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Successful treatment of a patient with herbal drug-induced immune thrombocytopenic purpura using freshly donated blood
Nwagu, Marcellinus Uchechukwu
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.222-226
BackgroundDrug-induced thrombocytopenia (DITP), which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for haematologists. Drug-induced thrombocytopenia is often misdiagnosed as immune thrombocytopenic purpura with resulting inappropriate treatment. Immune thrombocytopenic purpura (ITP) is a clinical disorder that leads to easy bruising (purpura), excessive bleeding or extravasation of blood from capillaries into skin and mucous membranes (petechiae). The bleeding tendency is due to decreased number of circulating platelets (thrombocytopenia). There is production of antibodies against the platelets by the patient’s immune system. This case report was conducted to introduce the effectiveness of freshly donated blood and steroids on patients with immune thrombocytopenic purpura (ITP) after ingestion of herbal drugs.Case descriptionDT was a 30-year old female who presented with bleeding per vagina, gum bleeding and weakness. The patient did not have any systemic disease that would cause any spontaneous hemorrhage. The patient was referred to a hematologist urgently and her thrombocyte count was found to be 2000/ìL. Other test results were in normal range. Full blood count revealed severe thrombocytopenia. Freshly donated whole blood was given to the patient and then the changes in her general condition were analyzed, as well as the blood test results.ConclusionIn the absence of platelet concentrate especially in rural settings and resource-poor countries, freshly donated whole blood can be used in the management of a case of severe thrombocytopenia from ITP.
Highly active antiretroviral therapy increases fibrinolytic and protein activity in pregnant women
Osime, Evarista Odaburhine;
Obar, Catherine
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.181-187
BACKGROUNDVarious studies have examined optimal methods for Prevention of Mother to Child Transmission (PMTCT) of human immunodeficiency virus (HIV) and subsequent outcome of response to highly active antiretroviral therapy (HAART) as well as the impact of pregnancy on outcomes of HIV in the Pre-HAART era. Little is known of the impact of pregnancy in response to HAART in Africa. This study is aimed to evaluate euglobulin lysis time (ELT), protein C and protein S in HIV-positive pregnant women on HAART. METHODSThis was a cross-sectional study comprised of 150 participants attending Ante-Natal Clinic (ANC) in Central Hospital, Benin City. Pregnant women on HAART (Test subjects) (n=50, mean age 34 years), 50 pregnant newly diagnosed HIV-positive women that had not yet commenced HAART (n=50, mean age 31 years) and 50 pregnant HIV-negative women (n=50, mean age 30 years) which served as controls. The ELT was determined by methods described by Bain, protein C and protein S were determined using Enzyme Linked Immunosorbent Assay (ELISA). RESULTSThere was a significant increase in ELT in both pregnant women on HAART and not on HAART) when compared to HIV-negative pregnant women (p<0.05). There was a significant decrease in protein C in test subjects when compared with controls (p<0.05) and protein S increased significantly in HIV-positive pregnant women on HAART when compared to those not on HAART and HIV-negative pregnant women (p<0.05).  CONCLUSIONThere are changes in ELT, protein C and protein S parameters with the introduction of HAART in pregnancy.
