Background In Indonesia the number of persons with type 2 diabetes mellitus (T2DM) was 8.5 million in 2013, and is estimated to be 11.8 million in 2030. The aim of this study was to determine the major risk factors associated with T2DM prevalence in urban aged >15 years. Methods An observational study with cross-sectional design was used with the data from Riskesdas 2007 and 2013 on population aged >15 years. Total respondents were 294,352 (2007) and 368,281 (2013). Data were collected by trained personnel through interviews, blood pressure and anthropometry measurements, and blood glucose and lipid tests. Odds ratio (OR) was used to test the relationship between T2DM and a number of other variables. Multiple logistic regression analysis was obtained to determine the main risk factor associated with T2DM prevalence. Results Type 2 diabetes mellitus prevalence increased from 2.3% (2007) to 2.5% (2013). T2DM tended to be increased in the younger age groups. Low education, middle-to-high economic status, less physical activity, smoking >200 cigarettes, and high risk blood lipid levels were strongly associated with T2DM prevalence. The main risk factors were inadequate physical activity (2007: OR 1.9;95% CI:1.16–2.98 and 2013: OR 2.44;95% CI: 1.57-3.78) and central obesity (2007: OR 1.8;95% CI:0.99–3.10, and 2013:OR 3.84; 95% CI: 2.49-5.93) after controlling for age, gender, employment and economic status. Conclusions Type 2 diabetes mellitus prevalence in the population aged >15 years increased within 5 years. Lack of physical activity and central obesity were the major risk factors of T2DM prevalence in urban adults.

BACKGROUND Guava is an herbal with proven antioxidant and anti-inflammatory properties. The aim of this study was to investigate the anti-arthritic activity of the ethanol extract of Psidium gujava leaves (EEPG) against complete Freund’s adjuvant (CFA) induced arthritis in rats. METHODS An experimental study was conducted on 40 male Wistar Sprague Dawley rats, which were divided into 5 groups. Each group was induced with 0.2 mL CFA (1 mg/mL) on day 1 and 0.1 CFA mL booster injection on day 5. Group I served as an arthritic control, group II received dexamethasone (6.75 mg.kg-1 orally), group III, IV and V received EEPG at oral doses of 250, 500, and 750 mg/kg BW, respectively, on days 14 to 28. Anti-arthritic activity was observed from the arthritis score, the paw circumference was measured on days 0, 1, 4, 8, 12, 16, 20, 24, and 28, the mobility score was determined on days 12 and 28, and the histolopathology of the knee joint was examined on day 29. RESULTS Ethanol extract of Psidium guajava leaves significantly suppressed the swelling of the paws in chronic phase based on increasing of edema (%), while starting on day 20. EEPG at 250 mg/kg was most effective in significantly reducing arthritis scores (p<0.05). Histopathological examination showed repair of the knee joint synovial membrane and cartilage. CONCLUSIONS Psidium guajava leaf extract is effective in decreasing the inflammatory response and arthritic symptoms in rats with adjuvant-induced arthritis. Psidium guajava leaves can be developed into an alternative anti-arthritis treatment.

Dietary saturated fat (SF) intake has been shown to increase low density lipoprotein (LDL) cholesterol and therefore has been associated with increased risk of cardiovascular disease (CVD). This evidence coupled with inferences from epidemiologic studies and clinical trials, had led to longstanding public health recommendations for limiting SF intake as a means of preventing CVD. However the relationship between SF and CVD risk remains controversial, due at least in part to the intrinsic limitations of clinical studies that have evaluated this relationship. A recent meta analysis showed that current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids (PUFA) and low consumption of total SF. They found weak positive associations between circulating palmitic and stearic acids (found largely in palm oil and animal fats, respectively) and CVD, whereas circulating margaric acid (a dairy fat) significantly reduced the risk of CVD.(2,3) Saturated fat are not associated with all cause mortality, CVD, CHD, ischemic stroke or type 2 diabetes, but the evidence is heterogenous with methodological limitations.

