Backgound Invasive prenatal diagnosis (PND) through amniocentesis and chorionic villus sampling (CVS) can detect Down syndrome. Pregnant women usually experience a variety of psychological responses associated with invasive PND. This study is intended to assess depression, anxiety and stress levels and the factors related to their psychological responses in pregnant women with invasive prenatal diagnosis of Down syndrome. Methods A cross sectional study was conducted at Kandang Kerbau Women’s and Children’s Hospital, Singapore. The psychological responses of 70 women undergoing PND were assessed by Depression Anxiety Stress Scale 21 (DASS 21) questionnaire. A multiple linear regression analysis was used to analyze association between knowledge and perceived risk with psychological responses (CI 95% and significance value p<0.05). Results More than half of the participants had normal anxiety (55.7%), stress (72.8%), depression levels (65.8%). The results revealed significantly higher level of anxiety in women with gestational age >13 weeks who had pursued amniocentesis. Women with no previous children had higher levels of depression and stress. Women who pursued amniocentesis had significantly higher anxiety scores compared to women undergoing CVS (p=0.015). Conclusions Women’s psychological responses are associated with gestational age, type of procedure and parity. The level of anxiety increased in women who underwent amniocentesis for diagnosis of Down syndrome. Knowledge and perceived risk of having a baby with Down syndrome do not seem to have psychological effects to women.

In May 2015 the 62th World Health Assembly formulated a global malaria strategy for 2016-2030 aiming to “reduce the global disease burden by 40% by 2020, and by at least 90% by 2030. It also aims to eliminate malaria in at least 35 new countries by 2030”.(1) As a reminder, it was 60 years ago that the Eighth World Health Assembly decided in 1955 to shift from malaria control to malaria eradication, with the aim to make many areas of free of malaria “within 10 to 15 years”.(2) This has yet to be accomplished in many malaria endemic countries such as Indonesia, where the earliest program was the malaria eradication program of 1959, evolving into the malaria control program, the roll-back malaria program, and finally in 2012 into the malaria elimination program.(3) In view of the ever-present insecticideresistance

BACKGROUND Cancer cells have a relatively high telomerase activity and a lower p53 protein expression than normal cells, so that cancer cells have the ability to continue to proliferate and do not undergo apoptosis. One of the cancer treatments is chemotherapy using bioactive ingredients from synthesis or isolation of natural materials. One of the plants that have potential as anticancer agent is periwinkle (Catharanthus roseus L). The research objective was to evaluate the effect of ethanolic periwinkle leaf extract against p53 protein and telomerase expression in T47D cancer cells. METHODS An experimental study with controls was conducted involving T47D breast cancer cells. They were divided into 3 groups (control, ½ dose of IC50/26.849 µg/mL, and one dose of IC50/53.699 µg/mL) at a cell density of 1 x 104 cells/well. Expression of p53 and telomerase was measured by the immunohistochemistry method. Data were analyzed using one-way ANOVA followed by a multiple comparison test. RESULTS Periwinkle leaf extract significantly increased p53 protein expression (p<0.05) at both treatment doses, ½ IC50 and IC50, compared to the control group and it highly significantly reduced telomerase expression (p<0.01), in comparison with the control group at both treatment doses. CONCLUSION Periwinkle leaf extract has potential as an anti-breast cancer agent by increasing p53 protein expression and inhibiting telomerase expression.

BACKGROUND Sleep deprivation is a significant problem among adult men and is considered as a risk factor for several diseases. Paradoxical sleep deprivation (PSD) induces Leydig cell apoptosis through elevation of corticosterone, with testicular malondialdehyde (MDA) and Leydig cell caspase-3 expression as parameters. The aim of this study was to observe testicular MDA level and caspase-3 expression treated with paradoxical sleep deprivation (PSD), immobilization, and footshock stress and to determine the stress model with a significant effect in white male rats (Rattus norvegicus) . METHODS This experimental randomized study of posttest only with control group design was conducted on 24 white male Wistar strain rats, randomly allocated into four treatment groups, i.e. control (K1) without any stress treatment, PSD (KII), immobilization (KIII), and footshock stress (KIV). Treatments were given for 25 days to produce chronic stress. Testicular MDA concentration was examined by the ELISA method while caspase-3 was examined by the TUNEL method. RESULTS Mean testicular MDA concentration with one-way ANOVA test showed differences in means between the groups (p=0.000) and post hoc Tukey-HSD test showed significant results between PSD stress group versus control, immobilization and footshock stress groups. One-way ANOVA test showed a significant difference in caspase-3 expression in at least two treatment groups (p=0.008) and post-hoc Tuckey-LSD test showed significant differences between controls and all stress groups. CONCLUSION Sleep deprivation is a type of stress inducing changes in testicular MDA concentration and caspase-3 expression in male rat testes.

