Introduction: Toxoplasma encephalitis (TE) is the most commonly found in HIV patients who have no cotrimoxazole prophylaxis, especially when the CD count is <100 / µL. Therapy is often based on a presumptive diagnosis because definitive diagnosis is difficult, and TE can be life threatening. Aim of this study is to provide a characteristic description of TE in HIV patients who admitted at Sanglah Hospital.

Methods: This is a retrospective descriptive study of 43 adult patients admitted with diagnosis TE at the Sanglah Hospital, Indonesia between January 1^st 2018 to December 31^th 2018. 

Results: Most patients were male (69.8%), with the predominant age ranged 31-40 years old (39.5%).  Among all patients; 14% on cotrimoxazole prophylaxis, and 23.3% on antiretroviral therapy. The most common clinical manifestation was headache (58.1%). Oral candidiasis was found in 67.4% of patients. CD4 levels <100 cells / µL were found in 62.8% of patients, absolute lymphocytes <500 / µL in 32.6% of patients. Anemia was found in 37.2% of patients. Multiple ring enhancement was the most common feature found on head CT scan, with the profound location was parietal lobe (46.5%). Pyrimethamine + clindamycin is used in 72.1% of cases. The TE mortality rate in HIV patients in this study was 11.6%.

Conclusion: TE in HIV patients was more common on male, younger age and who are not receiving appropriate prophylaxis and/or without antiretroviral therapy. Laboratory study predominantly showed severe immunodeficiency. The most patients making a full recovery with pyrimethamine and clindamycin treatment. 

Introduction: Diabetes mellitus is a major public health problem worldwide that may cause organ failure and dysfunction such as reproduction dysfunction, including infertility. Glucose metabolism is an important process in spermatogenesis. Glucose Transporters (GLUTs) play an important role in transferring glucose into cells to carry out the sperm capacitation process and maintain sperm motility. Although glucose is needed in spermatogenesis, hyperglycaemic conditions may cause detrimental effects on male fertility. This study was conducted to analyze the impact of hyperglycaemic status in rats on testicular function of spermatogenesis, specifically regarding GLUT-1 and GLUT-3.

Methods: This study was an experimental study done in the integrated research and testing laboratory of Universitas Gadjah Mada from June to August 2018. This study used male Wistar rats, randomly divided into three groups as two intervention groups given Streptozotizin (STZ) induction for 4 and 8 weeks and one control group. The minimum sample size in each group was 9. Furthermore, the mRNA expression of GLUT-1 and GLUT-3 genes were assayed by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR).

Results: This study showed an increase in GLUT-1 and GLUT-3 expression in rats that experienced hyperglycemia for 4 weeks (p = 0.008 and p = 0.002, respectively). Increased expression of GLUT-1 and GLUT-3 also occurred in rats that experienced hyperglycemia for 8 weeks, but the increase was not statistically significant (p=0.36 and p=0.079).

Conclusion: Hyperglycaemia may cause an increase in GLUT-1 and GLUT-3 expression. This expression indicates that GLUT-1 and GLUT-3 are very sensitive to glucose levels changes and may play a role in spermatogenesis changes in patients with diabetes mellitus.

Background: Neonatal asphyxia is the second leading cause of neonatal death in Indonesia. According to the World Health Organization (WHO), neonatal asphyxia is the failure of neonates to begin and maintain normal breathing. Neonatal asphyxia can be caused by several factors, namely neonatal, maternal, placental, and delivery factors. This study is aimed to describe the factors associated with the incidence of neonatal asphyxia in Wangaya General Hospital.

Methods: This study used an analytical method with a cross-sectional design. Data for the study were obtained from medical records. Study samples were selected using a simple random sampling technique, and the number of samples included was 170 neonates. The dependent variable was neonatal asphyxia, while the independent variables were preterm gestation, low birth weight baby, premature rupture of membrane, and delivery requiring the procedure. Data were analyzed with bivariate and multivariate analysis on SPSS.

