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POTENSI INHIBITOR SENYAWA PADA SUKUN (Artocarpus altilis) TERHADAP PROTEIN POLY (ADP-RIBOSE) POLYMERASE 2 (PARP2) PADA KANKER OVARIUM DENGAN MODEL MOLECULAR DOCKING: Inhibitor Potency of Compounds in Breadfruit (Artocarpus altilis) Against Protein Poly (ADP-Ribose) Polymerase 2 (PARP2) in Ovarian Cancer with The Molecular Docking Model I Putu Bayu Agus Saputra; Ni Made Wiasty Sukanty; I Putu Deddy Arjita; I Gede Angga Adnyana
Biomedika Vol 15, No 1 (2023): Biomedika Februari 2023
Publisher : Universitas Muhammadiyah Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23917/biomedika.v15i1.1748

Abstract

ABSTRACT Ovarian cancer is the third leading cause of cancer death in Indonesia. The mechanism of cancer needs to be understood to create drugs that play a role in inhibiting the development of cancer cells. PARP is a prime protein in cancer cell development. PARP is a target of chemotherapy, namely through its inhibition by 3-aminobenzamide compounds. Treatment using natural ingredients is safer than using synthetic drugs. Breadfruit (Artocarpus altilis) is a plant that grows in Indonesia. It is efficacious because it contains many compounds used in the manufacture of various types of drugs. The PARP receptor (3KCZ) was examined for the value of binding affinity with the flavonoid derivative ligands contained in breadfruit (Artocarpus altilis) using the help of the software Pyrx version 0.8. The test results showed tamoxifen (-8 kcal/mol), quercetin (-8 kcal/mol), cyclocommunal (-9.6 kcal/mol), morusin (-6.7 kcal/mol), and cyclomulberrin (-9 kcal /mol) have a lower binding affinity value compared to 3-aminobenzamide (-6.6 kcal/mol) which is the native ligand of PARP. These results prove that the flavonoid-derived compounds in breadfruit can potentially act as PARP inhibitors in ovarian cancer cells. ABSTRAK Kanker ovarium merupakan kanker penyebab kematian ketiga terbesar di Indonesia. Mekanisme kanker sangat perlu dipahami untuk menciptakan obat yang berperan menghambat perkembangan sel kanker. PARP merupakan protein yang berperan penting pada perkembangan sel kanker. PARP telah terbukti dapat menjadi target kemoterapi, yaitu melalui penghambatannya oleh senyawa 3-aminobenzamide. Pengobatan menggunakan bahan alami lebih aman dibandingkan penggunaan obat sintetis. Sukun (Artocarpus altilis) merupakan tumbuhan yang tumbuh di Indonesia yang berkhasiat karena mengandung senyawa yang dapat dimanfaatkan dalam pembuatan berbagai jenis obat. Reseptor PARP (3KCZ) dilihat nilai binding affinity dengan ligan turunan flavonoid yang terkandung pada sukun (Artocarpus altilis) menggunakan bantuan softwere pyrx versi o,8. Hasil uji menunjukkan senyawa tamoxifen (-8 kcal/mol), quercetin (-8 kcal/mol), cyclocommunal (-9,6 kcal/mol), morusin (-6,7 kcal/mol), dan cyclomulberrin (-9 kcal/mol) memiliki nilai binding affinity yang lebih kecil dibandingkan dengan 3-aminobenzamide (-6,6 kcal/mol) yang merupakan native ligan dari PARP. Hasil ini membuktikan bahwa senyawa-senyawa turunan flavonoid pada sukun dapat berpotensi sebagai inhibitor PARP pada sel kanker ovarium.
The Correlation Between Smoking Behavior and The Use of “Used Cooking Oil” with Hypertension Incidences at Malimbu Coastal Area I Gede Angga Adnyana; I Nyoman Bagus Aji Kresnapati; I Putu Bayu Agus Saputra; Maruni Wiwin Diarti; Yunan Jiwintarum
Jurnal Keperawatan Terpadu (Integrated Nursing Journal) Vol 5, No 2 (2023): OKTOBER
Publisher : Jurusan Keperawatan, Poltekkes Kemenkes Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32807/jkt.v5i2.518

