Background The number of people with diabetes mellitus (DM) is increasing due to population growth, aging, and increasing prevalence of obesity. Diabetic retinopathy and diabetic nephropathy are two main complications of DM. Some studies suggest a correlation between diabetic nephropathy and diabetic retinopathy. However, other studies found that renal cortex echogenicity is associated with chronicity of kidney disease and renal histopathology. The aim of this study was to determine whether there is a correlation between renal cortex echogenicity as determined by renal ultrasonography and degree of retinopathy as determined by funduscopy in subjects with DM. Methods A cross sectional study was conducted on 41 DM subjects from September to November 2014. Data obtained by anamnesis, physical examination, and examination of ureum, creatinine, urinalysis, glycated hemoglobin (HbA1c), renal and urinary tract ultrasonography and funduscopy, were collected from all subjects. Blood samples were taken from the median cubital vein for biochemical measurements using COBAS automated analyzers. Normality of data distribution was tested using the Shapiro-Wilk test. To determine the relationship between variables the Spearman correlation test was used. Results Using the Spearman correlation test, a strongly significant correlation was found between degree of renal cortex echogenicity and degree of retinopathy (r=0.773; p=0.0001). A significant relationship was also found for the degree of retinopathy with age (r=0.317; p=0.044), duration of diabetes mellitus (r=0.639; p=0.0001) and HbA1c (r=0.681; p=0.001). Conclusion This study found that renal cortex echogenicity increased the degree of diabetic retinopathy in diabetic subjects. Renal ultrasonography for patients with type 2 DM has a great role in diagnosing and grading diabetic retinopathy.

Background Bullying behavior is one of many behavioral and disciplinary problems among school students, which has a wide impact on youth, families, schools, and communities. Parenting and the role of parents as good educators (exposure) can prevent mental, emotional and behavioral disorders caused by bullying. The aim of this study was to determine the role of self-esteem and family factors on bullying behavior in junior high schools students. Methods A cross-sectional study was conducted including 1324 junior high school students of Penjaringan village, North Jakarta. Respondents filled out questionnaires on demographics (age, gender, economic status, educational level), Rosenberg self-esteem questionnaire, strength and difficulties questionnaire, Olweus bullying questionnaire, Hamilton scale for depression, parenting style, and family adaptability and cohesion scales III. Simple and multivariate logistic regression tests were used to analyze the data. Results Respondents consisted of 53.5% females and 46.5% males, with an age range of 13-16 years. A total of 45% was involved in bullying (victims, perpetrators, and victims and perpetrators). Gender, self-esteem, family relationships, and parenting were significantly associated with bullying role (p<0.05). Multiple logistic regression analysis showed that self-esteem (odds ratio=23.89; 95% CI:7.899-12.990) and non-exposure parenting (odds ratio=39.11;95% CI: 2.455-8.210) were significantly associated with bullying behavior. Conclusions Non-exposure parenting was the most relevant risk factor of bullying behavior. Low self-esteem increases the risk of bullying behavior. These findings suggest the need of timely bullying prevention and intervention programs that should have a special focus on families of primary high school students.

Background Cancer cells have a relatively high telomerase activity compared to normal cells, so that cancer cells have the ability for continued proliferation and uncontrolled mitosis. Telomerase is an enzyme responsible for the length of telomeres, DNA segments located at the ends of eukaryotic chromosomes. Natural materials such as rodent tuber (Typhonium flagelliforme) have anticancer potential. The purpose of the present study was to determine the effects of Typhonium flagelliforme extract on telomerase expression in HeLa cervical cancer and T47D breast cancer cells. Methods This experimental laboratory study was conducted on cultured HeLa and T47D cancer cell lines, with normal Vero cells as controls, and using RPMI and M199 culture media. The study comprised three groups, i.e. controls, and groups receiving Typhonium flagelliforme extract at doses of ½ IC50 and IC50. Telomerase expression was measured by immunohistochemistry (IHC). Analysis of variance and LSD multiple comparison test were used to analyze the data. Results Telomerase expression in cancer cells showed significantly higher values compared to normal Vero cells. Typhonium flagelliforme extract was capable of significantly decreasing telomerase expression in cancer cells receiving the extract. Conclusion Typhonium flagelliforme extract at different doses is capable of decreasing telomerase expression more effectively in cervical cancer cells than in breast cancer cells. This study shows that Typhonium flagelliforme may have anti-cancer activity, necessitating further investigations.

