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BALI MEDICAL JOURNAL (BMJ)
Published by Universitas Udayana
ISSN : -     EISSN : -     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Bali Medical Journal (BMJ), P-ISSN 2089-1180, E-ISSN 2302-2914 is an international and peer-reviewed journal published quarterly in print and online by Sanglah General Hospital in collaboration to Indonesian Physician Forum and Indonesian College of Surgeon, Bali-Indonesia which was founded in 2011. The Journal aims to bridge and integrate the intellectual, methodological, and substantive diversity of medical scholarship, and to encourage a vigorous dialogue between medical scholars and practitioners. The Journal welcomes contributions which promote the exchange of ideas and rational discourse between practicing educators and medical researchers all over the world.
Arjuna Subject : -
Articles 179 Documents
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MAXIMIZATION OF DNA DAMAGE TO MGMT(+) EGFR(+) GBM CELLS USING OPTIMAL COMBINATION OF TEMOZOLOMIDE-ANTI EGFR MONOCLONAL ANTIBODY NIMOTUZUMAB Inggas, Made Agus Mahendra; Wahjoepramono, Eka J.; Maliawan, Sri; Islam, Andi Asadul
BALI MEDICAL JOURNAL Vol 4 No 3 (2015)
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Abstract

Background: Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor in adultswith dismal prognosis due to the unavailability of an effective therapy. Up to now, there had been no definitive studies published on EGFR inhibition therapy as a chemosensitizer for GBM therapy using Temozolomide (TMZ). This study aims to reveal the most effective method and timing to administer TMZ anti EGFR targeted therapy which causes maximal DNA damage on GBM cells. Methods: Various regimens of anti EGFR monoclonal antibody Nimotuzumab (NMZ) was administered in different combinations with TMZ, performed on U87MG MGMT(+) EGFR(+) cells. The effectiveness of the combinations were evaluated by measuring yH2AX levels which reflects the degree of DNA damage. One-way Anova and LSD tests were performed to determine the effects of each treatment with p
Older Age and Worse Nutritional State Were Related with Impaired Inflammatory Response in Elderly Patients Kuswardhani, Tuty; Sukrawan, Gede; Suastika, Ketut
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Abstract

Background: Ageing process is related with multisystem disorders. One of them is immune response impairment. It is imperative to evaluate the association between age and related nutritional status with inflammatory response in elderly patient. Methods: A cross sectional study to evaluate inflammatory response among elderly patients (?60 years) at Geriatric Out -patient Clinic, Sanglah Hospital was conducted. Seventy-two patients were enrolled in the study. Age, nutritional states (body mass index and mini nutritional assessment), and inflammatory markers (interleukin-2 [IL-2] and C-reactive protein [CRP]) and other anthropometric as well as laboratory parameters were measured in the study. Results: In the study it was revealed that age has a moderately negative correlation with both of plasma IL-2 and serum CRP levels (R= -0.305, p=0.009; and R= -0.413, p=0.005, respectively). Plasma IL-2 levels were positively correlated with several variables like body mass index (R=0.282, p=0.016), mini nutritional assessment (R=0.237, p=0.045), biceps skin fold (R=0.291, p=0.013), and triceps skin fold (R=0.258, p=0.028). While serum CRP levels has positive correlation with lying diastolic blood pressure (R=0.345, p=0.020) and negative correlation with calf circumference (R=-0.312, p=0.037). No significant associations were found between diabetes and hypertension with inflammatory markers. Conclusion: This study concluded that older age and worse nutritional state were related to worse inflammatory response in the elderly patients.
Letter to the Editor MERS-CoV: An Emerging Public Health Threat Danasekaran, R.; Annadurai, K.; Mani, G.; Ramasamy, and J.
BALI MEDICAL JOURNAL Vol 3 No 1 (2014)
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Abstract