Abstract

Hypertension is the main risk factor that leads to cardiovascular disease such as heart attack, heart failure and stroke, which is the highest cause of death in the world. One area with high risk of hypertension is the coastal area. The famous coastal area in the Lombok is Malimbu, located in North Lombok, West Nusa Tenggara Province. This research is an analytical observational study with a cross sectional design. This study aims to determine the correlation between smoking behavior and use of “used cooking oil” and the incidence of hypertension. Samples in this study were 70 people (n=70), and was taken using accidental sampling technique. Data were analyzed using chi-square. The results showed that the incidence of hypertension was 48% of the 70 respondents. Most of the respondents (70%), had no history of hypertension in their family. This research shows that there is no correlation between smoking behavior and the incidence of hypertension (p=0.807) with PR=1.156 (0.354 - 3.797). The use of “used cooking oil” was also found to be not correlated with the incidence of hypertension (p=0.632) with PR=1.275 (0.486 - 3.345). Although several previous studies showed that the smoking behavior and the use of used cooking oil correlate to hypertension, but this study result shows different data. This can be caused by other factors. Future research needs to examine the characteristics of smokers that may be related to the incidence of hypertension
HUBUNGAN PENGELOLAAN SAMPAH DENGAN KEJADIAN DIARE DI DESA PANDANAN I PUTU BAYU AGUS SAPUTRA; I PUTU DEDY ARJITA; IRWAN SYUHADA; I GEDE ANGGA ADNYANA
GANEC SWARA Vol 18, No 1 (2024): Maret 2024
Publisher : Universitas Mahasaraswati K. Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35327/gara.v18i1.736

Abstract

Pandanan Hamlet is a favorite tourist destination in Lombok, admired by tourists for its beautiful beaches. Diarrhea represents a common and potentially serious global health issue, especially in areas with limited access to healthcare. This condition, characterized by increased frequency and fluidity of stool, can be caused by various factors ranging from bacterial or viral infections to chronic medical conditions. This research focuses on Pandanan Village, examining the impact of waste management on the incidence of diarrhea. Waste management is a crucial environmental issue worldwide. Improperly managed waste, encompassing various materials from household to industrial waste, can become a source of disease spread. The study indicates a correlation between good waste management and a decrease in diarrhea incidents. Results show a significant relationship (P<0.05) between poor waste management and increased diarrhea incidence, with poor waste management being linked to 22 cases of diarrhea. These findings underscore the importance of proper waste management as a preventive measure against diarrhea, particularly in the context of sanitation and environmental cleanliness. This research provides crucial insights into the relationship between environmental factors and public health, highlighting the need for interventions focused on improving sanitation infrastructure and health education in Pandanan Village.
Hubungan Anemia Kehamilan, Status Ekonomi dan Pola Pemberian Makan dengan Kejadian Stunting pada Anak di Puskesmas Pemenang, Kabupaten Lombok Utara Lubis, Nayna Aulia; Surasmaji, Lalu Irawan; Adnyana, I Gede Angga; Santosa, Hilda
Malahayati Nursing Journal Vol 7, No 3 (2025): Volume 7 Nomor 3 (2025)
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mnj.v7i3.18710