Background Asiatiocoside, a saponin component isolated from Centella asiatica can improve wound healing by promoting the proliferation of human dermal fibroblasts (HDF) and synthesis of collagen. The skin-renewing cells and type I and III collagen synthesis decrease with aging, resulting in the reduction of skin elasticity and delayed wound healing. Usage of natural active compounds from plants in wound healing should be evaluated and compared to retinoic acid as an active agent that regulates wound healing. The aim of this study was to compare and evaluate the effect of asiaticoside and retinoic acid to induce greater cell proliferation and type I and III collagen synthesis in human dermal fibroblast. Methods Laboratory experiments were conducted using human dermal fibroblasts (HDF) isolated from human foreskin explants. Seven passages of HDF were treated with asiaticoside and retinoic acid at several doses and incubated for 24 and 48 hours. Cell viability in all groups was tested with the MTT assay to assess HDF proliferation. Type I and III collagen synthesis was examined using the respective ELISA kits. Analysis of variance was performed to compare the treatment groups. Results Asiaticoside had significantly stronger effects on HDF proliferation than retinoic acid (p<0.05). The type III collagen production was significantly greater induction with asiaticoside compared to retinoic acid (p<0.05). Conclusion Asiaticoside induces HDF proliferation and type I and III collagen synthesis in a time- and dose-dependent pattern. Asiaticoside has a similar effect as retinoic acid on type I and type III collagen synthesis.

Background Intractable epilepsy considerably affects both the private and social life of the patient. The objective of this study was to determine the quality of life of intractable epileptic adolescents and its correlated factors. Methods A cross sectional study was conducted in the Pediatric Neurology outpatient clinic of Dr. Soetomo Hospital. All intractable epileptic adolescents aged between 10 to 16 years were asked to complete a questionnaire on quality of life in epilepsy for adolescents (QOLIE-AD-48). A multiple linear regression was used to analyze the data through SPSS v17.0. Results Thirty one patients with mean age of 12.41 ± 1.40 years were enrolled in the study. The mean duration of diagnosed intractable epilepsy was 6.12 ± 4.30 years. Mean score for impact of epilepsy was 57.11 ± 24.50, for memory and concentration 53.54 ± 26.66, physical functioning 65.56 ± 23.67, social stigma 52.23 ± 17.48, social support 52.64 ± 22.69, behavior at school 57.51 ± 26.50, attitude 53.40 ± 16.70 and health perception 61.51 ± 11.30. Multiple linear regression results showed that quality of life (QOL) was not significantly correlated with duration of epilepsy, sex and nutritional status (p>0.05), but increasing age was significantly decreases quality of life (p<0.05). Conclusions Intractable epileptic adolescents have higher scores for physical functioning and health perception, but lower scores for social stigmatization. Social support has extremely low scores. Increasing age decreases quality of life in adolescents with intractable epilepsy.

Background Soil-transmitted helminth (STH) infection is still a health problem in Indonesia. Vitamin A deficiency (VAD) is often found together with STH. The effect of the deworming program on the vitamin A status of primary school children is unknown. The objective of this study was to evaluate the effect of albendazole on serum retinol concentrations in primary school children. Methods An experimental study of pre-post test design without control was carried out on 118 children from grades 3-5 at one primary school in North Jakarta, from July to September 2014. Flotac examination was used to determine STH infections and high performance liquid chromatography was performed to measure serum retinol concentration. Stool and blood samples were taken twice: before and three weeks after treatment with albendazole 400 mg single dose for three consecutive days given to all children either infected or uninfected. Paired t-test was used to analyze the data. Results Of the 118 children, the prevalence of STH was 71.2%. The prevalence of low retinol serum (<1.05 mmol/L) was 17 (17.2%) and of mild VAD was 2 (2.0%). Albendazole given in 3 consecutive days could not increase serum retinol concentrations (p=0.055). Serum retinol concentration significantly increased after albendazole treatment in children with low retinol serum at baseline (p=0.001). Conclusions In children with low serum retinol concentration, treatment with albendazole increased retinol concentration. Integrated deworming and vitamin A supplementation strategies should be evaluated in this population.