Middle East Respiratory Syndrome Corona Virus (MERS - CoV) was first reported in September 2012 by Egyptian virologist Dr. Zakki in Saudi Arabia.1 The virus was first isolated from the lungs of a 60 year old male patient with acute pneumonia and acute renal failure.2 It is the sixth new type of corona virus similar to SARS virus and was initially referred to as the SARS like virus or simply the novel corona virus.3 Globally, from September 2012 to the end of July 2013, WHO has reported a total of 94 laboratory-confirmed cases of infection with MERS-CoV, including 46 deaths. Maximal number of cases were from Saudi Arabia (74) and 2-3 cases were reported each from Tunisia, Qatar, UK, UAE, France, Italy and Jordan. Health care workers in Saudi Arabia were screened and 7 were identified to have infection with MERS Co-V. Among them 2 were asymptomatic and 5 had mild upper respiratory symptoms.4 MERS Co-V infection may result in renal failure and acute pneumonia which often have a fatal outcome (Fatality rate- 49%). The virus has a strong affinity towards non-ciliated bronchial epithelial cells and it was found that dipeptidyl peptidase4 (DPP4) acts as a functional receptor for the virus. The amino acid sequence of DPP4 is unique to each species and is expressed in the bronchial and renal epithelial cells, which explains the involvement of kidney & lungs in the disease.5 Studies are being done to know the natural reservoir for the infection. MERS Co-V showed similar sequences as of bat and porcine corona viruses. In particular a bat corona virus carried by the genus Pipstrellus differed from the MERS Co-V by only 1.8%.6 Other study has reported that 100% of camels from Omen had protein specific antibodies against MERS Co-V. Most of the Middle East countries consume a large amount of camel meat and there is a possibility that bats harboring the virus may transmit the infection to camels.7 Outbreaks of MERS CO-V infection have been reported in several hospitals in Saudi Arabia, which confirms the human-human transmission of the disease. Patients with diabetes and renal failure are found to be especially at high risk of getting infected. It was also found that the incubation period of the disease to be 5.2 days. Although human transmission has been proved, the ability of the MERS Co-V infection resulting in an epidemic is under debate. But corona viruses are notorious for adaptation to new hosts as in the case of SARS outbreak which resulted in 800 of deaths.8 Either sub clinical or asymptomatic infections among healthcare workers will be a huge threat, since they may become the source of infection for patients with co-existing diseases.4 Several highly sensitive real time reverse transcriptase polymerase chain reactions (RT-PCR) assays are available to confirm the MERS Co-V infection from samples like broncho alveolar lavage or sputum.9 Vaccine based on spike protein have been under clinical trials.10 At the present situation World Health Organization (WHO) has advised the member states to have a strong surveillance against severe acute respiratory infections (SARI) and review any unusual disease occurrence. Recent travelers from Middle East who have symptoms of SARI should be tested for MERS Co-V infection. And among immune compromised, even atypical symptoms like diarrhea should be investigated for MERS Co-V infection. Healthcare facilities should take precautions when treating suspected or diagnosed patients, so as to prevent spread to other patients, healthcare workers and visitors.11
Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Novel Markers for Diagnosis of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis Bahrami, Mohammad Amin; Ansari, Abdollah; Ara, Kefayat Chaman; Bahrami, Elham; Bahrami, Sima; Bahrami, Mohammad Nabi; Barati, Omid; Moosazadeh, Mahmood; Kum, Rauf O?guzhan
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Abstract

