Introduction: Food and drinks taste sweet and sticky, which can trigger dental caries. The increasing number of dental caries for children shows the need for optimal treatment in increasing their knowledge. The aim of the research is to find a relationship between the level of knowledge of consuming donuts and sweet chewing gum as cariogenic foods on experiencing dental caries for grade 12 students at Cahaya Medan High School. Methods: Data collection using questionnaires and checking teeth. Data were analyzed using statistical tests Kruskal-Wallis. This type of research is an analytical survey through design cross sectional. Results: The research results showed that the majority of the level of knowledge of consuming donuts and sweet chewing gum as cariogenic foods in the sample was sufficient with the average DMFT score being .63 ± 2.723. Conclusion: it can be concluded that the better the level of knowledge about consuming donuts and sweet chewing gum as cariogenic foods, the lower the dental caries.
Background: Gingivitis is a dental and oral health problem caused by the bacteria Staphylococcus aureus. This research utilized the antibacterial effect of the chlorogenic acid compound content of green Arabica coffee beans (Coffea arabica L.) on the activity of the Staphylococcus aureus bacteria. The aim of the research was to determine the effect of chlorogenic acid from green Arabica coffee beans and its inhibitory diameter on the activity of Staphylococcus aureus bacteria. Methods: The research method used was laboratory experimental with post-test only with a control group design. The research samples were green Arabica coffee bean extract with various concentrations of 25%, 50%, 75%, and 100%, which is compared to various concentrations of pure chlorogenic acid (95% Sigma-Aldrich). The chlorogenic acid content in the extract was analyzed with liquid chromatography LC-MS/MS. The large sample was determined using the Federer formula with a total sample size of 24 samples. The parameter measured was the diameter of the growth inhibition zone for Staphylococcus aureus bacteria. Data were analyzed statistically using One-way ANOVA and Post Hoc LSD, and the research results were shown in regression graphs. Results: The results of the analysis of chlorogenic acid content of green arabica coffee bean extract amounted to 4.29% The results of this study showed that the average diameter of the inhibition zone of green Arabica coffee bean extract with concentrations of 25%, 50%, 75% and 100% on the growth of Staphylococcus aureus bacteria was 7.65 ± 0.289 mm; 9.63 ± 0.550 mm, 10.50 ± 0.374 mm, and 12.75 ± 0.370 mm. Research shows that the higher the concentration of green Arabica coffee bean extract, the larger the diameter of the inhibition zone. 95% pure chlorogenic acid from Sigma-Aldrich displays an inhibition zone above 12.5%. Conclusion: Chlorogenic acid exerts a substantial inhibitory impact on the proliferation of Staphylococcus aureus bacteria.
Introduction. Denture stomatitis is a prevalent issue among those who wear dentures, and it is caused by Candida albicans. Ketoconazole, an azole antifungal medication, is commonly employed to treat denture stomatitis. However, it is important to note that the usage of this agent might lead to hepatotoxicity and the development of resistance. The objective of the study was to assess the inhibitory efficacy of rambutan seed extract (Nephelium lappaecum L.) at concentrations of 50% and 80% on the proliferation of Candida albicans. Methods. This research employs a laboratory experiment using a design that includes a post-test only control group. The specimen is an uncontaminated culture isolation of Candida albicans. This study had four distinct groups: rambutan seed extract concentrations of 50% and 80%, a positive control group, and a negative control group. Each group was reproduced six times. Using digital calipers to measure the diameter of resistance. Upon completion of data collection, the acquired data was subsequently subjected to analysis utilizing one-way ANOVA and post hoc LSD statistical testing. Results. The research findings indicate that the average ± standard deviation inhibitory diameter of rambutan seed extract was 50%, 80%, and the positive control for the growth of Candida albicans was 8.68 ± 0.585; 12.38±0.505; 22.43 ± 0.809 mm, respectively. In contrast, the negative control (DMSO) did not exhibit any inhibitory effects. The one-way ANOVA test revealed a statistically significant difference in the mean inhibitory diameter of rambutan seed extract at concentrations of 50% and 80% on the growth of Candida albicans (p=0.000; p?0.05). The findings of the LSD post hoc test indicated a significant difference in inhibitory power between the 50% and 80% concentrations of rambutan seed extract, as well as between these concentrations and both the positive and negative controls. Additionally, there was a significant difference in the growth of Candida albicans between the 50% and 80% concentrations of rambutan seed extract (p?0.05). Conclusion. The research findings indicate that the extract derived from rambutan seeds effectively inhibits the development of Candida albicans. An 80% concentration is the optimal concentration for maximum effectiveness.
