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[REPRODUCTIVE HEALTH IN RICKSHAW DRIVERS: Occupational Exposure to Environmental Stressor ]]>
<![CDATA[Nabi, Ghulam]]>;
<![CDATA[Amin, Muhammad]]>;
<![CDATA[Khan, Ayaz Ali]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background: In urban environment, exposure to the emission of motor vehicles is common. In urban peoples it is a very difficult task to distinguish among peoples with different grades of momentous period exposure to such pollutants. Objective: The objective of this study was to determine the effects of diesel exhaust, gasoline emission, Particulate Matter (PM) noise and heat on the reproductive health of rickshaw drivers. Methods: Adult married male individuals were recruited randomly in the study from Btkhella, Malakand agency, Khyber Pakhtunkhwa, Pakistan. Two groups were made, control (n=45) and rickshaw drivers (n=50). A special questionnaire was designed about occupational activities, socio-demographic and clinical characteristics. From both groups 5 mL of the blood was collected and was analyze for serum total testosterone and cortisol using Biocheck (USA) and Antibodies-online GmbH (Germany) kits. Results: In control group the Mean±SEM of total serum testosterone was 657.6±16.84 ng/dl and cortisol was 443.8±14.67 mU/L. In rickshaw drivers the Mean±SEM of total serum testosterone was 577.1±11.42 ng/dl and cortisol was 595.1±8.879mU/L. In rickshaw drivers there was a significant reduction in total serum testosterone (P 0.0002) but a significant increase in serum cortisol level (P < 0.0001) at 95% confidence interval. Conclusions: Reproductive health problems like decreased libido, erectile dysfunction, absent morning and nocturnal erection, ejaculatory problems, primary infertility and secondary infertility were prevalent in rickshaw drivers but, no such problems were found in control group. Chronic exposure to pollutants such as diesel exhaust, gasoline emission, Particulate Matter (PM) noise and heat negatively regulate Hypothalmo-Pituitary Gonadal axis (HPG) leading to reproductive problems. ]]>
<![CDATA[SNP8NRG433E1006 NEUREGULIN-1 GENETIC VARIATION IN BATAKS ETHNIC WITH SCHIZOPHRENIA PARANOID AND HEALTHY CONTROL ]]>
<![CDATA[Effendy, Elmeida]]>;
<![CDATA[Loebis, Bahagia]]>;
<![CDATA[Amir, Nurmiati]]>;
<![CDATA[Siregar, Yahwardiah]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[The neuregulin 1 (NRG1) gene which influences the development of white matterconnectivity has been associated with schizophrenia. It influences neuronal migration, synaptogenesis,gliogenesis, neuron-glia communication, myelination, and neurotransmission in the brain and others.NRG1 is located in 8p13, and it is frequently replicated in schizphrenia. SNP8NRG433E1006 geneNRG1 is one of core at risk haplotype of schizphrenia. This study looked forward differencesSNP8NRG433E1006 neuregulin 1 between Bataks ethnic with schizophrenia paranoid and Bataksethnic healthy control. Methods: Batak ethnic with schizophrenia paranoid were recruited andinterviewed with semi-structured MINI ICD-X to establish the diagnosis. All the eligible subjectswere requested their permission for blood sampling. Healthy Batak ethnic were also recruited bymathcing the age and gender. The blood samples went through DNA isolation, Nested PCR, and DNAsequencing. Results: Ninety three subjects were recruited, but only 74 blood samples weresuccesfully sequenced. We found three types of polymorphisms, i.e. G/A allele at base pair (bp) 76,G/T allele at bp 112, and deletion at bp 110 in Batak ethnic with schizophrenia. There were two kindsequences at bp 113-116 in Batak ethnics, and Batak ethnics with ATCG were at higher risk forhaving schizophrenia. This study support that NRG1 is a schizophrenia-susceptibility gene.]]>
<![CDATA[TRANS-ARTERIAL EMBOLIZATION WITH N-BUTYL CYANOACRYLATE GLUE FOR RENAL BLEEDING: Case Report ]]>
<![CDATA[Young, Benny]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background: The objectivity in management of renal bleeding is to preserve a significant renal parenchyma tissue and prevent associated morbidities like anemic shock or renal impairment from substantial nephron demise or obstructed uropathy. Trans-arterial embolization therapy by interventional radiology offers a high success rate with potential of reserving normal renal tissue. The selection material for renal arterial embolization largely depends on vasculature anatomy and endpoint of procedure. N-butyl cyanoacrylate glue in our experience is applied in lesion supplied by small size of end-artery.]]>