Background: Sudden sensorineural hearing loss (SSNHL) is a common otologic disease characterized by a loss of hearing greater than 30 dB in three consecutive frequencies which occurs in less than 72 hours. Objective: To investigate the role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on sudden sensorineural hearing loss (SSNHL). Search strategy: A PubMed, Science Direct, Scopus, OVID, EMBASE and Google Scholar search (date last searched April 2016) without any time, language and location restriction was done. Inclusion criteria: All case-control studies, which have been investigated the relationship of NLR and PLR with the occurrence of SSNHL were included in our meta-analysis. Results: A total of 5 case-control studies were included in the study. All 5 studies have been reported NLR of patients and control groups (611 patients and 804 controls). Our analysis showed that the mean NLR of patients is 1.12 (0.82-1.43) unit higher than that of controls with 95% CI which is statistically significant. Also, 3 studies have been reported PLR of patients and control groups (512 patients and 705 controls). Our analysis showed that the mean PLR of patients is 0.57 (0.08-1.05) unit higher than that of controls with 95% CI which is statistically significant too. Conclusions: This metaanalysis confirmed the relationship of NLR and PLR with SSNHL. Therefore, these parameters can be considered as new markers in diagnosis of SSNHL.
PREVALENCE OF ANTI-STREPTOLYSIN O ANTIBODIES AT BANKE REGION NEPAL Khan, S.; Singh, P.; Siddiqui, A.H.
BALI MEDICAL JOURNAL Volume 1, Number 3, September-December 2012
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Abstract

Objective: Serum levels of anti-streptolysin O antibodies (ASO) in the routine evaluation of patients with rheumatic conditions. Prevalence of elevated serum ASO titer in patients which were coming in OPD & IPD of Nepalgunj Medical College & teaching hospital with various clinical conditions. Method: This was a retrospective cross sectional study, which was performed in the central laboratory of Microbiology at Nepalgunj Medical College and teaching Hospital, Banke, Nepal during the period of September 2010 to April 2012. The serum samples were tested for Antistreptolysin O (ASO) antibodies by latex agglutination test. Results: Total 308 patients including 40.91% male and 50.09% female  were tested for ASO serum levels.140 were positive and 168 were negative .In 140 positive cases 57 were male and 83 were female. In 168 negative cases 69 were male and 99 were female. Conclusion: The prevalence of Anti-streptolysin O (ASO) antibody in total cases was 45.45%.In male was 45.24% and in female was 45.60%.the highest percentage was found in age group 0-21years. The presence of elevated streptococcal antibody titers in such a population, which probably re?ects a high background prevalence of streptococcal infections, should be taken into consideration when evaluating the role of the group A streptococcus in non-purulent complications of infections.
EPIDEMIOLOGICAL AND MOLECULAR ANALYSIS OF TOXOPLASMA GONDII IN FAECAL SAMPLES OF CATS OBTAINED FROM HOUSE OF MATERNAL IN BALI Subrata, I M.; Suryadhi, N. T.; Astawa, N. Mantik; Damriyasa, I M.
BALI MEDICAL JOURNAL Vol 4 No 2 (2015)
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Abstract

Background: toxoplasmosis is a zoonotic-parasite disease caused by T.gondii that spread in many countries. Recently, this disease is one of the major public health problems associated with severe enocomical and social impacts such as miscarriages, hydrocephalus, blindness and mental retardations. The human parastic infection are closely related with the presence of infected cats around their houses, in which the animals are the definitive host releasing the parasites into the environment via their feces. The aim of this research was to determine the correlation between morphological prevalence and molecular detection of T.gondii in cats feces. Methods: detection of molecular was carried out by applying microscopic and a specific polymerase chain reaction (PCR). A case-control study using 40 maternal with positive serology of T. gondii and 40 maternal with negative serology were selected by purposive sampling method. Similarly, 80 faecal sample of cats were also obtained from each house of the women. The major risk factors considered as the important rule for human toxoplasmosis such as age, education, occupation, contact with soil, cat’s age, un-owned cats and oocyst-positive feces were determined by questionnaire. Results: The epidemiological analysis showed that the highest risk factor was oocyst-positive feces (OR= 8.143; p= 0.003), followed by education (OR= 3.414; p=0.045), contact with soil (OR= 2.255; p= 0.073), un -owned cats (OR= 2.25; p= 0.210), age (OR=2.23; p=0.074), occupation (OR= 1.556; p= 0.348) and cat’s age (OR= 1.138; p= 0.799). However, the pregnant women with serologically positive to T. gondii had a very high probability of miscarriages (OR= 18.857; p= 0.0001) compared to whom with serologically negative. Moreover, logistic regression model analysis revealed that only oocyst-positive feces and education contributed a significant factor in causing toxoplasmosis among pregnant women. Microscopic observation of 80 faecal samples indicated that only 14 (17.5%) contained typical oocyst of T. gondii. All of the 8 oocyst of T. gondii positive-faecal samples were further confirmed with PCR, and we found that 4 (50%) were positive. Conclusion: This study concluded that the presence of oocyst-positive feces in the environment in conjuction with education level were considered to play significant contribution to the accident of toxoplamosis in pregnant women.
The Effect of Phytosterol on Serum Beta-Carotene Concentration of Hypercholesterolaemic Subjects Dina-Keumala, S.; -, Sri-Sukmaniah; -, Sri-Widya A. J
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
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Abstract