Background. Osteoarthritis (OA) is a prevalent disease of the musculoskeletal system that affects over 528 million individuals worldwide, with 73% of those diagnosed being aged 55 or older. The knee joint is most commonly affected, along with the hip and hand joints. Vitamin D is essential for maintaining bone and cartilage metabolism. In chondrocytes, the presence of the vitamin D receptor (VDR) regulates the expression of metalloproteinase. The purpose of this investigation is to examine the correlation between vitamin D (25(OH)D) and cartilage oligomeric matrix protein (COMP) serum in knee osteoarthritis. Methods. The cross-sectional study was conducted by the Rheumatology Division at RSMH Palembang. Patients diagnosed with knee osteoarthritis based on the 1990 ACR criteria were included. The chemoluminescent immunoassay and the Human Cartilage Oligometric Matrix Protein ELISA Reagent were used to measure the levels of vitamin D (25(OH)D) and COMP serum. Results. Thirty participants took part in this study from July to December 2022. According to this study, 33% had insufficiency and 67% had a deficiency of vitamin D. Spearman's Rho test shows that there is a strong negative correlation between vitamin D (25(OH)D) and COMP serum. Conclusion. Vitamin D (25(OH)D) and COMP serum levels were significantly correlated in knee osteoathritis.
Introduction: Most patients with systemic lupus erythematosus (SLE) show signs of pulmonary involvement. The clinical manifestations of Lupus Pneumonitis are the similar to those of acute interstitial pneumonia. The use of cyclophosphamide in lupus nephritis (LN) is associated with high CMV titers. Ganciclovir is the main choice of therapy for CMV pneumonia infection. Case presentation: A 19-year-old female with previous history of lupus nephritis presented with worsening dyspnea, productive cough with yellowish sputum and hemoptysis. Following physical, laboratory and radiological examinations, the patient was diagnosed with acute lupus pneumonitis, with a differential diagnosis of pneumonia infection. During treatment in the intensive care unit (ICU), she was put on ventilator and received routine hemodialysis due to pulmonary edema. She was given intravenous antibiotics before the culture results came out, but there was no clinical improvement. Once the culture results returned negative, the antibiotics were discontinued and IV pulse methylprednisolone was started. There was significant clinical, radiological, and laboratory improvements. After discharge, the patient experienced hemoptysis again due to CMV pneumonia infection and was given ganciclovir therapy with satisfactory results. Conclusion: In patients with advanced LN and pulmonary involvement, distinguishing between infection and SLE flares may be challenging, which can cause dilemma in diagnosis and treatment decisions. Adequate oxygenation with ventilator, hemodialysis, and administration of ganciclovir and mycophenolic acid provides significant improvements in patient care.
Background. Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterized by highly diverse and nonspecific symptoms with clinical presentations involving more than one organ system which often leads to delayed diagnosis and poor prognosis. This study aims to understand patients’ initial clinical presentation in order to enhance early detection and establish an early diagnosis. Methods. This descriptive cross-sectional quantitative study included patients who commenced their visits to the Rheumatology Clinic at RSCM from May 2021-December 2022. A consecutive sampling method was used, and data were analyzed for age, gender, symptom onset, as well as patients' initial clinical presentations (SPSS 25.0). Results. Out of 231 subjects, 96.1% were females. A total of 38.1% of the patients belonged to the 21-30 age group, and symptom onset was most commonly observed in the 0-1 year age group, accounting for 67.5%. Approximately 24.2% of the patients exhibited constitutional manifestations with involvement of other organs, including musculoskeletal (87.4%), mucocutaneous (84%), hematologic (3.,5%), renal (33.3%), and neuropsychiatric (8.7%) systems. Lungs, heart, blood vessels, gastrointestinal and hepatic systems, eyes, obstetric, and endocrine involvements were not found in this study. Among the 231 subjects, 44.2% of them had simultaneous involvement of two organs, which emerged as their initial clinical presentation. Conclusion. Musculoskeletal and mucocutaneous involvement were most commonly observed as the initial clinical presentation of SLE patients at RSCM, followed by hematologic, renal, and neuropsychiatric involvement.
