Effication of amniotic membrane topical stem cell-conditioned medium combined with YAG erbium fractional laser 2940 nm in photoaging skin

Background: Skin ageing is a natural process in humans that is influenced by endogenous and exogenous factors. Nowadays, many people have the concept of health and skin beauty considered as one of the main factors that represent the perception of health in human wellness. Therefore, various anti-ageing therapy strategies that have been developed over the past few years include stem cell therapy. Amniotic Membrane Stem Cells (AMSC) are stem cell products taken from amniotic membranes that contain various proteins and have low immunogenicity. Objective: Proving that Amniotic Membrane Stem Cell (AMSC) metabolite products can improve the clinical picture of photoaging.

Method: Study design using one group pre and post-test design model. Samples were obtained by consecutive sampling and the number of samples was 33 people. Clinical examination of patients with the Glogou scale followed by an one smart skin analyzer. Application of AMSC products 3 times daily at intervals of 2 weeks after the Erbium YAG Fractional 2940 nm laser and evaluation were carried out at weeks 0, 4, and 8.

Results: Pore diameter showed significant improvement (p<0.001) from first to fifth visit (6.52 ± 0.57 vs 5.79 ± 0.7), wrinkles showed significant improvement (p<0.001) from baseline copared to fifth visit (4.28 ± 0.38 vs 4.09 ± 0.20), pigment, moisture, and skin elasticity showed significant improvement (p<0.001) from the (baseline) compared to fifth consecutive visits (4.35 ± 1.41 vs 3.09 ± 0.68), (42.2 ± 7.64 vs 59.1 ± 7.94), (48.2 ± 14.1 vs 61.7 ± 13.1) respectively. Sebum T Zone and U zone showed significant improvement (p<0.001) from (baseline) and compared to fifth consecutive visit (12325 ± 10616.8 vs 2047.5 ± 1887.9) and (8529.8 ± 9026.8 vs 1560.6 ± 895.7). Side effects of urticaria were found in 1 person.

Conclusion: AMSC product therapy can be used as a potential for anti-ageing therapy.

In vivo antioxidant and hepatoprotective activity of ethanol leaf extract of Senna hirsuta Mill

Purpose: Liver diseases as a problem all over the world has led to many deaths because the conventional drugs known for the cure are inadequate to effect perfect healing. This study aims to evaluate the in vivo antioxidant and hepatoprotective potentials of ethanol leaf extract of Senna hirsuta using mice model.

Methods: After the initial effect of hepatic injury in mice with 1 g/kg body weight of paracetamol in a single dose for three days, 200, 400, 800, 1000 and 2000 mg/kg body weight of extract concentrations were used for treating the mice for five days. Blood and liver tissue samples were collected for analyses

Results: The results obtained proved that paracetamol elicited toxicity in the mice. The red blood cells mean count in the negative control (7.67±0.92 million/mm³) was higher than the values obtained from the positive control (4.36±0.12 million/ mm³). The WBC mean values of 3.50±0.18 thousand/mm³ from negative control were lower than the positive control group (9.62±0.39 thousand/ mm³). Also, a higher value above the permissible level (11-19 %) was obtained in the haemoglobin estimation of the positive control (20.11%) than the negative control (11.50%). Values of the positive control and extract treated were higher than the negative control value while lower values were recorded in GSH and CAT in positive control and extract treated. Higher biochemical values were recorded in the positive control, and the extract administered except for albumin and protein. However, the injuries caused that manifested in the mice haematology, biochemical and liver disorders were significantly improved with the 200 – 2000 mg of extract concentrations.

Conclusion: Leaf extract of Senna hirsuta proved the hepatoprotective activity of the employed extracts. The observation did by biochemical, hematological indices, and recovery improvement in liver function by histologic findings. Therefore, established that S. hirsuta ethanol leaf extract has hepatoprotective affinity over paracetamol-induced liver toxicity.

