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   Table of Contents - Current issue
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November 2019
Volume 10 | Issue 3 (Supplement)
Page Nos. 1-165

Online since Tuesday, January 14, 2020

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EDITORIAL  

Precision medicine: Leading medical research to change life results Highly accessed article p. 1
Hariyono Winarto
DOI:10.4103/0976-9668.275607  
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ORIGINAL ARTICLES Top

The impact of coresidence with the children on the relationship between perceived closeness and psychological well-being of the elderly Highly accessed article p. 2
Annies Sekar Firdausi, Lathifah Hanum
DOI:10.4103/jnsbm.JNSBM_16_19  
Introduction: The influence of coresidence with children is reported to be both beneficial and detrimental on the psychological well-being of the elderly. We investigated whether perceived closeness with their children could be correlated with psychological well-being among the elderly. Subjects and Methods: A correlational analysis was performed involving two variables. Relationship Closeness Inventory (RCI) was used to measure perceived closeness of the elderly with their children. Ryff's Scales of Psychological Well-Being (RSPWB) was used to measure psychological well-being in elderly participants. RCI and RSPWB were collated from 102 elderly participants (60–89 years old) who lived with their children. Results: We observed that the relationship between perceived closeness and psychological well-being of the elderly had a negative correlation. Despite that fact, we also observed that the type of living arrangement variably influenced the perceived closeness and psychological well-being. Specifically, the elderly who lived in a household with grandchildren's had a higher psychological well-being. Conclusion: This study did not observe any positive correlation between perceived closeness and psychological well-being of the elderly. Hence, close relationship with their children alone is unlikely to influence psychological well-being among the elderly.
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Effect of oxygen content on postoperative cognitive dysfunction in patients undergoing open-heart surgery Highly accessed article p. 7
Ratna Farida Soenarto, Aditya Arbi
DOI:10.4103/jnsbm.JNSBM_28_19  
Introduction: Brain's decreased oxygen delivery is proposed as a risk factor for postoperative cognitive dysfunction (POCD). This study's objective was to investigate the effect of arterial oxygen content (CaO2) on POCD in patients undergoing open-heart surgery. Subjects and Methods: Adult patients listed for elective open-heart surgery at Cipto Mangunkusumo General Hospital were enrolled. The patients' cognitive function was tested using the Rey Auditory Verbal Learning Test, trail-making test, and digit span test (forward–backward) before and 5 days after surgery. The hemoglobin level, arterial saturation (SaO2), and arterial oxygen partial pressure (PaO2) were measured at the following five time points: before induction, 10 min after the commencement of cardiopulmonary bypass (CPB), 10 min after the cessation of CPB, 6 h postoperatively, and 1 day postoperatively. The CaO2 was calculated as follows: CaO2= 1.36 × hemoglobin × SaO2 + 0.003 × PaO2. Data were compared using Student's t-test or the Mann–Whitney test with SPSS software version 20.0 (IBM Corp., Armonk, NY, USA). Results: POCD was found in nine patients (47.4%). The CaO was significantly lower in patients with POCD than those without POCD at 10 min after the cessation of CPB (12.1 ± 2.6 vs. 14.5 ± 1.7, respectively; P = 0.03). The hemoglobin level appeared to be the cause of the decreased CaO2 in the POCD group (8.5 ± 2.3 vs. 10.2 ± 1.2, P = 0.06). Decreased oxygen content after CPB cessation may impair brain tissue oxygenation that causes POCD. Conclusion: Hemoglobin level may play an important role in POCD development after open-heart surgery.
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Prothrombin time, albumin, and fibrinogen values of the liver cirrhosis stages based on the aspartate aminotransferase-to-platelet ratio index p. 11
Yusra Yusra, Claudio Agustino
DOI:10.4103/jnsbm.JNSBM_59_19  
Introduction: Liver cirrhosis can be classified into three groups using the aspartate aminotransferase-to-platelet ratio index (APRI) score, which is a noninvasive technique. This study was designed to determine the differences between the albumin levels, prothrombin time (PT), and fibrinogen levels of the cirrhosis stages based on the APRI scores. Materials and Methods: This cross-sectional study included 60 patients who met the inclusion criteria based on their records from the Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia. The study analysis included the Kolmogorov–Smirnov test for the un—normalized data, including the albumin level (median = 2.91 g/dL) and PT (median = 1.8 s), and the normalized fibrinogen level (mean = 273.7117 mg/dL). Results: The analysis of variance (ANOVA) and Kruskal–Wallis test results showed significant differences between these three components based on the APRI score (all P < 0.05). The post hoc tests (Bonferroni for the ANOVA and Mann–Whitney U for the Kruskal–Wallis test) of the albumin levels showed a significant difference in the comparison between the APRI score of <0.5 group and >2 group. The post hoc tests of the PT showed significant differences in all the comparisons. The post hoc tests of the fibrinogen levels showed significant differences for the comparisons between the APRI score of <0.5 group and >2 group and between the APRI score = 0.5–2 group and >2 group. Conclusion: PT is the optimal biomarker to distinguish between each stage of liver cirrhosis compared to serum albumin or fibrinogen levels.
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Association between the national early warning score and the mortality among neuroemergency patients p. 16
Ramdinal Aviesena Zairinal, Mohammad Kurniawan
DOI:10.4103/jnsbm.JNSBM_87_19  
Objective: The objective of this study was to determine the association between the National Early Warning Score (NEWS), a standardized tool for assessing acute illness severity, and the mortality of the neuroemergency cases seen in the emergency room (ER). Subjects and Methods: This retrospective cohort study was conducted from July to December 2017 in the ER at the Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia. All of the ER patients examined by the neurology team were included in this study. The demographic, NEWS, Glasgow Coma Scale, and mortality data were collected from the medical record. Results: Of the 1526 patients admitted, the NEWS data were available for 907 of the cases (59.4%). Of the 1421 well-documented patients, 143 died. There was a significant relationship between the NEWS category and the mortality risk (P < 0.001). Going from the low to the medium and from the medium to the high NEWS categories dramatically increased the mortality risk, with relative risks of 20.238 (8.808–46.501) and 6.466 (2.466–16.957), respectively. The NEWS cutoff point for determining mortality in this study was 6, with a sensitivity of 73.5% and specificity of 80.1%. Conclusion: The NEWS category was significantly related to the mortality risk of neuroemergency patients; therefore, it should be implemented routinely to help predict the mortality in the ER.
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Effect of continuous environmental enrichment and aerobic exercise on rat plasma and hippocampal brain-derived neurotrophic factor p. 20
Sri Redjeki Prasetyo, Sophie Yolanda, Kesit Ivanali
DOI:10.4103/jnsbm.JNSBM_20_19  
Objective: Environmental enrichment (EE) or exercise can positively affect memory function through increased long-term potentiation and neurogenesis, which is facilitated by brain-derived neurotrophic factor (BDNF). BDNF promotes blood vessel growth, angiogenesis linked to adult neurogenesis, and neuronal survival. Here, we investigated the effects of EE, aerobic exercise, and their combination on plasma and hippocampal BDNF levels. Materials and Methods: Twenty-four 7-month-old adult male Wistar rats weighing 300–400 g were randomly assigned to the following four groups: control (C), aerobic exercise (A), EE, and combined EE and aerobic exercise (EEA). Interventions were given for 8 weeks, and plasma and hippocampal BDNF levels were measured using enzyme-linked immunosorbent assay. Results: A combination of aerobic exercise and continuous EE produced the largest increase in hippocampal and plasma BDNF levels in adult rats. A positive correlation (r = 0.686, P = 0.002, n = 24) was observed between plasma and hippocampal BDNF levels in adult rats. Conclusion: We conclude that a combination of aerobic exercise and continuous EE increases plasma and hippocampal BDNF in adult rats.