<![CDATA[EVALUATION OF CSF FERRITIN AS AN EARLY MARKER FOR DIFFERENTIATING MENINGITIS IN PEDIATRIC PATIENTS ]]>
<![CDATA[Sharma, Shikha]]>;
<![CDATA[Dabla, Pradeep Kumar]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background and Objectives: - Bacterial meningitis is a medical emergency with a potential for serious neurological damage or even death. Rapid diagnosis is important and henceforth critical for the early intervention by antibiotic therapy to prevent complications. Therefore the aim of the present study was to evaluate CSF ferritin levels in children with different etiologies of meningitis. Materials and Methods: - 65 children (1-124 months) with suspected meningitis admitted at Chacha Nehru BalChikitsalya hospital were included in the study. CSF sample was analyzed for glucose, protein, cell count, ferritin, gram stain and culture. Results: - Based on the laboratory findings the 65 children were classified into 3 groups: 21 cases had bacterial meningitis, 18 had aseptic (viral) meningitis and 26 cases as the no-meningitis group. A significant relationship was observed between age and ferritin level in the non-meningitis group (p<0.05). CSF ferritin in bacterial meningitis group was 34.80 ±11.20 ng/mL and was significantly higher than the aseptic meningitis group. Cut off value of ferritin to differentiate meningitis vs. no-meningitis group was estimated at 18.2ng/ml with a sensitivity of 94.9% and specificity of 96.2 %. However on differentiating bacterial from aseptic meningitis cutoff value was 20.3 ng/mL with a sensitivity of 98% and specificity of 33.3%. Conclusion: - CSF ferritin levels were found to be significantly different between the meningitis and the no-meningitis groups. However due to low specificity it may not prove useful for the early differentiation of different types of meningitis. Further studies are required on a larger sample size before we can substantiate our findings.]]>
<![CDATA[ROLE OF HEPCIDIN IN MECHANISM OF ANEMIA CHRONIC DISEASE PATIENTS ]]>
<![CDATA[Suega, Ketut]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background: Anemia chronic disease (ACD) is an anemia found in certain chronic disease states, typically marked by the disturbance of iron homeostasis or hypoferremia. This condition leads to shortage of iron for hemoglobin synthesis but the iron storage in bone marrow is left undisturbed. The discovery of hepcidin and its role in iron metabolism has given new insights in anemia chronic disease management. Consecutive sampling method was applied to choose ACD patients at Sanglah General Hospital, Bali-Indonesia. Questionnaire was constructed to note demographic aspect and disease or clinical condition underlies ACD (inflammation, infection, malignancy and others). Hepcidin, Serum IL-6 and CRP level were measured. Sample size and Path analysis mediation method were used to define hepcidin’s role on mechanism how anemia develop in ACD patients in which the direct and indirect effects of IL-6 and CRP to hemoglobin (Hb) were counted partially or combined through hepcidin mediation variable. The cumulative influence of IL-6, CRP and hepcidin on anemia (Hb) was only 0.12 or about 12% of hemoglobin level was influenced by IL-6, CRP and hepcidin together whereas the other 93% was influenced by another unknown and unclear factors. Hepcidin could be used as a mediation variable for the development of anemia because the direct influence of IL-6 as exogenous factor was less than its indirect influence through hepcidin. It was not proven for CRP as exogenous variable because the direct influence of CRP to hemoglobin was stronger than the influence of CRP through hepcidin.]]>
<![CDATA[Letter to editor NEONATAL NERVE PALSIES: A CONTEMPORARY OBSTETRIC PERSPECTIVE ]]>
<![CDATA[Roberts, Darren J.]]>;