Abstract

ABSTRACT Stunting refer to impaired physical and cognitive growth. It is often caused by prolonged malnutrition. This Condition is influenced by several factors, such as history of pregnancy-related anemia, feeding patterns, and economic status. Understanding the relationship between these factors is Important for stunting control and prevention. This study investigates the correlation between history of pregnancy-related anemia, feeding patterns, and economic status with the incidence of stunting at Puskesmas Pemenang in North Lombok Regency. This study was an analytical observational with cross-sectional design approach. A total of 91 participants were selected through non-probability purposive sampling. The Study was conducted at Puskesmas Pemenang, North Lombok Regency, in September 2024. The data obtained were analyzed through the Chi-square test, with a significance threshold established at p<0.05. Univariate analysis revealed that 41 (45.1%) children exhibited stunting, 49 (53.8%) mothers had a history of pregnancy-related anemia, 35 (38.5%) respondents demonstrated inappropriate dietary patterns, and 68 (74.7%) respondents were classified as having an economic status below the minimum wage. Bivariate analysis revealed a statistically meaningful correlation between a history of pregnancy-related anemia and stunting, yielding a p-value of 0.002 (PR: 2.33; 95% CI: 1.343-4.070). Additionally, a significant association was found between inappropriate dietary patterns and the incidence of stunting, with a p-value of <0.001 (PR: 3.08; 95% CI: 1.894-5.028). Conversely, no significant association was observed between economic status and the incidence of stunting, with a p-value of 0.165 (PR: 1.64; 95% CI: 0.847-3.185). History of pregnancy-related anemia and inappropriate dietary patterns are strongly linked to the occurrence of stunting in a statistically significant manner. In contrast, economic status does not show a significant statistical association with the incidence of stunting. Keywords: Stunting, Child Nutrition, Maternal and Child Health, Dietary Patterns, Pregnancy-Related Anemia, Economic Status.  ABSTRAK Stunting merupakan suatu kegagalan pertumbuhan pada tubuh dan otak anak. Hal ini muncul sebagai akibat dari kekurangan gizi dalam waktu yang lama. Stunting dipengaruhi oleh beberapa faktor seperti riwayat anemia kehamilan, pola pemberian makan dan status ekonomi. Mengetahui hubungan berbagai faktor ini penting untuk pencegahan dan pengendalian stunting. Mengetahui hubungan antara riwayat anemia kehamilan, pola pemberian makan dan status ekonomi dengan kejadian stunting pada Puskesmas Pemenang, Kabupaten Lombok Utara. Penelitian ini adalah penelitian kuantitatif-observasional, dengan desain cross-sectional. Penelitian ini menggunakan 91 sampel dengan metode purposive sampling. Penelitian dilakukan di Puskesmas Pemenang, Kabupaten Lombok Utara pada bulan September 2024. Data yang diperoleh dianalisis dengan uji Chi-square dengan nilai signifikansi p<0,05. Hasil analisis univariat menunjukkan 41 (45,1%) anak mengalami stunting, 49 (53,8%) ibu memiliki riwayat anemia kehamilan, 35 (38,5%) responden memiliki pola makan tidak tepat dan 68 (74,7%) responden memiliki status ekonomi dibawah UMR. Analisis bivariat pada riwayat anemia kehamilan dan stunting menunjukan hubungan yang signifikan dengan nilai p: 0,002 (PR: 2,33; CI 95%: 1,343-4,070). Hubungan signifikan juga didapatkan antara pola pemberian makan dan stunting dengan nilai p <0,001 (PR: 3,08; CI 95%: 1,894-5,028). Antara status ekonomi dan kejadian stunting tidak menunjukan hubungan yang signifikan, dengan nilai p: 0,165 (PR 1,64; CI 95%: 0,847-3,185). Riwayat anemia pada masa kehamilan dan pola pemberian makan berhubungan signifikan secara statistik dengan kasus stunting. Antara status ekonomi dan kejadian stunting juga tidak menunjukan hubungan yang signifikan. Kata Kunci: Stunting, Gizi Balita, Kesehatan Ibu dan Anak, Pola Makan Balita, Anemia Kehamilan, Status Ekonomi Keluarga
FAKTOR RISIKO YANG BERHUBUNGAN DENGAN INFEKSI MENULAR SEKSUAL (IMS) PADA PELAKU WIISATA DI WILAYAH KERJA PUSKESMAS MENINTING TAHUN 2020-2021 Lalu Afrial Imam Anugrah; Icha Aisyah; Nyoman Cahyadi Tri Setiawan; I Gede Angga Adnyana
Cakrawala Medika: Journal of Health Sciences Vol. 1 No. 2 (2023): Cakrawala Medika: Journal of Health Sciences
Publisher : Lembaga Penelitian dan Pengabdian Masyarakat Universitas Medika Suherman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59981/y6k33131