Results: The risk factors that showed association with neonatal asphyxia were preterm gestation (p=0.000; PR= 6.87; 95% CI: 3.19-14.79), low birth weight (p=0.000; PR=9.55; 95% CI 4.14-22.01), and premature rupture of membrane (p=0.002; PR=3.06; 95% CI: 1.48-6.3). while delivery requiring procedure was found to have no significant association with neonatal asphyxia (p=0.219, PR=0.64; 95% CI: 0.31-1.31). On multivariate analysis, it was found that preterm gestation, low birth weight, and premature rupture of membrane all showed significant association with neonatal asphyxia.

Conclusion: There was a significant association between preterm gestation, low birth weight, and premature rupture of the membrane with neonatal asphyxia in Wangaya Regional General Hospital.

Background: Chronic kidney disease (CKD) is a non-communicable disease with high morbidity and mortality. Treatment options for CKD patients are kidney transplantation, hemodialysis, and peritoneal dialysis. Kidney transplantation remains the best option for CKD patients, which has the best Quality of Life compared to other therapies. The cost of therapy for CKD patients is relatively high. Even in developed countries, renal replacement therapy costs are still a burden on the health system and a public health problem. Therefore, this study aims to compare the cost of care for CKD patients undergoing kidney transplantation, hemodialysis, and peritoneal hemodialysis at dr. Sardjito General Hospital, Indonesia.

Methods: This study was a retrospective cohort study of patients who underwent kidney transplantation, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis from January 2018 to December 2020 at dr. Sardjito General Hospital. We reviewed the medical records, and the data collected was ordinal, numeric, and categorical data. The data was then coded and processed using SPSS version 25.0. The results are presented in descriptive form, tables, or diagrams.

Results: In this study, we found 87 CKD samples. Thirty patients underwent kidney transplantation, 27 patients underwent CAPD, and 30 patients were randomly assigned to undergo routine hemodialysis. Based on the data obtained from this study, the average cost incurred in the first year for patients undergoing kidney transplantation at dr. Sardjito General Hospital amounted to 384.6 million IDR. For CAPD patients, it was 93.7 million IDR, and the average cost for patients undergoing outpatient hemodialysis routinely was 104.1 million IDR. The estimated average cost incurred in the third year after the procedure for kidney transplant patients is 393.7 million IDR, CAPD patients 273.7 million IDR, and patients undergoing routine hemodialysis 307.8 million IDR. The estimated average cost incurred for CKD patients undergoing kidney transplantation was 402.7 million IDR in the fifth year. For CAPD patients was 273.7 million IDR, and for patients undergoing routine hemodialysis was 511.5 million IDR.

Background: Anemia in patients with diabetes mellitus (DM) is often associated with anemia of chronic disease caused by inflammation or iron metabolism disorders. Hepcidin is known to function in initiating the internalization and degradation of ferroportin. It can inhibit the release of iron from cells where an increase in hepcidin levels will reduce iron absorption in the intestine, resulting in a decrease in serum iron levels. This study aims to determine the relationship between serum hepcidin levels and anemia in patients with Type-2 Diabetes Mellitus (T2DM).

Methods: This cross-sectional study was conducted on 77 consecutive T2DM patients who met the inclusion and exclusion criteria and received health services at Sanglah Hospital, Bali, Indonesia, during the study period. The variables assessed in this study included T2DM status (controlled and uncontrolled), anemia, hemoglobin, HbA1c, erythrocyte sedimentation rate, and hepcidin. Data were analyzed with SPSS version 20 for Mac.

Results: There was no significant difference in age, sex, disease duration, SGOT, SGPT, leukocytes, platelets, and ESR between controlled and uncontrolled T2DM groups (p>0.05). However, there was a significant difference in eGFR and hemoglobin levels between controlled and uncontrolled T2DM groups (p<0.05). Mann-Whitney U test found a significant difference in hepcidin levels between controlled and uncontrolled T2DM groups (MD=138.14; 95%CI=10.65-286.94; p=0.046). A weak significant negative correlation was found between hemoglobin and hepcidin levels by the Spearman correlation test (r=-0.259; p=0.043).

