Uncontrolled blood sugar levels in patients with diabetes mellitus will result in peripheral neuropathy in the lower extremities, so that the sensitivity of the feet will decrease. Ankle Brachial Index (ABI) assessment is necessary for Type 2 Diabetes Mellitus (T2DM) patients to detect peripheral neuropathy early, particularly on the soles of the feet. Low ABI values that cause vascular disorders are influenced by increasing age, duration of DM and obesity. Objective: To determine the relationship between blood sugar levels and the ankle brachial index value of patients with diabetes mellitus in the Out-Patient Department (OPD) Siloam Hospital, Denpasar. Methods: This study employed a correlational research design with a cross-sectional approach, using simple random sampling to involve 227 respondents. The research instruments used were a Sphygmomanometer to measure the ABI value and a Glucometer (Glukotest) to measure the blood sugar levels of respondents. Data analysis was carried out using Spearman's rank correlation. Results: Based on the value of blood sugar levels, it shows that the majority of respondents have a high category, namely 205 respondents (90.3%) and based on the value of the ankle brachial index (ABI), the majority of respondents' right foot ABI values are in the mild obstruction category, namely 128 respondents (56.4%) and the majority of the left foot has mild obstruction, namely 133 respondents (59.5%). The analysis yielded a p-value of 0.001, indicating a significant relationship between blood sugar levels and ankle brachial index (ABI) values. Conclusion: There is a significant relationship between blood sugar levels and ABI index on T2DM. Keywords: ankle brachial index, blood sugar level, T2DM
Amiodarone is classified as a class III antiarrhythmic agent that primarily inhibits adrenergic stimulation by blocking alpha and beta-adrenergic receptors. This drug also affects sodium, potassium, and calcium channels and prolongs the action potential and refractory period in myocardial tissue. Amiodarone, a drug well known for its wide range of side effects, can also affect the kidneys. The incidence of amiodarone-induced acute kidney failure is rare. There are limited studies regarding kidney injury caused by amiodarone. It has been reported a 45-year-old woman was admitted with leiomyoma and was scheduled for surgery. During hospitalization, the patient complained of palpitations that had been continuously present for one day. Electrocardiographic examination showed supraventricular tachycardia. The patient received intravenous amiodarone therapy followed by oral amiodarone. Renal function test results showed a decline after the patient received amiodarone therapy for 24 hours. The supraventricular tachycardia converted to normal sinus rhythm. After amiodarone was discontinued for several days, renal function returned to normal significantly. Keywords: acute kidney injury, amiodarone, renal toxicity
Type 2 Diabetes Mellitus (T2DM) is a metabolic disease that can cause various complications, one of which is cognitive dysfunction. Specific characteristics in T2DM patients can be risk factors for cognitive dysfunction, such as sex, age, employment status, education level, duration of diagnosis, comorbidity status, and degree of treatment adherence. Objective: To determine the association between the characteristics of Type 2 DM patients and cognitive dysfunction. Methods: This study used an observational analytical method with a cross-sectional study design conducted on 104 Type 2 DM patients at the Andalas Community Health Center, Padang, who met the inclusion and exclusion criteria. This study utilized the Montreal Cognitive Assessment-Indonesia (MoCA-Indonesia) questionnaire to evaluate the cognitive level of patients. This study was conducted from January to October 2024. Results: The Chi-square test showed a significant association between employment status (p = 0.038) and education level (p = 0.046) and cognitive dysfunction. Meanwhile, there is no significant association between sex (p = 1.000), age (p = 0.456), duration of diagnosis (p = 1.000), comorbidity status (p = 1.000), and degree of treatment adherence (p = 0.188) with cognitive dysfunction. Conclusion: Employment status and education level are significantly associated with cognitive impairment. Keywords: cognitive dysfunction, T2DM, patient characteristics
