BALI MEDICAL JOURNAL (BMJ)
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.
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<![CDATA[BLOOD ANTHOCYANIN LEVELS OF HEALTHY AND DIABETIC RATS AFTER FEED WITH A SINGLE DOSE OF PURPLE SWEET POTATO TUBERS AQUEOUS EXTRACT ]]>
<![CDATA[Sutirta-Yasa, I W. P.]]>;
<![CDATA[Jawi, and I M.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
Publisher : <![CDATA[BALI MEDICAL JOURNAL ]]>
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<![CDATA[Background: Aqueous extract of purple sweet potato tuber shown to decrease the blood glucose levels and has antioxidant properties in rats with streptozotocin-induced diabetes. The purpose of this study is to prove that an increase in anthocyanin levels in the blood of rats after administration of aqueous extract of purple sweet potato tubers in healthy and diabetic rats. Methods: This is an experimental study with randomized post-test only control group design. The subject of experiments were 72 rats, divided into two major groups, namely diabetic rats (treatment group 36 rats) and control group (36 healthy rats). Each major group was divided into 6 small groups each 6 rats. The control group was given aqueous extract of purple sweet potato tuber with a dose of 4 ml single dose. The diabetic group were given streptozotocin and followed by aqueous extract of purple sweet potato tuber 4 ml single dose. Observed variables include: blood glucose levels to define diabetes. To determine the levels of anthocyanin, the blood were taken and the level of anthocyanin were examination by HPLC method, in healthy and diabetic rats after 30 min, 1 hours, 2 hours, 4 hours, 8 hours and 16 hours of giving single dose of aqueous extract of purple sweet potato tubers. Results: The results showed an increase in blood sugar levels were significant (p < 0.05) in group given streptozotocin compared to control. Anthocyanin levels in the blood of two groups were significantly different from 30 min after administration of the extract to 8 hours after administration of the extract (p < 0.05). Higher anthocyanin levels (p < 0.05) was observed in control group (healthy rats) compared to rats with streptozotocin-induced diabetes. Peak levels of anthocyanin in blood were achieved after 2 hours of feeding. Conclusion: The conclusion of this study is the absorption of anthocyanin in aqueous extract of purple sweet potato tuber better in healthy rats compared to diabetic rats. The peak levels of anthocyanin was reached after 2 hours of aqueous extract of purple sweet potato tubers single dose consumption either in healthy rats and in diabetic rats.]]>
<![CDATA[Letter to the Editor MERS-CoV: An Emerging Public Health Threat ]]>
<![CDATA[Danasekaran, R.]]>;
<![CDATA[Annadurai, K.]]>;
<![CDATA[Mani, G.]]>;
<![CDATA[Ramasamy, and J.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[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]]>
<![CDATA[IMMUNE RESPONSE AND COST ANALYSIS OF INTRADERMAL RABIES VACCINATION FOR POST-EXPOSURE PROPHYLAXIS REGIMEN IN HUMAN ]]>
<![CDATA[Budayanti, N. S.]]>;
<![CDATA[Susilawathi, N. M.]]>;
<![CDATA[Darwinata, A. E.]]>;
<![CDATA[Dwija, I. B. P.]]>;
<![CDATA[Fatmawati, N. D.]]>;
<![CDATA[Wirasandhi, K.]]>;
<![CDATA[Subrata, K.]]>;
<![CDATA[Susilarini, N. K.]]>;
<![CDATA[Wignall, F. S.]]>;
<![CDATA[Sudewi, A. A. R.]]>;
<![CDATA[Mahardika, and G. N. K.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background The outbreak of rabies in human in Bali-Indonesia is causing an extraordinary pressure for the government in providing adequate doses of anti-rabies vaccine for post-exposure prophylaxis (PEP). Here, we directly compare the immune response and benefit of the intradermal (ID) protocol for rabies vaccine delivery with the intramuscular (IM) route. Methods: Sixty health workers who were willing to participate in this study have been randomly selected and grouped into ID, IM, and control groups, each with 20 volunteers. The Thai Red Cross ID- and Zangreb IM-protocols have been applied to the respective group. The sera of the volunteers were collected at day 0, week 1, week 3, week 4, month 3, month 6, month 9, and month 12 after the first vaccination. Anti-rabies virus IgG was detected using PlateliaTM Rabies II Kit (Bio-Rad). Results: Anti-rabies IgG could be detected in the ID-group at one week. The ID-vaccine delivery induced a slightly higher maximum