A 40-year-old Woman with Hypercalcemia Crisis Caused by Bone Metastasis in Stage IV Breast Cancer

Breast cancer is still global burden especially for woman with 2.3 million cases every year dan 15% mortality among cancer diseases. In developing countries, most of the cases are diagnosed at terminal stage when metastasis already found. Bone metastasis is the highest among other metastasis sites such as: lung, liver and brain. Bone metastasis will cause hypercalcemia and bone pain as complications. Both will gradually decrease patient’s quality of life. Comprehensive and holistic management for these complications will reduce deterioration and hopefully increase patient’s quality of life even they were at terminal stage. We describe a 40-year-old woman who got hypercalcemia crisis. Hypercalcemia usually manifest as a consequence of other diseases. Epidemiologically, majority come from metastasis, but can be other diseases, such as multiple myeloma. Interestingly, during medical investigation through her medical history, and physical examination, and laboratory examinations, we conclude that her hypercalcemia crisis was caused by bone metastasis from breast cancer.

Analgesic Effect Study of Young Coconut Water (Cocos nucifera L.) on Mice (Mus musculus) Induced with Pain using Acetic Acid

Introduction: Pain signals tissue damage that is capable of reducing thequality of life. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are known as effective analgesic drugs which have various side effects, therefore natural minerals are used as an alternative medicine for pain and inflammation, one of which is known to be coconut water. Hence this research was conducted to find out the differences of the analgesic effect between young coconut water (Cocos nucifera L.) with non-selective and COX-2 selective NSAID on mice induced with pain from acetic acid 0.6% 1 ml/100gBW of mice.Methods: True experimental, conducted at the Pharmacology Laboratory in Faculty of Medicine of Airlangga University involving the sample of 48 mice (6 groups). The recorded data was tested using the oneway ANOVA methodology before then continued with the posthoc test of LSD.Results: The addition of young coconut water (Cocos nucifera L.) with the dosage of 3 ml/100gBW, 4 ml/100gBW, and 4.5 ml/100gBW of mice doesn't give any significant analgesic effect even though the analgesic protection percentage increases accordingly to its dosage (12.32%, 18.72%, 26.88%), but non-selective and COX-2 selective NSAID give significant analgesic effect (p<0.05) on mice induced with pain from acetic acid 0.6% 1 ml/100gBW of mice.Conclusion: There are differences in the analgesic effect of young coconut water (C. nucifera L.) with non-selective and COX-2 selective NSAID on mice induced with pain from acetic acid 0.6% 1 ml/100gBW of mice.

A Systematical Review of The Effect of Ketogenic Diet on Bcl-2 (B-cell lymphoma-2) Expression as An Apoptosis Marker in Cancer Treatment

Introduction: Ketogenic diet seems to be in a great demand nowadays as a lot of people are interested in adopting it into their lifestyle. It is also found that the ketogenic diet shows several beneficial effects including cancer prevention. However, the detail mechanism still remains unknown. Therefore, this review was aimed to find out the effect of ketogenic diet on Bcl-2 (B-cell lymphoma-2) expression in cancer.Methods: We searched published literatures in PubMed through 2011-2020 using specific keywords. The literatures were filtered according to inclusion and exclusion criteria. Animal model, total sample size, underlying condition/inflammatory process occurs, details of the intervention/diet including diet contents in control group and high-fat group, and the duration of the intervention, Bcl-2 results, and p-value were extracted.Results: 7 studies were included in this review. Bcl-2 expression found decrease in 5 out of 6 studies. Similar result also obtained in Bcl-2 protein level, which measured by western blot. Bcl-2 protein level shows a decrease in 2 out of 3 studies.Conclusion: This review shows that high-fat diet that contained in ketogenic diet most likely lead to decrease in Bcl-2 expression. Therefore, indicating the ability of ketogenic diet to affect cancer progression by inducing apoptosis process.

Immunomodulator Effect of Lemongrass Extract (Cymbopogon nardus L.) to Increase Immune Cells as a Precaution Against SARS-CoV-2

Introduction: In humans, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) can damage some tissue when the immune systems was decrease. Natural product from the plant often used to improve immune response against microorganism including virus. This study aimed to determine the potential antioxidant of lemongrass extract (C . nardus) with various dosage that can provide immunomodulatory effects and find an optimal dosage to be used. Methods: The method used observasional analytic, using animal model of 30 male mice strain BALB/C, weight 25-30 gram, divided into 5 groups; the positive control group was given 0.05 mL of 0.05% CMC within 14 days, negative control group was given IMBOOST® tablet 200 mg/kg body weight (bw) within 14 days, treatment groups were given C. nardus extract with various doses 50 mg/kg bw, 150 mg/kg bw, and 300 mg/kg bw. In day 21 all group were injected with 0,2 ml of pathogen bacterial (S. aureus). Blood samples were taken three times: 7th day, 14th day, and 21th day. Results: The results showed that lemongrass extract (C. nardus) was able to influence the leukocyte and lymphocytes count with significant different (p<0.05). The optimal dose is 150 mg/kg body weight. Conclusion: The antioxidant compounds that contain in the C. nardus extract have an ability to increasing the immune system in the dose 150 mg/kg bw , but in the dose 300 mg/kg bw became toxic that can make a skin injury or death in animal test.