Objective: Treatment of optic neuritic as recommended by the Optic Neuritic Treatment Trial (ONTT) was intravenous methylprednisolon followed by oral prednisone. This study aims to describe  characteristics and response to intravenous methylprednisolon followed by oral prednisone treatment of optic neuritic patient in Sanglah General Hospital Denpasar. Method: The study was a parallel clinical trial, forty subjects with hipercholesterolaemia were selected using certain criteria. The subjects were divided into two groups using block randomization. Twenty subjects in phytosterol group received phytosterol 2x0.6 g/day and dietary counseling (P), while twenty subjects in counseling group received only dietary counseling (C). Serum total cholesterol and ?-carotene concentration were assessed on day 0 and 42. Before and after treatment, dietary intake were assessed with 2x24 hour recall methods. Results: Seventeen subjects in P group and fourteen subjects in C group completed the study. There was no significant differences in baseline data both groups. After 42 days treatment, there was no significant differences in nutrients intakes in two groups except for ?-carotene and phytosterol intakes in P group. There was a 9.17% significant reduction in serum total cholesterol concentration in P group while no change was observed in the C group (p<0.05). Serum ?-carotene concentration was increased significantly in P group, 0.44±0.376 ?mol/L to 0.536(0.21–1.95) ?mol/L, while there was no significant increased in C group, 0.493±0.349 ?mol/L to 0.56±0.33 ?mol/L. There was a significant difference in serum ?-carotene concentration after adjusted with serum total cholesterol concentration between two groups (p<0.05). Conclusions: Dietary advice to consume an additionally of high ?-carotene sources when consuming phytosterol 2x0.6 g/day for 42 consecutive days maintains serum ?-carotene concentration while lowering serum total cholesterol concentration significantly in hypercholesterolaemic subjects, proved by statistical analysis.
Chondrogenic Differentiation Capacity of Human Umbilical Cord Mesenchymal Stem Cells with Platelet Rich Fibrin Scaffold in Cartilage Regeneration (In Vitro Study) Sumarta, Ni Putu Mira; D, Coen Pramono; Hendrianto, Eryk; Susilowati, Helen; Karsari, Deya; Rantam, Fedik A.
BALI MEDICAL JOURNAL Vol 5 No 3 (2016)
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Abstract

Background: Human umbilical cord mesenchymal stem cell is a promising source of allogenous MSC with great chondrogenic differentiation capacity. Meanwhile, platelet rich fibrin (PRF) is a natural fibrin matrix, rich in growth factors, forming a smooth and flexible fibrin network, supporting cytokines and cell migration, thus can be used as a scaffold that facilitate the differentiation of MSC. However, the differential capability of MSC cultured in PRF was still poorly understood. Method: We studied in vitro differentiation potential of MSC cultured in PRF by evaluating several markers such as FGF 18, Sox 9, type II collagen, aggrecan in 3 different culture medium. Result: The result showed that there was positive expression of FGF 18, Sox 9, type II collagen, aggrecan in all medium of in vitro culture. Conclusion: MSC cultured from human umbilical cord had the capacity of chondrogenic differentiation and able to produce cartilage extracellular matrix in vitro which means that hUCMSC is a potential allogeneic MSC for cartilage regeneration.
XANTHINE OXYDASE INHIBITION OF KOMBUCHA TEA IN HYPERURICEMIA INDUCED WISTAR RAT: decrease of uric acid, malondialdehyde, and 8-hydroxy-2'-deoxyguanosine Sukrama, I Dewa Made
BALI MEDICAL JOURNAL Vol 4 No 1 (2015)
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Abstract