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Progesterone increases capacitation and exerts a prosurvival effect in sperm via Akt activation p. 24
Dwi Ari Pujianto, Sisca Sisca, Luluk Yunaini
DOI:10.4103/jnsbm.JNSBM_24_19  
Objective: Progesterone receptor is present in human sperm. Here, we determined if progesterone (P4) improves capacitation and stimulates sperm survival by suppressing apoptosis to evaluate its relevance to be used as a preservation agent to increase and prolong sperm viability and motility. Materials and Methods: Semen samples were obtained from healthy human donors. The sample was washed by Percoll gradient centrifugation and was divided into five groups of 500 μL, each containing approximately 10 million sperm cells. P4 was added to each group at the final concentrations of 0 (control), 250, 500, 750, and 1000 ng/mL, respectively, and was incubated at 37°C for 2 h. Sperm motility was assessed using a computer-assisted sperm analyzer. Tyrosine phosphorylation, Akt phosphorylation, and caspase-3 activation in sperm were analyzed by western immunoblotting. Results: P4 did not increase the sperm motility. Western blot analysis revealed that P4 at the concentration of 500 ng/mL increased tyrosine phosphorylation, indicating increased sperm capacitation. P4 at 750 mg/ml also increased Akt phosphorylation. Interestingly, the activation of Akt was associated with a decrease in caspase-3 activity, indicating the prosurvival effect of P4. Conclusion: This study results suggest that P4 does not influence sperm motility; however, it increases sperm tyrosine phosphorylation (at a specific concentration of 500 ng/ul), activates AKT (Protein kinase B), and suppresses caspase-3 (at a specific concentration of 750 ng/ul). The biochemical effects of P4 on sperm may warrant its use as a preservation agent to increase sperm viability.
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Associations between the adverse drug reactions and the tuberculosis treatment dropout rates at the Cempaka Putih Islamic Hospital in Jakarta, Indonesia p. 29
Indrianti Asril, Vivian Soetikno, Purwantyastuti Ascobat
DOI:10.4103/jnsbm.JNSBM_31_19  
Objective: Tuberculosis (TB) treatment is associated with various adverse drug reactions (ADRs). The aim of this study was to determine the associations between ADRs and the rate of TB treatment dropout among the patients at Cempaka Putih Islamic Hospital in Jakarta, Indonesia. Materials and Methods: A cross-sectional study was conducted based on the medical records of the TB patients treated at Lung Polyclinic of Cempaka Putih Islamic Hospital between January 2016 and December 2017. Results: Of 178 study participants, 80 had a history of ADR while the other 98 did not. There were statistically significant relationships between the rate of TB treatment dropout and the characteristics of patient, including the age (P = 0.022, prevalence ratio [PR] = 0.599, 95% confidence interval [CI] = 0.408–0.870) and ADR type (P = 0.001, PR = 5.333, 95% CI = 1.402–20.285). Furthermore, there were significant relationships between ADRs and comorbid disease (P = 0.000, PR = 1.871, 95% CI = 1.370–2.555). However, ADR treatment status based on the given guidelines does not have a statistically significant relationship with the rate of TB treatment dropout (P = 0.172, PR = 2.028, 95% CI = 0.582–7.071). Conclusion: The results of this study showed that age and ADR type significantly increased the prevalence of the rate of TB treatment dropout among our patient cohorts.
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Risk factors of dry eye syndrome in the soekarno-hatta airport's air traffic controllers p. 34
Syougie Ali, Dewi Friska, Soemardoko Tjokrowidigdo
DOI:10.4103/jnsbm.JNSBM_57_19  
Objective: The prevalence of dry eye syndrome (DES) in air traffic controllers (ATCs) was 60.3%, according to one study conducted in 2017. The aim of this study is to identify risk factors of DES in ATCs of Soekarno Hatta International Airport (SHIA). Materials and Methods: A cross-sectional study was conducted among ATCs of SHIA who met inclusion and exclusion criteria. Data collected featured several demographic and health characteristics by questionnaire. Participants were classified as DES according to an Ocular Surface Disease Index questionnaire performed after the participants completed their work. The data were processed and analyzed using the SPSS version 20.0. Multivariate analysis was performed using Cox regression. Results: Variables that were associated with DES were an age of over 30 years (relative risk [RR], 2.04; confidence interval [CI], 1.30–3.19), and length of work over 10 years (RR, 2.00; CI, 1.25–3.20). After adjusting for all significant variables, the dominant risk factor for DES is age over 30 years (P = 0.002; RR, 3.33; CI, 1.58–7.01). Nonsignificant variables included sex, smoking habits, and use of contact lenses. Conclusion: The results suggest that employment conditions for ATCs with a 10-year-plus work history should be studied further to identify preventive measures, with age over 30 years as a dominant factor.
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Identification of a deletion variant in exon 9 of iduronate-2-sulfatase gene in patients with type II mucopolysaccharidosis p. 38
Rizky Priambodo, Yulia Ariani, Damayanti Rusli Sjarif
DOI:10.4103/jnsbm.JNSBM_77_19  
Objective: Mucopolysaccharidosis type II (MPS II) or Hunter syndrome is a lysosomal storage disorder caused by mutation of the iduronate-2-sulfatase (IDS) gene, which is located on chromosome X. The profile of IDS gene at exon 9 has not been previously studied in Indonesian patients. The objective of this study was to detect and analyze mutations in exon 9 of the IDS gene in MPS II patients from Indonesia. Subjects and Methods: DNA from 10 MPS II patients from Indonesia was analyzed along with 50 healthy individuals, both male and female, which formed the control group. DNA isolation, polymerase chain reaction amplification, electrophoresis, and sequencing were performed for the analysis. Results: The IDS gene was successfully analyzed for all samples. A DNA base deletion at position c.1549delATC was found in an MPS II patient. Conclusions: This IDS gene variant is novel. Further research would be necessary to detect other IDS gene variants, with mutations at other exons, in the Indonesian MPS II patients.
