Open Reduction of Supracondylar Humerus Fractures in Children for Failed Closed Reduction: Outcome of Delayed Treatment

Supracondylar fractures of the humerus are common in children and the advocated treatments for these fractures include closed reduction and percutaneous pinning. There are numerous debates on the intervention period selection for delayed treatment in children. This phenomenon is prevalent in regions with limited healthcare support. The objective of this study was to compare the outcome of early and late treatment groups, including preliminary presentations and the management of failed treatment. This was a prospective comparative study on early and late open reduction, featuring Kirschner wire fixation for Gartland type III supracondylar fracture of humerus in children aged less than 18 years. Patients from January 2018 to January 2019 were categorized into early and late groups (n=22 and n=26), consisting of 33 (86.8%) males and 15 (31.25%) females. Flynn’s criteria were used to evaluate them. The average time from injury to surgery was 50.24±23.5 hours in the early group and 373.79±89.23 hours in the late group (p<0.002). While the Bauman’s angle recorded after 12 weeks presented the values of 82.04 ± 5.18 and 77.38±6.43 (p=0.622) for the early and late groups, respectively. Pre-operative nerve injuries were observed only in 4 (8.33%) cases from the early group. The functional outcomes of both categories were not significantly different statistically (p=0.242). The outcome for children with supracondylar humerus fracture Gartland type III was satisfactory in both groups. In conclusion, treatment delay does not result in a difference in the outcome according to Flynn's criteria.

Association between Refractive Error Types and Asthenopia in Primary School Students

Refractive error is a condition in which the cornea and lens fail to focus the light, resulting in reduced visual efficiency. Twelve million children are experiencing refractive errors worldwide and uncorrected refractive errors in children have been reported to cause asthenopia. This study aimed to determine the association between the types of refractive errors and asthenopia in children. This cross-sectional study was conducted on 111 students aged 10-13 years old in a public elementary school in Indonesia, SDN Penjaringan 10, in 2019. A questionnaire was used to assess asthenopia and the Snellen Chart, trial frames, and trial lenses were used for refractive errors examination. It was demonstrated that 87.4% of respondents experienced asthenopia, and 53.2% of respondents suffered from uncorrected refractive errors, mostly due to myopia. Fisher’s exact test results showed an association between refractive errors and asthenopia (p=0.019) with all myopic students experienced asthenopia. However, there was no significant association between astigmatism and asthenopia (p=0.754). In conclusion, not all types of refractive errors are associated with asthenopia.

Positive Lateral Flow Urine Lipoarabinomannan Assay (LF-LAM) Result in Detection of Active Tuberculosis

Lipoarabinomannan (LAM) is the main component of M. tuberculosis (MTB) wall as result of MTB degradation by macrophages in the human body. In patients with active TB and HIV co-infection, a decrease in antibody responses may be apparent that some of LAM may not be bound with antibodies. In this condition, LAM can pass through the normal glomerular basement membrane and can be detected in the urine. One laboratory examination for detecting LAM is the Lateral Flow Urine Lipoarabinomannan (LF-LAM) assay that uses urine as the sample. The purpose of this cross-sectional observational descriptive comparative study was to compare the positivity rate of LF-LAM examination results in active TB patients with and without HIV infection. Random urine samples were collected from patients diagnosed with active TB with and without HIV infection who visited Dr. Hasan Sadikin General Hospital Bandung from August to October 2020. The proportion between the group with HIV and group without HIV was analyzed with the Chi-Square test. Subjects were 52 patients, consisting of 25 (48%) subjects with HIV infection and 27 (52%) subjects without HIV infection. The positive LF-LAM results were found in 11 (21%) subjects, consisting of 9 (36%) subjects with HIV infection and 2 (7%) subjects without HIV infection, with p=0.012. In conclusion, the positivity rate of LF-LAM results is higher in active TB patients with HIV infection compared to those without HIV infection.

