Background Exercise has been known to have beneficial effects on human health. The kidneys play an important role in regulating acid-base and water-electrolyte balance disturbances induced by exercise. The objective of this study was to investigate the effect of short term aerobic exercise (volleyball training) on the kidney function of apparently healthy individuals. Methods An experimental study of pre-post test design was conducted involving 41 amateur volleyball players, comprising 22 males and 19 females. They were randomly divided into seven different teams. Each team trained for at least 45 minutes for four consecutive days for two weeks. Both pre-and post-exercise blood pressure (BP) was measured using an automatic blood pressure measuring device OMRON 907 (OMRON, Hoofddorp, Netherlands). Likewise, both pre- and post-exercise blood samples were collected into lithium heparin tubes and centrifuged at 3000 rpm for 10 minutes and the plasma separated into plain tubes. Electrolytes were analysed using ion selective electrode machine (SFRI 4000, Germany), urea using modified Berthelot method, creatinine using Jaffe-Slot method and uric acid using the uricase method and estimated glomerular filtration state (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Results The mean levels of pre- and post-exercise systolic blood pressure, creatinine, urea, sodium, potassium, chloride, bicarbonate and eGFR did not differ significantly (p>0.05). However, serum uric acid was significantly increased (p<0.05), while diastolic BP significantly decreased after exercise (p<0.05). Conclusion The study showed that short-term moderate intensity aerobic exercise does not have any significant effect on the renal functions.

BACKGROUND Tracheostomy is one of the most frequently performed procedures in intensive care units. The widespread attraction of percutaneous dilatational tracheostomy (PDT) is increasing in modern intensive care units (ICU). Bronchoscopic guidance seems to secure the safety of the technique. Multiple studies done to explain characterize differences in complications and cost-effectiveness of open and percutaneous tracheotomy. The objective of this study was to evaluate the benefits of percutaneous dilatational tracheostomy (PDT) using the Ciaglia technique with bronchoscopic guidance. METHODS A total of 100 elective percutaneous dilatational tracheostomies using the Ciaglia technique with a little modification were performed under flexible fiber optic bronchoscopic guide. The demographic variables were recorded, the underlying cause for patient’s referred to the center for PDT, and intraoperative as well as early postoperative complications. Patients followed for several days after tracheostomy for early complications. RESULTS No severe complications related to percutaneous dilatational tracheostomy were noticed during and after the procedure. Three patients had bleeding during incision and two led to subcutaneus hematoma. There were no other complications such as infection, emphysema and puncture of posterior wall. CONCLUSIONS We recommended the use of endoscopic guidance bedside percutaneous tracheostomy using the Ciaglia technique with a little modification because it is safe and simple to do without significant complications. PDT with bronchoscopic guidance is a safe and easy procedure that can be done at the bedside setting.

Background Maternal mortality rate is still a health problem in Indonesia. One major contributor to maternal mortality rate in Indonesia is preeclampsia. One widely accepted theory is that preeclampsia is caused by oxidative stress. Placental hypoxia or ischemia among preeclampsia patients is thought to be the cause of the formation of free radicals such as malondialdehyde (MDA), which decreases endogenous antioxidants such as glutathione (GSH). This study aims to ascertain the difference in plasma malondialdehyde and glutathione levels between healthy and preeclamptic pregnant women. Methods This was an observational analytic study of cross sectional design. Research subjects were 30 normal (healthy) pregnant women (NP), and 30 pre-eclamptic pregnant (PE) women. The measurement of plasma MDA and GSH levels was done at the Biochemistry and Molecular Biology laboratories, Faculty of Medicine, Sriwijaya University using Sigma-Aldrich MDA and GSH assay kits. Mann Whitney test was used to analyze the data. Results Subjects aged >35 years, with age of gestation >35 weeks and multipara was significantly higher in the PE group compared to the NP group (p=0.016; p=0.01 and p=0.36; respectively). MDA level was significantly higher in the PE group than in the NP group (p=0.002). In contrast, GSH level was significantly lower in the PE group than in the NP group (p=0.003). Conclusion MDA and GSH may reflect vascular complications of PE, and the ensuing increases in lipid peroxidation may play important pathogenic roles.