antibody titer compared to IM, though not statistically significant (p>0.05). ID vaccination caused less adverse reactions and produces longer lasting protective immune response. Cost minimization analysis (CMA) on the provincial and national PEP data in 2009-2011 shows that the ID-delivery will reduce the total cost for a completed regimen by USD 28.5, and would have saved the Indonesian government budget approximately USD 3.6 and 4.3 million for complete regimens in Bali and Indonesia, respectively. Conclusion: The ID administration of anti-rabies vaccine induces a similar immune response compared to that of intramuscular injection. It also produces longer lasting protective immune response. It offers additional advantages of potential net cost savings as well as decreasing the pressure on vaccine availability due to the high number of dog bite cases.]]>
<![CDATA[ROLE OF ENVIRONMENTAL ALLERGENS ON ATOPIC DERMATITIS ]]>
<![CDATA[Wardhana, M.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background: Atopic dermatitis (AD) is a chronic eczematous skin disease that develops in a patient with atopic diathesis, which is characterized by an increased liability to produce IgE antibodies for allergens mostly derived from environmental or inhalant allergens and food allergens. They are produced by cell-mediated allergic contact reactions, and recently contact sensitivity to various environmental allergens has been demonstrated in patients with AD. Atopic patients are recognized by their ability to produce large amounts of specific IgE antibodies to common substances as environmental allergens, i.e. house dust mites, grass pollens, animal danders, molds, food, etc. These antibodies can be detected by skin prick test. The aim of this study was to identify the sensitization against environmental or inhalants allergens through skin prick tests in the patients with atopic dermatitis. Material and Methods: This is a retrospective, descriptive study. We revised all medical records of patients with AD since January 2002 to December 2004 in the Out Patients Unit of Sanglah General Hospital, Bali-Indonesia. The variables studied were: gender, age, work related, diagnosis associates to AD, and prick test of environmental allergens. Results: In 3 years periods we had revised 46 of patients with AD that was done skin prick tests. The median age was 38 years (range 29-54 years), 34/46 (73.9 %) of these were male and 12 (26.1 %) female. Twenty nine patients presented pure AD, and 17 patients had AD with asthma and allergic rhinitis. Only 16 (34.7%) of patients had no history of allergic disease. Thirsty six of 46 (78.20%) of all tested AD patients had a positive skin prick tests against inhalant (aeroallergens) 16 patients and food allergens 21 patients. Sixteen patients with positive of skin test include; dust mite in 12 patients, animal dander in 10 patients, grass pollen in 9 patients and cockroach in 6 patients. Conclusion: We concluded that Environmental work related particularly dust-mite were significant that contributed to symptoms exacerbation and positive skin prick test. The skin prick tests are important methods to determine inhalant allergens in work related that exacerbation of AD patients.]]>
<![CDATA[TRAUMATIC GASTRIC RUPTURE FOLLOWING BLUNT TRAUMA ABDOMEN: A Case Series ]]>
<![CDATA[Hota, P. K.]]>;
<![CDATA[Babu, M.]]>;
<![CDATA[Satyam, G.]]>;
<![CDATA[Praveen, and Ch.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background: Gastric rupture following blunt injury abdomen is a rare presentation with a reported incidence of 0.02-1.7% in current literature. History of recent meal has been implicated in traumatic gastric rupture. Commonly traumatic gastric rupture is associated with other injuries like splenic injury and fractures. Prompt diagnosis and early intervention reduces mortality and morbidity. Primary two layered closure can be done for a better surgical outcome. We report 2 cases of blunt injury abdomen with gastric rupture, one with road traffic accident and other being from a fall from a height, which were managed successfully without any post operative morbidity and mortality.]]>
<![CDATA[HIGH BLOOD LEVELS PROCALCITONIN AS SYSTEMIC IMFLAMATORY RESPONSE SYNDROME PREDICTOR IN SEVERE AND MODERATE HEAD INJURY ]]>
<![CDATA[Sinaga, B.]]>;
<![CDATA[Mahadewa, T. G. B.]]>;