Conclusion: There was a significant difference between the mean hemoglobin and hepcidin levels in the controlled T2DM group compared to uncontrolled T2DM group patients. A weak statistically significant negative correlation was found between hepcidin levels and anemia in T2DM patients.

Introduction: Jaundice comes from the Greek, a clinical condition with skin color and mucosa to become yellowish. The cases number of obstructive jaundice with choledocholithiasis at Hasan Sadikin Hospital Bandung-Indonesia from 2014 to 2016 were 132 cases. On the other hand, honey and vitamin C, which are supplements that are easy to locate in Indonesia, have antioxidant and hepatoprotective abilities to inhibit liver fibrosis and reduce MDA levels effectively, which is one indicator of lipid peroxidation. Therefore, this study tried to compare the role of honey with vitamin C in inhibiting the occurrence of liver fibrosis and lipid peroxidation.

Methods: This study was an experimental study with a parallel design that aimed to determine the formation of liver fibrosis and plasma malondialdehyde (MDA) values as an indicator of lipid peroxidation in biliary obstruction conditions given honey and vitamin C (treatment group) and without honey and vitamin C (control group) in Wistar rats.

Results: Giving honey 3 mg and vitamin C 225 mg in biliary obstruction for 14 days gave an inhibitory effect on liver fibrosis and lower plasma MDA levels compared to the control group. Also, honey had an inhibitory effect on fibrosis and lower plasma MDA levels compared to vitamin C.

Conclusions: Oral administration of 3 mg honey in biliary obstruction of Wistar rats had better results than 225 mg of vitamin C in inhibiting liver fibrosis and lipid peroxidation.

Background: The SARS-CoV-2 infection has triggered a global health crisis. Early detection of COVID-19 infection using hematology and radiology examination is the fastest method to detect the infection. This study aims to evaluate the characteristics of sign and symptom, hematology, and radiology examination of COVID-19 patients at Universitas Gadjah Mada (UGM) Academic Hospital, Yogyakarta, Indonesia.

Methods: This is a retrospective study with quantitative descriptive methods and uses a total sampling technique. This study was conducted at UGM Academic Hospital, with a total sample of 147 patients diagnosed with COVID-19. Data were collected from medical records and were analyzed with Microsoft Excel for Windows.

Results: This study showed that the most signs and symptoms of COVID-19 patients were cough (46.26%) and cold (37.41%), followed by hypertension (31.97%). Hematology examination showed that the leukocyte count of patients was mainly higher than the normal level (82.99%). The data showed that 22.45% of patients had increased C-Reactive Protein (CRP) and 2.72% of patients had increased procalcitonin. The result of thorax x-ray (16.33%) and CT-scan (28.57%) examination of the COVID-19 patients indicates pneumonia.

Conclusions: This study illustrated that the symptoms of COVID-19 patients at UGM Academic Hospital, Yogyakarta were various. Respiratory problems such as cough and cold were the most common symptoms, followed by muscle fatigue and digestive disorders. Hematology and radiology test results of COVID-19 patients depend on the severity of the disease. 

Background: Chronic exposure of human skin to ultraviolet B (UVB) affects the structure and function of the skin, and causing skin aging. Caffeine is hypothesized to inhibit the skin aging process through the inhibition mechanism of the Ataxia Telangiectasia and Rad3-Related–Checkpoint Kinase 1 (ATR-Chk1) pathway. This study aimed to prove that caffeine cream can increase the apoptotic cells and decrease the expression of phosphorylated ATR (Thr 1989) in the skin of male mice (Mus musculus) exposed to UVB.