Background Family support and low discrimination perceptions are a factor in protecting against mental disorders and poor quality of life in male to female (MtF) gender dysphoric individuals. The aim of this study was to determine the role of family factors, peer support, self-esteem, perceived discrimination, depression, anxiety, and stress on the quality of life among MtF gender dysphoric individuals. Methods A cross-sectional study was conducted involving 106 MtF gender dysphoric individuals of Sanggar Swara Jakarta. Respondents filled out questionnaires on demographics, WHOQL-BREF, perceived discrimination, Rosenberg self-esteem, family support, social support (SSQ6), family relations (FACES III), and depression anxiety stress scale (DASS). Simple and multivariate logistic regression tests were used to analyze the data. Results Among the 106 MtF gender dysphoric individuals of Sanggar Swara Jakarta with an age range of 18-45 years, 78.3% had no family support, 64.1% no peer support, 62.3% high perception discrimination, 64.1% low self-esteem, 36% extreme family relations, 44.3% depression, 59.4% anxiety, 35.8% stress and 62.3% poor quality of life. Employment, perception of discrimination, self-esteem, family support, and anxiety were significantly associated with quality of life (p<0.05). Multiple logistic regression analysis showed that perceived discrimination (Odds Ratio=13.89; 95% CI: 5.89-11.99), and family support (Odds Ratio=29.11; 95% CI: 2.45-8.21) were significantly associated with quality of life. Conclusion High perceived discrimination and no family support increase the risk of poor quality of life in MtF gender dysphoric individuals. These findings suggest the need for prevention and intervention of stigmatization and discrimination that should have a special focus on families with MtF gender dysphoric individuals.

Background Stroke is the main cause of disability and death in many countries. The high incidence of disability in stroke survivors requires special attention to determine various predictive factors of disability. This study aimed to identify the various predictive factors of disability in ischemic stroke. Methods This study was a cross sectional study on 4510 ischemic stroke patients. Each patient’s data had been recorded in the electronic stroke registry of Bethesda Hospital. Ischemic stroke diagnosis was confirmed by brain CT scan, which was interpreted by a neurologist and a radiologist. Disability was assessed using the modified Rankin scale. Predictors of disability were assessed. Multiple logistic regression analysis was used to analyse the data. Results The subjects were predominantly males, >60 years of age, and suffered stroke for the first time. The incidence of disability was 31.5% (1420/4510). Multiple logistic regression analysis showed that the presence of complications (OR: 6.43; 95% CI: 4.74-8.73; p<0.001), decreased level of consciousness (OR: 4.82; 95% CI: 3.95-5.90; p <0.001), onset ³3 hours (OR: 1.93; 95% CI: 1.52-2.45; p<0.001), recurrent stroke (OR: 1.63; 95% CI: 1.39-1.90; p<0.001), and age >60 years (OR: 1.55; 95% CI: 1.35-1.79; p<0.001) were independent predictive factors of disability. Conclusion We demonstrated that a substantial proportion of patients with ischemic stroke become disabled. And the presence of complications was the most predictive factor of disability in ischemic stroke.

Background Stress induces neuronal cell damage in the hippocampus and prefrontal cortex. Propolis has a neuroprotective effect that can inhibit apoptosis and decrease neuronal cell count. This study aimed to determine the effect of propolis on neuronal cell count in hippocampal area CA1 and prefrontal cortex in Sprague Dawley rats with induced stress. Methods A study of laboratory experimental design was conducted involving 24 male Sprague-Dawley Rattus norvegicus. The animals were randomly divided into 4 groups, i.e. controls (K), and stress groups P1, P2 and P3. Controls did not receive treatment, stress group (P1) received stress treatment, groups P2 and P3 received stress and propolis at 100 and 200 mg/kgBW, respectively. Stress and propolis were given for 14 days, followed by termination. The number of neurons in the hippocampal area CA1 and prefrontal cortex were counted. One way ANOVA was used to analyze the data. Results The neuronal count in the hippocampal area CA1 and prefrontal cortex in the stress group (P1) was lower than in groups K, P2 and P3. There were significant differences in the neuronal count of the hippocampal area CA1 between P1 and P3 and P1 and K (p=0.019) and also in the neuronal count of the prefrontal cortex between P1 and P2, P3 and K (p=0.002). Conclusions This study strongly suggest that propolis inhibits the decrease in neuronal count in in the hippocampal area CA1 and prefrontal cortex of Sprague Dawley rats with induced stress. The present study suggests a potential neuroprotective effect of propolis in the prevention of neurodegenerative disorders.

Background Vitamin D insufficiency is associated with obesity and central obesity, which is in turn associated with the accumulation of visceral fat. Visceral fat secretes adiponectin which has a role in the pathogenesis of the metabolic syndrome, diabetes mellitus and cerebrovascular disease. The aim of this study was to determine the relationship between serum 25-hydroxy vitamin D [25(OH)D] level and adiponectin level in adults with central obesity. Methods This study was a cross sectional study with 80 subjects with central obesity and 80 healthy subjects as controls. The age of the subjects ranged from 55 to 65 years. The data collection included anthropometry and blood biochemistry (lipid profile, fasting blood glucose, 25(OH)D, and adiponectin). The data were analyzed using independent t test with p <0.05. Results Mean waist circumference and 25(OH)D level in the central obesity group were 94.9 ± 7.8 cm and 14.3 ± 6.6 ng/mL, respectively, and in the control group 72.4 ± 5.0 cm and 19.2 ± 8.6 ng/mL respectively. There were significant differences in adiponectin level between the central obesity group and the control group at the 25(OH)D level of <20 ng/mL (p=0.001), but no significant differences between the two groups at the 25(OH)D level of ³20 ng/mL (p=0.538). Conclusion The central obesity subgroup with 25(OH)D level of <20 ng/mL have lower adiponectin levels compared with the control group. This study demonstrates the role of adiponectin as a link between insulin resistance and vitamin D status in adults.

