. The objective of the study is to determine the morphology and motility of Wistar Rats’ spermatozoa in the control group given MSG and in the experimental group given MSG and a combination of green tea and roselle extract at a dose of 200 mg/kg/day and 400 mg/kg/day for 14 days.
Methods: Fifteen Wistar rats were randomly divided into three groups, a control group with MSG, group 1 with MSG and a combination of green tea and roselle extract at a dose of 200 mg/kg BW/day (P1), and group 2 with MSG and combination green tea and roselle extract at a dose of 400 mg/kg BW/day (P2). After 14 days of treatment, the morphology and motility of the spermatozoa of each mouse were studied and assessed microscopically.
Results: In the morphological study, the control group had the lowest normal value and the highest abnormal value among all groups. Meanwhile, the P1 group had the highest normal and lowest abnormal values compared to the other two groups.
Conclusion: The administration of a combination of green tea and roselle extract improved the morphology and motility of Wistar rats’ spermatozoa. However, an increased dose of a combination of green tea and roselle extract was not proven to affect the morphology and motility of Wistar rats' spermatozoa.
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Adapalene-Benzyl Peroxide Combination as an Option for Acne Vulgaris Treatment: A Systematic Literature Review
Views: 1,987Downloads: 767Background: Acne vulgaris affect 9,4% of the world population, especially in teenage age. Treatment of acne is based on severity; mild acne is treated with a topical agent, whereas moderate and severe acne is treated with topical and systemic agents. Topical therapy, including retinoids, antibiotics, and benzoyl peroxide, is the foundation of acne treatment. Adapalene-benzoyl peroxide therapy can be used in treatment to avoid antibiotic resistance. This study aimed to evaluate the efficacy and tolerance of adapalene/benzoyl peroxide topical treatment in mild to moderate acne vulgaris.
Methods: This systematic review conducted a literature search through 3 databases, following PRISMA 2020 guidelines. Inclusion criteria were written in English or Indonesian, published in 2016-2020, a randomized controlled trial (RCT) study designed using human samples, and discussed the efficacy of topical adapalene-benzoyl peroxide in mild and moderate acne vulgaris. Studies that were unavailable in full text and based on secondary data were excluded.
Results: Acne vulgaris lesions and scars decreased significantly with adapalene/benzoyl peroxide topical therapy. The addition of moisturizer to therapy can reduce the side effects of retinoate.
Conclusion: The combination of adapalene/benzoyl peroxide can be an alternative treatment for mild to moderate acne.
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Gaucher Disease with Normocytic Normochrome Anemia Manifestation in a 13-Month-Old Baby: A Case Report
Views: 726Downloads: 686Background: Gaucher disease is a sphingolipidosis, an inherited disorder of metabolism resulting from glucocerebrosidase deficiency, causing the deposition of glucocerebroside and related compounds. This study aimed to describe Gaucher disease in one year old baby girl.
Case presentation: A 13-month-old girl was referred from the district hospital with a diagnosis of hemolytic anemia. The Patient come with major complaints in the form of enlarged abdomen since 6 months ago. The patient looked pale and coughed since 7 days ago, accompanied by a cold. Ultrasound examination of the abdomen shows splenomegaly. Based on supporting examinations, the effect of normocytic normochrome anemia with reticulocytosis was obtained. The bone survey resulted in an Erlenmeyer flask image on both the humerus and femur suitable for Gaucher disease. The results of microscopic evaluation on bone marrow smear found large cells with Gaucher cell characteristics. Laboratory evaluation of glucocerebroside enzymes showed that there was a deficiency deficiency β-glucosidase. Patients get enzyme replacement therapy for 7 times, each therapy is carried out every 2 weeks.
Conclusion: Enzyme replacement therapy is the definitive effective therapy in patients with Gaucher disease. Follow-up should, in principle, be individualized, as the heterogeneity of the disease and a number of associated conditions precludes strict protocolized follow-up.
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Intrahepatic and Extrahepatic Cholestatic Jaundice Caused by Adenocarcinoma Pancreas with Hepatitis B Infection: A Case Report
Views: 6,636Downloads: 985Background: Cholestasis is defined as the stagnation of biliary duct secretion. Intrahepatic jaundice cholestasis is caused by inflammation that happens intrahepatic from an infection such as hepatitis. Meanwhile, extrahepatic cholestasis is caused by obstruction of the biliary duct outside the liver. Stagnation of the bile flow due to these couple of conditions occurring concurrently has been rarely reported. Biliary duct stagnation that occurs with an infection of hepatocytes will cause more serious and progressive effects.
Case presentation: A 73 years old woman with extrahepatic and intrahepatic cholestasis caused by pancreatic adenocarcinoma along with chronic hepatitis B. The diagnosis is made based on clinical findings, lab findings, and radiology findings. Quick action is mandatory to prevent complications caused by hyperbilirubinemia and slows the progression of hepatitis B-induced liver fibrosis. A Whipple procedure was performed on this patient to treat the biliary duct obstruction. The patient's condition improved after surgery. The patient is then planned to be given adjuvant chemotherapy, preceded by the administration of antivirals for hepatitis.
Conclusion: Cholestasis jaundice causes hyperbilirubinemia that presents with clinical complaints such as jaundice, itchy and could cause several complications due to damage to the liver tissue whose clinical manifestations are related to impaired liver function caused by hyperbilirubinemia in the form of hypoalbumin, hypercoagulation, and in advanced stages can end up with liver cirrhosis. The principle management for cholestatic jaundice is bile duct decompression which is expected to rule out the etiology of the blockage. Tenofovir was given before chemotherapy in these patients to prevent hepatitis flare due to hepatitis B.
