Journal Of The Indonesian Medical Association

The Potency of Ficus deltoidea Jack Leave Extract as Anti Breast Cancer

Rizky Clarinta Putri — 2024-04-05

Female breast cancer is the most common diagnosed cancer worldwide in 2020, with an estimated 2.3 million new cases or 11.7% from total 18,1 million cases, followed by lung, colorectal, prostate, and stomach cancers. In 2040, the breast cancer cases are predicted will be increased into 3 million cases per year or grow 40% from 2020 data. It is also estimated the number of deaths due to breast cancer will be one million death per year in 2040. In Indonesia, the number of new breast cancers reached 68,858 cases (16.6%) of a total of 396,914 new cases of cancer in 2020. The incidence and mortality rates of breast cancer are 44 and 15.3 per 100,000 population, respectively in Indonesia. The most common breast cancer treatments used currently are surgery, chemotherapy, and radiation. These three treatments involve a rather invasive approach and often causes side effects. Serious side effects can reduce a patient's quality of life, lead to non-compliance to chemotherapy, and lead to drug resistance. Some cancer patients use alternative therapy such as complementary medicine including herbal medicine to treat the cancer. Patients try to discover and utilize natural-derived anti-cancer drugs because it believes has fewer side effects and more affordable. One of Indonesia plant which is therapeutically beneficial is Ficus deltoidea. Ficus deltoidea leaves had been used in traditional medicine to treat diabetes, inflammation, diarrhoea, cancer and infections. F. deltoidea leaves contained flavonoids, saponins, tannins, steroids and terpenes which known for its anticancer effect.

Effect of Umbilical Cord Mesenchymal Stem Cells on Vascular Maturation in Rabbit Arteriovenous Fistula (AVF) Model Assessed Using Doppler Ultrasonography

Iman Akbar Hasibuan — 2024-04-05

Introduction: The need for arterio-venous fistula (AVF) procedures continues to increase along with the rising incidence of chronic kidney disease. However, AVF maturation remains a challenge in clinical applications due to its susceptibility to various factors with complex mechanisms. Mesenchymal stem cells (MSCSs) have the potential to stimulate tissue regeneration, particularly in vascular injuries. This study aims to assess the effect of in situ and intravascular MSCSs administration on AVF maturation.
Methods: This study employed an experimental design utilizing an animal model, specifically the Lepus domestica rabbit. Vascular maturation was assessed through parameters such as diameter, hyperplasia, and flow using Doppler Ultrasonography (USG) over a 14-days period. The production of stem cells was conducted using fluids and umbilical cord membranes. Statistically analysis involved one-way ANOVA and Kruskal Wallis test, followed by a post Hoc, with a confidence level of 95%.
Results: A total of 28 Lepus domesticas were utilized, distributed across three groups: P1-negative control (n=9), P2-MSCSs in situ (n=9), and P3-MSCSs intravenous (n=10). Group P2 showed the widest vascular diameter (p<0.001) and the least formation of hyperplasia (p=0.014), with mean values of 4.5 mm and 1.2 mm, respectively. The P3 group demonstrated the fastest flow compared to the other groups (p=0.02), with an average flow of 144.6 mL/min.
Conclusion: The administration of MSCSs in situ enhances vascular maturation following AVF procedures by increasing diameter size and reducing the formation of vascular hyperplasia.

The Association of COVID-19 Patient Comorbidities With Mortality at Pertamina Jaya Hospital Central Jakarta

Siti Nurhayati — 2024-04-05

Introduction: The COVID-19 pandemic is a disease outbreak caused by SARS-CoV-2; as of July 20, 2021, there were 2,950,058 positive cases and 76,200 deaths in Indonesia. COVID-19 patients with comorbidities are mostly hypertension (50%), diabetes mellitus (37.2%), and heart disease (16.7%). This study aims to prove how comorbidities affect the mortality of COVID-19 patients at Pertamina Jaya Hospital, Central Jakarta.
Method: This study is a retrospective cohort analysis. The sample comprised 500 patients, 250 comorbid groups, and 250 without comorbidities. The secondary data source is medical records of COVID-19 patients at Pertamina Jaya Hospital from April 2020 to September 2021. Data analysis using univariate, bivariate, and multivariate.
Result: Multivariate analysis with logistic regression resulted in a value of (32.197 95% CI 9.714 - 106.718) so that there is an influence on the risk of death with a comorbid history in COVID-19 patients. The relative risk value proves that hypertension has a 3-fold risk of death (3.124 95% CI 1.441 - 6.773), diabetes mellitus is 2.5 times (2.521 95% CI 1.055 - 6.024), while heart disease is 2.3 times (2.325 95% CI 1.169 - 4.622).
Conclusion: Hypertension, diabetes mellitus, and heart disease are comorbidities that are predictors of mortality for COVID-19 patients due to a higher risk of death.