The association between Body Mass Index (BMI) and knee pain on flexible flat foot among students at Universitas Warmadewa, Bali, Indonesia

Background: Flatfoot (pes planus) causes mechanical pressure in the knee and increases contact between the patellar articulation surfaces, increasing knee pain. The weight gain can increase the risk of flatfoot because of excessive loading and ligament stretching beyond the elastic limit. This study aims to determine the association between body mass index (BMI) and knee pain on flexible flat foot among students at Universitas Warmadewa, Denpasar.

Methods: A cross sectional analytic study was conducted among 100 new students of the Universitas Warmadewa Denpasar between May-December 2019. Flat foot screening was carried out using the wet footprint test and plantar arch index (PAI) measurement. BMI was measured through the weight and height of the sample. Patellofemoral pain was measured using the Kujala anterior knee pain scale questionnaire. Descriptive analysis was analyzed by SPSS version 20 for Windows to determine the mean, SE, maximum, and minimum value of all ratio variables. The correlation was tested with Spearman with a significance level of p <0.05.

Results: The average BMI value was 27.6 kg/m², the average PAI of the right foot was 1.42, the average PAI of the left foot was 1.48, and the average score of the Kujala score was 77.22. There was a positive correlation between BMI with flexible flat foot on the right and left foot with significant results (p = <0.05, r = -0.24; p = <0.05, r = 0.307 respectively). There was a negative correlation between Kujala score with flexible flat foot on the right and left foot with significant results (p = <0.05, r = -0.238; p = <0.05, r = -0.366 respectively).

Conclusion: Flexible flat foot significantly correlates to BMI and Kujala score. The higher BMI value, the PAI leg will be higher. The higher PAI value of the foot, the Kujala score will be lower.

Simulation-based learning compared with conventional methods in procedural skill

Background: Recently in the development of the technology, the handling, and management taken for patients are increasingly complex and diverse, especially in the field of cardiology intervention. There are various interventions that residents need to know and cleanse in the field of cardiology in fulfilling their competencies before becoming cardiologists. If the intervention is not done properly, it can affect the patient safety risk or other undesirable complications of the patient. Conventional learning as one of the learning methods always seems to be used in several learning topics. In the middle of resident's hectic schedule and the competencies that must be mastered by them, it triggered the emergence of new learning methods in cardiology, especially in the field of intervention. Simulation-based learning (SBL) has a role in cardiology medicine. Thus, the present review aims to describe the conventional learning, SBL and develop a more effective method in the learning process of cardiology resident procedural skill.

Method: We searched for all articles using the term "SBL in interventional cardiology, the effectiveness of SBL for cardiology resident skill, conventional learning method in cardiology medicine, SBL vs. conventional method in cardiology medicine, SBL vs. conventional method in interventional cardiology" in the title or research abstract. We did search on Google Scholar, Medical Education Journals, and Cochrane from 2004 until 2019. We also take a similar topic from the citation of the journal that included in this review.

Conclusion: The effectiveness of SBL compared with conventional learning method is better in improving procedural cardiology resident skills. Given the increasing demand for procedural capability competencies that must be possessed by resident cardiology, some benefit of that learning method can be achieved from SBL especially in terms of procedural skills and patient safety.

The relationship between nutritional status with length of stay in 1-5 years old children with diarrhea at Wangaya General Hospital Denpasar

Background: Diarrhea is still the second-largest cause of children under-five's mortality worldwide. Six million children die every year due to diarrhea and it mostly occurs in developing countries. The main cause of diarrhea deaths is due to malnutrition. In malnutrition there is an increase in the severity of diarrheal diseases, this makes malnutrition and diarrhea a vicious circle.

Objective: To investigate the relation between nutritional status and length of stay under-five children with diarrhea

Method: A cross-sectional study was conducted from August 2018 to January 2019 using the consecutive sampling methods. The subjects were children aged 1-5 years old hospitalized for diarrhea at Wangaya Hospital Denpasar that fulfills the inclusion and exclusion criteria. The characteristics of the subject such as gender, children's age, birth weight, exclusive breastfeeding status, immunization status, degree of dehydration, mother’s employment, and economic factor.

