Subacute Spinal Subdural Hematoma in One-Year Old Boy Due to Severe Hemophilia A

Background: Paraparesis may result from a variety of or primary central nervous system conditions or systemic disorders, and although rare, it may also caused by spinal cord hemorrhage. Spontaneous spinal subdural hematomas (SSDH) are most frequently associated with coagulopathies. People with congenital clotting disorders such as hemophilia are at increased risk for experiencing spontaneous spinal subdural hemorrhage at unusual sites, which is a rare case and a neurological emergency required urgent recognition. We report a boy with paraparesis caused by subacute SSDH due to hemophilia A. Case Presentation: A 15 month-old boy, with chief complain of difficulty in moving his leg and pain when walking, physical examination revealed a lower motor neuron lesion, laboratory showed a low factor VIII at 0.4% level, Magnetic Resonance Imaging (MRI) showed anterior and posterior displacement of the spinal cord due to the presence of the subacute subdural hematoma extending from 1st cervical to 1st lumbar spine. He assessed with inferior paraparesis caused by subacute spinal subdural hematoma due to hemophilia A. The patient’s condition was improved after received replacement therapy of factor VIII and proper laminectomy neurosurgery. Conclusion: This case showed an approach for a comprehensive diagnostic and management for a rare case of paraparesis due to hemophilia. Pay attention to the physical examination which shows a lower motor neuron lesion in an acute paralysis cases, there is still a possibility that it is an upper motor neuron lesion.

Melatonin, A Promising Therapeutic for Diabetes Mellitus and Its Complications: A Narrative Review

Diabetes mellitus (DM) is a non-communicable disease and still a health problem in the world. Melatonin is responsible to metabolize carbohydrate and regulate blood sugar levels. Several studies proved Melatonin is useful in the diabetes therapy and its complication by performing antioxidant activity through various signaling pathways. The role of the melatonin hormone in the pathogenesis of complications of diabetes mellitus is still a lot of controversy. Animal studies are still incomplete to explain the mechanism of action of melatonin. Therefore, this review aims to discuss Melatonin role administration in DM and its complications. This review was started by searching articles using electronic databases such as Google Scholar, Science Direct, SpringerLink and Pubmed between 2009-2019. Melatonin increased respiration within mitochondria; acted as antioxidant that fight free radical production; and reduced oxidative stress. It diminished proinflammatory cytokines in diabetes and prevents various DM complications on eyes, cardiac and male reproductive organs through antioxidant effects. It inhibited proinflammatory within several signaling Pathways, included PI3K/Akt-Nrf2,cGMP-PKG, Nrf-2-HO-1 and MAPK, Syk, p38MAPK pathways. There are various melatonin roles in diabetes and DM complications as a promising new breakthrough of DM treatment. It is necessary to explore Melatonin role in other DM complications. Most of this research is on experimental animals, thus clinical trial studies should be carried out in humans to make melatonin a promising therapeutic or prevention for diabetes and its complications in the future

The Effectivity of Parsley (Petroselinum crispum) Extract on The Growth Inhibition of Candida Albicans

Background: Denture stomatitis is a type of Candida-associated infection that mainly affects the palatal mucosa. Candida albicans is one of the normal flora that is considered to be the primary etiologic agent in the pathogenesis of denture stomatitis. Denture decontamination is necessary to prevent denture stomatitis. One method of decontamination is by immersing removable dentures in an antifungal solution. Parsley (Petroselinum crispum) is a medicinal plant showing antifungal activity. Objectives: To determine the effectivity of immersion of acrylic resin Plate in parsley extract on inhibition of growth of Candida albicans. Methods: The effectivity of immersion of heat-cured acrylic resin plates in parsley extract on inhibition of C. albicans growth was tested using an experimental laboratory study with a post-test-only control group design. Thirty samples were divided into 5 groups as 0.01%, 0.02%, and 0.05% parsley ethanol extract, 0.1% sodium hypochlorite, and sterile aquadest. The number of colony forming units per mL was obtained after calculating the colonies on SDA media, allowing the minimum inhibitory concentration (MIC) obtained according to the formula. Results: 0.01% parsley ethanol extract is MIC with a mean of 7.4 CFU / ml, which inhibited the growth of C. albicans by 31.05%. The Kruskal Wallis test (p<0.001) results indicate that there is an effectivity of immersion of acrylic resin plate in parsley extract on inhibition of growth of C. albicans. Conclusions: The immersion of acrylic resin plates in parsley ethanol extract with a concentration of 0.01%, 0.02%, and 0.04% has effectivity on the inhibition of growth of C. albicans.