The Role of Alphamangostin in Corn Oil in Improving Lipid Profile in High-Fat Diet-Induced Rats

Susy Tjahjani — 2024-04-05

Introduction: Alphamangostin is a component of the mangosteen peel extract (Garcinia mangostana L) that has potential as a therapy for dyslipidemia. However, alphamangostin has low solubility, resulting in low bioavailability when administered orally. This study aims to investigate the potential of alphamangostin dissolved in corn oil on serum lipid profiles in vivo.
Methods: The study was conducted on 24 Sprague Dawley strain Rattus norvegicus rats divided into 6 treatment groups (NC, HFD, CO, D1, D2, and Sim), with 4 rats each group randomly assigned. After a 1-week acclimatization period, each group received the following treatments: standard diet for 4 weeks (NC), high-fat diet + propylthiouracil (PTU) for 4 weeks (HFD), HFD + corn oil (CO), HFD + alphamangostin in corn oil at 7 mg/KgBW (D1), HFD + alphamangostin in corn oil at 35 mg/KgBW (D2), and HFD + simvastatin at 3.6 mg/KgBW (Sim). Treatments for CO, D1, D2, and Sim were administered for 2 weeks. Serum total cholesterol, HDL, LDL, and triglycerides were examined before and after treatment, and the differences were analyzed statistically.
Results: The administration of alphamangostin at a dose of 7 mg/KgBW (D1) and corn oil (CO) significantly decreased LDL cholesterol levels (p<0.05), and alphamangostin at a dose of 35 mg/KgBW (D2) significantly decreased triglyceride levels (p<0.05). Meanwhile, there were decreases in total cholesterol levels and increases in HDL cholesterol levels in the alphamangostin and corn oil groups, but these changes were not statistically significant (p>0.05).
Conclusions: Alphamangostin can reduce LDL cholesterol and triglyceride levels in high-fat diet-induced rats.

Death Risk Description Of Confirmed COVID-19 Patients In Bethesda Hospital: 4C Mortality Score Analysis

Vallentino Ardine Prasetya Bisay — 2024-04-05

Introduction: The high incidence of death in patients with COVID-19 requires a risk stratification tool to assess the patient's condition and determine appropriate medical action. The 4C mortality score is a stratification tool that uses patient demographics, clinical observations and laboratory parameters to describe the patient's risk of death.
Method: This study used a nested case-control method with secondary data on patients with confirmed COVID-19. The sample with 71 confirmed COVID-19 patients was categorized into groups of patients who died (cases) and patients who recovered (controls). Data analysis using the independent T test and bivariate using the chi-square method to see the relationship between the 4C mortality score and the incidence of patient death.
Results: It was found that the 4C mortality score in the group of patients who died was higher compared to patients who recovered (mean = 8.20 vs 4.05). A significant relationship was found between the 4C mortality score and the incidence of death in COVID-19 patients (OR = 22.696; 95% CI = 2.82-182.9; p = 0.0034)
Conclusion: It can be concluded that the 4C mortality score of medium and high COVID-19 patients is associated with the risk of patient death.

Raynaud's Syndrome: A Case Report

Sanny Kusuma Sary — 2024-04-05

Introduction: Raynaud’s phenomenon is a condition characterized by sudden discoloration of the skin on the fingers caused by vasospasm. It can occur either as a primary condition or secondary to other diseases, such as Sjogren’s syndrome. Laboratory tests play an essential role in diagnosing and treating Raynaud’s syndrome.
Case Report: A 38-year-old woman with clinical Raynaud’s syndrome underwent Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) examinations, which resulted in prolonged values. The patient complained of pain and a black wound on the tips of the 2nd and 3rd fingers of the left hand. The patient was checked for PT, APTT, lupus anticoagulant (LA), antinuclear antibody (ANA), anticardiolipin antibody (ACA) IgG and IgM, Beta 2 GP IgG and IgM, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ANA profile with fluctuating PT and APTT results, weak positive LA, indeterminate ACA IgG, fast ESR, increased CRP, ANA profile (++) Ro-52 recombinant.
Discussion: Raynaud’s syndrome is a group of symptoms caused by vasospasm and is often associated with autoimmune diseases. The patient presented with typical complaints of Raynaud’s phenomenon and laboratory results of the ANA profile that support a diagnosis of Sjogren’s syndrome. Fluctuations in PT and APTT may be due to intravenous heparin therapy, warfarin, inflammatory conditions, or antiphospholipid antibodies.
Conclusion: ANA profile results in patients corresponding to Sjogren’s syndrome, which underlies Raynaud’s syndrome. It is advisable to check mixing studies, liver synthesis function, and antiphospholipid antibodies with an interval of 12 weeks to look for other causes of prolonged PT and APTT.

Management of Cough Variant Asthma

Muhammad Bimo Adi Wicaksono — 2024-04-05

Cough is one of the innate primitive reflexes that is part of the immune system to protect the body from foreign substances. Cough is a manifestation of symptom found in various lung diseases, both infectious and non-infectious lung diseases. Cough variant asthma is a phenotype of asthma with the only symptom of cough. In cough variant asthma, airway (bronchial) hyperresponsiveness is found without abnormalities in pulmonary function tests. Airway hyperresponsiveness is assessed from the bronchial provocation test by measuring provocation dose (PD₂₀) or provocation concentration (PC₂₀). Management of cough variant asthma is no different from classic asthma, which are inhalation of bronchodilators and corticosteroids. Partial response to inhalation therapy can be reversed by changing the treatment regimen, increasing the inhaled dose, or adding other drugs such as long-acting β2 agonists, sustained-release theophylline or leukotriene receptor antagonist (LTRA).