Methods: This study used a randomized post-test only control group design. The subject used in this study was 36 mice and divided into two groups. The control group was treated with emulgide cream as a placebo and the treatment group was treated with cream containing 4.8% of caffeine. Both groups were exposed to UVB at a dose of 343 mJ/cm² for 8 weeks. Skin biopsy from the central area of the back obtained after the last session and followed by an examination of apoptotic cells of epidermis using H&E staining and phosphorylated ATR (Thr 1989) expression in epidermis using immunohistochemistry.

Results: It showed that the mean number of apoptotic cells in the treatment group was higher (2.15±0.43 cells/hpf) than the control group (0.81±0.55 cells/hpf) (P<0.001). The mean phosphorylated ATR (Thr 1989) expression in the treatment group was lower (8.03±3.91%) than the control group (23.62±4.39%) (P<0.001).

Conclusion: The administration of caffeine cream can increase apoptosis and decrease phosphorylated ATR (Thr 1989) expression in the UVB-exposed male mice (Mus musculus) skin epidermal cells.

Background: Necrotic teeth with periapical lesions often experience root canal treatment failure. Enterococcus faecalis bacteria cause 85-90% of root canal infections. 2% Chlorhexidine digluconate (CHX) can eliminate Enterococcus faecalis bacteria but cannot dissolve necrotic tissue, while green meniran phytochemical compounds (Phyllantus niruri Linn) have anti-bacterial properties. This study aims to determine the effectiveness, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) between green meniran leaf extract with 2% chlorhexidine digluconate and meniran extract only against the growth of Enterococcus faecalis.

Method: This is an in vitro experimental study with a broth microdilution method consisting of two treatment groups. The negative control contained BHIB media and 0.05 ml of bacteria; the positive control had 0.05 ml of bacteria with 2% chlorhexidine digluconate, the group one consisted of BHIB media, bacteria and various concentrations of meniran extract. In contrast, group two consisted of BHIB media, bacteria, various concentrations of green meniran with 2% chlorhexidine digluconate. Data were analyzed using the One Way Anova test with LSD test.

Results: Compared with negative control, in group one, we found the MIC of meniran extract was 3.125% with 94% anti-bacterial power, and the MBC was 6.25% with no bacterial growth. In group 2, we found the MIC of meniran extract and the 2% chlorhexidine digluconate was 0.78% with 9.3% anti-bacterial power, while the MBC was 1.56%.

Conclusion: The increasing concentration of meniran extract also increases the anti-bacterial effect. A combination of meniran extract and 2% chlorhexidine digluconate give better anti-bacterial effects than meniran extract only. 

Background: Nevus of Ota is a well-defined dermal melanocytosis characterized by bilateral multiple small, bluish-brown macules in the area innervated by the first and second branches of the trigeminal nerve. Currently, the therapeutic modalities for this condition are still limited and complete resolution is difficult to achieve.

Case Description: A 23-year-old woman complained a brown spot on the right cheek since the patient was born. It looked like the skin but slightly darker than its surroundings. Four years ago the patient had received 6 sessions of QS: Nd-YAG laser therapy, but the spot is still clearly visible. Dermatological status of the orbital, infraorbital, zygomatic, and right buccal regions showed multiple hyperpigmented patches, gray-brown, well-defined, geographically in shape with size 0.2 x 0.3cm – 5 x 7cm. The lesion was unilateral and distributed within the innervation area of the second and third trigeminal nerve. Miravex® skin analysis showed that the average level of melanin was 0.464 with a melanin variation of 45%. Therefore, patient was diagnosed with Nevus of Ota. The proposed treatment was  picosecond alexandrite 755nm laser, with a frequency of 2.5 Hz, pulse duration 550-750 ps, spot size 4 mm, and fluence 1.59 J/cm². A marked improvement was observed after the treatment and after 21 days, a good grade of improvement was reported.

Conclusion: Nevus of Ota can effectively treated with 755nm picosecond alexandrite laser therapy and results in a good grade of improvement.