Therapeutic Effect of Red Spinach (Amaranthus tricolor L.) Extract on Pancreatic MDA Levels Rats (Rattus norvegicus) Exposed to MLD-STZ

Background: Several studies have reported that an increase in blood glucose in patients with diabetes mellitus (DM) can cause complications to death that occur due to oxidative stress conditions due to excessive ROS production. Red spinach extract was found to be rich in antioxidant compounds. However, there has been no further research on the ability of red spinach to lower blood glucose levels and prevent oxidative stress, which can be seen from the levels of malondialdehyde (MDA; a marker of oxidative stress) in the DM body.Objective: This study aims to determine whether there is a change in blood glucose levels and MDA levels in DM animal models between the groups that were given red spinach extract and not.Methods: This study used white rats (Rattus norvegicus) which were divided into 5 groups: K(-) group in which the rats were not induced by diabetogenic agent and were not treated; K(+) group, the rats were made DM induced by multiple low dose streptozotocin (MLD-STZ); and T1, T2, and T3 groups were exposed to MLD-STZ and treated with red spinach extract (Amaranthus tricolor L.) at a dose of 200 mg/kgBW, 300 mg/kgBW and 400 mg/kgBW, respectively. Blood sugar levels were checked before and after treatment with extract using glucometer digital. Meanwhile, MDA levels were measured by TBA test using protein isolates from the pancreas of each rat.Results: The results showed that the average MDA levels in the K-, K+, T1, T2, and T3 groups were 1.759±0.08, 2.280±0.15, 2.303±0.11, 1.927±0.06, and 1.801±0.04. While the average blood sugar levels in the K-, K+, T1, T2, and T3 groups were 114.4±8.82, 464±72.78, 421.2±37.60, 140.6±20.19, and 176±13.06.Conclusion: It can be concluded that the administration of red spinach extract therapy in DM model rats was able to reduce both glucose levels and MDA levels. By lowering the levels of MDA compounds, it is also believed to be able to prevent oxidative stress in cells which causes tissue damage.

Diagnostic Value of Vascular Endothelial Growth Factor C (VEGF-C) and CA 15-3 in Breast Cancer

ABSTRACT Background: expression of VEGF-C and CA 15-3 may be useful to differentiate between malignant and benign breast tumour because VEGF-C plays a role in promoting angiogenesis and lymphangiogenesis in malignant processes and CA 15-3 is the soluble form of transmembrane protein MUC1, a tumour marker which shows higher expression in breast cancer.Objective: to determine the diagnostic value of VEGF-C and CA 15-3 as tumour markers in patients with breast cancer.Methods: this diagnostic study recruited 76 patients that underwent surgical biopsy procedures at Dr. Kariadi and Pantiwilasa Citarum Hospitals Semarang. The VEGF-C and CA 15-3 levels in blood specimens taken before surgical biopsy procedure was determined using ELISA method. An ROC curve and AUC were used to establish the cut-off points and diagnostic value. Pathology examination results from the biopsy specimens were used as the gold standard.Results: the cut-off value for VEGF-C and CA 15-3 were 989.50 pg/mL and 74.00 U/mL. Sensitivity for VEGF-C, CA 15-3 and VEGF-C+CA 15-3 were 76.6%, 64.1% and 89.1%. Specificity for VEGF-C, CA 15-3 and VEGF-C+CA 15-3 were 75.0%, 75.0% and 50.0%. The AUC for VEGF-C, CA 15-3 and VEGF-C+CA 15-3 was 0.831 (95% CI = 0.727-0.934), 0.742 (95% CI = 0.628-0.856) and 0.840 (95% CI = 0.742-0.938).Conclusion: VEGF-C in combination with CA 15-3 is the best diagnostic parameter for breast cancer and has the best accuracy as a tumour marker for breast cancer.