<![CDATA[Maliawan, and S.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background Numerous studies have shown that procalcitonin (PCT) was not related to degree of trauma. High PCT serum levels have been found in patients with bacterial or fungal infection and also in acute phase of trauma. Currently, there has been no research discussed about changes in serum levels of PCT in particular head injuries and severe head injuries. Moderate and severe head injuries were common trauma cases in Emergency Room (ER) and had high mortality rate. Based on Glasgow Coma Scale (GCS), moderate and severe head injuries were scored between 3 and 13. This research aim to determine whether high blood levels PCT can be used as a predictor of the occurrence of SIRS. Method: A cohort prospective study was applied in this research to determine high blood levels of PCT as a predictor for SIRS in moderate and severe head injury. This study was conducted from June 2013 - August 2013 at Sanglah General Hospital with 40 research subjects. Data was presented in tables and analyzed with Chi Square test at 95% CI and p <0.05% was considered significant. Results: From the 40 samples, there were 34 males (85%) and 6 females (15%), 18 samples (45%) had moderate head injury and 22 samples (65%) had severe head injury. One sample (2.5 %) was 0-10 years old, 15 samples (37.5%) were 10-20 years old, 13 samples (32.5%) were 20-40 years old, 7 samples (17.5%) were 40-60 years old and 4 samples (10%) were>60 years old. PCT levels in the blood obtained on day first were normal in 6 samples (15%) and elevated in 34 samples (85%), SIRS (+) were found in 35 samples (87.5%) and 5 samples (12.5%) were SIRS (-). Using bivariate analysis between PCT levels and SIRS showed p = 0.000 (p < 0.05), and multivariate analysis of the control variables showed no significant correlation between variables with PCT levels. Conclusion: From 40 samples moderate head injury and severe head injury, there were 34 samples (85%) with elevated PCT level on the first day, while 35 samples (87.5%) had SIRS on the third day (p=0,000, CI=95%). Elevated PCT level could be used as a predictor for SIRS in moderate and severe head injury patients.]]>
<![CDATA[ORAL ADMINISTRATION OF NUTMEG ON MEMORY BOOSTING AND REGAINING IN WISTAR ALBINO RATS ]]>
<![CDATA[Jissa, G.]]>;
<![CDATA[Sai-Sailesh, K.]]>;
<![CDATA[Mukadan, and J. K.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background: This study provides further evidence for improvement of memory by oral consumption of nutmeg. The present study was undertaken with an objective to study the effects of oral administration of nutmeg on memory boosting and regaining. Methods: Here we investigate the influence of oral intake of nutmeg on behavioral task performance by using T-maze and radial arm maze and physiological measures relative to a milk control group. Results: We have observed significant memory boosting and memory regaining effects of nutmeg when administered orally. This effect may be due to facilitation of acetylcholine activity by decreasing acetylcholinesterase activity of nutmeg. Hence we recommend further research in this area by investigating compound metabolism to optimize quantification of memory performance following nutmeg consumption.]]>
<![CDATA[CORRELATION OF PARATHYROID HORMONE-1 RECEPTOR EXPRESSION TO BONE METASTASIS OF BREAST CARCINOMA PATIENTS ]]>
<![CDATA[Tusta-Adiputra, P. A.]]>;
<![CDATA[Wibawa-Manuaba, and I. B. T.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background: Bone metastasis is a common complication of metastasis of breast cancer and it is a unique pathobiology process. The Parathyroid Hormone-related Peptide (PTHrP) is a protein which has an important role in breast cancer cells to invade and infiltrate bones or bone marrow and accelerate angiogenetic process. The objective of this study is to reveal the relationship of PTHrP receptor named Parathyroid Hormone-1 Receptor (PTH1R) expression to bone metastasis in breast cancer patients. Methods: This was an analytical cross-sectional study, applying a non probability consecutive sampling. Samples were divided into two groups, i.e. one group of breast cancer metastasis to bone (+others) and another group with non-bone metastasis. Patients were collected from an existed data base (from medical record, cancer register, histopathology), since 2007. The specimen paraffin blocks were re-examined using IHC technique for PTHrP receptor. The data were analyzed and tested with Chi-Square (X2), otherwise it would be tested using Fisher Exact Test. Each group would be allocated minimal of 17 patients/samples. Results: The Chi-Square test failed to show the association between PTH1R expression in breast cancer patients with bone metastasis (p=0.295). The relative prevalence result for positive PTH1R expression was 1.48. There was no proof that positive PTH1R expression was an associated factor for bone metastasis (95% confidence interval). Conclusion: PTH1R expression is not a factor associated with bone metastasis in breast cancer patients.]]>