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Effects of nitrox II during a single decompression dive on endothelial nitric oxide synthase expression and flow-mediated dilation among trained male divers Highly accessed article p. 43
Ika Rahma Mustika Hati, Guritno Suryokusumo, Ambar Wahyuningsih Roestam
DOI:10.4103/jnsbm.JNSBM_88_19  
Background: Nitrox II, associated with higher oxygen partial pressure, induces an increase in reactive oxygen species, which can interfere with endothelial nitric oxide synthases (eNOSs), causing endothelial dysfunction and lower flow-mediated dilation (FMD). This study aimed to determine the influence of nitrox II on eNOS expression and FMD as markers of endothelial function. Materials and Methods: A double-blind approach was used with 39 trained male divers who were divided using randomized block design into a control group (the air group) that used compressed air or an intervention group that used nitrox II (the nitrox II group). Both the groups underwent a single decompression dive to 28 m sea water (msw) with a bottom time of 50 min in a hyperbaric chamber. Pre- and postdive eNOS expression was measured by quantitative enzyme-linked immunosorbent assay and FMD by laser Doppler flowmetry on the regio brachii. Results: eNOS (P = 0.029) and FMD (P = 0.001) decreased in the air group, whereas eNOS (P = 0.018) and FMD (P = 0,023) increased in the nitrox II group. The average difference in eNOS and FMD in the nitrox II group was greater compared with the air group (P < 0.05). There was no significant correlation between eNOS and FMD. Conclusion: Nitrox II prevents endothelial dysfunction during a single decompression dive to 28 msw with a bottom time of 50 min, as indicated by divers' increased FMD from increased eNOS expression.
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Predictors of 3-month mortality in elderly patients visiting the emergency department: A retrospective cohort study p. 48
Syafitri Yuliani, Aulia Rizka, Ceva Wicaksono Pitoyo, Muhadi Muhadi
DOI:10.4103/jnsbm.JNSBM_32_19  
Objective: Various studies have documented the cases of failure to thrive among elderly patients following admission to the emergency department (ED), leading to early mortality. However, studies determining the predictors of 3-month mortality in elderly patients visiting the ED in Indonesia are lacking. Materials and Methods: A retrospective cohort study was performed using secondary data of elderly patients in the ED at Dr. Cipto Mangunkusumo National Hospital between September 2016 and January 2017. We gathered 3-month mortality data using medical records and telephone interviews. Functional status decline, cognitive function impairment, polypharmacy, delirium, frailty, hypoalbuminemia, malnutrition risk, and Rapid Emergency Medicine Score were analyzed using the Chi-square test. Multivariate logistic regression analysis was performed to identify independent predictors of mortality. Results: From the 501 patients studied, 36 (7.2%) were lost to follow-up. A total of 465 patients were evaluated, with a median age of 67 years old (60–89). The overall 3-month mortality of elderly patients admitted to the ED was 32.5%. The independent predictors of 3-month mortality obtained from the multivariate analysis were functional status decline (odds ratio [OR]: 3.05; 95% confidence interval [CI]: 1.63–5.73), polypharmacy (OR: 2.65; 95% CI: 1.74–4.04), delirium (OR: 2.01; 95% CI: 1.26–3.21), and hypoalbuminemia (OR: 1.89; 95% CI: 1.02–3.50). Conclusion: Functional status decline, polypharmacy, delirium, and hypoalbuminemia are independent predictors of 3-month mortality among elderly patients in the ED.
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Relationship between blood flow rate and quality of life in patients undergoing hemodialysis p. 53
Pringgodigdo Nugroho, Jeremia Immanuel Siregar, Rudi Putranto, Cleopas Martin Rumende
DOI:10.4103/jnsbm.JNSBM_33_19  
Background: A low quality of life (QoL) score in patients undergoing hemodialysis (HD) is associated with an increased risk of mortality. However, no study has evaluated a direct relationship between the blood flow rate (BFR) and QoL in patients undergoing twice-weekly HD. Materials and Methods: This cross-sectional study was conducted on patients undergoing HD (twice weekly) at the HD Unit in Cipto Mangunkusumo Hospital, Jakarta. The patients were divided into two groups: those with a BFR of >250 ml/min and those with a BFR of ≤250 ml/min. QoL was assessed using the Kidney Disease QoL-Short Form questionnaire, which is divided into physical composite summary (PCS), mental composite summary, and kidney disease composite summary (KDCS) scores. The relationship between the BFR and QoL scores was analyzed using the Chi-square test and logistic regression analysis to determine the adjusted prevalence ratio (PR). Results: In total, 132 patients were included in the analysis. Patients with a BFR of >250 ml/min were more likely to have a higher PCS score (PR, 1.86; 95% confidence interval [CI], 1.15–2.99) and KDCS score (PR, 1.41; 95% CI, 1.03–1.92) than those with a BFR of ≤250 ml/min. After the multivariate analysis, the BFR was still associated with the PCS score (adjusted PR, 1.75; 95% CI, 1.12–2.36) and KDCS score (adjusted PR, 1.31; 95% CI, 1.04–1.49). Conclusion: Higher BFR values were significantly associated with higher PCS and KDCS scores in patients undergoing twice-weekly HD.
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Screening for exonic mutation L444P in Indonesian patients with gaucher disease using exons 9–11 p. 59
Rabbil Pratama Aji, Rizky Priambodo, Cut Nurul Hafifah, Damayanti Rusli Sjarif
DOI:10.4103/jnsbm.JNSBM_38_19  
Objective: Gaucher disease (GD) is the most common lysosomal storage disorder. It is caused by a deficiency of β-glucocerebrosidase (GCase, encoded by GBA) and its inheritance is autosomal recessive. Analyses of common mutations in GBA have been performed in China, Singapore, Taiwan, and Thailand, but not previously in Indonesia. The objective of this study was to identify a common exonic mutation in exons 9–11 of GBA in GD patients in Indonesia. Materials and Methods: Genetic analysis was performed using blood samples from two GD patients and thirty non-GD patients. Peripheral leukocyte samples were collected at the Dr. Cipto Mangunkusumo Referral Hospital, Jakarta, Indonesia. The polymerase chain reaction was performed to amplify exons 9–11 of the GBA gene using specific primers, then the product was digested with Nci I restriction enzyme, and the sequence confirmed by sequence analysis. Results: This identified an L444P mutation located in exon 10. This missense mutation changes amino acid 483 of GCase from leucine to proline and is categorized as a pathogenic variant. Conclusion: This identification of the L444P mutation adds to a database for determining the prevalence of GD in Indonesia. However, further research is needed to ascertain the impact of the L444P mutation on the structure of GCase and to explore any mutations in the other exons.
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Validation of assessment tools for the early detection of ocular involvement in leprosy p. 62
Vania Vashti Lasrindy, Sri Linuwih Menaldi, Shannaz Nadia Yusharyahya, Yunia Irawati
DOI:10.4103/jnsbm.JNSBM_55_19  
Objective: Ocular leprosy needs early detection to prevent blindness, but early detection tools for ocular leprosy vary. Thus, it is important to develop a valid and sensitive screening tool that physicians other than ophthalmologists who treat leprosy can use. This study aims to validate and measure the sensitivity of an early detection checklist that we created for ocular examination in patients with leprosy. Materials and Methods: We designed a checklist according to the symptoms and signs of ocular leprosy based on suggestions from dermatovenereologists and ophthalmologists. Leprosy patients at the Dermatology and Venereology Outpatient Clinic of Dr. Cipto Mangunkusumo General Hospital were examined by a general practitioner (nonophthalmologist) using the checklist as a screening tool; then, they were re-examined by an ophthalmologist as a gold standard. We conducted data analysis to validate and determine the sensitivity of the screening tool. Results: The checklist had good validity, reliability, and sensitivity, with a correlation value of 0.664 (P < 0.05), a Cronbach's α of 0.715, 85.42% sensitivity, and 73.33% specificity. The prevalence of ocular involvement in this study was 77%, with dry eyes, cataract, madarosis, lagophthalmos, and glaucoma as the most common ocular complications found. Conclusion: The checklist in this study is validated and sensitive; thus, it can be used as a screening tool to detect ocular involvement in leprosy.