<![CDATA[Svigos, and John M.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background: Birth trauma and its often incorrect inference of iatrogenic causation has led to unfortunate implications for the affected child, the parents, the obstetrician and the midwife due to unwarranted medico-legal attention in our current litigious society. A more discerning evaluation of neonatal nerve palsies following labour and delivery has led to a better understanding of their aetiology with potentially more appropriate outcomes for all parties involved.]]>
<![CDATA[CLINICAL-IMMUNOLOGICAL ASSESSMENT FAILURE ON INITIAL COMBINATION USE OF ZIDOVUDINE-LAMIVUDINENEVIRAPINE IN CHILDREN WITH HIV/AIDS AT SANGLAH HOSPITAL BALI ]]>
<![CDATA[R., Niruri]]>;
<![CDATA[Maharani, A. A. S.]]>;
<![CDATA[Kumara, K. D.]]>;
<![CDATA[Rahajeng, I. M.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background: Assessing clinical progression and CD4+ level were important in determining the efficacy of antiretroviral (ARV) and switching to other regimens, especially when viral-load data were not available. This research aims to assess combination of zidovudine-lamivudine-nevirapine (Co-ZLN) failure using WHO 2010 criteria on clinical failure (CF) and immunological failure (IF), single or together, to determine correlation between CF and IF; and to evaluate two failure categories (CF alone and combination of CF-IF) in making decision to switch to second-line of ARV. Methods: Children at Sanglah General Hospital, who gain initial treatment of Co-ZLN in period of March 2006–March 2013 were selected. Cross sectional study was applied. The ARV response was assessed twice. First period (P1) and second period (P2) of evaluation were conducted after patients received the Co-ZLN at least 6 and 12 months. Results: Forty five patients were included in this study. After at least 6 and 12 months of therapy, more patients showed IF (10 and 9 children in P1 and P2) than those in CF (4 and 2 patients in P1 and P2). Only one child met to CF-IF category in P2. The low clinical condition (HIV stage 4) did not always associate with deteriorating immunologic marker in the treatment-failure (TF). The patients who fit on CF and CF-IF based decision to switch regimen criteria were different. In resource-limited hospital, CF-IF based decision could give a better picture of patients’ condition and be used as an indicator to assess TF compared to single CF criteria.]]>
<![CDATA[DEBRIDEMENT WITH FASCIOTOMY ON DIABETIC FOOT REDUCES TUMOR NECROSIS FACTOR ALPHA AND INCREASES VASCULAR ENDOTHELIAL GROWTH FACTOR PLASMA WITH CLINICAL IMPROVEMENT ]]>
<![CDATA[Yasa, K. P.]]>;
<![CDATA[Siki-Kawiyana, K.]]>;
<![CDATA[Budhiartha, A.A. G.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background: Clinical and animal studies find out any increase of TNF-? and decrease of VEGF level in tissues of diabetic foot ulcers. Levels and abnormal activity of VEGF related to hypoxia and increase of TNF-? in diabetic tissue lead to impaired healing of ulcers. This study aims to determine debridement with fasciotomy simultaneously reduce TNF-? and increases VEGF plasma level and clinical improvement of diabetic foot ulcers. Methods: A clinical study by a randomized pretest - posttest control group design was carried out. Patients were divided into two groups of debridement without fasciotomy as a control group and group of debridement with fasciotomy as the treatment group. Sixty patients of diabetic foot ulcer Wagner II, III, and IV classification met inclusion and exclusion criteria, 28 patients were selected as control group and 32 as treatment group. Clinical improvement of ulcers was observed every week for 4 weeks using the instrument of Leg Ulcer Measurement Tool (LUMT) score. Result: Plasma TNF-? pretest was 422.30±17.05 (pg/ml) on control group and 424.47±12.02 (pg/ml) on treatment group. Plasma TNF-? posttest was 390.91±12.85 (pg/ml) on control group and 290.26±16.42 (pg/ml) on treatment group (p<0.05), with ? TNF-? (pg/ml) was 31,40±17,98 on control group and 134.21±14.50 on treatment group (p<0.05). Plasma VEGF level (pg/ml) pretest was 282.50±11.58 on control group and 286.74±10.19 on treatment group. Plasma VEGF level (pg/ml) posttest was 289.19±21.91 on control group, 338.70±20.11 on treatment group (p<0.05), with ? VEGF (pg/ml) was 15.23±10.73 on control group and 51.96±13.54 on treatment group (p<0.05). There was significant clinical improvement of ulcer on treatment group on 2nd , 3rd, and 4th week of treatment (p<0.05) There was average increase pressure (13-21 mmHg) on all foot compartments of the two groups Conclusion: debridement with fasciotomy simultaneously decreases TNF-? and increases VEGF plasma level accompanied clinical improvement of diabetic foot ulcer. Increase of foot compartment pressure may support phenomenon of microvascular permeability on diabetic patients, therefore fasciotomy on diabetic foot to become rational as adjunct of treatment.]]>