<![CDATA[RENAL FUNCTION TEST ON THE BASIS OF SERUM CREATININE AND UREA IN TYPE-2 DIABETICS AND NONDIABETICS ]]>
<![CDATA[Singh, P.]]>;
<![CDATA[Khan, S.]]>;
<![CDATA[Mittal, and R. K.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background: Type-2 diabetes mellitus has quickly become a global health problem due to rapidly increasing population growth, aging, urbanization and increasing prevalence of obesity and physical inactivity. Diabetic nephropathy is one of the major causes of chronic renal failure. Both serum urea and creatinine are widely used to assess the function of kidney. This study was conducted to observe the impaired renal function in type 2 diabetics and compare with non-diabetics controls. Method: To determine the incidence of renal dysfunction in diabetics in Nepalgunj medical college and Hospital , Nepalgunj , Banke, Nepal , blood samples from 100 diabetic subjects and 100 non-diabetic controls were taken between the period 1st February , 2012 to 31st January , 2013 for investigation of plasma glucose fasting(FPG), blood urea and serum creatinine. These biochemical parameters were determined by using a fully automated clinical chemistry analyzer. Results: Our findings showed that the level of blood urea (P<0.0001, 95%Cl) and serum creatinine (P?0.0004,95%Cl ) were significantly higher in type 2 diabetics as compared to non-diabetics in both male and female. There was no significant difference between diabetic male and female. 15 out of 100 diabetes samples have high urea level whereas 7 out of 100 had increased creatinine level. In control only 3 samples had high urea value and 1 had high creatinine level. There was statistical signi?cant increased in urea level with increased in blood sugar level. Conclusion: Blood urea and creatinine is widely accepted to assess the renal functions. Good control of blood glucose level is absolute requirement to prevent progressive renal impairment.]]>
<![CDATA[NON NEUROLOGICAL OUTCOME COMPARISON OF EARLY AND DELAYED SURGICAL STABILIZATION IN C-SPINE FRACTURES ]]>
<![CDATA[Mahadewa, T. G. B.]]>;
<![CDATA[Subawa, and D. M.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 1 (2014) ]]>
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<![CDATA[Background: Non neurological outcome postsurgical stabilization in C-spine injury has not been reported. Non neurological outcome i.e. the risk of lung infection (pneumonia), systemic inflammation response syndrome (SIRS), length of postoperative care (LOPOC) which can compromise the recovery process and treatment period. This study aims to investigate non neurological outcome comparison after early surgical stabilization (ESS) and delayed surgical stabilization (DSS) in patients with C-spine fractures. Methods: The author retrospectively reviews 59 of 108 consecutive patients who met the inclusion criteria with C-spine fractures who underwent surgical stabilization at the Sanglah General Hospital, between 2007 and 2010. Consisting of 25 patients underwent ESS and 34 patients were treated by DSS. The last follow up period range was 3-36 months. Non neurological outcome were evaluated and compared; the risk of pneumonia, SIRS and LOPOC. Results: Significant statistically between ESS and DSS in; the risk of pneumonia (ESS: DSS= 1:9) by Chi-square-test (p=0.023); the risk of SIRS (ESS: DSS= 1:11) by Chi-square-test (p=0.008); and the LOPOC (ESS: DSS= 6.84:9.97) by independent t-test (p=0.000). Application of ESS for C-spine fractures could provide early mobilization, prompt treatment and facilitate early rehabilitation thus significantly reduces complications due to prolong immobilization and reduces LOPOC. Conclussion: It can be concluded that the ESS strategy is effective and efficient thus may propose an option of surgical timing in C-spine fractures.]]>