Result: A total of 42 patients were the subjects of the study. Of 10 subjects with wasted nutritional status, 7 (70%) subjects had long stays (> 4 days), and 3 (30%) others with a short length of stay (≤4 days). Most subjects aged 12-24 months were 52.4%. Most of the subjects were male (57.1%). The results of the analysis showed that nutritional status significantly affected the length of stay of diarrhea in children under five (p-value 0.001; PR 5.6; 95% CI 2.05-9.26).

Conclusion: There is a significant relationship between nutritional status with the length of stay in children under five.

Characteristics of Chronic Suppurative Otitis Media (CSOM) patients who underwent tympanoplasty surgery at Sanglah General Hospital for the period 2017 - 2019

Background: One way to deal with deafness from Chronic Suppurative Otitis Media (CSOM) is middle ear reconstruction surgery known as tympanoplasty. The success of surgery is when complete eradication of the disease is possible as well as hearing improvement. This study aims to evaluate the characteristics of chronic suppurative otitis media patients who underwent tympanoplasty surgery at Sanglah General Hospital for the period 2017 – 2019.

Methods: A retrospective descriptive study was conducted through secondary data from the medical records of CSOM patients who had undergone tympanoplasty surgery at Sanglah General Hospital in Denpasar during the January 2017 - December 2019 period. Variables assessed in this study were age, sex, address of residence, infected side, perforation surface area, CT-scan, culture, surgical findings, graft type and antibiotic therapy, post tympanoplasty tympanic membrane perforation condition, audiometry results before and after undergoing tympanoplasty. Data were analyzed using SPSS version 20 for Windows.

Results: Most of the respondents were male (53.3%), aged 46 - 55 years (26.7%), and living in Denpasar (30.0%). Based on the ear side, the most infected were unilateral (53.3%) and the subtotal perforation surface area (78.3%). No visible abnormalities (40.0%) were the most cases on the CT-Scan, following by the Pseudomonas aeruginosa (21.7%) infection and surgical findings in the form of tympanic membrane perforation only (55.0%). Based on the 3 months post tympanoplasty condition, it was found that the perforation had closed (83.3%), normal audiometric results (38.3%), and a degree of improvement in the hearing threshold after undergoing tympanoplasty was found to be mostly 5-10 dB (48.3%).

Conclusion: CSOM patients who underwent tympanoplasty surgery were mostly men, aged 46-55 years, unilateral, subtotal perforation, and no CT scan abnormalities. In comparison, the membrane perforation condition 3 months post tympanoplasty was closed, mild deafness before tympanoplasty, normal degree of deafness after tympanoplasty, and the average mean hearing threshold improvement was 5 - 10 dB.

Recent updates of sperm cryopreservation technique: a literature review

Background: Nowadays, the decline in male fertility is a significant concern due to the mechanical, systems disturbances, genetic, diet, lifestyle, and environment. Currently, no strategies for medical protection of the germinal epithelium are available. Sperm cryopreservation technique has been established to overcome those issues. Accordingly, this study aims to informed the recent updates of sperm cryopreservation technique from kinds of literature. 

Methods: A review of relevant literature was performed to elaborate the recent updates in the sperm cryopreservation technique. A total of 45 qualified published literature of all years until 2019 were collected from several electronic database and manual search and included in this review.

Results: According to the literature, the first record of sperm cryopreservation was made by Lazzaro Spallanzani in 1776. He used to snow during winter and observed that the motility of human spermatozoa could be preserved after freezing and thawing. Sperm cryopreservation programs provide temporarily or permanently infertile men an opportunity to seek paternity. Sperm cryopreservation is the most effective and the most strongly recommended option for fertility preservation prior to any treatment or occupational gonadotoxic exposures. Sperm cryopreservation should be discussed and offered prior to therapy for malignant diseases. Freezing sperm before the initiation of treatment provides patients with future fertility potential.