<![CDATA[ANTI-MÜLLERIAN HORMONE AND INHIBIN-B LEVEL PROFILE IN CERVICAL CANCER PATIENTS TREATED WITH PACLITAXEL AND CISPLATIN COMBINATION ]]>
<![CDATA[Abdullah, Nusratuddin]]>;
<![CDATA[Kouwagam, Anggrainy Dwifitriana]]>;
<![CDATA[Andina, A.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Background: The age of nulliparous women has increased in developed countries and the 5-year survival rate for the late stage does not exceed 58%. Moreover, as more women are delaying childbearing, preservation of fertility and reproductive function is a major concern when young women are counseled with regard to the effects of treatment for cervical cancer. Objective: To determine the effect of the combination chemotherapy on serum levels of Anti-Mullerian Hormone (AMH) and inhibin B. Methods: This study is a prospective cohort study in 16 cervical cancer patients aged 28-48 years who received Paclitaxel-Cisplatin chemotherapy. AMH and inhibin B levels were examined before and after third series chemotherapy. Statistical analysis used the Wilcoxon test with a level of significance selected at 0.05. Results: There is a significant decrease in median serum levels of AMH and inhibin B patients between before and after Paclitaxel–Cisplatin chemotherapy with p=0.000 (P<0.05). Similarly, a decrease in the median value of serum levels of AMH and inihibin B after Paclitaxel-Cisplatin chemotherapy in each series of chemotherapy was significant with p=0.000 (P<0.05). Conclusions: Serum levels of AMH and inhibin B in cervical cancer patients who received the combination chemotherapy decreased dramatically after 3 months of chemotherapy and the factors that contribute to the diminution is age.]]>
<![CDATA[OBSTRUCTIVE NEPHROPATHY OF KIDNEY STONE: The Role of Caspase-3, Transforming Growth Factor-? and Tumor Necrosis Factor-? in Kidney Fibrosis ]]>
<![CDATA[Oka, A. A. G.]]>;
<![CDATA[Suwitra, K.]]>;
<![CDATA[Soebadi, D. M.]]>
<![CDATA[ BALI MEDICAL JOURNAL Vol 3 No 2 (2014) ]]>
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<![CDATA[Objective: Kidney stones are one of the causes of obstructive nephropathy and chronic kidney disease (CKD), characterized by the presence of hydronephrosis and kidney dysfunction. The histhopathologycharacteristics of CKD is kidney fibrosis, which consists of glomerulosclerosis (GS), tubulointerstitial fibrosis (TIF) and tubular atrophia (TA).This research aims to find out that the role of caspase-3, TGF-? and TNF-? as risk factors for kidney fibrosis in obstructive nephropathy of kidney stone. Methode: A total of 82 samples of kidney biopsy patientsduring kidney stone surgery in Sanglah General Hospital Denpasar-Bali from February until December 2013 wereapplied match paired based on age and sex divided in to 41 samples as case and 41 samples as control. Determination of caspase-3, TNF-? and TGF-?1 were carried out using Kit Methode and kidney fibrosis stained with Masson's Trichrome. Results: Bivariate analysis test indicates that OR caspase-3 activity and kidney fibrosis were 3.50; 95%CI (2.95-4.19); p=0.001, OR levels of TGF-? an kidney fibrosis were 2.00; 95% CI (1.72-2.34); p=0.04 andOR levels of TNF ? and kidney fibrosis were 0.60; 95% CI (0.53-0.68); p=0.14. On the other hand, multivariate analysis test OR for caspase-3 activity , levels of TGF-?, levels of TNF-? and kidney fibrosis after adjustment of hydronephrosis, eLFG, and Hb were 2.43; 95% CI (0.86 – 6.90); p=0.09, 2.14; 95% CI (0.74-6.18) p=0.16 and 1.12; 95% CI (0.40-3.16); p=0.82. Conclusion: In obstructive nephropathy of kidney stone patients with high activity of caspase-3 have 3.5 fold risk to gain kidney fibrosis and with high levels of TGF-? have a 2 fold risk to gain kidney fibrosis. However, high levels of TNF-? was not as a risk factor to gain kidney fibrosis. These results can be used as a based data to run further research for obtaining new strategy for managing kidney fibrosis.]]>