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Determination of cancer-associated fibroblast and stromal phenotypes as novel prognostic factors for colorectal carcinomas associated with tumor budding p. 68
Noza Hilbertina, Nurjati Chairani Siregar, Murdani Abdullah, Septelia Inawati Wanandi
DOI:10.4103/jnsbm.JNSBM_61_19  
Objective: Tumor microenvironments consisting of stroma and extracellular matrix play important roles in tumor progression, particularly through the induction of epithelial-mesenchymal transition (EMT). It has been suggested that the phenotype of cancer-associated fibroblasts (CAFs) in stroma might be correlated with the prognosis of patients with colorectal carcinoma (CRC). We aimed to determine the stromal and CAF types for prognostic determinants of CRCs associated with tumor budding (TB) grade, reflecting EMT. Materials and Methods: Using hematoxylin and eosin-stained paraffin wax sections from 23 patients with CRC, three stromal and two CAF phenotypes were evaluated, TB grades, invasion depth, lymph node metastases, and lymphovascular invasion (LVI) were also analyzed as established prognostic determinants. Data were analyzed statistically using the Chi-squared tests. Results: There was a significant association between CAF phenotype and TB grade (P < 0.01). CRC specimens with immature CAF have higher TB grades than the mature phenotype. Nevertheless, a significant association between stroma and TB grade could not be demonstrated. Moreover, high TB grades were significantly associated with lymph node metastasis (P < 0.01) and LVI (P < 0.01). However, there were no significant associations between CAF phenotype and either of these prognostic determinants. Conclusion: CAF phenotype could be considered as a prognostic determinant of CRC through its association with TB grade, indicating the role of CAFs in EMT processes. Future studies are required to examine the secretomes of CAFs that play important roles in EMT and determine the prognosis for patients with CRCs.
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The impact of caregiving on anxiety and depression symptoms in caregivers of hospitalized geriatric patients p. 73
Steven Sutanto Sihombing, Rudi Putranto, Kuntjoro Harimurti, Ikhwan Rinaldi
DOI:10.4103/jnsbm.JNSBM_75_19  
Objective: Research focusing on anxiety and depression among caregivers of hospitalized geriatric patients is lacking. The objective of this study was to determine the prevalence of anxiety and depression among caregivers of hospitalized geriatric patients for 1 week. Subjects and Methods: A prospective cohort study of caregivers of geriatric patients who were hospitalized at Cipto Mangunkusumo Hospital was conducted from February to May of 2018; levels of anxiety and depression symptoms were assessed on the 1st day of hospitalization compared with those from the 7th day using the Hospital Anxiety and Depression Scale questionnaire. The analysis was conducted using SPSS Statistics for bivariate and multivariate logistic regression. Results: On the 1st day of hospitalization, 29.1% of the caregivers had mild anxiety symptoms, 5.1% had moderate anxiety symptoms, and 2.6% had mild depression symptoms. On the 7th day, 44.4% of the caregivers had mild anxiety symptoms, 23.1% had moderate anxiety symptoms, and 3.4% had severe anxiety symptoms, whereas 49.6% had mild and 12.8% had moderate depression symptoms. The duration of caregiving ≥8 h/day (P = 0.041; odds ratio [OR]: 4.228; 95% confidence interval [CI]: 1.060–16.860 for anxiety and P = 0.008; OR: 8.392; 95% CI: 1.723–40.880 for depression) and ≥6 days/week (P = 0.019; OR: 2.500; 95% CI: 1.163–5.375 for anxiety and P < 0.001; OR: 4.184; 95% CI: 1.982–9.256 for depression) significantly increased symptoms of anxiety and depression. Conclusion: Caregiving for hospitalized geriatric patients can aggravate anxiety and depression, and the duration of caregiving ≥8 h/day and ≥6 days/week significantly increased both symptoms.
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Contribution of a program of insecticide treated nets for reducing malaria prevalence in Kori Subdistrict, Southwest Sumba p. 78
Saleha Sungkar, Didit Fathurrahman, Stanley Buntaran, Aria Kekalih
DOI:10.4103/jnsbm.JNSBM_95_19  
Introduction: Malaria is endemic in Indonesia, especially in East Nusa Tenggara (ENT). To reduce its prevalence, the Ministry of Health has launched a program of insecticide-treated net (ITN) distribution to protect people from mosquito bites. The aim of this study was to evaluate the contribution of ITNs in reducing malaria prevalence in Kori Subdistrict, Southwest Sumba, ENT. Materials and Methods: This study used secondary data from the primary healthcare center in Kori. The data were the number of patients, gender, age, and presenting with fever and diagnosed by rapid diagnostic test in the year before and after the distribution of ITNs. The effects were evaluated using Chi-square test. Results: The prevalence of malaria in 2014 was 51.1% and consisted of 30.6% Plasmodium falciparum, 19.5% Plasmodium vivax, and 1% mixed infection. After the distribution of ITNs in 2015, the prevalence decreased to 41.3% (P < 0.001) with the fall occurring in infections by P. falciparum, though the prevalence of P. vivax and of mixed infections did not change identifiably. The decrease in the prevalence was most marked for women and children under the age of five. Conclusion: The prevalence of malaria in Kori subdistrict, Southwest Sumba, fell substantially from 51.1% to 41.3% in the year after ITN distribution.
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In vitro transfection of manganese superoxide dismutase small interfering rna suppresses stemness of human breast cancer stem cells (aldehyde dehydrogenase 1-positive): Focus on OCT4 mRNA expression and mammosphere-forming capacity p. 82
Sekar Arumsari, Dimas Ramadhian Noor, Syarifah Dewi, Resda Akhra Syahrani, Septelia Inawati Wanandi
DOI:10.4103/jnsbm.JNSBM_113_19  
Introduction: Aldehyde dehydrogenase 1-positive (ALDH1+) breast cancer stem cells (BCSCs) are a small population of tumor cells with high capacity of tumorigenicity and oxidative stress. Manganese superoxide dismutase (MnSOD) is specifically expressed in mitochondria as the primary defense against superoxides, which are one of the causes of oxidative stress in cells. The aim of this study was to determine the impact of suppressing MnSOD expression using small interfering RNA (siRNA) on the stemness, tumorigenicity, and viability of BCSCs. Materials and Methods: In vitro transfection of ALDH1+ BCSCs was performed using 33 and 66 μM specific MnSOD siRNA under standard culture conditions. Total RNA and protein were extracted from the transfected cells using TriPure® Isolation Reagent and RIPA® lysis buffer. Cell viability was measured using a trypan blue exclusion assay. The relative expression of MnSOD and OCT4 mRNAs was analyzed using one-step quantitative reverse transcription polymerase chain reaction. MnSOD activity was determined by xanthine oxidase inhibition assay (RanSOD® kit). Cellular superoxides were measured using a dihydroethidium assay, and tumorigenicity was observed with mammosphere-forming unit. Results: After siRNA incubation for 48 h, MnSOD was suppressed by 0.176-fold (P < 0.01), MnSOD enzyme-specific activity was reduced 70.4%, cellular superoxide levels increased by 1.13-fold, OCT4 expression was suppressed by 1.98-fold (P < 0.05), and mammosphere-forming unit decreased by 36.5% (P < 0.05) compared with the corresponding negative controls. The viability of the ALDH1+ BCSCs was reduced 75% (P < 0.05). Conclusion: Our results suggest that suppression of MnSOD expression may be a promising target to reduce stemness and tumorigenicity of ALDH1+ BCSCs.