WNT7A (rs104893832) polymorphism increases the risk of recurrent spontaneous abortion in Iranian women
Mazdapour, Manouchehr;
Ashkezari, Mahmood Dehghani;
Seifati, Seyed Morteza
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.167-172
BACKGROUNDRecurrent spontaneous abortion is defined as the occurrence of three or more clinical miscarriages in one woman. Several factors, including genetics and environmental factors, are involved in this kind of infertility, in which WNT7A (rs104893832) polymorphism plays a major role. The aim of the present study was to determine the association between a common polymorphism of WNT7A (rs104893832) with recurrent spontaneous abortion in females. METHODSIn the present case-control study, the WNT7A (rs104893832) polymorphism was investigated in 70 women with recurrent spontaneous abortion as cases and 100 women with at least one child and no history of infertility or abortion as controls. Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) was used to investigate the WNT7A (rs104893832) polymorphism in both case and control groups. The data were subsequently analyzed using the chi-square and logistic regression tests by SPSS software (version 18.0). RESULTSA significant association was found between the WNT7A (rs104893832) polymorphism and recurrent spontaneous abortion (OR=25.00, 95% CI=5.52-157.09; p<0.0001). Our finding showed that G allele frequency in women with recurrent spontaneous abortion was significantly different compared to the control group. (OR=6.42, 95% CI=2.82-15.16; p<0.0001).Therefore, genetic variation in WNT7A (rs104893832) polymorphism may play a role in recurrent spontaneous abortion. ConclusionThis study revealed that WNT7A (rs104893832) polymorphism increased the risk of recurrent spontaneous abortion. Knowledge of these mutations and polymorphisms can provide an insight into the prognosis for individual patients. Therefore, further studies are necessary to establish the association of WNT7A (rs104893832) polymorphism with recurrent spontaneous abortion in a larger population.
Duration of dialysis increases risk of hepatitis C virus infections among hemodialysis patients in Anambra state, Nigeria
Chizoba, Okeke Okechukwu;
Chibuogwu, Ajulu A
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.173-180
Background Sexually transmitted infections and syphilis are a major public health concern. Hemodialysis patients are at an increased risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. The aim of this study was to determine the seroprevalence of HBV, HCV, syphilis, and the association between these infections and hemodialysis among hemodialysis patients.MethodsA cross-sectional study was conducted involving 90 hemodialysis patients. Blood samples were collected and analysed for HBV, HCV and syphilis using immunochromatographic test kits. All subjects completed a questionnaire on demographic characteristics and other risk factors. A chi-square test was used to analyse the data.ResultsThe prevalence of HBV, HCV and syphilis infections was 4.4%, 6.7% and 2.2% respectively. Highest prevalence of HBV, HCV and syphilis were found in patients whose duration of dialysis were >1 year, >1 year, and 4 months to 1 year, respectively. Similarly, those who had undergone dialysis for > 10 times had the highest prevalence of these infections. The major risk factor the patients was exposed to was blood transfusion (100%), with those who had been transfused for 5 times having the highest prevalence of HBV and HCV and those transfused twice for syphilis. A significant association was seen between duration of dialysis and HCV infection (p<0.05).ConclusionThis study has demonstrated that duration of dialysis increased HCV infection in hemodialysis patients. The prevalence of HBV, HCV and syphilis in the hemodialysis unit is a warning that universal precautions will be the next challenge for decentralised hemodialysis services.
Ageing, longevity and fitness: towards new paradigms in healthy ageing
Abikusno, Nugroho
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.165-166
We have nearly reached the end of the second decade of the Millennium. Within 5 years we hope the Third Ageing Summit will be held to discuss lessons learned and future directions in the field of Ageing and Longevity. 1) I mention the word Longevity since many countries especially in the Asia Pacific region, the second Hub of Ageing after the Western world countries, have experienced this phenomenon since the early years of this Millennium.