Congenital vaginal agenesis is a rare abnormality of the female genital tract caused by abnormal embryological development of the Müllerian ducts. Clinical manifestations vary depending on the extent of the anomaly, severity, and the patient's age at presentation. It has been reported that a 16-year-old presented to the Urogynecology Clinic at Dr. Hasan Sadikin General Hospital, Bandung, with a chief complaint of cyclic abdominal pain that had been intermittent for the past 2 years and no history of menstruation. The patient was referred from several private hospitals with a history of previous exploratory laparotomies. The girl had normal secondary sexual development. No vaginal sac was found on pelvic examination. A hematocolpos measuring 10.08 x 6.80 x 6.02 cm and a hematometra measuring 14.41 x 12.92 x 10.62 cm were found on ultrasound. An exploratory laparotomy revealed bilateral hematosalpinx with a normal uterus. Vaginoplasty, bilateral partial salpingectomy, and bilateral fimbrioplasty were performed. In this case report, the authors successfully performed vaginoplasty and fimbrioplasty to evacuate the hematocolpos, hematometra, and hematosalpinx. Vaginal molding was then inserted into the neovaginal to prevent spontaneous vaginal collapse and maintained in situ for 2 weeks after surgery. Keywords: hematocolpos, hematometra, hematosalpinx, vaginal agenesis
Myocardial infarction and ischemia are progressive manifestations of coronary heart disease due to coronary artery stenosis. ECG examination can be an initial tool for detecting infarction and ischemia. However, it has relatively low sensitivity and specificity in detecting arterial stenosis. Objective: To determine the relationship between infarction and ischemic ECG patterns with the degree of stenosis based on the Gensini score and risk factors that influence the degree of stenosis. Methods: This observational analytical study employed a cross-sectional design, utilizing secondary data from medical records at RSI Sultan Agung Semarang from January 2018 to December 2023. The degree of stenosis was calculated using the Gensini score method. Results: A total of 500 patient data were analyzed using a Chi-square test to examine ischemic and infarction ECG patterns in relation to the degree of stenosis, yielding a p-value of 0.001 and a contingency coefficient of 0.15. Conclusion: A significant relationship was found between infarction and ischemic ECG patterns, as well as the degree of stenosis, based on the Gensini score, with a very weak correlation strength. Keywords: degree of stenosis, Gensini score, infarction, ischemic
Sepsis is a life-threatening organ dysfunction due to dysregulation of the body's immune response to infection. The Sequential Organ Failure Assessment score (SOFA score) is a diagnostic tool used to quantitatively and objectively assess the level of organ dysfunction. Sepsis as a stressor of systemic inflammation, causes an increase in cortisol secretion by the adrenals to target tissues, which suppresses inflammation. Objective: To determine the correlation between SOFA score and blood cortisol levels in sepsis patients at RSUP Dr. M. Djamil Padang. Method: Observational analytic study with a cross-sectional method. The sample consisted of 55 patients who had been diagnosed with sepsis. The data used was secondary data from medical records. The data were tested using the Spearman correlation test. Result: A correlation was found between the SOFA score and blood cortisol levels, yielding a correlation coefficient of r = 0.338 and a p-value of 0.012. Conclusion: There is a significant moderate correlation between SOFA scores and blood cortisol levels. Keywords: blood cortisol, sepsis, SOFA score
Stunting is a linear growth failure caused by chronic malnutrition and recurrent infections that mainly occur in the first 1000 days of life. Infectious diseases can be prevented by providing immunizations. Immunization is one way to increase one's immunity against disease exposure actively. Objective: To determined the relation of immunization status with the incidence of stunting in children. Methods: Analytical research with a case-control design on 98 under-five children in the working area of Andalas Health Center was conducted from June to November 2024. Sampling was done by simple random sampling. Anthropometry was measured using body length or height measurements according to standards and data were collected by questionnaire. The data analysis used was Chi-square. Results: The incidence of stunting in the working area of Andalas Health Center was mainly (89.8%) experienced by children aged 24 - 59 months and more than half (59.2%) were female and most (81.6%) had an incomplete basic immunization status. The study also found that more than half (59.2%) of mothers' education in stunted children was high school and most (81.6%) occurred in mothers who did not work. There is a statistically significant relation between immunization status and the incidence of stunting in children, with p = 0.027 (p value <0.05) and OR value = 3.065. Conclusion: This means that under-five children who do not have complete basic immunization status have a 3.065 times higher chance of stunting than under-five children with complete basic immunization status. Keywords: immunization status, under-five children, stunting