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The relationship between laryngopharyngeal reflux based on pepsin value and clinical characteristics of laryngeal cancer patients p. 88
Susyana Tamin, Indah Saraswati, Bambang Hermani, Ina Susianti Timan, Saptawati Bardosono
DOI:10.4103/jnsbm.JNSBM_17_19  
Introduction: Laryngopharyngeal reflux (LPR) is a suspected risk factor for laryngeal cancer. High prevalence of LPR is observed in patients suffering from laryngeal cancer. Hence, we studied the association between the presence and levels of LPR (as measured by pepsin value) and selected characteristics of laryngeal cancer patients. Materials and Methods: An observational analytic study involving 26 patients diagnosed with laryngeal cancer was designed. All patients provided sputum twice to be evaluated later for pepsin level (pepsin I and pepsin II) using ELISA. Data analysis was performed using Statistical Package for the Social Sciences software (SPSS, Inc. version 23.0, Chicago). Results: Twenty-four out of 26 patients were male with a mean age of 60.65 ± 8.41 years, 7 were severe drinkers, 12 were severe smokers, and 24 patients had late-stage laryngeal cancer. All patients were diagnosed with LPR. There was a significant association of pepsin I (daytime/provoked LPR) level with alcohol consumption (P = 0.002) and a significant difference between the value of pepsin I in heavy and light smokers (P = 0.039). Conclusion: LPR was significantly correlated with alcohol consumption and smoking status among the laryngeal cancer patients. It is recommended that avoiding alcohol consumption and smoking can significantly curtail LPR and hence potentially the incidence of laryngeal cancer.
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Relationship between morphology of tripronuclear embryo and chromosomal abnormalities potential in intracytoplasmic sperm injection cycles p. 92
Shanty Olivia Jasirwan, Pritta Ameilia Iffanolida, Victor Prana Andika Santawi, Dewi Friska, Budi Wiweko
DOI:10.4103/jnsbm.JNSBM_19_19  
Introduction: Tripronuclear (3PN) zygote is a frequently observed abnormal outcome in vitro fertilization/intracytoplasmic sperm injection (ICSI) technology. They are usually discarded because of concerns about their abnormal chromosomal constitution. However, in rare cases when availability of the embryos is limited, evidence-based information on the suitability 3PN zygotes for implantation will be valuable. Materials and Methods: In this study, we analyzed the chromosomal constitution of 3PN to investigate the relationship between their morphology and chromosomal status. Thirty 3PN zygotes developed into embryos from 18 cycles were reviewed during 6 months. Biopsies were performed on day 5/6 and were subsequently screened for chromosomal status using a next-generation sequencing method. Results: Of the 30 3PN screened, 66.7% were chromosomally abnormal. At the cleavage stage, there was no association between any of the morphological features and chromosomal status. In contrast, at the blastocyst stage, a grade <3 blastocyst expansion had a significantly higher chromosomal abnormality (90%, P = 0.05) than the other grades of expansion. Embryos with grade non A (grade B and C) for both inner cell mass and tropectoderm, had significantly higher chromosomal abnormalities (100%, P = 0.001 and 93.3%, P = 0.001, respectively). Conclusion: We concluded that chromosomal status and 3PN morphology are linked at the blastocyst stage, and thus morphological assessment of 3PN blastocysts can be used in conjunction with preimplantation genetic screening to select which embryo should be transferred when no other embryos from two pronuclear ICSI zygotes are available.
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Identification of a novel variant in exon 5 of galactosamine (N-acetyl)-6-sulfatase gene in mucopolysaccharidosis IVA patients in Indonesia p. 99
Nurul Muhammad Prakoso, Rizky Priambodo, Yulia Ariani, Cut Nurul Hafifah, Damayanti Rusli Sjarif
DOI:10.4103/jnsbm.JNSBM_40_19  
Objective: Mucopolysaccharidosis IVA (MPS IVA), or Morquio A syndrome, is a lysosomal storage disorder caused by a deficiency of galactosamine (N-acetyl)-6-sulfatase (GALNS) enzyme that leads to the accumulation of keratan sulfate and chondroitin-6-sulfate in the lysosome and eventually in the tissue or organ damaged. This enzyme deficiency occurs because of mutations in the galactosamine (N-acetyl)-6-sulfatase (GALNS) gene located at locus 16q24.3. GALNS comprises 14 exons, has a size of ~43 kb, and encodes 522 amino acids. Currently, 47 of 368 mutations have been detected in exon 5, indicating that this region is a hotspot of mutations. The objective of this study was to analyze the mutations in exon 5 of GALNS in MPS IVA patients in Indonesia. Materials and Methods: Genomic DNA was isolated from fresh blood samples obtained from patients with MPS IVA and normal individuals at Cipto Mangunkusumo Hospital. Exon 5 of GALNS was amplified using a pair of specific primers, and polymerase chain reaction products were sequenced using an automated sequencing technique. Results: We found a novel missense mutation c.503G>T that alters the amino acid at position 168 from glycine to valine (G168V). Three previously reported variations identified in this study are c.510T>C (Y170), c.566 + 5T>C, and IVS5 + 134G>A. Conclusion: This finding provides new data about variants in exon 5 of GALNS. Further, research is needed to identify variations in other exons and to map the mutation profile in MPS IVA patients in Indonesia.
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Association between the muscle mass index and physical frailty in geriatric outpatients p. 103
Purwita Wijaya Laksmi, Nur Ainun, Bambang Setyohadi, Siti Setiati, Anna Ariane, Gunawan Tirtarahardja
DOI:10.4103/jnsbm.JNSBM_43_19  
Objective: Frailty syndrome is commonly seen in geriatric patients. In this study, we investigated the association between the muscle mass index and physical frailty in elderly outpatients. Materials and Methods: A cross-sectional study was conducted among elderly patients (≥60 years old) from the Geriatric Clinic of the Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia, from April to June 2018. Each subject underwent anthropometric measurements, a frailty evaluation using the Cardiovascular Health Study questionnaire, and lean mass measurements using dual-energy X-ray absorptiometry. The appendicular lean mass (ALM) measurement was adjusted by the height squared (ALM/ht2) and by the body mass index (ALM/BMI) to indicate the muscle mass index. Results: The proportions of the frail, prefrail, and robust patients were 29.17%, 58.33%, and 12.5%, respectively. There was a significant difference in the ALM/ht2 values between the frail and nonfrail (prefrail and robust) patients (6.54 [1.01] kg/m2 vs. 7.03 [0.91] kg/m2, P = 0.01), but not in the ALM/BMI values. No significant association was observed between frailty and the muscle mass index. Multivariate analysis indicated that the frailty status was significantly associated with the nutritional status (odds ratio [OR] = 3.67, 95% confidence interval [CI] = 1.59–8.49) and functional status (OR = 4.94, 95% CI = 2.01–11.75). Conclusion: Physical frailty was not significantly associated with the muscle mass index, but it was associated with the nutritional and functional statuses.