Knowledge and Severity of Female Urinary Incontinence and Reasons for Not Seeking Treatment

Urinary incontinence (UI) is a commonly overlooked problem in women, particularly women of post-menopausal age. Despite the medical, social, and hygiene burdens conferred by UI to its sufferers, past studies have shown that only a few among women afflicted with UI sought treatment. This may be due to various reasons: lack of knowledge and awareness of UI or a wrong belief of UI as a natural part of aging. This study aimed to investigate the association between knowledge and severity of UI and reasons for not seeking treatment among post-menopausal women in Bandung, Indonesia. This was an analytic cross-sectional study conducted at the Geriatric and Gynecology Clinic, Dr. Hasan Sadikin General Hospital, in September 2013. Ninety-one women who met the inclusion criteria were interviewed to assess their knowledge of UI. The severity of UI was assessed using Urinary Distress Inventory 6 (UDI-6). Data were analyzed using the chi-square test. Sixty-five respondents (70.7%) had poor knowledge of UI. Knowledge of UI was not associated with awareness of UI as a medical condition (p=0.633). The difference in UI severity was associated with the perception of UI as a normal part of aging (p=0.008). Post-menopausal women are poorly informed regarding urinary incontinence. However, knowledge alone might not be adequate to encourage women to seek treatment. Further studies are needed to investigate women’s reasons for not seeking treatment for UI.

Anti-Aging Activities of Asparagus Gel Ethanol Extract in Cosmetic Gel Agent for Facial Skin

Asparagus is a vegetable that contains phenolic compounds with antioxidant properties that scavenges aging-triggering free radicals. This study aimed to investigate the components and anti-aging potentials of Ethanol Extract form Asparagus (EEA). The study was performed in February 2020 at the Pharmacy Laboratory, University of North Sumatera. The EEA was obtained through maceration using 96% ethanol. An antioxidant assay was performed and the total phenol and flavodoid content were determined using the spectroscopic method. Three gel formulas with different concentrations of EEA was prepared (F1: 1.5%, F2: 2.5%, and F3: 3.5%), and F0 was used as control. The parameters evaluated were moisture, oil content, texture, collagen, wrinkle, pigment, sensitivity, and pore. The result showed that asparagus had a moderate antioxidant activity (IC50: 118,992) with the total phenol and flavonoid contents of 15,9407 mg GAE/g and 3,2286 mg QE/g extract, respectively. The highest aging activities was seen in F3 (3.5%), followed by F2 (2.5%) and F1 (1.5%). The percentage of moisture, oil, texture, collagen, wrinkle, spot, sensitivity, and pore recovery were found to be 40.15%, 49.73%, 71.76%, 17.70%, 70.93%, 49.34%, 42.56% and 25.31%, respectively. Hence, it can be concluded that the EEA Gel at the highest concentration (3.5%) has a high content of phenol and flavonoid which can improve the skin moisture, oil content, texture, collagen, wrinkles, spots, sensitivity, and pores, which promotes anti-aging activities.

Methicillin-Resistant Staphylococcus aureus (MRSA) Patterns and Antibiotic Susceptibility in Surgical and Non-Surgical Patients in a Tertiary Hospital in Indonesia

Methicillin-Resistant Staphylococcus aureus (MRSA) in the hospital is found mainly in surgical patients, which increases morbidity and mortality. Currently, vancomycin is the drug of choice for the treatment of MRSA infections. The increasing use of vancomycin and its inappropriate administration may increase the resistance of S. aureus to vancomycin. This study aimed to describe the distribution of MRSA and types of antibiotics that are still sensitive to MRSA in surgical and non-surgical patients. This cross-sectional, observational, retrospective descriptive study was conducted at the Microbiology Laboratory, Dr. Hasan Sadikin General Hospital, in 2019 using secondary data on the results of culture examination and antibiotic susceptibility of positive S. aureus culture isolates from all types of isolates from surgical and non-surgical patients. All specimens were cultured in appropriate media. Identification of S. aureus was performed by Gram staining to identify bacterial morphology, and automatic tools. Antibiotic susceptibility test was performed using an automatic machine. Seventy-five isolates (17%) were identified to be MRSA with 46 (53%) of them retrieved from surgical patients. Most of the MRSA isolates came from pus and were mostly due to skin infections. Antibiotic susceptibility results showed two Vancomycin-Resistant Staphylococcus aureus (VRSA) isolates from surgical patients. The positive culture of the MRSA and VRSA was dominated by surgical patients with pus coming from surgical wound infection, burn, and other skin infection as the most common sources. Thus, the proportion of MRSA isolates in the hospital in 2019 is 17% and two VRSA isolates are identified in the same year. The surgical ward was the primary origin of most MRSA isolates. Further studies are necessary to identify the MRSA incidence rate, evaluation and periodic monitoring of antibiotic use, and active surveillance in the surgical patient rooms.