Grave's Ophthalmopathy can occur in three phases depending on the inflammatory process. Immunosuppressant therapy is an anti-inflammatory option for managing the active phase of GO. A study showed a significant improvement in GO proptosis in patients treated with methylprednisolone. Objective: To determined the frequency of proptosis in Thyroid Eye Disease (TED) patients and the differential effect of oral or intravenous steroid administration. Methods: This study was a prospective cohort study through medical record data from March 2023 to March 2024. The subjects are all inpatients with thyroid eye disease in Dr M Djamil General Hospital, Padang. T-tests were performed to determine each group's different perceptions. Results: Thirty-six subjects with Grave’s ophthalmopathy. The effect size of the changes in Hertel values in patients given both oral and intravenous corticosteroid therapy is significant in both eyes. The effect size of the oral therapy is significant, with 0.341 in the right eyes and 0.303 in the left eyes. The intravenous therapy is also significant, with the effect size 0.347 in the right and 0.271 in the left. The change of Hertel value in patients given both oral and intravenous corticosteroid therapy is significant in the right eyes (p = 0.009 and p = 0.008). Conclusion: Oral and injectable corticosteroids have similar effectiveness, thus providing flexibility in therapy selection for patients with thyroid eye disease. Keywords: Grave ophthalmopathy, intravenous methylprednisolone, oral methylprednisolone
Cikal Tulang (Cissus quadrangularis) contains ketosteroids that can be used as a traditional obesity treatment. Objective: To evaluated the potential of Cikal Tulang (Cissus quadrangularis) extract in preventing obesity (loss of body weight and abdominal fat) in Galur Swiss mice. Methods: A quasi-experimental post-test only design was conducted from July to August 2021, involving 30 male Swiss albino mice aged 1.5 months with body weights of 18–30 grams. The mice were divided into five groups: negative control (high-fat diet and fructose solution), positive control (orlistat 15.6 mg/kgBW), and three treatment groups receiving Cissus quadrangularis extract at doses of 30, 90, and 180 mg/kgBW for 14 days. The extract was administered orally via a gastric sonde. Body weight and Lee index were obesity parameters, and abdominal adipose tissue was analyzed morphometrically using hematoxylin-eosin staining. Data were analyzed with One-Way ANOVA at a significance level of p < 0.05. Results: One-Way ANOVA test showed significant differences in Lee index among groups before treatment (p = 0.0097), with values >300 indicating obesity. Post-treatment, Lee index decreased across groups but without statistically significant differences (p = 0.878), with values remaining >300. Conclusion: There was no significant association between administering cikal tulang (Cissus quadrangularis) extract and its anti-obesity effect. Keywords: anti-obesitas, cikal tulang (Cissus quadrangularis), fat
Cutaneous tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. One form of cutaneous tuberculosis that is rare and often difficult to diagnose is Verrucous Cutaneous Tuberculosis (VCTB). This case report aims to describe the clinical presentation, diagnosis and management of VCTB in a delayed patient receiving appropriate therapy. It has been reported a 32-year-old man presented with a painful verrucous rash and yellowish discharge on his left thigh that has lasted for 20 years. The patient had a history of trauma at the lesion site and had received topical and oral therapy, but did not show satisfactory results. Physical examination and histopathology confirmed the diagnosis of VCTB. The patient was treated with antituberculosis drugs for six months and experienced significant clinical improvement. VCTB is often challenging to diagnose because of its non-specific clinical manifestations and similarity to other skin diseases. Delay in diagnosis and therapy may worsen the prognosis and increase the risk of complications. The VCTB diagnosis is based on a combination of history, physical examination, histopathological examination, and other supporting tests. Treatment for VCTB is the same as pulmonary tuberculosis, namely with antituberculosis drugs for six months. VCTB needs to be considered in diagnosis because many clinical verrucous rashes resemble this disease, especially in patients with a history of trauma and inadequate response to therapy. Keywords: antituberculosis, rash, verrucous cutaneous tuberculosis