The Effectivity of Thymus vulgaris Extract on IL-1 Level and Bacterial Count in The Heart of Balb-c Mice Infected with MRSA

Background: The increasing phenomenon resistance of bacteria to various types of antibiotics, for example MRSA (Methicillin Resistant Staphylococcus aureus) became a serious problem. Over the last few decades S. aureus has become the dominant cause of endocarditis. MRSA data in Indonesia are still rarely reported. This has led to the importance of extracting natural substances that have anti-bacterial effects or that modulate immune response such as Thymus vulgaris (TV). It was hypothesized that TV can overcome MRSA infection by increasing IL-1, which is the initial cytokine in a natural immune response stimulated by the presence of S. aureus. Objective: This study was to investigate the effect of Thymus vulgaris extract on IL-1 and bacterial counts in the heart of balb-c mice infected with MRSA. Methods: There were 30 male Balb-c mice randomly divided into six groups. Group K (mice infected with MRSA without treatment),P1(mice treated with TV extract 7 days later infected with MRSA), P2(mice infected and treated with vancomycin), P3(mice infected and treated with TV+vancomycin extract), P4(mice infected and treated with amoxicillin), and P5 (mice infected and treated with TV extract+amoxicillin). IL-1 and bacterial count was assessed by ELISA and microbiological culture. Results: The result showed that there was a significant increase in IL-1 between groups (p=0.001).The median decrease in the bacterial count in the heart was 0 in almost treatment group except for P4 group which its median was 26.000 (p=0.161). The correlation between IL-1 levels and MRSA count in the heart had a weak negative correlation (r=-0.182). Conclusion: Thymus vulgaris extract was effective to increase IL-1 levels significantly but was not proven to decrease MRSA count in the heart of balb-c mice.

The Differences of Lipoprotein-Associated Phospholipase A2, Apolipoprotein B and Low Density Lipoprotein In Obese and Lean Men

ABSTRACT Background: An increase in fat accumulation in obesity has been suggested to link with an increase in inflammation. This inflammation may be associated with an elevated of Lipoprotein-Associated Phospholipase A2 (Lp-PLA2), Apolipoprotein B (Apo B), and Low-Density Lipoprotein (LDL), thereby associated with the risk of atherosclerosis.Objective: To investigate the differences between Lp-PLA2, Apo B, and LDL levels in obese and lean men.Methods: A cross-sectional study was conducted on 74 men (obese and lean) at the Faculty of Medicine, Diponegoro University, Indonesia, in 2020. The concentration of LDL was measured using the homogenous enzymatic colourimetric method, whereas the levels of Lp-PLA2 and Apo B were determined using the ELISA method. Data were analyzed using an Independent t-test, setting statistical significance at p <0.05.Results: This study showed that Lp-PLA2 levels were significantly different between obese and lean men (p = 0.039). Furthermore, LDL levels were also significantly different between obese and lean men (p = 0.002). However, we did not find any differences in Apo B between obese and lean men (p = 0.640).Conclusion: Lp-PLA2 and LDL levels were slightly higher in obese compared to lean men, but no difference of Apo B.

