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Over the past decade, antimalarial drug resistance has rapidly become a major public health problem in South East Asia region including South Sumatra. This study aimed to determine the extent of gene polymorphisms associated with chloroquine resistance (CQR) in P. falciparum isolates from Lahat, Sekayu, Baturaja and Palembang district. Methods: A molecular study was conducted to identify the mutant alleles of the genes associated with the resistance to chloroquine among the isolates of Plasmodium falciparum from South Sumatera. Blood from 25 patients was collected, DNA was isolated, and the sequences of two different genes (Plasmodium falciparum chloroquine resistance transporter/pfcrt and Plasmodium falciparum multidrug resistance/pfmdr1) were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Results: This study identified polymorphism in the pfcrt 76-Thr in all isolates and pfmdr1 86-Tyr. These findings may reflect the failure of treatment with the standard dose of chloroquine within the last few years in South Sumatera. Conclusion: PCR-RFLP technique provide a simple and rapid method of detecting polymorphisms in genes that may predict chloroquine resistance (CQR). Although the identification of the polymorphism in the pfcrt and pfmdr1 genes provides a significant indicator of CQR, further studies are needed to determine the role of these polymorphisms in the in vivo and in vitro responses to drug treatment.

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Despite the advancement of bone reconstruction in the past decade, large bone defect remains a challenge for orthopedic surgery. As mesenchymal stem cells (MSCs) emerges as one of the possible treatment of these defects, we evaluate the effect of its transplantation, particularly in combination with hydroxyapatite-calcium sulphate pellets. Methods: Twenty eight rabbits were randomly assigned into four different treatment groups. Each group received a different type of grafts (Autograft, hydroxyapatite-calcium sulphate [HA-CaSO4], HA-CaSO4 combined with marrow aspirate, or HA-CaSO4 combined with 2x106 MSCs). One centimeter long bone defects were created then immediately fixated with mini plate-screw and two cerclage wires. It was followed by the graft transplantation. Callus thickness was measured from the x-rays taken at 4, 8, 12 week after transplantation by two authors working independently. At the end of the study, histological staining along with osteocyte index were obtained by sacrificing the rabbits. These data were analyzed by one-way ANOVA test.Results: At the fourth week, callus thickness showed significant difference (p = 0.018). Although statistically insignificant, callus in MSCs group at the eighth week seemed to be thicker than any other groups of intervention (p = 0.546). The MSCs group also tend to have a higher osteocyte index at the follow-up weeks.Conclusion: MSC transplantation on bone defect results in faster callus formation and tends to generate a thicker callus.

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Based on data from the Hospital Information System (HIS) in 2007, breast cancer is the top ranked diagnosed cancer in Indonesia. Estrogen receptor alpha (ERα) is associated with breast cancer because it is found in high levels in cancer tissues. Curcumol, curcumenol, isocurcumenol of white tumeric rhizomes (Curcuma zedoaria (Christm.) Roscoe), and β-sitosterol from seeds of pumpkin (Cucurbita pepo L.) have been reported to have inhibitory activity against cancer cells. This study presents the in silico study of these compounds as inhibitors of ERα. Methods: Docking simulations are carried out in this paper to visualize molecular-level interactions between the four compounds with ERα. Docking simulations between estradiol and tamoxifen on ERα are carried out as well. Results: Docking results indicated that curcumol, curcumenol, isocurcumenol, and β-sitosterol showed inhibitory activity againts estrogen receptor alpha (ERα). The order of potency is shown consecutively by isocurcumenol, curcumol, curcumenol, and β-sitosterol with values 0.584 M, 1.36 M, 1.61 M, and 7.35 M respectively. Curcumenol and estradiol interacts with ERα through hydrogen bonds and hydrophobic interactions, whereas curcumol, isocurcumenol, β-sitosterol and tamoxifen through hydrophobic interactions in succession. Conclusion: Natural products containing all four compounds have the potential to be used as drugs or adjuvant drugs in breast cancer therapy.

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The use of levonorgestrel implants as a contraceptive method have undergone changes in the number of implants used, beginning from six rods in the early methods to two rods in the present method and have been proven effective. This study aims to evaluate the efficacy of single rod implant (Monoplant®) by measuring serum levonorgestrel concentration and cervical mucus quality. Methods: Thirty healthy women, aged 20-40 year old, and have been proven fertile, underwent single rod implant insertion. Levonorgestrel serum levels was measured every month and cervical mucus viscosity was examined every three month, until six months. Results: Levonorgestrel serum concentration was consistently above minimum effective level (200 pg/mL), from month 3 to 6 respectively 338.9 pg/mL, 424.8 pg/mL, 320.3 pg/mL, and 337.5 pg/mL. Almost all of the acceptors (96.7%) had good cervical mucus viscosity since three months following implant insertion. Conclusion: Levonorgestrel serum concentration in Monoplant® users was still above minimum contraceptive level until the sixth month. Viscosity of cervical mucus increased immediately following implant insertion. This indicates that single rod levonorgestrel implant is effective as a contraceptive method.