Conclusion: Sperm cryopreservation could be offered to the patient before the vasectomy procedure in order to prevent reversal vasectomy or surgical sperm retrieval in the future.

Extravesical diverticulectomy: a case report

Background: Several factors cause bladder diverticula. In adult males, the incidence tends to be due to infravesical obstruction. Various techniques have already been introduced to remove the bladder diverticula, which the most hazardous method is the extravesical diverticulectomy technique. This case study aims to report our successful experience in treating a patient with bladder diverticula with extravesical diverticulectomy technique.

Case Description: A 69-year-old man was admitted to the urology clinic with recurrent urinary tract infection. Ultrasonography examination revealed bladder diverticula, mild bilateral hydronephrosis without prostate enlargement. Preoperative urethroscopy confirmed the presence of urethral stricture. Internal urethrotomy was performed, followed by extravesical diverticulectomy. The postoperative patient healed remarkably and no complaints were reported.

Conclusion: The extravesical diverticulectomy approach seems to be a safe, simple, effective method and can be performed for many sizes of bladder diverticula when performed by an experienced surgeon.

Predictor scale of delayed cerebral ischemic in aneurysmal subarachnoid hemorrhage case series: what a radiologist should know

Introduction: Delayed cerebral ischemic (DCI) was one of the most difficult and occurs in about 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) that could be predicted from computed tomography (CT) scans findings with the Fisher scale, modified Fisher scale, Claassen scale, and scale Hijdra score.

Case description: We reported 5 cases of aSAH at different locations with different DCI prediction scales. 4 of our 5 cases were treated for clipping aneurysm, but in the end, all of our cases developed DCI in the period of 10 to 14 days after aSAH from the mild form of hemiparesis to death.

Discussion: CT scan could predict DCI by some predictor scale. The first predictor scale was the Fisher scale, divided into four classes by assessing the amount of blood. Besides, the modified Fisher scale separated classes for patients with thick blood in the cisterna and IVH. The other scale was the Claassen Scale, which detailed the site of intraventricular blood-filled. Hijdra score is a broader alternative scale but requires more time, which assessed each cisterna amount of blood separately. The outcome was clinical DCI, defined by at least the occurrence of new focal neurological signs or a decrease in consciousness, with or without angiographic vasospasm or new infarct.

Conclusion: The high incidence of DCI leading to death in aSAH indicates the importance of accurate early diagnosis. Therefore, it is necessary to have an in-depth understanding of the essential imaging findings that include the Fisher scale, modified Fisher scale, Claassen scale, and Hijdra score to quickly and accurately guide patient management.

Van der woude syndrome: A case report and review

Introduction: The prevalent autosomal disorder, with or without cleft palate and lip, is Van der Woude Syndrome (VWS). The condition has been known for its lower lip pits. Interferon Regulatory Factor 6 (IRF6) gene mutations are causing a range of cases of VWS. The furrows caused an accumulation of mucous and felt esthetic pain during meals and crying.

Purpose: To determine VWS causes, prevalence, treatment, symptoms, and diagnosis.

Case report: A six-month-old baby was with lip pits, a bilateral cleft lip and palate since birth. The extraoral exam showed bilateral pit swellings with dome form on the lower vermilion boundary laterally to the midline. Simultaneous operations with the Nordhoff technique and simple excision were conducted combined with a breakthrough procedure under general anesthesia to correct bilateral cleft lips. The patient showed better clinical condition after the seventh-day post-surgery without infection sign, and bilateral cleft in lower lip pit closed in a month after surgery.

Conclusion: VWS is generally not known and not always diagnosed. It is peculiar that the cleft palate and lip phenomenon is routinely integrated into the same pedigree. The patient with a lip pit can be thoroughly examined, for example, by revealing the secret shape of the cleft. In this case, the surgical repair was handled simultaneously to both functional and esthetic aspects to achieve satisfying results.