Association between Smoking Habit and Pulmonary Tuberculosis at Dr. Soetomo General Academic Hospita

Introduction: Smoking has been reported as one of tuberculosis (TB) risk factor. The association between smoking and TB has been proven in multiple studies, but little known about the association between smoking degree and sputum smear positive. Methods: An analytic observational study using cross-sectional design. Data of patients with pulmonary TB conducted at DOTS (Directly Observed Treatment Short course)/MDR (Multi Drug Resistance) outpatient and inpatient ward in Dr Soetomo General Hospital Surabaya from January to October 2018. The degree of smoking was measured using Brinkman Index (BI). The odds ratio (OR) and 95% confidence intervals (CI) were also estimated.Results: There were 94 patients with pulmonary TB, 56 non-smoker and 38 smoker. Light smoking (P = 0,120, OR = 0.200, 95% CI: 0.022-1.823), moderate smoking (P=0.377, OR = 1.667, 95% CI: 0.533-5.209), heavy smoking (P=0.076, OR= 0.333, 95% CI: 0.96-1.160). Moderate smoking compared to heavy smoking as a control (P=0.33, OR = 5.000, 95% CI=1.096-22.820). Conclusion: There’s no significant correlation between smoking habits and sputum smear positive, but the present study evidenced the patients with smoking habits had greater chance to get sputum smear positive than non-smokers. Patient with moderate smoking compared to heavy smoking had greater chance to get sputum smear positive.

Risk Factor Characteristics Of Patients With Uterine Prolapse In Gynecology Outpatient Clinic In Dr. Soetomo Hospital, Surabaya

Introduction: Uterine prolapse can occurs due to the failure of the ligamentous and fascial supports of the uterus. It causes inconvenience to the patients because of genital tract dysfunction and decrease quality of life. The risk factor are multifactorial. Advancing age, increasing parity, vaginal delivery, and menopause is associated with the uterine risk factors. The aim of this study is to describe the stage, treatment, age, parity, vaginal delivery, and menopause status of women with uterine prolapse in Dr. Soetomo General Academic Hospital, Surabaya. Methods: This research is a descriptive study. The sample is included all women with complaints of uterine prolapse diagnosed and treated at Dr. Soetomo General Academic Hospital, Surabaya from January – December 2017. Statistical was analysed descriptively.Results: From total 82 patients of uterine prolapse in Gynecology Outpatient Clinic Dr. Soetomo General Academic Hospital, Surabaya in 2017, most of the uterine prolapse patients were older than 65 years old (45.1%) and multiparous (62.2%). More than half of the patients (61%) have had more than three vaginal deliveries and have gone through menopause (91.5%). Stage IV prolapse, 33 cases (40.2%) has the highest percentage. Mostly, 47 cases (57.3%) received conservative treatment. Conclusion: Uterine prolapse is most likely to be found in women with older age, came from those in the age group of >65 years old. The incidence of uterine prolapse might increase in multiparous women, have more than three vaginal deliveries, and have gone through menopause. Most of them is on stage IV and received conservative treatment. It is important for women to be educated about uterine prolapse risk factor as an uterine prolapse prevention.

Antibacterial mechanism of Kratom (Mitragyna speciosa) methanol extract on Streptococcus pneumoniae and Eschericia coli bacteria

Introduction: Kratom (Mitragyna speciosa) is a tropical herbal plant native to the North Malay Peninsula, Malaysia and Thailand. In Indonesia, kratom us a typical plant of West Kalimantan, especially in Putussibau. Kratom leaf has many pharmacological effects, one of them is antioxidant. However, the antioxidant and antimicrobial activities of Mitragyna speciosa leaf extracts are lacking. This study was to examine the effect of the methanol extract of Mitragyna speciosa (Rubiaceae Family) leaves on microorganisms Escherichia coli and Strepococcus pneumoniae.Methods: Kratom leaves were extracted with methanol as solvent. In this study, S. pneumoniae and E. coli bacteria have been used. Antibacterial activity tests were carried out at concentrations of 0.78%, 1.56%, 3.125%, 6.25%, 12.5%, 25%, 50% and 100%. Insilico was used to search for secondary metabolites and metabolite interactions in Mytragina speciosa. Results: Mitragyna speciosa leaf methanol extract was effective in inhibiting the growth of E. coli and S. pneumoniae significantly (P<0.001). The growth of e.coli was not identified from a concentration of 25% to 100%. However, there was no bacterial growth in S. pneumoniae from a concentration of 6.25% to 100%. In the insilico study it was found that the secondary metabolite of Mitragyna speciosa is quercetin, which interacts with the ATP1 protein as a predictor in the mechanism of Mitragyna speciosa as an antibacterial. Conclusion: In conclusion, there is no correlation between nutritional status and remission outcome of patients with ALL in the induction phase of therapy. However, high percentage of underweight patients shows nutrition needs special attention to improve therapy outcomes.