Background: In the present day, the utilization of cardiac implanted electronic devices is increasing globally due to advancements in medical technology. However, a significant concern arises in the form of serious and life-threatening consequences such as mediastinitis and deep sternal wound infections. Poor control of mediastinitis significantly increases morbidity and mortality rates associated with it. Case presentation: A 44-year-old male presents with a palpable mass on the left jaw that has been present for four days before admission. The patient is currently experiencing symptoms of fever and dyspnea. The patient's medical history from six months ago reveals the insertion of a permanent pacemaker VVIR (dual sensor ventricular demand rate responsive) due to a sinus pause with ventricular escape beat. The patient was admitted to the Intensive Care Unit (ICU) with a diagnosis of post-sternotomy for a submandibular abscess with intra-thoracic extension, respiratory failure, sinus arrest caused by the insertion of the permanent pacemaker, and sepsis. By the third day in the Intensive Care Unit (ICU), the patient's hemodynamic condition had reached a stable state. Conclusion: Upon assessing the patient's reliance on permanent pacemakers (PPM), it is advisable to contemplate the possibility of reprogramming or resetting the implanted PPM. Thorough treatment of critically ill patients is necessary for those who are undergoing surgery with an implanted cardiac device.
Background: Septic arthritis is an infectious disease that severely damages the joints with clinical manifestations such as swelling, erythema and warmth of the affected joint. The most common cause of this disease is the result of hematogenous spread of microorganisms. Some of the risk factors include injection drug use, prosthetic joints and skin infection. The incidence of septic arthritis is 5 to 8 per 100,000 population per year with 5-10% mortality rate, therefore preventive behavior is needed to minimize the incidence of septic arthritis. Methods: This study is an observational analytic study with a cross-sectional approach. The research population consisted of students from batch 2019-2020 of the Faculty of Medicine, University of North Sumatra and the sample was determined using stratified random sampling method. Primary data were obtained directly from research subjects using questionnaires via Google Forms. Results: The univariate research analysis found that the knowledge level of the majority of respondents was in the good category, with 45 subjects (53.6%). The most predominant behavior observed in the respondents was negative behavior, with 49 subjects (58.3%). Bivariate analysis found that there was no significant relationship between knowledge level and septic arthritis prevention behavior with p value = 0.809. Conclusion: Students from batch 2019-2020 of the Faculty of Medicine, University of North Sumatra, on average have a good level of knowledge and negative behavior on the prevention of septic arthritis. There is no relationship between the level of knowledge with septic arthritis prevention behavior.
Background. Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multisystem involvement which arises from multifactorial causes. Continuous exposure to autoantigens and chronic activation of the immune system, especially memory T lymphocytes, contribute to premature immunosenescence. sCTLA-4 and sCD86 are soluble costimulatory molecules of CTLA-4 and CD86, which play a role in the occurrence of immunosenescence in SLE. The presence of immunosenescence will cause higher morbidity and mortality. This research was conducted to establish the correlation between the increased levels of sCTLA-4 and sCD86 and the severity of SLE, as measured by the SLE Disease Activity Index (SLEDAI) score. Methods. This analytical observational research utilized a cross-sectional approach involving 35 female SLE patients diagnosed according to the SLICC 2012 criteria. SLE disease activity was measured using SLEDAI score. Serum sCTLA-4 and sCD86 levels were measured using the ELISA method. Statistical analysis was conducted using the Mann-Whitney test for comparisons and the Spearman test for correlation analysis, with a significance level of p<0.05. Results. sCTLA-4 levels were higher and significantly different in patients with moderate SLE (p=<0.001; p<0.05), and there was no significant difference in sCD86 levels (p=0.915; p>0.05). Increased sCTLA-4 levels were positively correlated with the severity of SLE (r =0.361, p=0.033), while no significant correlation was observed in sCD86 levels (r=-0.094, p=0.591). Conclusion. Elevated sCTLA-4 levels were positively correlated with increased severity of SLE based on the SLEDAI score.