Abstract

Infeksi Menular Seksual (IMS) adalah penyakit yang dapat menular dari satu orang ke orang yang lain, dapat disebabkan oleh bakteri, virus, parasit, dan jamur. IMS dapat ditularkan melalui hubungan seksual secara vaginal, anal, dan oral. Penelitian ini bertujuan untuk menganalis faktor risiko yang berhubungan dengan IMS pada pelaku wisata di wilayah kerja Puskesmas Meninting tahun 2020-2021. Penelitian ini menggunakan metode observasional analitik dengan desain penelitian cross sectional. Teknik pengambilan sampel menggunakan purposive sampling. Sampel penelitian sebanyak 184 data rekam medis. Data yang diperoleh dianalisis dengan uji kolerasi Chi-Square. Hasil dari penelitian pada karakteristik sampel didominasi usia ≥ 18 tahun (88,6%), berjenis kelamin perempuan (77,7%), berpendidikan rendah (66,3%), dan berstatus tidak kawin (79,3%). Sampel terjangkit IMS (68,5%) dengan jenis IMS terbanyak adalah Servisitis (40,5%). Pada analisis bivariat didapatkan hasil usia (p=0,029; PR=2,71), jenis kelamin (p=0,000; PR=4,52), tingkat pendidikan (p=0,028; PR=6,44), dan status perkawinan (p=0,438). Kesimpulan dari penelitian ini adalah terdapat hubungan yang signifikan antara usia, jenis kelamin, dan tingkat pendidikan dengan IMS sedangkan status perkawinan tidak terdapat hubungan yang signifikan dengan IMS.
HUBUNGAN KEBIASAAN MENCUCI TANGAN MENGGUNAKAN AIR BERSIH DAN SABUN DENGAN KEJADIAN DEMAM TIFOID PADA ANAK USIA 7-12 TAHUN DI WILAYAH KERJA PUSKESMAS MANTANG David Maulana Abdurraman Qudus; I Gede Angga Adnyana; Hardinata; Herlinawati
Cakrawala Medika: Journal of Health Sciences Vol. 2 No. 1 (2023): Cakrawala Medika: Journal of Health Sciences
Publisher : Lembaga Penelitian dan Pengabdian Masyarakat Universitas Medika Suherman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59981/k44qj722

Abstract

Demam tifoid merupakan penyakit infeksi akut pada saluran pencernaan yang disebabkan oleh Salmonella typhi. Faktor risiko penyebaran terjadinya demam tifoid dapat terjadi melalui berbagai cara, salah satunya dikenal dengan 5F yaitu (food, finger, fomitus, fly, feces). Aspek mencuci tangan menggunakan air bersih dan sabun sangatlah penting, kebiasaan mencuci tangan harus dibiasakan sedini mungkin agar tidak terjadinya kejadian-kejadian klinis yang tidak diinginkan. Tujuan penelitian untuk mengetahui hubungan mencuci tangan menggunakan air bersih dan sabun dengan kejadian demam tifoid di wilayah kerja Puskesmas Mantang. Desain penelitian ini yaitu observasional analitik dengan pendekatan rancangan case control. Teknik pengambilan sampel non probability sampling dengan pendekatan purposive sampling. Penelitian dilaksanakan pada bulan Februari 2023. Tempat penelitian dilakukan di wilayah Kerja Puskesmas Mantang Kabupaten Lombok tengah. Sampel penelitian sebanyak 50 responden. Data yang diperoleh dianalisis dengan uji Chi Square. Batas nilai signifikasi adalah (p-value < 0,05). Hasil dari penelitian pada karakteristik responden didominasi berjenis kelamin perempuan (58,0%), berada pada rentang usia 10 dan 12 tahun tahun (32,0%), memiliki kebiasaan mencusi tangan yang baik (60,0%), dan kejadian demam tifoid maupun tidak demam tifoid sebesar (50,0%). Pada analisis bivariat didapatkan p-value sebesar 0,000 (p-value < 0,005) memiliki arti terdapat hubungan yang bermakna atau adanya korelasi yang signifikan antara kebiasaan mencuci tangan menggunakan air bersih dan sabun dengan kejadian demam tifoid. Terdapat hubungan yang signifikan antara kebiasaan mencuci tangan menggunakan air bersih dan sabun dengan kejadian demam tifoid di wilayah kerja Puskesmas Mantang.
HUBUNGAN STATUS GIZI, TINGKAT PENGETAHUAN ORANG TUA ATAU WALI DAN SANITASI LINGKUNGAN DENGAN KEJADIAN DEMAM BERDARAH DENGUE (DBD) PADA ANAK DI RUMAH SAKIT UMUM DAERAH KOTA MATARAM Siti Safira Khairunnisa; Fahriana Azmi; I Gede Angga Adnyana; Ayu Anulus
Indonesian Journal of Health Research Innovation Vol. 2 No. 3 (2025): Indonesian Journal of Health Research Innovation
Publisher : Yayasan Menawan Cerdas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.64094/ydbckb38