Effect of Mangkokan (Polyscias scutellaria) Leaf Extract on Blood Sugar Levels in Alloxan-Induced Male White Rats

Type 2 diabetes is a metabolic disorder caused by insulin resistance and is associated with oxidative stress. In Indonesia, the mean prevalence of diabetes ranges from 1.4% to 1.6%; however, some areas have a much higher diabetes prevalence such as Pekajangan (2.3%) and in Manado (6%). The 2013 Indonesian Basic Health Research (IBHR) stated that the number of people with DM in Indonesia has reached an alarming rate. This study aimed to determine the antidiabetic effect of Polyscias scutellaria on alloxan-induced male Wistar. This was an experimental study conducted in July 2020 in the Faculty of Medicine, Prima Indonesia University. This study used 25 rats that were grouped into 5 treatment groups: control group (Na-CMC), standard (Metformin), and 3 extract groups with different doses (125 mg/kg BW, 250 mg/kg BW, and 500 mg/kg BW). Mangkokan leaf extract was obtained through the maceration method. All ratswere induced intraperitoneally using alloxan monohydrate 10% at a dose of 175 mg/kg BW. The parameters used in this study were fasting blood glucose level before induction, after induction, and after treatment and body weight before treatment. It was observed that there was a significant change in blood glucose level between the extract groups. The blood sugar level in the 125 mg/kg BW group was 495.00 mg/dl while in the 250 mg/kg BW and 500 mg/kg BW, the blood glucose levels were 317.00 mg/dl and 126.00 mg/dl, respectively, with the 500 mg/Kg BW dose as the most effective dose (P-value = 0.001). Thus, mangkokan leaves have the potential to reduce blood glucose level but are not as good as the standard group.

Characteristics of Enterovesical Fistula Patients Visiting the Urology Department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from 2015 to 2019

Enterovesical fistula (EVF) represents an abnormal channel between the intestine and the bladder. The EVF is a complication of inflammatory or neoplastic diseases and injuries. Diagnosis of EVF can be challenging and often delayed up to several months after the onset of the symptoms. This study aimed to determine the characteristics of patients with enterovesical fistula visiting Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This retrospective descriptive study used the medical records of EVF patients treated in the urology department of Dr. Hasan Sadikin General Hospital from 2015 to 2019 as the secondary data to be analyzed. A total of 58 patients with EVF were enrolled in this study. By gender, that more than half of the patients were male patients (n=30, 51.7%) and 45% of patients were between 41 and 50 years old. The most common symptoms of EVF were pneumaturia and fecaluria which were seen in 30 (51.7%) and 20 (34.5%) patients, respectively. Twenty-nine (50%) patients experienced malnutrition and 18 (31.1%) patients had diabetes mellitus as a comorbid. The most common type of fistula was rectovesical fistula (n=45, 77.6%) and 26 (66.6%) patients suffered from rectosigmoid cancer and malignancy (68.95) had become the most predominant etiology. Escherichia coli was found in 42 (72.4%) urine cultures collected from the patients and cystoscopy with fistula biopsy was found in 43.1% of cases, followed by fistula repair (29.3%) and urethral catheter drainage (15.5%). Hence, malignancy and rectosigmoid cancer become the most common etiology of EVF while cystoscopy with fistula biopsy is the most frequently performed procedure.