Background Tuberculous meningitis (TBM) is a severe intracranial infection with fatal outcomes, permanent disabilities, and electroencephalographic (EEG) abnormalities. Seizures may occur in TBM. The EEG findings in TBM vary according to the site of the inflammatory process. There are few studies describing the EEG patterns and clinical manifestations of TBM. The objective of this study was to investigate the correlation between clinical findings and EEG patterns in children with TBM. Methods A study of cross-sectional design using medical records was conducted on 12 children with TBM, with their EEG patterns classified as abnormal and normal. Clinical manifestations such as seizures, altered consciousness, headache or fever were collected. A positive cerebrospinal fluids Mycobacterium tuberculosis culture was considered to indicate definitive TBM. Abnormal EEG descriptions were classified into abnormal I, II or III. Correlation between EEG pattern and clinical manifestation were analyzed with Fisher’s exact test. Results The study found cases of 12 children with TBM, the majority presenting with seizures, decreased consciousness and fever. Abnormal EEGs were found in 75% of children and 77% of them showed epileptogenic activities. The EEG results mostly described epileptogenic potentials in the frontotemporal region. There was a significant correlation between EEG abnormality and seizures in children with TBM (p<0.05). Conclusions The EEG pattern in children with TBM varies, and EEG abnormalities were more frequently localized in the frontotemporal region. Seizures were associated with EEG abnormalities in children with TBM. EEG abnormalities occurring simultaneously with seizures may predict the occurrence of seizures.

Background Endothelial dysfunction and associated increased blood viscosity (BV) play an important role in the formation of atherosclerosis during inflammatory processes. C-reactive protein (CRP) is a biomarker of inflammation with an active role in endothelial dysfunction and development of atherosclerosis that is marked by degree of coronary stenosis (CS). The purpose of this study was to determine the relationship of BV and CRP with varying degrees of CS among coronary heart disease (CHD) patients. Methods This cross-sectional study involved 24 subjects taken consecutively among patients with CHD who underwent angiography. Blood viscosity levels were determined using an Ostwald viscometer, with reference limits of 1.5 to 1.72 (cP). C-reactive protein was determined by turbidimetric immunoassay, with a normal reference value of <3 mg/L. Degree of CS was examined with angiography, where 0% = no stenosis; <50% = nonsignificant stenosis; > 50% = significant stenosis. Data was analyzed using non-parametric Spearman correlation test. Results There were 17 male and 7 female subjects, with mean age of 55.96 ± 7.29 years. The angiography results were: non-significant stenosis in 2 subjects (8.3%), significant stenosis in 22 subjects (91.7%) and none with normal stenosis. Statistical analysis of the relationship of BV with degree of CS found a moderate significant positive relationship (r=0.549; p=0.005). A poor significant positive relationship was found between CRP and degree of CS (r=0.481; p=0.017). Conclusion Blood viscosity increased the degree of CS in CHD patients. Therapy should target both BV-associated risk and angiographically evident stenosis.

Background Coronary heart disease (CHD) is a major cause of morbidity and mortality throughout the world, including Indonesia. One of the risk factors for CHD is hypercholesterolemia. One of the natural products that has been developed for the treatment of hypercholesterolemia is honey. Honey contains fructooligosaccharides, various vitamins, minerals, and enzymes which are supposedly able to lower blood cholesterol levels. This research aimed to study the influence of honey on the levels of blood total cholesterol, triglyceride, and low density lipoprotein (LDL) levels in Wistar rats. Methods This study was of experimental post test control group design. Twenty-four male Wistar rats (Rattus norvegicus) were randomly divided into 4 groups. K1 was the negative control group (with normal diet), K2 was the positive control group (with high-fat diet), P1 was fed a high-fat diet for 7 days, followed by high-fat diet plus honey for the next 7 days. P2 was fed a high-fat diet for 7 days, followed by regular diet plus honey for the next 7 days. After completion of this treatment, total cholesterol, triglycerides, and LDL levels were measured by the cholesterol oxidase phenol+aminophenazone (CHOD-PAP) method using enzymatic spectrophotometry principles. Results There were significant differences in total cholesterol, triglyceride, and LDL levels between all groups after day 15 (p<0.05). Conclusion Honey supplementation was able to reduce the blood levels of total cholesterol, triglycerides, and LDL. Honey supplementation accompanied by non-cholesterol feeds could more effectively lower total cholesterol, triglycerides, and LDL serum levels in Wistar rats.

Background Atherosclerosis, the underlying cause of heart attack, stroke and peripheral disease, is a main cause of morbidity and mortality worldwide. Hypercholesterolemia and hypertriglyceridemia are independent factors in the development and progression of atherosclerosis. The atherosclerotic index (AI) is a strong indicator of cardiovascular heart disease. The objective of this study was to determine the relationship between lipid serum level and AI in subjects 50-70 years of age. Methods A study of cross-sectional design was conducted among male and female subjects 50-70 years of age. The inclusion criteria were: healthy, and capable of active communication. The exclusion criteria were: subjects not completing the study, currently consuming antihyperlipidemic drugs. Lipid profile comprising total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides, and malondialdehyde (MDA), was analyzed using commercial kits. Systolic and diastolic blood pressure and body mass index was measured in all subjects. Atherogenic index was calculated from (total cholesterol – HDL cholesterol) / HDL cholesterol. Multiple linear regression was used to analyze the data. Results Mean age of the subjects was 60.6 ± 3.30 years and there was a significant relationship of LDL cholesterol and triglycerides with AI (b=0.009; p=0.000 and b=0.008; p=0.000, respectively). Triglyceride level was the most influencing factor for AI (b=0.008; Beta=0.616; p=0.000) Conclusions Higher triglyceride levels increase AI in subjects 50-70 years of age. Subjects with high serum triglyceride level but without symptoms of cardiovascular disease should be examined for the development of coronary artery blockage.