Chronic Kidney Disease (CKD) is an irreversible, catastrophic condition. CKD is most commonly caused by hypertension, it is important to explore risk factors in hypertensive patients associated with Glomerular Filtration Rate (GFR) as an indicator of kidney function. Objective: To determined the relationship between risk factors, namely Body Mass Index (BMI) and High Density Lipoprotein (HDL), and how these factors influence GFR in hypertensive patients. Methods: This analytical observational study, using a cross-sectional approach, used 100 medical records from hypertensive prolanis patients at Media Farma Clinic, Samarinda, from January to December 2021. Statistical analysis was conducted using the Spearman correlation test, with p < 0.05 considered a significant correlation. Results: There were 40 male and 60 female patients. Among them, 51 patients had controlled blood pressure, while 49 had uncontrolled blood pressure. The median systolic blood pressure was 136.5 mmHg, and the mean diastolic blood pressure was 82.83 mmHg. The median age of the patients was 54.50 years. The median BMI was 27.23 kg/m², the median HDL was 41.5 mg/dL, and the median GFR was 73 ml/min/1.73 m². The relationship between BMI and GFR in hypertensive patients showed p = 0.034; r = 0.212. The relationship between HDL and GFR in hypertensive patients showed p = 0.020; r = 0.232. Conclusion: Both BMI and HDL have a significant positive correlation with GFR in hypertensive patients. Keywords: BMI, HDL, hypertension, GFR
Platelet-rich plasma (PRP) has been identified as a potential agent to enhance the tendon healing process and prevent complications such as adhesion and tendon displacement after surgery. Objective: To determined the difference in the degree of peritendinous adhesion after administration of platelet-rich plasma (PRP) on the healing of Achilles tendon rupture in Wistar rats. Methods: This study used a post-test only control group experimental design. Tendons in the control group were treated without PRP, while the treatment group received PRP before care. After one week, the degree of peritendinous adhesion was evaluated microscopically using the Tang scoring system. Results: The mean degree of adhesion in the control group was 3.38, and in the treatment group it was 3.83. The independent t-test yielded a non-significant value of 0.411 (p > 0.05). Conclusion: There was no significant difference in the degree of peritendinous adhesion in Achilles tendon rupture healing of Wistar rats between the group given PRP and the group not given PRP. Keywords: peritendinous adhesion, PRP, tendon rupture, Tang score
Stroke can cause changes in the heart, which are associated with excessive activation of the sympathetic nervous system as a response to damage occurring in the insular cortex. Cardiac biomarkers such as creatine kinase myocardial band (CK-MB) show increased levels in some patients with acute cerebrovascular accidents without direct cardiac injury. CK-MB activity has been found to increase in the early phase of patients with ischemic stroke, subarachnoid hemorrhage, and head trauma. Objective: To determined the effect of aerobic exercise on serum creatine kinase myocardial band (CK-MB) activity in elderly post-stroke patients. Methods: This was a pre-experimental study with a one-group pretest-posttest design. The study involved 16 elderly post-stroke respondents who received aerobic exercise using a static cycle at light to moderate intensity for 10-15 minutes, 2-3 times per week, over the course of 4 weeks. CK-MB activity was evaluated using the Enzyme-Linked Immunosorbent Assay (ELISA) method. Results: There was a significant effect of aerobic exercise on serum CK-MB activity in elderly post-stroke patients, with a p-value of 0.000 or p < 0.05. The mean serum CK-MB level increased to 29.43µL, while the mean serum CK-MB level decreased to 23.12 µL after receiving aerobic exercise with a static cycle for 4 weeks. Conclusion: Aerobic exercise using a static cycle at light to moderate intensity for 10-15 minutes, 2-3 times per week, over the course of 4 weeks, had a significant effect on serum creatine kinase myocardial band (CK-MB) activity in elderly post-stroke. Keywords: aerobic exercise, static cycle, creatine kinase-myocardial band, stroke, elderly