Abstract

Demam Berdarah Dengue (DBD) adalah penyakit endemis di Indonesia yang disebabkan oleh virus dengue dan ditularkan oleh nyamuk Aedes aegypti. Penyakit ini dapat menyerang semua kelompok umur, terutama anak-anak yang memiliki daya tahan tubuh lebih lemah sehingga lebih rentan terinfeksi. Risiko terjadinya DBD dipengaruhi interaksi antara vektor, inang, dan kondisi lingkungan; status imun yang terkait dengan status gizi memegang peran penting. Sanitasi lingkungan yang buruk serta rendahnya pengetahuan orang tua turut meningkatkan risiko penularan. Kota Mataram, dengan mobilitas dan kepadatan penduduk yang tinggi, mencatat angka kesakitan DBD yang cukup besar. Penelitian ini, bersifat kasus-kontrol dan dilaksanakan pada Juli–Agustus 2024 di RSUD Kota Mataram, melibatkan 90 anak yang dibandingkan antara kelompok kasus (menderita DBD) dan kontrol (sehat). Data dikumpulkan melalui wawancara, kuesioner, dan rekam medis; variabel independennya meliputi status gizi, pengetahuan orang tua, dan sanitasi lingkungan, sementara variabel dependen adalah kejadian DBD. Analisis dengan uji Chi-square menunjukkan adanya hubungan signifikan antara status gizi (p ≤ 0,001) dan sanitasi lingkungan (p ≤ 0,000) dengan kejadian DBD, sedangkan tingkat pengetahuan orang tua tidak berkaitan secara statistik dengan kejadian DBD (p = 0,205). Dengan demikian, status gizi dan kondisi sanitasi lingkungan berhubungan dengan kejadian DBD pada anak di RSUD Kota Mataram, sedangkan pengetahuan orang tua tidak terbukti berpengaruh.
Relationship Between Body Mass Index, Duration of Diabetes Mellitus, and Physical Activity Degree with The Incidence of Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients at Praya Hospital Asary, Teguh Mayadi; Effendi, Raden Gunawan; Khairunnisai T.; Adnyana, I Gede Angga
Jurnal Biologi Tropis Vol. 24 No. 1b (2024): Special Issue
Publisher : Biology Education Study Program, Faculty of Teacher Training and Education, University of Mataram, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jbt.v24i1b.8187

Abstract

Diabetes Mellitus is a chronic condition that leads to complications and premature death worldwide. Diabetic retinopathy is a posterior segment anomaly and one of the most prevalent microvascular problems.  The purpose of this study is to examine the link between body mass index, diabetes duration, and level of physical activity with the incidence of diabetic retinopathy in Praya Regional Hospital's type 2 diabetes patients. This study employed a case control design and observational quantitative analytical research as its methodology. Purposive sampling is the method employed, and it involves questionnaire completion, interviews, and medical records. The data was analyzed using the Chi Square test, with a significance level of p < 0.05. The study comprised 54 samples in each case and control group, for a total sample size of 108. Body mass index was substantially linked with the development of diabetic retinopathy (p=0.013). Diabetic retinopathy was significantly associated with diabetes duration (p-value = 0.001). The degree of physical activity had no significant association with the development of diabetic retinopathy (p-value = 0.823). At Praya Regional General Hospital, the incidence of diabetic retinopathy in persons with type 2 diabetes mellitus is linked to body mass index and diabetes duration, but not to physical activity level.
Omega-3 Fatty Acids and Vitamin D Combination Affected TG Levels in Rattusnorvegicus with Limited Fat Intake Adnyana, I Gede Angga; Aji Kresnapati, I Nyoman Bagus; Agus saputra, I Putu Bayu; Diarti, Maruni Wiwin; Jiwintarum, Yunan
Poltekita : Jurnal Ilmu Kesehatan Vol. 17 No. 3 (2023): November
Publisher : Poltekkes Kemenkes Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33860/jik.v17i3.2248