Gout is an inflammatory disease caused by the deposition of monosodium urate (MSU) crystals. Recently, the American College of Rheumatology (ACR) has recommended the usage of interleukin (IL)-1 inhibitor in gout patients who are refractory to typical anti-inflammatory drugs. An example of IL-1 inhibitor is canakinumab. Not much is known regarding the usage of canakinumab in gout arthritis. Thus, we decided to conduct a narrative review that summarizes the efficacy and safety of canakinumab in gout patients. In this review, we found that canakinumab is superior to non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in treating acute gout flares. In addition, canakinumab may also be considered as a preventive therapy for gout flares in patients receiving urate-lowering therapy. Overall, canakinumab has mild side effects but may occasionally cause serious infections. Canakinumab is also generally safe for use during pregnancy. Due to the lack of studies, the safety of canakinumab in lactating women, geriatric patients, and patients with hepatic or renal impairment is still unknown.
Introduction. Candida albicans commonly causes oral thrush, an opportunistic illness that affects the mouth. Both topical and systemic antifungal medications effectively treat oral thrush. The study compared tomato leaf (Lycopersicum esculatum Mill) antifungal effects on Candida albicans growth at two different concentrations: 25% and 70%. Methods. This research utilizes laboratory trials employing post-test-only control groups. The Microbiology Laboratory Universitas Sumatera Utara supplied the investigation with a pure culture isolate of Candida albicans. To figure out the sample size, we used the Federer formula six times, once for each group of tomato leaves at 25% and 70% concentrations and once for the nystatin (positive control) and DMSO (negative control) groups. Use of a digital caliper for measuring the resistance diameter. We used the Mann-Whitney U test and the Kruskal-Wallis test to look at the data. Result. Tomato leaves at 25% and 70% concentrations successfully limit Candida albicans development, according to the Kruskal-Wallis and Mann-Whitney tests. The efficiency of tomato leaves at 25% and 70% concentrations in inhibiting the development of Candida albicans was shown by mean inhibitory diameters of 7.73 ± 0.366 mm and 10.21 ± 0.948 mm, respectively. Nystatin, the positive control, had an average inhibitory diameter of 25.77 ± 0.505 mm, whereas DMSO solvent, the negative control, showed no inhibition at all. Between the groups, there was a significantly different inhibitory diameter of Candida albicans growth, as shown by the Kruskal-Wallis test (p=0.000; p?0.05). At doses ranging from 25% to 75%, the Mann-Whitney test showed that there was a significant difference (p?0.05) in the effectiveness of tomato leaf extracts in inhibiting the development of Candida albicans compared to the negative control group. Conclusion. Tomato leaves inhibit the development of Candida albicans. The antifungal efficacy of tomato leaves is higher at a concentration of 70% compared to 25%.
Ventilator-associated pneumonia (VAP) is a kind of pneumonia that arises within 48–72 hours or later after the insertion of a breathing tube into the windpipe. The fundamental idea of preventing ventilator-associated pneumonia is to minimize the length of time a patient is on mechanical ventilation and to extubate them as early as possible. Adhering to the bundle of care can influence the risk of VAP. Researchers conducted several studies between 2020 and 2023 to assess the effectiveness of a ventilation care bundle in preventing ventilator-associated pneumonia. Each study varied in terms of the specific version of the care bundle used, compliance rates, sample size, and duration of the research. The conclusion drawn on the effectiveness in question may be impacted by these disparities. Proper execution of an effective ventilator care package can decrease the occurrence of ventilator-associated pneumonia in patients who are critically ill. Employing a variety of tactics backed by long-term teaching initiatives is crucial to ensure adherence to the care bundle.