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Mutation analysis of exon 8 of the iduronate-2-sulfatase gene in mucopolysaccharidosis type II patients in Indonesia p. 109
Anggia Nurwulan Kusno Putri, Rizky Priambodo, Yulia Ariani, Steven Arianto, Damayanti Rusli Sjarif
DOI:10.4103/jnsbm.JNSBM_44_19  
Objective: Mucopolysaccharidosis II (MPS II), also known as Hunter syndrome, is a rare, recessive, X-linked lysosomal storage disorder caused by a deficiency of lysosomal enzyme iduronate-2-sulfatase (IDS), encoded by IDS gene. I2S plays an important role in the lysosomal degradation of dermatan sulfate and heparan sulfate, with I2S deficiency leading to the accumulation of these glycosaminoglycans in the tissues. Materials and Methods: Exon-specific analyses of IDS exon 8 from eight Indonesian patients with MPS II from Cipto Mangunkusumo Hospital, Jakarta, Indonesia, were performed using polymerase chain reaction and sequencing-based methods. Results: Two novel mutations and a deletion variant of exon 8 were identified among the patients. A single-nucleotide deletion variant (c.1023delA), causing a frameshift in the corresponding amino acid sequence (p.Glu341AspfsTer19), was observed in all patients. In addition, a novel missense mutation (c.1033T>C) resulting in a tryptophan to arginine substitution (p.Trp345Arg), along with a single-nucleotide deletion (c.1041delA) resulting in a second frameshift in the amino acid sequence (p.Lys347AsnfsTer13), was also observed in one patient. Conclusion: This study provides the first mutation analysis of exon 8 of IDS and successfully identified mutations within the IDS gene that may be associated with MPS II. These findings will be added to the IDS gene profile database and may help in the diagnosis of MPS II in future.
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IIIB-plus: A new classification recommended for stage IIIB cervical cancer patients with renal impairment p. 113
Laila Nuranna, Puja Agung Antonius, Alfu Nikmatul Laily, Fitriyadi Kusuma, Kartiwa Hadi Nuryanto
DOI:10.4103/jnsbm.JNSBM_53_19  
Objective: This study was designed to define the differences between Stage IIIB cervical cancer patients with and without renal impairment (RI), particularly with regard to the pathology results, laboratory values, therapies, and prognoses, in order to justify the need for separate classifications for these two different patient types. Materials and Methods: A retrospective cohort technique was used to evaluate consecutive Stage IIIB cervical cancer patients from July 2010 to July 2015. The data collected included the age, parity, cancer cell type, pelvic wall involvement, hydronephrosis degree and bilateral involvement, laboratory values (urea, potassium, and creatinine), treatment modalities, 3-month postradiation treatment response, hospital stay duration, and 1-year survival rate. Results: The study patients included 102 Stage IIIB cervical cancer patients with RI and 204 individuals without RI. The results showed significant differences between individuals with and without bilateral pelvic wall involvement (100% vs. 68.1%, respectively), hydronephrosis degree (severe hydronephrosis incidences: 69% vs. 3.9%, respectively), bilateral hydronephrosis (96.5% vs. 6.9%, respectively), median urea level (148 vs. 22 mg/dl, respectively), median creatinine level (8.0 vs. 0.8 mg/dl, respectively), and median potassium level (5.8 vs. 3.9 mEq/L, respectively). The hazard ratio was 3.07 for the survival analysis. Conclusion: Cervical cancer patients with RI are faced with worst prognosis, and their treatment modalities are limited due to their renal comorbidities, resulting in lesser type of therapy modalities (such as chemotherapy procedure prohibition), longer hospital stays, and a lower survival rate. Therefore, a new classification for cervical cancer patients with kidney impairment, named Stage IIIB-plus, should be considered.
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The relationship between empathy, prosocial behavior, peer relationships, and emotional problems in elementary schoolchildren in Indonesia p. 118
Eloisa Nathania, Kindah Mahdiyyah, Kamila Ratu Chaidir, Yudi Reza Phalapi, Tjhin Wiguna
DOI:10.4103/jnsbm.JNSBM_71_19  
Introduction: Empathy is an essential attribute for coping in society. Empathy can be exhibited in the form of good prosocial behavior management and the ability to build peer relationships and regulate emotions. One of the most serious mental health problems is the antisocial behavior that arises from a lack of empathy. The study aimed to elaborate the association between empathy quotient and prosocial behavior, peer relationship and emotional problems among elementary schoolchildren. Materials and Methods: This was a cross-sectional study that included 620 parents and their children, and it was performed using an online questionnaire. The study used the Empathy Quotient-Children/Systemizing Quotient-Children Questionnaires and the strength and difficulties questionnaire, in which the Indonesian versions have been validated. The inclusion criteria were that the parents had a minimum educational background of junior high school level and had a child attending elementary school. The Chi-square analysis was done through the SPSS for Mac software, version 21. Results: The children ranged in age from 4 to 14 years. The study found that a lack of empathy was associated with emotional problems and problems with peer relations (P < 0.05). However, the relationship between empathy and prosocial behavior showed no statistically significant relationship (P > 0.05). Conclusion: Children require good empathy to properly function in their daily lives. Therefore, it is necessary to create and foster an educational environment that supports the development of empathy.
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Screening of intronic mutation IVS9+141A>G in an Indonesian patient with Gaucher disease p. 123
Rabbil Pratama Aji, Ika Citay Lestari, Rizky Priambodo, Cut Nurul Hafifah, Damayanti Rusli Sjarif
DOI:10.4103/jnsbm.JNSBM_79_19  
Objective: Gaucher disease (GD) is an autosomal recessive lysosomal storage disorder caused by the accumulation of the glycolipid glucosylceramide encoded by the GBA gene in certain organs. At present, more than 460 GBA intronic mutations have been reported in several subpopulations worldwide, but many have never been reported in Indonesia. Here, we aimed to screen for intronic mutations of GBA that might be present in patients with GD in Indonesia. Materials and Methods: Blood samples from patients with and without GD were obtained from the National Dr. Cipto Mangunkusumo Referral Hospital, Jakarta, Indonesia. Genomic DNA samples from peripheral leukocytes were extracted, purified, and amplified using the polymerase chain reaction (PCR) with specific primers. Products of PCR were visualized by gel electrophoresis and were further sequenced to analyze the presence of mutations in intron (intervening sequence [IVS]) 9 of GBA. Results: A mutant allele was identified at IVS9+141A>G, discovered at nucleotide 9335 in IVS 9. This mutation had been reported in India before and was categorized as nonpathogenic. Conclusion: Our study may be used as supplemental information for the GD database in Indonesia and will also open new research opportunities for predicting splicing processes in other intronic variants among patients with GD in Indonesia.