Background Chronic hepatitis and hepatic cirrhosis are chronic liver diseases that cause disorders of liver function, such as the formation of platelets and coagulation factors (prothrombin time/PT and activated partial thromboplastin time/APTT). Chronic hepatitis in the long term can develop into hepatic cirrhosis. The aim of this study was to determine platelet count, PT, and APTT as indicators in the progression of chronic hepatitis towards hepatic cirrhosis. Methods A cross-sectional study was conducted on 50 patients with chronic hepatitis and hepatic cirrhosis in Semarang City Regional General Hospital, Telogorejo Hospital and Kariadi General Hospital. The platelet count was measured with a Sysmex XP-100, while PT and APTT was measured with a Sysmex CA-1500 coagulometer. The Mann Whitney test was applied to analyze the difference in platelet count, PT, and APTT between chronic hepatitis and hepatic cirrhosis. Results Median, minimum, and maximum values of platelet count, PT and APTT in chronic hepatitis were 284.000/µl, 210.000/µl, 390.000/µl; 10.6 sec, 9.5 sec, 13.6 sec; and 30.5 sec, 24.2 sec, 46.4 sec, respectively, and in hepatic cirrhosis they were 96.300/µl, 48.200/µl, 133.800/µl; 27.5 sec, 11.9 sec, 44.7 sec; and 55.6 sec, 31.3 sec, 72.0 sec, respectively. There was a significant difference the reduction of platelet count, and the prolongation of PT and APTT in chronic hepatitis compared to hepatic cirrhosis (p=0.000). Conclusions Prothrombine time and APTT were prolonged and platelet count was decreased in hepatic cirrhosis subjects. The three parameters may be used to evaluate the progression of chronic hepatitis towards hepatic cirrhosis.

Background Atopic dermatitis (AD) is a common skin disease that is usually chronic, relapsing, causing pruritus and frequent in children. The pathogenesis of AD involves genetic, immunological and environmental factors causing skin barrier dysfunction and dysregulation of the immune system. Probiotic treatment has been claimed to offer several functional properties including stimulation of the immune system and plays an important role in AD. The objective of this study was to evaluate the effect of probiotic therapy on atopic dermatitis in children. Methods A randomized controlled trial was conducted on 62 children suffering from AD from December 2015 to January 2016. AD severity was assessed based on the scoring of atopic dermatitis (SCORAD) index. Subjects were divided into two groups consisting of 32 and 30 children, the probiotic (probiotic + emollient) and control (emollient) groups, respectively. SCORAD index was re-evaluated after 2 weeks of therapy. The data was analyzed using Mann Whitney test. Results After the intervention, the mean SCORAD index in the probiotic group was significantly much lower than the control group (18.09 ± 8.59 vs 23.21 ± 8.71; p=0.001). The mean decrease in SCORAD index in the probiotic group was 40.4 %, much higher than the control group 25.2%. The number needed to treat (NNT) score of probiotic treatment was 5.3. Conclusion The addition of probiotics to conventional therapy effectively lowers SCORAD index by 40.4% in atopic dermatitis. The impact of probiotics on SCORAD indices is thought to be attained by modification of the immunogenicity of potential allergens.