Background: Hyperuricemia is a condition of high level of uric acid in the body due to distortion of purine nucleoside metabolism through hipoxanthin, xanthin, and guanin of basic purine. Objective: to find a cure of hyperuricemia base on the utilization of kombucha tea. Methods: This is a true experimental study by applying posttest only control group design to determine whether kombucha tea inhibit xanthine oxidase in hyperuricemic induced rat reveales by decrease of uric acid, malondialdehyde (MDA), and 8-hydroxy-2’-deoxyguanosine (8-OHdG). In this study, hyperuricemia rat was achieved by intake of high purine diet. Rats were fed with a mixture of 4 g/kg BW of Gnetum gnemon with 50 mL/kg BW of chicken liver ad libitum for 9 days. Treatments in this research are combination of fermentation time of Kombucha tea and volume of this tea, i.e fermentation time 4, 8, and 12 days and the volume are 1 mL and 4 mL. Therefore, there would be seven groups of treatment including control group. ANOVA was then applied to determine the treatment effect with p < 0.05 was concidered significant. Results: This study indicates that kombucha tea has an ability to inhibit xanthine oxidase in hyperuricemic induced rat and decrease uric acid, MDA, and 8-OHdG. This ability was achieved with combination treatment of 12 days fermentation and 4 mL of kombucha intake. Xanthine oxidase, uric acid, MDA, and 8-OHdG levels by this treatment were obtained significantly lower compare to control group. Conclusion: This study proved that kombucha tea was potent to cure hyperuricemia of wistar rat via inhibition of xanthine oxidase produced.
HEMATOPOIETIC PROGENITOR CELLS AS A PREDICTIVE OF CD34+ ENUMERATION PRIOR TO PERIPHERAL BLOOD STEM CELLS HARVESTING Zulkafli, Zefarina; Mustaffa, Rapiaah; Yusoff, Shafini Mohammed
BALI MEDICAL JOURNAL Vol 3 No 3 (2014)
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Abstract

Background: To date, the CD34+ cell enumeration has relied predominantly on flow cytometry technique. However, flow cytometry is time consuming and operator dependent. The application of the hematopoietic progenitor cells (HPCs) channel in Sysmex XE-2100, a fully automated hematology analyzer offers an alternative approach, which is with minimal sample manipulation and less operator dependent. This study evaluates the utility of HPC counts as a predictive of CD34+ enumeration prior to peripheral blood stem cells harvesting. Materials and methods: HPC, CD34+, white blood cell (WBC), reticulocytes (retic), immature platelet fraction (IPF) and immature reticulocyte fraction (IRF) were determined in 61 samples from 19 patients with hematological malignancies (15 lymphoma and 4 multiple myeloma patients) at Hospital Universiti Sains Malaysia (Hospital USM) who had received granulocyte-colony stimulating factor (G-CSF) and planned for autologous transplantation. Results: CD34+ count showed strong and significant correlation with HPC. The receiver operating characteristics (ROC) curve analysis revealed that HPC count > 21.5 x 106 / L can predicts a pre harvest CD34+ count of >20 x 106 / L with sensitivity of 77%, specificity of 64% and area under the curve (AUC) of 0.802. Conclusion: We concluded that HPC count can be a useful potential parameter in optimizing timing for CD34+ enumeration prior to leukapheresis.

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