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Diagnostic merit of using the calf circumference to estimate the muscle mass as a component of sarcopenia in elderly outpatients p. 126
Purwita Wijaya Laksmi, Siti Hapsari Mitayani, Bambang Setyohadi, Muhadi Muhadi, Anna Ariane, Gunawan Tirtarahardja
DOI:10.4103/jnsbm.JNSBM_42_19  
Objective: Sarcopenia is a geriatric syndrome that can lead to poor clinical outcomes. Therefore, a simple measurement is necessary to estimate the muscle mass as a component of sarcopenia. The aim of this study was to determine the diagnostic merit of using the calf circumference (CC) to estimate the muscle mass in elderly individuals. Materials and Methods: This was a cross-sectional study of patients over 60 years conducted at the Geriatric Clinic of the Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia, from April to June of 2018. Dual-energy X-ray absorptiometry was used as a reference test for the muscle mass measurements, and the classification of normal or low muscle mass was based on the Asian Working Group for Sarcopenia criteria. The nondominant leg was used to measure the CC. Results: Out of 120 patients, 74 were female (61.7%). The optimal CC cutoff points for low muscle mass were 34 cm for the male patients (the values for the sensitivity [Sn], specificity [Sp], positive predictive value [PPV], negative predictive value [NPV], and area under the receiver operating characteristic curve [AUC] were 64.7%, 79.3%, 64.7%, 79.3%, and 73.1%, respectively) and 29 cm for the female patients (the values for the Sn, Sp, PPV, NPV, and AUC were 71.4%, 95.5%, 62.5%, 97.0%, and 96.4%, respectively). Conclusion: The sensitivities and specificities of the CCs were 64.7% and 79.3%, respectively, for the males and 71.4% and 95.5%, respectively, for the females. The CC could be used in clinical practice to estimate the muscle mass of elderly outpatients.
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Evaluation of sanger sequencing method for ESR1 mutation detection in primary breast tumor p. 131
Ramadhan Karsono, Adhitya Bayu Perdana, Fahreza Saputra, Yulia Pratiwi, Ayu Nurdiantika Sari, Abi Abinawanto
DOI:10.4103/jnsbm.JNSBM_46_19  
Objective: Exon 8 estrogen receptor 1 (ESR1) mutations in the ligand-binding domain play an important role in mechanisms of hormonal therapy resistance in breast cancer. Identification of ESR1 mutations is very important in determining the appropriate steps of therapy. In this study, we evaluate Sanger sequencing technique to detect the ESR1 mutation. Methods: This retrospective study was conducted using 49 advanced breast cancer patients with estrogen receptor positive. Deoxyribonucleic acid (DNA) material was extracted from primary breast tumor samples. Exon 8 ESR1 gene mutation was analyzed by Sanger sequencing method using BigDye Direct Sequencing Kit (Applied Biosystem) with gBlock synthesis gene fragment (Integrated DNA Technologies) D538G as a positive control. Results: The mean age of patients was 46.14 (±9.6) years, and 61.2% were in stage 4. There are no exon 8 ESR1 gene mutations detected in 49 primary tumor samples, whereas the gBlock-positive control showed base substitution in 1613A>G (D538G) indicating the success of sequencing reaction. Conclusion: Sanger sequencing has failed to detect ESR1 mutation in primary tumor breast samples. Other advanced molecular techniques should be performed for diagnosis of primary breast tumors.
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The effect of interval versus continuous training on actin and myosin heavy chain levels in adult rat skeletal muscle p. 136
Nurul Paramita, Sari Tri Yulianti, Dewi Irawati Soeria Santoso, Sri Widia A Jusman, Delima Enggar Maretha, ErmitaI I Ibrahim Ilyas
DOI:10.4103/jnsbm.JNSBM_47_19  
Objective: Exercise helps maintain and improve contractile proteins and muscle mass. It is necessary to determine which type of exercise and its intensity yields maximal benefits. This study compared the effects of interval versus continuous training on levels of actin and myosin heavy chain (MHC) in the gastrocnemius muscles of adult Wistar rats. Materials and Methods: Twenty male Wistar rats aged 12 months were evenly and randomly divided into three groups: (1) the control group, (2) the interval training group, which consisted of four rounds of running for 4 min (with 1 min of active rest between each run), and (3) the continuous training group, which consisted of 40 min of continuous running. The treatments were given for 8 weeks, 5 days per week. Actin and MHC levels in gastrocnemius muscle were measured using the ELISA. Results: Actin levels in the continuous training group were significantly higher than the interval training group (P = 0.039). We found actin levels in continuous training group were significantly higher than the control group (P = 0.016), but there was no significant difference between interval training and control group (P = 0.624). There were no significant differences in MHC levels between the continuous and the interval training groups (P = 0.231). Conclusion: We found that continuous training was more effective than interval training in stimulating actin proteins in the gastrocnemius muscle.
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Effect of interval and continuous training on proliferator-activated receptor gamma coactivator-1α and lactate dehydrogenase B levels in adult rat heart p. 140
Dewi Irawati Soeria Santoso, Trimar Handayani, Delima Engga Mareta, Nurul Paramita, Sri Widia A Jusman, Ermita I Ibrahim Ilyas
DOI:10.4103/jnsbm.JNSBM_69_19  
Introduction: Mitochondrial biogenesis is affected by peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) and can be induced through physical exercise. Lactate from the skeletal muscle produced in the heart during exercise can be used as an energy source through conversion by lactate dehydrogenase B (LDH B). This study compared the effects of continuous training (CT) and interval training (IT) on PGC-1α and LDH B levels in the adult rat hearts. Materials and Methods: Fifteen male adult Wistar rats (12 months old) were randomly divided into three groups as follows: A control Group (c), a CT group and an IT group. Training was conducted using a rodent treadmill, 5 days/week for 8 weeks. The duration was 50 min for the CT group. In the IT group, training consisted of 4 bouts of 4 min of exercise, followed by rest intervals of 1 min. Speed was increased each week. After 8 weeks of training, the rats were sacrificed, and the levels of PGC-1α and LDH B in heart tissue were measured using enzyme-linked immunosorbent assay. Results: Differences in PGC-1α levels between groups were statistically significant (P = 0.008), while differences in LDH B levels were not statistically significant (P = 0.063). Levels of PGC-1α and LDH B were higher in the CT group than in the IT group. Conclusion: We concluded that CT has a greater effect on energy metabolism in the heart than IT.
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Learning environment assessment on the pediatric residency program at Dr. Moewardi Hospital, Surakarta, Indonesia p. 144
Annang Giri Moelyo, Muhammad Riza, Fadhilah Tia Nur, Hari Wahyu Nugroho, Sri Martuti, Dwi Hidayah, Endang Dewi Lestari, Harsono Salimo
DOI:10.4103/jnsbm.JNSBM_110_19  
Background: The learning environment plays an important role in resident education, and the Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire is a tool to assess the student's perception of the learning environment. The aim of this study was to assess the perceptions of the learning environment in 2012 and 2017 on the pediatric residency program at Dr. Moewardi Hospital, Universitas Sebelas Maret, Surakarta, Indonesia. Methods: A modified PHEEM questionnaire was distributed in April 2012 and September 2017 to all ongoing pediatric residents. The learning environments (sex, grade, perceptions of autonomy, teaching, and social support) in 2012 and 2017 were analyzed by Mann–Whitney test and Kruskal–Wallis test. Results: There were 32 and 49 participants in 2012 and 2017, respectively. The overall PHEEM score (mean ± standard deviation) was 105.3 ± 19.1 in 2012 and 116.4 ± 12.1 in 2017. The mean scores for perceptions of autonomy, teaching, and social support were 36.3 ± 6.6, 41.0 ± 7.7, and 27.9 ± 5.7, respectively, in 2012, and 41.0 ± 4.7, 44.7 ± 4.4, and 30.7 ± 3.9, respectively, in 2017. In 2012, 21%, 27%, and 18% of items on perceptions of autonomy, teaching, and social support, respectively, rated >3; in 2017, these values were 35%, 53%, and 36%. Conclusion: The perceptions of the learning environment for the pediatric residency program at Dr. Moewardi Hospital Surakarta in 2012 and 2017 were rated more positively, but there remains room for improvement. In 2017, there were more perceived difficulties with autonomy and social support.