Abstract

Vitamin D is a group of secosteroids that have fat-soluble properties. Vitamin D regulates calcium absorption, bone growth and remodeling, and regulates metabolic processes and immunity. Omega-3 fatty acids are a type of polyunsaturated fatty acids (PUFAs) that are essential fatty acids for humans. Omega-3 fatty acids have various positive effects on health, especially cardiovascular-related ones. This study aims to determine the effect of omega-3 fatty acid and vitamin D combination on the TG/HDL-C ratio in high fat fed Rattus norvegicus. The research design is experimental study with a post-test-only control group design. This study used 24 male rats aged 3–4 months with a body weight of 250–300 grams which were divided into four groups; negative control group, positive control group; treatment group one; and treatment group two. The high-fat diet (HFD) is an additional (emulsion) feed added to standard feed with increased fat composition. The results showed that increased triglyceride (TG) levels of 83.40 mg/dL and HDL levels of 62.60 mg/dL after consumed high-fat diet. There was a significant decrease in TG levels of 54.15 mg/dL (p=0.026) and a decrease in HDL of 53.00 mg/dL (p>0.05, α=0,05) after administration of Omega-3 and Vitamin D combination. Conclusions in this study is the intake Omega-3 and Vitamin D combination has a positive effect on TG levels. Still, this positive effect must be accompanied by limiting the fat intake to the body. Meanwhile, combining Omega-3 and Vitamin D did not significantly affect HDL levels.
Immunological Profile of Patients with Controlled and Uncontrolled Type 2 Diabetes Melitus in Mataram City, West Nusa Tenggara Arjita, I Putu Dedy; Adnyana , I Gede Angga; Anulus, Ayu; Saputra, I Putu Bayu Agus; Diarti, Maruni Wiwin
JURNAL INFO KESEHATAN Vol 21 No 2 (2023): JURNAL INFO KESEHATAN
Publisher : Research and Community Service Unit, Poltekkes Kemenkes Kupang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31965/infokes.Vol21.Iss2.933

Abstract

The prevalence of DM disease in West Nusa Tenggara Province is not much different from that in Indonesia. DM cases in NTB are included in the ten most non-communicable illnesses suffered by the community and the incidence continues to increase from year to year. An increase in the levels of pro-inflammatory cytokines in the body is one of the causes of insulin resistance in cells which can further develop into type 2 diabetes. This study involved diabetic patients at the Mataram Community Health Center, who were assigned into 2 groups, namely the controlled diabetes group and the uncontrolled diabetes group and involved a standard group which was a group consisted of healthy people. Each group was examined for Fasting Blood Glucose (FBG) and HbA1c levels. The results of the examination in the standard group, controlled diabetes group and uncontrolled diabetes group obtained the FBG levels of 89.22 mg/dl, 110.0 mg/dl, and 245.80 mg/dl, respectively. Furthermore, the results of the HbA1c test in the standard group, controlled diabetes group and uncontrolled diabetes group were 5.44%, 6.03%, and 10.49%, respectively. The results of the examination of IL-6 levels in the standard group, controlled diabetes group and uncontrolled diabetes were 329.36 pg/ml, 331.52 pg/ml, and 320.33 pg/ml, respectively. The results of the IL-10 test in the standard group, controlled diabetes group and uncontrolled diabetes were 71.80 pg/ml, 116.60 pg/ml, and 128.10 pg/ml, respectively. Based on the results of the study, there was no significant difference in the levels of interleukin 6 and interleukin 10 between respondents with diabetes mellitus and healthy respondents (p>0.05). It can be concluded that there were no differences in interleukin 6 and 10 levels between healthy people with patients with controlled and uncontrolled diabetes.