Background Malaria is re-emerging because of imported cases and the presence of potential vectors that can transmit and spread malaria. Malaria is a health problem in Banyumas District. Mapping the spread of infectious diseases is epidemiologically important. The purpose of this study was to determine the relationship between the variables and the epidemiology of malaria that were spatially modeled using the geographic information system (GIS). Methods This was a case-control study with ratio of 1:1. Cases were malaria-positive patients and controls were people without malaria, as diagnosed by microscopic examination. Minimum sample size was 139 per group and total sample size was 282 people. Chi-square was used to test the relationship between the variables, and GIS modeling to determine the spatial distribution of malaria cases. Results There were significant relationships between level of income below minimum wage, not using mosquito nets, not using wire netting, not using insect repellents, habit of going out at night, history of malaria, cattle sheds not located between woods and residential area, history of going to endemic areas, residence at distances <1000 m from plantations, bushes, swamps and puddles, with incidence of confirmed malaria (p<0.001). The group of cases living <1000 meters from plantations numbered 141 (100%). Conclusions Malaria incidence is clustered and buffers around plantations at <1000 m. Malaria hot spots are displayed as risk maps that are useful for monitoring and spatial targeting of prevention and control measures against the disease.

Background Antiretroviral therapy adherence (ART adherence) is a factor significantly extending life expectancy of people living with HIV/AIDS. The objective of this study was determine several factors on ART adherence in women infected with HIV/AIDS. Methods A cross-sectional study involving 99 women with HIV/AIDS who were infected through their sexual partner or spouse was conducted in Dharmais Hospital between March and August 2014. The instruments used were demographic and self-esteem questionnaires, Hamilton rating scale for depression, Hamilton rating scale for anxiety, knowledge, perception of ART benefits and limitations, family support, peer support as well as assessment of ART adherence. The knowledge questionnaire has been validated with Cronbach’s alpha = 0.823. Data were analyzed using Chi-Square test and multivariate logistic regression. Results A total of 99 women with HIV/AIDS participated in the study, with an age range of 30- 60 years and mean age of 36 ± 3.72 years. A total of 57.58% of participants showed poor ART adherence. Multivariate logistic regression analysis showed that knowledge, ART side effects, depression, peer support and ARV availability significantly affected ART adherence (p<0.05). The most dominant factor affecting ART adherence was knowledge, with OR = 64.02 (95% CI 4.99-670.12). Conclusion With good knowledge about HIV/AIDS infection, ART benefits, and possible ARV side effects, women living with HIV/AIDS are expected to carry out ART adherence according to the recommended rules.

Background Coconut milk is an essential ingredient of the Indonesian cuisine. In view of its saturated fatty acid content, coconut milk has frequently been blamed as a cause of cardiovascular disease. The objective of this study was to determine any association between coconut milk intake and vascular disease among adults. Methods A cross-sectional study was conducted in 2011-2012 on adults aged 25-65 years. Self-reported health and nutritional data were collected by means of questionnaire-based interviews, with the aid of 3-D food models. Medical data comprised blood pressure and anthropometry (waist circumference and body mass index), neurological status, ECG, blood glucose and lipid profile. Data analysis was done using multiple logistic regression. Results A total of 4,187 respondents fullfilled the inclusion criteria. Frequent coconut milk intake (>3 times/week) significantly increased the risk of vascular disease by 1.3-fold compared with infrequent coconut milk intake (<2 times/week) (OR=1.33; 95% CI: 1.11-1.60; p=0.002) after controlling for age, gender, hypertension, diabetes mellitus and stress. The influence of coconut milk intake on vascular disease risk was lower than that of age, gender, hypertension and diabetes mellitus. Conclusion Frequent coconut milk intake increased the risk of vascular disease in adults. Further investigations are needed about the effect of coconut milk intake on noncommunicable diseases.