Weil's disease is a severe leptospirosis characterized by multiorgan failure with symptoms of high fever, jaundice, kidney failure, liver necrosis, lung abnormalities, cardiovascular collapse, neurological changes, and bleeding. Acute kidney injury may occur in 20% to 85% of patients during the second phase of leptospirosis disease. It has been reported a 31-year-old male patient had a persistent high fever, pain in the muscles and joints throughout the body, especially in the muscles of both calves, headache, eyes and the whole body looked yellow, urinating like dark tea. The patient once fished in the river barefoot. Physical examination showed icteric sclera, ciliary injection, and temperature 38.9ºC. Laboratory examination of leukocytes 16,880/mm3, platelets 26,000/mm3, ureum 152 mg/dl, creatinine 6.8 mg/dl, direct bilirubin 15 mg/dl, indirect bilirubin 7.2 mg/dl, SGOT 192 U/L, SGPT 71 U/L. Urinalysis showed hematuria and proteinuria. Anti-leptospira IgM serology showed reactive results. On direct dark field microscopic examination of urine samples, fine spiral-shaped Leptospira bacteria were found. On ultrasound examination of the kidneys, the impression of both kidneys showed acute nephritis. The Modified Faine Criteria Score was 39, which suggests presumptive leptospirosis. The patient was treated with intravenous antibiotics Ceftriaxon 2x1 gram and hemodialysis. Keywords: acute kidney injury, hemodialysis, leptospirosis, Weil’s disease
The Diet Dietary Approach to Stop Hypertension (DASH) diet limits sodium and saturated fat and is high in fiber and minerals that can help control blood pressure. Date fruits are high in fiber and contain minerals and polyphenolic compounds that can lower blood pressure along with the DASH diet. This report is to observe the effect of DASH diet with date fruit combination on blood pressure changes in chronic hypertensive clients under fasting conditions. The study design was a single case study design to observe the effect of DASH diet combined with date fruit on hypertensive patients in fasting conditions. Subjects are patients undergoing homecare nutrition or diet programs by a nutritionist. The intervention was carried out for five days. The procedures include nutritional screening and assessment, diagnosis and nutritional care planning, implementation of nutritional care, and monitoring and evaluation. Data were analyzed through a descriptive approach to describe changes in blood pressure. Respondents' food intake during the intervention reached >80% of needs. Sodium intake was <1500 mg/day and fiber was>20 g/day. Blood pressure before the intervention showed grade I hypertension, while blood pressure on day 1 to day 5 of the intervention showed normal. The DASH diet combined with the provision of dates can support the reduction of blood pressure in patients with hypertension. Keywords: DASH Diet, date fruit, hypertension, fasting
Collagen and melanin production are two biological processes that are significant in determining the health and appearance of the skin. Collagen affects the elasticity, hydration, and overall appearance of the skin. Melanin protects the skin from damage caused by ultraviolet rays, but excessive production can lead to hyperpigmentation. Hyperpigmentation, dry skin, and wrinkles are signs of premature aging and can be caused by oxidative stress due to exposure to UV rays (photoaging). Probiotics are living microorganisms that provide health benefits when consumed in sufficient amounts and are currently gaining more and more attention as potential agents for skin health. This article reviews the role of probiotics in inhibiting melanogenesis through inhibition of tyrosinase cell activity and microphthalmia-associated transcription factor (MITF) expression. Probiotics can slow down collagen degradation due to sunlight by inhibiting the Metalloproteinase Matrix (MMP) activity and improve the skin's barrier function, reduce inflammation, and support a healthy skin microbiota. Recent studies show that the use of probiotics, both oral and topical, offers a natural and multifunctional approach to skin care. In conclusion, probiotics have promising potential as an ingredient for skincare, but more research is needed to understand the underlying mechanisms and ensure their safety and effectiveness in clinical applications. Keywords: hyperpigmentation, melanogenesis, photoaging, probiotics
Multiple primary cancer (MPC) is multiple tumors with synchronous or metachronous occurrence in the same individual. Metachronous tumors are defined as those that occur more than six months after the first tumor is diagnosed. It has been reported two serial cases with metachronous multiple primary cancers. One of the cases was triple metachronous, a combination that has never been previously reported. First case: A 58-year-old woman presented with a lump in her right breast and axilla. Histopathology found an invasive micropapillary carcinoma with many lymph node metastases. Two years later, the patient got a rectal mass biopsy with an adenocarcinoma diagnosis. In one month, the patient got a nodule on the right