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Brain relaxation and prevention from cerebral edema are essential in craniectomy. Osmotherapy with 20% mannitol are generally used to withdraw fluid from the brain parenchyma, however may cause hemodynamic fluctuation, due to increase diuresis. On the other hand 0.5 M hypertonic sodium lactate (HSL) appeared as an alternative of osmotherapy. This study aimed to observe the effect of hypertonic sodium lactate (HSL) on brain relaxation, blood glucose level and hemodynamic variables in craniectomy due to moderate brain injury. Methods: A randomized controlled study of 42 cases with moderate brain injury, aged 18 - 65 years, ASA 1 - 3, between September-November 2012, was carried out. The patients were divided into group M (n = 21) that received 2.5 mL/kg 20% mannitol and group HSL that received 2.5 mL/kg 0.5M HSL. Mean arterial pressures (MAP), central venous pressures (CVP) and urine output were measured after induction, and at 15, 30, 45, 60 min after infusion. Brain relaxation was assessed at a four-point scale after opening the duramater. Blood glucose levels were measured before induction and at 60 min after the infusion. Appropriate statistical tests were used for comparison. Unpaired t-test was used to compare hemodynamic and blood glucose level, and chi-square was used to compare brain relaxation. Results: MAP at 60 minute was significantly higher in HSL group than M group (81.66 ± 7.85 vs 74.33 ± 6.18 mmHg; p = 0.002). There was no difference in brain relaxation (p = 0.988). A significant increase in blood glucose level was observed in group HSL (17.95 ± 11.46 mg/dL; p = 0.001). Conclusion: Half-molar HSL was as effective as 20% mannitol in producing brain relaxation, with better hemodynamic stability and gave significant increase in blood glucose level.

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Venous thromboembolism (VTE) is a fatal yet potentially preventable complication of surgery. Routine thromboprophylaxis is still unequivocal prescription is problematic due to perception of low VTE incidence among Asian population. This study aims to investigate the incidence of VTE and thromboprophylaxis prescription among patients undergoing major surgery in a Singapore hospital. Methods: This was a cross-sectional study. Data were obtained from medical record of 1,103 patients who had underwent major orthopaedic or abdominal surgery in 2011-2012 at Khoo Teck Puat Hospital, Singapore. Incidence of VTE events either in the same admission or re-admission in less than one month time were noted as study parameters. Results: Incidence of VTE was 2.1% (95% CI: 1.67 - 2.53) of which 1.3% and 0.8% were DVT and PE cases respectively. Age, gender, history of VTE, ischemic heart disease, and mechanical prophylaxis were associated with VTE incidence based on bivariate analysis. The prescription of pharmacological thromboprophylaxis was associated with prior anticoagulant medication, type of surgery, and incidence of new bleeding. Conclusion: Subsequent to major surgeries, VTE is as common in Asian patients as published data in other populations. Pharmacologic thromboprophylaxis should be considered as recommended in non-Asian guidelines.

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Physical excercises are hoped to improve functional capacity and quality of life of patients with chronic obstructive pulmonary disease (COPD). This study is aimed to assess the differences between treadmill and ergocycle exercise on changes in functional capacity and quality of life in patients with stable COPD. This is an experimental study with complete randomization and repeated pre and post-intervention observation. The study was conducted on 44 subjects with COPD who were presented at Persahabatan Hospital, Medical Rehabilitation Clinic, consisting of 22 subjects undergoing ergocycle exercise and 22 subjects undergoing treadmill exercise test. Functional capacity was assessed by using the 6 minutes walking test (6 MWT) performed at week I, V and IX. Quality of life was measured using the St. George Respiratory Questionnaire (SGRQ) at week I and IX. Training program was conducted for 8 weeks with exercise dosage based on the results of exercise test on week I. Treadmill and ergocycle exercise produce significant improvement in both the 6 MWT and SGRQ test since week I to IX. But in comparison, treadmill exercise improves 6 MWT distance better than ergocycle consistently at week I-V, V-IX and I-IX (p < 0.001). For the SGRQ score, both exercises did not differ significantly. Conclusion: Treadmill exercise is associated with significantly better improvement in functional capacity compared to ergocycle exercise in stable COPD subjects. Concerning quality of life, both exercises gave an equivalent improvement in stable COPD subjects.

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A 43-year old male presented with persistent discomfort and pain upper abdomen (epigastrium) more on left side associated with fever on and off, along with fatigue and loss of appetite for the last four months. Physical examination revealed mass on left hypochondrium extending to epigastrium with mild distension of the abdomen. Imaging studies of the patient showed dextrocardia on chest x-ray postero-anterior (PA) view, thoracic and abdominal CT scan showed situs inversus totalis with multiple SOL (space occupying lesion) in right lobe of liver with largest measuring 8x6 cm2 in the 4th segment. USG-guided FNAC of the mass showed features of hepatocellular carcinoma. Thereupon, hepatocellular carcinoma in situs inversus totalis was diagosed to this patient and was clinically staged as T3aN0M0. He was given sorafenib 400 mg orally twice daily with an advice to come for regular assessment every 4 week.

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Nasopharyngeal carcinoma (NPC) is the most frequent head and neck malignancy in Indonesia. Misdiagnosis of NPC is common because of unspecific symptoms as unilateral ear complaint. This case reminds doctors of the early symptoms of NPC and of other factors which lead to misdiagnosis and addresses also patients and their families. Reported is a 44 years old man with unilateral ear disorder that had been treated by otorhinolaryngologists, an ophthalmologist, a neurologist, and dentist first, but diagnosed with nasopharyngeal carcinoma stage IVA (T4N1M0) one year later. NPC has unspecific early symptoms such as unilateral ear disorder. Primarily doctors, but also patients and their families should be aware of unilateral ear complaint.