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Estimating the incidence of prediabetes and type 2 diabetes among taxi drivers in Indonesia p. 150
Tri Juli Edi Tarigan, Erni Hernawati Purwaningsih, Yusra , Murdani Abdullah, Nafrialdi , Joedo Prihartono, Made Ratna Saraswati, Abdullah Shidqul Azmi, Imam Subekti
DOI:10.4103/jnsbm.JNSBM_109_19  
Objective: Health problems among taxi drivers can affect their performance and increase the risk of accidents. The aim of this study was to determine the prevalence of dysglycemia and metabolic risk factors affecting taxi drivers in Jakarta to provide baseline information for programs to prevent type 2 diabetes mellitus (T2DM) in this specific population. Methods: This cross-sectional study involved 106 male taxi drivers from 1006 total taxi drivers in Jakarta, Indonesia. All drivers underwent a general medical interview, physical examination, and oral glucose tolerance test. Results: The prevalence of dysglycemia in the taxi driver population was 54.7% (29.2% prediabetes and 25.5% diabetes). Central obesity was identified in 74.1% of dysglycemic individuals (P = 0.032). In the final multivariate analysis, waist circumference was the dominant factor that predicted dysglycemia (odds ratio 0.8; 95% confidence interval 1.01–5.26; P = 0.048). Conclusions: There is a high prevalence of dysglycemia in taxi drivers in Jakarta compared with the prevalence of dysglycemia in Indonesia (29.9% prediabetes and 6.9% diabetes), of which waist circumference is the strongest predictor. Programs must be implemented to prevent T2DM in this population.
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Embryo fragmentation and its relationship with aneuploidy p. 154
Naylah Muna, Budi Wiweko, Pritta Ameilia Iffanolida, Oki Riayati, Kresna Mutia, Ririn Rahmala Febri, Eliza Mansur, Tita Yuningsih, Andon Hestiantoro
DOI:10.4103/jnsbm.JNSBM_51_19  
Objective: Selecting embryos is an important step in the in vitro fertilization process before transferring them to the uterus. There are some invasive methods for choosing a good quality embryo, such as embryo grading. This method evaluates the equality and fragmentation of an embryo. However, this method does not adequately evaluate the chromosomal status of the embryos, which is often necessary for high-risk embryos. Here, we evaluated embryo fragmentation and chromosomal numbers using next-generation sequencing. Materials and Methods: Each embryo was biopsied on the 3rd or 5th culture day to obtain a single blastomere cell. DNA was then extracted from each blastomere and whole-genome amplification was carried out. Amplification products were then sequenced to obtain a ploidy number. Results: Among the 30 embryos that were evaluated, 19 embryos had no fragments, 10 embryos had small fragments, and 1 embryo had moderate fragments. However, 12 of 19 embryos, 57.9% with no fragments were detected to have chromosomal abnormality. Aneuploidy was increased in 7 of 10 embryos (70%) with mild fragments. One moderately fragmented embryo included was surprisingly found to have normal ploidy (100%). Gamma correlation test showed that there was no correlation between fragmentation and the incidence rate of aneuploidy (P > 0.05). Although there was no correlation, the study's result exemplifies that aneuploidy rate increased along with higher fragmentation. Conclusion: This research concluded that embryo fragmentation was not correlated with aneuploidy.
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Outcomes and complications of cataract surgery in Indonesia: A multicentric study p. 158
Nur Aisyah Rahmawati, Randy Sarayar, Annisa Nindiana Pertiwi, Herdanti Rahma Putri, Arnes Tasya Citra Anggini, Nizma Permaisuari, Andrew John Widya Sieman, Cynthia Viryawan, Gabriella Chandra, Dyah Astri Paramaramya, Muhammad Khoirul Huda, Yeni Dwi Lestari
DOI:10.4103/jnsbm.JNSBM_63_19  
Objective: Cataract is the leading cause of blindness worldwide and its only treatment is surgery, which is intended to restore the visual function; the expected outcomes are improved visual acuity (VA) and elimination of blindness. Therefore, evaluation of the outcomes of cataract surgery is needed to improve the quality of treatment programs. Materials and Methods: This was a cross-sectional study of 193 postcataract surgery eyes from August 2017 to March 2018 in six hospitals in Indonesia. Convenience sampling was used. Bivariate and multivariate analyses were performed on the medical records of pre- and postoperative VA, types of surgery, and complications.Results: Of the 193 eyes, 170 were analyzed. Phacoemulsification, manual small-incision cataract surgery, and extracapsular cataract extraction with intraocular lens (IOL) implantation were performed in 45.3%, 51.2%, and 3.5% of eyes, respectively. Preoperatively, 70% were blind, 8.8% had severe visual impairment (SVI), 17.1% had moderate visual impairment (MVI), and 4.1% were normal. Postoperatively, 78.2% were normal, 15.3% had MVI, 2.4% had SVI, and 4.1% were still blind. There were 93.5% of eyes with visual improvement; the blindness conversion rate was 95%. The overall complication rate was 15.3%, mostly from corneal edema (7.1%), followed by IOL dislocation (1.8%) and endophthalmitis (1.2%). There was no statistically significant difference in the postoperative visual outcome between groups treated with or without phacoemulsification (P = 0.870), but complications from corneal edema were statistically significantly higher with phacoemulsification (P = 0.003). Conclusion: All types of cataract surgery significantly improved VA, but the complication rate was higher with phacoemulsification, mostly from corneal edema.
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Exogenous ochronosis: Screening by dermoscopy and histopathological confirmation p. 163
Melyawati Hermawan, Irma Bernadette Simbolon Sitohang, Sondang Pandjaitan Sirait
DOI:10.4103/jnsbm.JNSBM_74_19  
A 51-year-old female presented with a 10-year history of brownish skin marks on her cheeks. Dermatological examination showed malar brownish macular lesions with diffused reddish areas and superimposing brownish papules. Further dermoscopic examination showed short circinate brownish-red structures and cutaneous pseudo-rete accentuation. Histopathological examination confirmed Stage II exogenous ochronosis (EO). Hydroquinone is the most commonly used topical agent for hyperpigmentation skin disorders. One side effect of its long-term use is EO. Clinically, EO is difficult to diagnose, and clinicians should be more aware of this condition. Dermoscopy is an in vivo diagnostic tool that is used to enhance the visualization of cutaneous lesions. The use of this device can potentially assist in identifying the progress of melasma disorder into EO.
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