Preterm delivery is one of the causes of high perinatal morbidity and mortality. Matrix metalloproteinase 9 (MMP-9) is important for extracellular matrix (ECM) remodeling and may cause preterm labor and premature rupture of membranes (PROM). Tumor necrosis factor-a (TNF-a) as a pro-inflammatory cytokine plays a role in stimulating uterine activity and cervical ripening by degrading the ECM of the amniotic membranes through MMP-9. This study aimed to determine differences between MMP-9 and TNF-a expression of the membranes in preterm delivery with premature rupture of membranes (PPROM) and without PROM. Methods An analytic observational study with cross-sectional approach was conducted in 24 subjects, who were divided into 2 groups, with 12 subjects in the preterm delivery group with PROM and 12 subjects in the preterm delivery group without PROM. The expression of MMP-9 and TNF-a in the amniotic membrane was determined by immunohistochemistry. Data were analyzed using the t test. Results MMP-9 expression in the amniotic membrane of preterm delivery subjects with PROM (8.6 ± 3.1%/field) differed significantly with that of preterm delivery subjects without PROM (5.5 ± 2.3 %/ field) (p=0.001). TNF-a expression in the amniotic membrane of preterm delivery subjects with PROM (8.0 ±3.0%/field) also differed significantly with that of preterm delivery subjects without PROM (3,3 ± 1.5%/field) (p=0.000). Conclusion Expression of MMP-9 and TNF-a was higher in the amniotic membrane of preterm delivery subjects with PROM than in preterm delivery subjects without PROM and can thus be used as predictor to avoid PPROM.

Background Subjects with metabolic syndrome (MetS) have a greater risk for acquiring type 2 diabetes mellitus (type 2 DM). The MetS criteria usually used are those of the National Cholesterol Education Program Expert Panel (NCEP) and Adult Treatment Panel III (ATP III) and of the International Diabetes Federation (IDF). This study aimed to evaluate the modified NCEP-ATP III and IDF criteria as predictor of type 2 DM among subjects with MetS. Methods A cohort study was conducted among 4240 subjects with MetS. MetS was determined according to the modified NCEP-ATP III and IDF criteria. The study followed up 3324 non-diabetic subjects of the cohort study of non-communicable disease (NCD) risk factors (NCD study) during a 2-year period. Type 2 DM was determined from the diagnosis by health personnel or from fasting blood glucose of =126 mg/dL or blood glucose of =200 mg/dL, 2 hours after 75g glucose loading. Results The MetS prevalence based on modified NCEP ATP III and IDF criteria in non-DM subjects was 17.1% and 15.6%, respectively. The risk for DM in subjects with MetS using modified NCEP ATP III and IDF criteria was 4.7 (CI 95%: 3.4-6.5) and 4.1 (CI 95%: 3.0-5.7), respectively. Conclusions Both MetS criteria can be used as predictors of the occurrence of DM type 2, but the modified NCEP-ATP III is more properly applied than the IDF criteria in subjects with MetS. Screening programs and routine monitoring of MetS components are required for early detection of type 2 DM.

Backgroud. Mass drug administration (MDA) has been one of the strategies for lymphatic filariasis elimination. Since the start of implementation in 2011 in Pekalongan, no study on MDA acceptability has yet been done. The objectives of the study were to determine the microfilaria rate (mf rate) and the risk factors of drug compliance in the MDA program. Methods A longitudinal study was conducted at Pabean region, Pekalongan City. There were 90 household heads as subjects, who were selected by proportional cluster random sampling. Microfilaria rate (mf rate) was determined by finger blood examination. Drug compliance was measured using questionnaires and observation sheets. Drug compliance observers, filariasis counseling participation, and presence of filariasis patients were factors influencing drug compliance. Results Mf rate in 2015 was 1.35% and drug compliance rate was 86.80%. Reasons for failing to take drugs were fear of side effects (50%), refusals (25%), laziness (16.7%), and perceiving the drug to be useless (8.3%). The chi-square test shows a significant difference between the presence of drug compliance observer and compliance (p=0.006). Filariasis counseling participation and presence of filariasis patients did not show a significant difference with drug compliance (p= 0.986). Conclusions Families as the source of observers was associated with increased filariasis drug compliance. It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.