Uncontrolled blood sugar tends to increase prevalence of dermatomycosis in diabetic type 2 patients
Surja, Sem Samuel;
Hermawan, Melyawati;
Wijaya, Meiliyana;
Pramanta, Pramanta;
Yolanda, Hanna
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.188-194
Background The prevalence of type 2 diabetes mellitus (DM) is increasing. Diabetic patients have a higher risk of getting dermatomycosis. Dermatomycoses, although a common health problem amongst DM, is often misdiagnosed and consequently undertreated. Studies on the association between dermatomycosis and type 2 diabetes are lacking, especially in Indonesia. Therefore, the aim of this study was to determine the prevalence, etiology, and association of dermatomycosis with diabetic control of type 2 DM. MethodsA cross-sectional study was performed involving 87 subjects with type 2 DM. Demographic and clinical data, including age, sex, and blood glucose level, were collected. If a dermatomycosis lesion was found, a specimen would be taken for identification. Determination of serum glucose level was conducted using Roche c111 analyzer®. Statistical analysis was performed with the chi-square test and Kolmogorov-Smirnov two-independent sample test.ResultsSeventeen (19.55%) subjects had dermatomycosis. The predominant age group affected was 51 - 60 years (42.4%). The number of clinically apparent dermatomycosis was greater in the uncontrolled than in the controlled blood sugar group, but the difference was statistically not significant (p > 0.05). The lesions were mostly found on the nails (74%) and the most common etiology was candida (50%) followed by dermatophyte (25%) and non-dermatophyte molds (25%). ConclusionUncontrolled blood sugar tends to increase the risk of dermatomycosis in type 2 DM patients. Fungal skin infections are common in type-2 DM patients, especially in those with poor glycemic control.
Hypoglycemic effect of Phaleria macrocarpa (Scheff.) Boerl dry extract in healthy adults
Meiyanti, Meiyanti;
Margo, Eveline;
Pusparini, Pusparini;
Merijanti, Lie Tanu;
Lesmana, Alvina
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.195-202
BackgroundThe prevalence of diabetes in Indonesia continues to increase and causes many complications. Fruits of Phaleria macrocarpa (Scheff.) Boerl. (PM) are used in the traditional health system of the Indonesians, as effective remedy in the management of diabetes mellitus. The aim of this study was to evaluate the effect and magnitude of doses of PM dry fruit extract (PME) on blood glucose levels in healthy adults.MethodsThis research was of pre-posttest design involving 30 healthy volunteer subjects aged 20-55 years receiving glucose loads. At pre-test the subjects were given orally 75 g glucose, and at post-test they were given PME at doses of 125 mg and 250 mg. Data collection included anthropometric examination and blood glucose level. The area under the curve (AUC) of blood glucose levels was measured at 0, 15, 30, 60, 120 and 180 minutes. Data analysis was performed using paired t-test with p <0.05.ResultsThe percentage of reduction in AUC between pre- and post-test after administration of PME 125 mg was 12.1% and significant (p=0.000). But the percentage of reduction in AUC between pre- and post-test after administration of PME 250 mg was 4.07% and not significant (p=0.06). The reduction in AUC between post-test PME 125 mg vs PME 250 mg showed significant results (p=0.011).Conclusion This study demonstrated that a dose of 125 mg Phaleria macrocarpa (Scheff.) Boerl. dry extract has a hypoglycemic effect in healthy adults, and may therefore be suitable for use as traditional anti-diabetic drug.
Later age at menopause was associated with higher cognitive function in post-menopausal women
Rachmiyani, Irmiya;
Surjadi, Lily Marliany;
Nirmalasari, Rully Ayu;
Imran, Yudhisman
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.203-208
BACKGROUND Menopause is a condition in which the menstrual periods have stopped for the last 12 months due to cessation of ovarial functions causing estrogen hormones to decrease. Various studies find that many factors affect cognitive function at post-menopausal age among others the decrease in estrogens, age at menopause, duration of menopause, and education. However, the effects have been subject to controversy. The aim of this study was to determine the relationship of age, age at menopause, estradiol level, and education with cognitive function among healthy post-menopausal women. METHODS A cross-sectional study was conducted involving 31 post-menopausal women between 50 to 75 years old. Data on age, age at menopause, and education were collected using a questionnaire. The estradiol levels were measured using an electrochemiluminescent immunoassay (ECLIA). The Indonesian version of the Montreal Cognitive Assessment (MoCA INA) was used to assess the cognitive function. Multiple linear regression was used to analyze the data. A p<0.05 was considered statistically significant.RESULTS Age (b=-0.086; 95% C.I.