Patient-Driven Findings of Genetic Associations for PANS and PANDAS

Background: There are presently very few genetic studies for PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). More work in genetic associations for PANS and PANDAS (P/P) is needed to increase understanding of these debilitating childhood disorders that have a range of presentations.Objective: This work represents a novel approach that aims to determine genetic associations between P/P and other diseases, disorders and traits (hereafter referred to as phenotypes).Methods: Consumer genetic data (23andMe, AncestryDNA) for 155 patients with P/P were obtained from consenting parents over a period from 2018 to 2020. An analysis plan for this work was registered at Open Science Framework, additional genotypes imputed using Impute.me, and polygenic risk scores for 1,702 phenotypes calculated for each of the 155 P/P patients.Results: One-sample t-tests performed across the 155 individual risk scores revealed that P/P is statistically significantly associated with 21 different groups of Single Nucleotide Polymorphisms (SNPs) that are in turn associated with 21 phenotypes. Some of the 21 phenotypes (see Table 3) are previously known to be related to or associated with P/P: a group of SNPs associated with Tourette’s Syndrome, and another group associated with Autism Spectrum Disorder or Schizophrenia, and a third associated with “feeling nervous” yielded t-tests with p values of 1.2x10-5, 1.2x10-11 and 1.0x10-5 respectively for association with the P/P data. This validated our analysis methodology. Our analysis also revealed novel genetic associations such as between P/P and plasma anti-thyroglobulin levels (p=1.3x10-7), between P/P and triglycerides (p=5.6x10-6), and between P/P and Lewy body disease (p=7.8x10-6), inviting further investigation into the underlying etiology of P/P.Conclusion: P/P is associated with many phenotypes not previously recognized as being connected to P/P. Further work on these connections can lead to better understanding of P/P.

Delayed Puberty in Girls with Primary Amenorrhea: A Report of Cases

Background:Female puberty starts when the pituitary hormone producing follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which will stimulate the ovaries to produce estrogen. Delayed puberty with primary amenorrhea in female is the lack of breast development followed by the absence of menses 3 years after the initiation of breast development. Sex chromosomes have an important role in determining the sex, germ cell differentiation of foetus, and reproductive functions of an offspring, thus, sex chromosomal aberrations frequently cause primary amenorrheaCase presentation: We report two delayed puberty cases with the chief complain of primary amenorrhea. Both cases showed hypoplasia of uterus and ovaries on pelvic imaging and hormonal assay showed low of FSH. The first case was gonadal dysgenesis with 46,XX karyotype and low level of estrogen and the second case was a turner syndrome with 45,X karyotype and normal level of estrogen. Conclusion:This study reported delayed puberty with primary amenorrhea cases due to different chromosomal aberration pattern which have similar clinical features. Therefore, cytogenetic examination is needed for any primary amenorrhea cases in order to accomplish the confirmatory diagnosis and for the clinicians to make a correct intervention and treatment.

Correlation between Non-Alcoholic Fatty Liver Disease (NAFLD) fibrosis score (NFS) with Left Ventricular Mass Index (LVMI) in patients with NAFLD

Background: Cardiovascular-related mortality is a major concern in NAFLD. Advanced fibrosis was known to be associated with cardiovascular diseases. NAFLD Fibrosis Score (NFS) is used to identify the development of liver fibrosis in NAFLD patients. Left ventricular mass index (LVMI) is a sign of subclinical cardiovascular complications in NAFLD. The correlation between NAFLD fibrosis score with LVMI in NAFLD patients is not fully established.Objective: To analyze the correlation between NAFLD fibrosis score with LVMI in NAFLD patients.Methods: A cross-sectional study of NAFLD patients in Kariadi Hospital Indonesia. NFS was done using a formula based on clinical and biochemical parameters. LVMI was measured with echocardiography. Pearson’s, Mann-Whitney, and logistic regression were used for analysis.Results: A total of 64 patients with primary NAFLD were enrolled, 54.7% males and 45.3% females. Mean age was 52,8 ± 10,5 years (30-77 years). Based on NFS criteria, high probability group was the highest (50%), followed by intermediate probability group (34,4%) and low probability group (15,6%). Highest increase in LVMI was obtained in the high probability group (93,8%), followed by intermediate probability (59,1%), and low probability group (10%) respectively. There was significant correlation between NFS and LVMI (P 0,002). Logistic regression showed that NFS has a more significant correlation with LVMI compared to gender (P=0,002).Conclusion: NFS is a non‐invasive liver fibrosis scores which independently corelated with Left ventricular mass index (LVMI), a marker of cardiovascular abnormality.