Background Pre-eclampsia is the largest direct cause (42%) of maternal mortality death in Brebes district in 2013. The cause of pre-eclampsia is not known with certainty, oxidative stress being one of its causes. The aim of this study was to determine macro- and micronutrient intakes that do not correspond to the needs, as pre-eclampsia risk factors in post-partum women. Methods The research was an observational study of case control design. Study subjects were 20-35 year-old post partum women consisting of 55 cases (pre-eclampsia) and 55 controls (non-pre-eclampsia). Nutrient intakes were measured using semi-quantitative food frequency questionnaires and data on levels of pesticide exposure, body mass index (BMI), mid-upper arm circumference (MUAC) and education were collected from structured interviews. Data was analyzed by chi-square tests and multiple logistic regression. Results There was no difference in age and MUAC between the cases and controls. Low vitamin C intake (OR: 20.93; 95% CI: 2.72 – 161.36), high polyunsaturated fatty acid intake (OR: 10.50; 95% CI: 2.47 – 44.57), and low vitamin E intake (OR: 8.57; 95% CI: 2.07 – 35.46) were pre-eclampsia risk factors after controled for pesticide exposure, BMI and education. Low vitamin C intake played the most important role in the incidence of preeclampsia. Conclusion Low vitamin C intake played the most important role toward pre-eclampsia. Greater caution is needed when issuing recommendations regarding the consumption of vitamin supplements in pregnancy, as high doses of some vitamins may be deleterious.

Background There are people in Yogyakarta, who use black sugarcane decoction (BSD) to prevent stroke. BSD contains policosanol and antioxidants. It has been proven that policosanol can reduce global ischemia in Mongolian gerbils. This study aims to evaluate the effect of BSD on brain ischemia in a rat stroke model. Methods A laboratory experiment using eighteen 3-month old male Wistar rats without any defects, of 175-250 g body weight. Brain ischemia was produced by a 20-minute bilateral carotid communis artery oclusion (BCCAO). Using a rat stroke model, brain ischemia was produced by a 20-minute BCCAO. The rats were randomized into three groups: BSD treated stroke model rats (group 1), non treated stroke model rats (group 2), and sham operated rats (group 3). BSD was administered by gavage for 1 week before BCCAO. Decapitation of rats was performed two hours post BCCAO. Brain tissues were stained with 2,3,5-triphenyltetrazolium chloride (TTC). Ischemic areas were analyzed using Image J softwere. Statistical analysis was conducted by one way ANOVA test. Results The mean percentages of rat brain ischemic area differed between group 3 (0.0 ± 0.0%), group 2 (3.13 ± 0.59%) and group 1 (1.15 ± 0.47%) p =0.001). Post hoc test showed that there was no difference between group 3 with group 1. Instead, there was a significant difference between group 2 and the other groups. Conclusion The administration of BSD reduced rat brain ischemia after bilateral carotid artery ligation.

Background In Indonesia, the prevalence of injury has increased from 7.9% in 2007 to 8.2% in 2013. Among older persons, falls were the main cause of injury. The objective of this study was to determine the major risk factors and the magnitude of the risk for fall-related injury in older persons. Methods A study of cross-sectional design was conducted on 4,222 respondents aged 60 years and over. Injury was defined as fall-related injury occurring in the previous 12 months that disturbed activity dailyu living (ADL). Data collection was done by: 1) interview about sociodemographics and health (including hearing impairment, non-communicable diseases and injury) using a questionnaire, 2) measurement of blood pressure and anthropometry (body mass index), 3) examination of vision in the right nd left eyes using tumbling E cards and pinhole eye covers. Data were analyzed using the chi square test and multiple logistic regression with 0.05 significance level. Results After controlling for age, occupation, vision disorder, educational level and economic status, older women had a 2.0-fold increased risk for fall-related injury compared to men (aOR=2.30; 95% CI: 1.93-2.73; p=0.000); subjects with a history of stroke had a 2.0-fold increased risk for fall-related injury compared to those without a history of stroke (aOR=2.07; 95% CI: 1.38-3.09; p=0.000). Educational level was a confounding factor. Conclusion Women and stroke sufferers were at higher risk of fall-related injury among older persons. Prevention of fall-related injury should be done by older persons through periodic control of their health condition.