Introduction: Perforated peptic ulcer is the most common indication for emergency gastric surgery. good management of postoperative peptic ulcer perforation patients in the ICU will reduce patient mortality rates. Case presentation A 76-year-old male patient presented with a major complaint of pain throughout the abdomen that had worsened since 1 day, the abdominal pain had been felt for 4 days before admission. The patient had a history of painkiller drug consumption routinely for 3 years. The patient’s vital signs were normal, with a qSOFA score 1 and a VAS score 5. Abdominal physical examination showed the abdominal distended, no visible contour and no visible peristaltic, decreased bowel sound, and there is tenderness and rebound tenderness at the whole abdomen Patient was taken up for emergency laparostomy, then the patient underwent diagnostic laparoscopic in an elective setting with intraoperative findings of gastric perforation, then patient continued with the gastric repair. In the postoperative period, the patient was treated in the ICU of Dr. M. Djamil General Hospital. Conclusion: Intensive care management for post-gastric repair surgery patients is generally the same as for other abdominal surgery patients. The intensive care management needs comprehensive treatment, starting from oxygen therapy, monitoring, analgesia, fluid therapy, antibiotic therapy, glycemic control, and nasogastric tube nutrition.
Introduction: Streptococcus sanguinis is a pioneer bacteria in the formation of dental plaque that causes caries. Fenugreek (Trigonella-foenum-graecum L.) is a medicinal plant that has antibacterial properties because it contains alkaloids, tannins, flavonoids, glycosides, and terpenoids. The aim of this research was to determine the effectiveness of fenugreek seed extract with concentrations of 25%, 50%, 75%, and 100% on bacterial growth of S. sanguinis. Methods: This study is the post-test-only control group. The research sample is a pure culture of Streptococcus sanguinis bacteria ATCC 10556. Antibacterial testing uses the disc diffusion method by sight diameter bacterial inhibition zone. Data was analyzed using the Kruskal-Wallis test. Results: The test results showed that the ethanol extract of fenugreek seeds with concentrations of 25%, 50%, 75%, and 100% had an inhibitory zone against the growth of Streptococcus sanguinis bacteria with the average diameter of the inhibitory zone for each concentration being 7.77 ± 6.13 mm. 9.90 ± 8.09, 12.22 ± 5.05, and 14.75 ± 4.83 mm, but the antibacterial effectiveness did not have a significant difference with a value of p = 0.12. Conclusion: The ethanol extract of fenugreek seeds has antibacterial activity against the Streptococcus sanguinis bacteria but is not significant.
Background. Systemic lupus erythematosus (SLE) is associated with a global reduction in regulatory T cells (Tregs). Vitamin D supplementation that is efficacious, safe, and reasonably priced has the potential to reduce morbidity in SLE. This study was aimed to systematically assess the efficacy of vitamin D supplementation in enhancing Tregs concentration or Tregs-related marker. Methods. A systematic review of the literature for clinical studies was performed on Pubmed, Proquest, and Google Scholar. Studies were assessed for risk of bias using Newcastle Ottawa Scale. All clinical studies that investigated the effects of vitamin D supplementation on Tregs in SLE patients were included. Key evidence was analyzed and qualitatively synthesized. Results. Three relevant studies were included. All studies were of high-quality. Vitamin D supplementation consistently increased Tregs concentration across all included studies. Conclusion. The current study supports the evidence that vitamin D supplementation enhanced Tregs concentration in SLE patients.
Background. Methotrexate is an anchor drug in the management of rheumatoid arthritis (RA). However, the association between methotrexate and development of liver fibrosis remains a subject of controversy. Non-invasive methods to assess liver fibrosis, such as the FIB-4 score, have been developed. RA patients on methotrexate therapy should be monitored for any signs of liver fibrosis. This study aims to investigate the correlation between methotrexate cumulative dose and the FIB-4 score in rheumatoid arthritis patients who received methotrexate therapy to assess the hepatotoxic effects of methotrexate. Methods. This cross-sectional study involved rheumatoid arthritis patients who received methotrexate therapy at Dr. Hasan Sadikin General Hospital Bandung from September 2022 to November 2022. Clinical data, laboratory tests (including platelet values and liver function test), and cumulative methotrexate doses were extracted from medical records. Data were analyzed using the Spearman correlation test. Results. This study involved 100 subjects aged between 22-82 years, comprising 93% women and 7% men. The median FIB-4 score was 0.73 (0.24-6.80), while the median methotrexate cumulative dose was 2477.5 mg, with a range of 1005-10400 mg. The results showed that correlation coefficient between the FIB-4 score and methotrexate cumulative dose in rheumatoid arthritis patients was -0.089 (p=0.378). Conclusion. There is no significant correlation between FIB-4 score and cumulative dose of methotrexate in rheumatoid arthritis patients. The use of methotrexate in RA patients over 4 years is relatively safe as it does not increase the risk of liver fibrosis.