=-0.263-0.090; p=324) and estradiol levels (b=0.106; 95% C.I.=-0.018 -0.230; p=0.092) were not significantly associated with cognitive function. However, education (b=1.537; 95% C.I.=0.176-2.898; p=0.028) and age at menopause (b=0.364;0.056-0.671; p=0.022) were significantly associated with cognitive function. Age at menopause was the most influential factor of cognitive function (Beta=0.402) compared to education (Beta=0.394).CONCLUSION Later age at menopause could increase cognitive function in post-menopausal women. Our findings are that modifiable factors that delay age at menopause should receive attention, in order to promote cognitive function. Keywords: Age at menopause, estrogens, cognitive function, post-menopausal women
Antibiotic resistance and prevalence of class 1 and 2 integrons in Escherichia coli isolated from hospital wastewater
Ranjbar, Reza;
Zeynali, Maryam;
Sohrabi, Nooshin;
Kamboh, Asghar Ali;
Moshaveri, Arman
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.209-215
BACKGROUND Hospital wastewaters may contain antibiotic resistant bacteria such as Escherichia coli. These E. coli harbor integron genes that are responsible for antibiotic resistance. The purpose of the current study was to evaluate the frequency of class 1 and 2 integrons in environmental antibiotic resistant E. coli strains isolated from the hospital wastewaters in Tehran, Iran.METHODSAs a descriptive cross-sectional study, this research was performed from April to September 2015 on hospital wastewaters in Tehran. Bacterial isolation and identification was performed by standard biochemical and bacteriological procedures. Susceptibility testing was done by employing the disk diffusion method using different antibiotics. Total DNAs were extracted to evaluate the presence of class 1 and 2 integrons by using the polymerase chain reaction (PCR) method with specific primers. RESULTSFifty E. coli strains were isolated and identified from the wastewaters of 25 hospitals in Tehran. The phenotype results showed that 46 isolates (92%) were resistant to at least one antibiotic and 27 isolates (54%) were multidrug resistant. PCR showed that 35 (70%) and 20 (40%) of the isolates had class 1 and 2 integrons respectively and 14 isolates (28%) had both class 1 and class 2 integrons.CONCLUSIONThis study has shown a considerable presence of class 1 and class 2 integrons in E. coli strains isolated from hospital wastewaters in Tehran. Proper antibiotics prescription and appropriate hospital wastewater treatment can prevent resistance genes in E. coli from circulating in the environment.
Hashimoto’s thyroiditis is not a risk factor for thyroid cancer
Eshraghi, Mohsen;
Mousavi, Seyed Mojtaba
Universa Medicina Vol 37, No 3 (2018)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2018.v37.216-221
BackgroundThyroid carcinoma is the most common endocrine malignancy. Chronic inflammation can be involved in tumorigenesis. It is estimated that more than 20% of all tumors are caused by persistent inflammatory conditions. The objective of the present study was to compare the inflammatory factor level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and thyroiditis between benign and malignant thyroid nodules.MethodsA cross-sectional study was conducted involving 94 patients (47 patients with benign tumors as controls and 47 patients with malignant tumors as cases). ESR and CRP were measured and analyzed. Mean ESR and CRP in both groups was compared using independent t-test. The chi-square test was used to assess the risk of cancer in patients with Hashimoto’s thyroidits and with significance level at p<0.05.ResultsThe mean age of the patients in the benign group was 42.28 ± 13.43 years and in the malignant group 42.20 ± 16.32 (20-85) years, which was not significantly different (p=0.350). Independent t-test results were not significantly different between mean ESR and CRP in both groups (p=0.800 and p=0.993 respectively). Hashimoto’s thyroiditis was not a risk factor for thyroid cancer (OR=1.58; 95% CI:0.63-4.01).ConclusionThis study demonstrated that Hashimoto’s thyroiditis was not a risk factor for thyroid cancer. Factors such as ESR and CRP are acute phase reactants and their levels increase in cases of acute inflammation, but may not increase significantly in chronic inflammatory conditions and malignancies.