BACKGROUND Approximately 10-27% of the population aged >65 years suffers from frailty. The percentage increases with age so that the prevalence of frailty in the population aged >85 years reaches 45%. The objective of this study was to determine the relationship between frailty and quality of life (QOL) in nursing home elderly. METHODS This was a cross-sectional study of 138 subjects aged >60 years who were recruited from 4 nursing homes in West Jakarta. Participants with frailty status were evaluated by the Survey of Health, Ageing and Retirement in Europe (SHARE) instrument and QOL was evaluated by the WHOQOL-BREF questionnaire. One-way ANOVA and chi-square tests were used to find relations between the frailty syndrome and QOL. RESULTS The percentages of respondents with pre-frail, frail, and non-frail status were 30.4%, 52.2%, and 17.4%, respectively. A decline in QOL scores of pre-frail and frail respondents was found for almost all QOL domains (physical, psychological and environment domains), except social relationships. The subdomains most influenced were “energy and fatigue” in the physical health domain, “thinking, learning, memory and concentration” in psychological health, and “opportunities for acquiring new information and skills” in the environment domain. CONCLUSIONS More than half of the nursing home elderly were frail and one-third were pre-frail. The main factor of frailty was weakness. The frailty syndrome in the elderly has a negative impact on QOL, especially in the physical health, psychological and environment domains in nursing home elderly.

BACKGROUND Thalassemia is an autosomal recessive genetic disorder, in which the patient requires life-long blood transfusion. As Indonesia harbors 6 to 10% thalassemia carriers, thalassemia prevention measures such as early screening and education in the community are urgently needed. The aim of this study was to explore the knowledge, attitude and practice about thalassemia among young medical students. METHODS A cross-sectional analytic observational study was conducted on 179 subjects in 2015, using a questionnaire with items on knowledge, attitude and practice about thalassemia for data collection. After signing informed consent, the questionnaire was filled in by the students and a blood test was performed when the students agreed to be examined. Detection of probable thalassemia carrier status was done by determination of hemoglobin, mean corpuscular volume and mean corpuscular hemoglobin. RESULTS The knowledge about thalassemia of the first year medical students (n=179) was good (21.1%), moderate (70.9%) and poor (21.1%). Only 67 (38.3%) of the students agreed to a blood examination for determination of their carrier status after filling-in the questionnaire. The knowledge of thalassemia among first year medical students was statistically related to the timing when they would agree to have their thalassemia carrier status examined (p=0.021, one way ANOVA test). CONCLUSION A higher thalassemia knowledge score causes medical students to be willing to undergo thalassemia carrier status examination at an earlier point in timing. A well-organized educational program focusing on thalassemia and early screening in young adults may enhance the thalassemia prevention program.

Background Flavonoids have positive effects on health, including the nervous system. High flavonoid content can be found in chocolate, especially dark chocolate. Verbal working memory is important for reasoning, language comprehension, planning, and spatial processing. The purpose of this study was to evaluate the effect of a single dose of dark and white chocolate administration on verbal working memory in medical students. Methods A study of experimental pre-post test design with controls was conducted on 60 students. These were simply randomized into two groups: the first group was supplemented with white chocolate as control, and the second group received dark chocolate, at an identical single dose of 100 g. Working memory was measured with the digit span forwards (DSF) and the digit span backwards (DSB) tests, before, at 1 hour, and at 3 hours after intervention. Independent t and Mann-Whitney tests were used for data analysis. Results Scores for DSF and DSB in control and treatment groups were similar at baseline. At 1 hour after dark and white chocolate administration, DSF and DSB scores were not significantly different between the two groups (p=0.832; p=0.683). Supplementation of dark chocolate at 3 hours after intervention significantly increased DSB scores compared to white chocolate (p=0.041), but DSF scores were not significantly different between the two groups (p=0.204). Conclusions Dark chocolate as a single dose is capable of improving verbal working memory in students, 3 hours after its consumption. Since cocoa contains multiple bioactive compounds, one approach might be to examine the neurocognitive effects of combinations of potential functional ingredients.