Background. Sjogren’s syndrome (SS) is a systemic autoimmune disease that affects exocrine glands. Dealing with SS is challenging due to the low level of awareness and knowledge about SS, as well as the difficulty in diagnosing and treating the disease. Diagnosing SS requires many supporting examinations from many medical specialties. Therefore, these recommendations were developed to serve as a guide for health practitioners in diagnosing and treating SS. Methods. Six selected rheumatologists from the Indonesian Rheumatologist Association (IRA) formulated the recommendations based on key questions formed by a steering committee from IRA. These recommendation materials were taken from several online databases such as PubMed, Science Direct, and Google Scholar. Level of evidence and grades of recommendation were then assigned, and every member of the panellist team will assign a score for level of agreement. Results. The panel generated a total of 19 recommendations discussing the diagnosis, pharmacological and non-pharmacological therapy, and prognosis for SS. Conclusion. These recommendations can be used to help clinicians correctly diagnose and choose the most suitable therapy for SS patients. All recommendation statements were created with the consideration of Indonesia’s clinical setting, facility, and drug availability.
Background. Systemic lupus erythematosus (SLE) is an autoimmune disease that can attack multiple organs and has a high prevalence in women. Due to its treatment and resulting pathological conditions, SLE makes the patient susceptible to infections. Furthermore, physiological changes in the body that occur during pregnancy renders pregnant women with SLE vulnerable to disease exacerbation. Therefore, the management of such cases necessitates the evaluation and intervention of a multidisciplinary medical team. Case Presentation. We present the case of a female patient in her second trimester of pregnancy who complained of shortness of breath. The patient has a history of SLE diagnosed five years ago. Within 7 days of treatment, the patient experienced an improvement in symptoms. Conclusion. This is a rare case, and we report on the outcomes of treatment and our limitations to ensure better future treatment for pregnant women with SLE to prevent maternal and fetal death.
Introduction: Problems regarding dental and oral health have an important influence on overall health. Accumulation of food waste is a key factor in this influence on dental and oral health, and poor oral hygiene can cause periodontal problems and dental tissue disorders. This study aimed to compare the effectiveness of chewing manalagi apples and green melons in cleaning dental debris on dentistry students of Universitas Prima Indonesia. Methods: The research used various materials such as disclosing solutions to identify debris, biscuits chewed by the samples, and two types of fruit, namely manalagi apples and green melons. The research design involved a pre-test and post-test with an experiment for the sample group, without a comparison group. Results: The study showed that consuming manalagi apples was more effective in cleaning dental debris than green melons. This difference is significant with a value of p = 0.000. Conclusion: Manalagi apples have better potential to improve self-cleaning of the oral cavity, which contributes to overall dental and oral health.
Background. Sjögren's syndrome (SS) is a rare autoimmune disease in children, with only a few hundred reported cases. Its clinical presentation is atypical. We report the case of a 14-year-old boy diagnosed with recurrent parotitis. Case Presentation. Our patient, a 14-year-old male, presented with a one-year history of recurrent bilateral parotid swellings. Clinical examination revealed an objective oculo-buccal dryness. Ultrasound imaging showed hypoechoic hypertrophy of the parotid glands. Anti-SSA/SSB antibodies were strongly positive. Histological study of the accessory salivary glands revealed lymphocytic sialadenitis with a focus score of 3. The diagnosis of SS was confirmed according to the ACR/EULAR 2016 criteria. The combination of treatment with hydroxychloroquine and corticosteroids resulted in the resolution of clinical signs and biological inflammatory markers. Conclusion. Given the rarity of SS in children, several diagnostic and therapeutic difficulties arise, in the absence of classification criteria adapted to the juvenile form of the disease, and the absence of therapeutic recommendations consolidated by clinical trials in children.