Gram Negative Bacteria (Escherichia coli) Win Against Gram Positive Bacteria (Staphylococcus aureus) in The Same Media

Introduction: Biodiversity of the microorganism in Indonesia lead to the large amount of patient with infection. Human can get infected in two different place, with different kind of bacteria that cause the infection. This may lead to bacteremia without knowing which bacteria type whose causing it, either the Gram positive or Gram negative bacteria, whereas the treatment of this two types of bacteria are different. The aim of this study is to determine the doubling time of the Gram positive and Gram negative bacteria when they are grown in the same lesion and the kinds of bacteria that we need to eliminate first.Methods: Staphylococcus aureus and Escherichia coli bacteria were used as samples in this study. Bacterial culture in nutrient broth with 0.5 OD turbidity were mixed then incubated in incubator with 35˚C. Every one hour within 24 hour, 0.01 ml of bacterial culture was taken in serial dilutionover time, varying between 106 – 1012, . It was then planted in nutrient agar plate with droplets technique. After it had been incubated for 24 hours, we counted the Colony Forming Unit per ml (CFU/ml) to time, then the doubling time of the bacteria. The result were then compared between the Staphylococcus aureus and Escherichia coli group.Results: Two tailed t-test result of the doubling time between Staphylococcus aureus dan Escherichia coli was < 0,05 (p=0,000) wich means that there is significant difference of the doubling time between Staphylococcus aureus (24,35 ± 2,23 munites), and Escherichia coli (18,37 ± 0,50 minutes). When grown in the same media, Gram positive bacteria (Staphylococcus aureus) had slower doubling time than Gram negative bacteria (Escherichia coli) as much as 1.32 times.Conclusion: In bacteremia with two possible kinds of bacterial suspect, we need to eliminate the Gram negative bacteria first.

Factors Associated with Acid Fast Bacilli and Sputum Culture Conversion in Patients with Multidrug-Resistant Tuberculosis in Surabaya

Introduction: Indonesia is a high incidence country of multidrug-resistant tuberculosis. There are approximately 11,000 MDR TB cases, 2.8% of them are new cases and 16% of them are relapse cases. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Indonesia. Therefore the aim of the study is to identify risk factors that effect on sputum and culture conversion.Methods: Data on short-term regimen for MDR TB in Dr. Soetomo General Hospital from January 1st – December 31st, 2018 were collected with a total sampling approach, and fulfill the inclusion and exclusion. Data were analyzed by computer software IBM SPSS Statistic 24 for windows. Results: Male is more likely to have delayed sputum conversion and culture conversion but no statistical difference is observed (p>0.05). Smoking history is more likely to have delayed sputum and culture conversion but only in sputum smear test shows a significant difference (p≤ 0.05). Alcohol consumption has delay effect on sputum and culture conversion but there is statistically difference in only culture conversion (p<0.05). The high baseline smear test also affects delay the sputum and culture conversion but only in sputum smear reveals a significant effect (p<0.05).Conclusion: In this present study, we identified sex, smoking history, high bacillary loads as significant factors on sputum conversion. In addition, we revealed that alcohol-consumption history is a significant factor affecting on culture conversion.

The Effect of Simvastatin and Virgin Coconut Oil (VCO) Combination Therapy as Triglyceride Plasma Lowering Agent in White Dyslipidemic Male Rat (Rattus norvegicus)

Introduction: Dyslipidemia is a major health problem in Indonesia which leads to other diseases. Triglycerides (TG) is one of the increased lipid fractions which is related to dyslipidemia. Simvastatin is the main therapy in Indonesia to lower TG levels. The use of virgin coconut oil (VCO) becomes popular as a blood cholesterol-lowering agent even though the effects on TG level remains elusive. Since there is no empirical evidence VCO as a complementary therapy of simvastatin on TG levels, this experimental trial is conducted to determine the effect of simvastatin and VCO combination therapy on blood TG levels in dyslipidemic male white rats.Methods: 42 white rats (Rattus norvegicus) divided into 5 treatment groups and preliminary test of dyslipidemia. The blood was collected intracardially and TG level was measured by using spectrophotometric methods. Independent variables are simvastatin and VCO and combination therapy while the dependent variable is TG levels of white rats. The data was afterwards analyzed using Mann-Whitney U test.Results: The control group’s triglyceride plasma level, receiving standard diet, is 59±13,4 mg/dl. The VCO-only group shows 72±35,4 mg/dl while simvastatin-only group shows 61,9±22,6 mg/dl triglyceride level. Combination therapy of simvastatin and VCO shows 62,3±31,3 mg/dl (p>0,05).Conclusion: There were no significant differences between groups with control. However,the use of VCO with particular dose and duration of therapy, will significantly decrease triglyceride level in the blood as effective as simvastatin. VCO has no efficacy while used as combination therapy of simvastatin.