toe, and the result revealed squamous cell carcinoma with moderate to poorly differentiated. Second case: A 76-year-old woman presented a lump on her left cheek with keratinizing squamous cell carcinoma. The patient had a left breast nodule eight months later, and the diagnosis was invasive carcinoma of no special type. Both patients died within 1 year of the last diagnosis. We revealed two cases of primary cancers with different locations and histopathology. The causes of MPCs are unclear, but they may be related to various factors. Multiple primary cancer patients should be closely followed up for possible growth of other cancers. Interdisciplinary collaboration can guarantee the best possible diagnosis and treatment for the patient. Keywords: metachronous, multiple, primary cancer
Pityriasis sicca is a common problem in Indonesian society that can be caused by various factors and the main cause is the fungus Pityrosporum ovale which causes rough and smooth scales. Objective: To prove the relationship between the degree of stress, age and gender with the incidence of Pityriasis sicca (dandruff) in students at the faculty of medicine Muhammadiyah University Semarang. Methods: This research used a cross-sectional design with a purposive sampling technique on students class of 2023 from the faculty of medicine at Muhammadiyah University Semarang. Primary data was obtained through filling out questionnaires and physical examination of respondents. Analysis of the age variable was carried out using the Mann-Whitney test and the gender and degree of stress variables used the Chi-square test. Results: From 112 respondents, it was found that age was not related to the incidence of Pityriasis sicca in students at the faculty of medicine Muhammadiyah University Semarang (p=0.185). Gender was not related to the incidence of Pityriasis sicca (p= 0.899). The degree of stress was related to the incidence of Pityriasis sicca (p=0.000). Conclusion: The degree of stress is related to the incidence of Pityriasis sicca, while age and gender are not related to the incidence of Pityriasis sicca. Keywords: dandruff, Pityriasis sicca, stress levels
Infection is one of the factors associated with stunting. The relationship between stunting and infection can have reciprocal effects. Stunting can increase the risk of infection. Conversely, infections such as Soil-Transmitted Helminths (STH) and Mycobacterium tuberculosis (M. tuberculosis) can also increase the risk of stunting. Objective: To analyzed the correlation between STH infection and the incidence of tuberculosis (TB) in stunting toddlers. Methods: The subjects of this study were 108 stunting toddlers obtained from a simple random sampling method. It was conducted from May 2023 to March 2024 in several villages within the Rambipuji District of Jember Regency, including Gugut, Rambigundam, Pecoro, and Kaliwining. The statistical analysis used in this study was the contingency coefficient test. Results: Findings revealed that the occurrence of STH infection with TB in stunting toddlers was 0%. Conclusion: There is no statistically significant relationship between STH infection and the incidence of TB in stunting toddlers in the Rambipuji District, Jember Regency.Keywords: soil-transmitted helminths, tuberculosis, stunting
The increasing number of antibiotic resistance cases have to seek alternative treatments, including the petai plant (Parkia speciosa Hassk). Petai seeds primarily contain chemical compounds such as tannins, saponins, alkaloids, and flavonoids, which are known for their antibacterial properties. Objective: To determined the antibacterial activity of petai seed ethanol extract (P. speciosa Hassk) against Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella typhi. Methods: This experiment used the Kirby-Bauer Method. Petai seeds were extracted with ethanol using maceration techniques, and the viscous extract was dissolved into concentrations of 25%, 50%, 75%, and 100%. Screening paper soaked in the extract was placed on agar plates inoculated with the test bacteria, and the plates were incubated for 24 hours. The inhibition zones were measured with a caliper, and the data were analyzed statistically. Results: The study found that the ethanol extract of petai seeds exhibited moderate antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa and weak antibacterial activity against Salmonella typhi. Conclusion: Increasing the concentration of the extract significantly enhanced its antibacterial effect against Staphylococcus aureus and Pseudomonas aeruginosa, indicating that petai seed ethanol extract could be a potential alternative treatment for bacterial infections.Keywords: antibacterial, extract ethanol, Kirby-Bauer method, petai seed