BACKGROUND Non-alcoholic steatohepatitis (NASH) is a chronic liver disease associated with increased free fatty acids, trans fatty acids and free radical compounds due to the consumption of deep frying oil (DFO). Ginger has hypolipidemic and antioxidant properties, and acts as an insulin sensitizer. The present study was conducted to evaluate the hepatoprotective effect of an ethanol extract of Zingiber officinale Roxb var rubrum (EEZO) in DFO-fed male Wistar rats. METHODS A study of experimental design was conducted involving 24 non-alcoholic steatohepatitis (NASH) male Wistar rats that were randomly divided into 4 groups. Group K1 (control) was given DFO-3 (3 times heated DFO) at a dose of 10 ìl/g BW/day. The treatment groups (P1, P2, P3) were given DFO-3 and red ginger rhizome extract at doses of 100, 200, and 400 mg/kg BW orally for 30 days. The histopathology examination assessed fatty degeneration, and degree of fibrosis. The data were analyzed with the Kruskal-Wallis and Mann-whitney test. RESULTS The Kruskal-Wallis test showed that fatty degeneration (steatosis, lobular inflammation, hepatocyte ballooning and NASH) were significantly different among the four groups (p<0.05). Mann-Whitney test proved that fatty degeneration was not significantly different between control and treatment groups (p>0.05). CONCLUSION Deep frying oil increased fatty degeneration and NASH, and none of red ginger rhizome extract doses was able to inhibit fatty degeneration significantly. For the future research it is intended to prolong the induction time and the administration of red ginger rhizome extract.

Background In acquired immunodeficiency syndrome (AIDS) cases, cytopenias of all major blood cell lines were increasingly recognized in patients with HIV infection. Anemia commonly occurs during HIV infection and has been associated with increased progression to AIDS and decreased survival. The aim of this study was to determine the prevalence of anemia and associated risk factors in adults with HIV-AIDS receiving antiretroviral therapy (ART). Methods A cross sectional study was conducted involving 90 adults with HIV-AIDS. Sociodemographic data were collected using a questionnaire. In all patients, CD4+ lymphocyte counts were performed by means of a PIMA analyzer, while hemoglobin was determined using a Sysmex hematology analyzer. The WHO cutoff value of hemoglobin was adjusted to altitude to define anemia. Mild to moderate anemia was defined as hemoglobin 8-13 g/dL for men and 8-12 g/dL for women. Severe anemia was defined as hemoglobin 8 g/dL. Data was analyzed by using logistic regression test. Results There were 90 subjects with HIV-AIDS in this study. Anemia was found in 50 subjects (55.6%), consisting of 12.2% with mild anemia and 43.4% with moderate to severe anemia. Multiple logistic regression showed that an important risk factor for anemia was low body mass index (BMI) between <17-18.5 (OR=4.20; 95% CI=1.23-14.36). However, the CD4 <350 cells/mm3 was not a significant risk factor for anemia (OR=1.03; 95% CI=0.21-5.04). Conclusions Low BMI increases the risk of anemia in subjects with HIV receiving ART. Better screening for anemia and infectious diseases, and modified harm reduction strategy for injection drug users are primary needs in HIV patients.

Background Low vitamin D has been associated with various health problems. Aging influences body composition, especially body fat and fat-free mass. Anthropometric measurements, such as body weight (BW), body mass index (BMI), body fat (BF), skeletal muscle mass (SMM), waist circumference (WC) and the waist-height ratio (WHtR) represent body composition which many studies proposed will influence serum vitamin D [25(OH)D]. The objective of the present study was to determine which anthropometric measurements were determinants of 25(OH)D levels in elderly. Methods A cross-sectional study was conducted involving 126 elderly (>60 years old) men and women at Pusat Santunan Dalam Keluarga (PUSAKA) Central Jakarta centers. Anthropometric measurements [body mass index (BMI), skeletal muscle mass (SMM), body fat (BF), and waist circumference (WC)] were determined by bioelectrical impedance analysis using the Omron body composition monitor with scales (HBF-375, Omron, Japan). Fasting blood samples were taken to measure 25(OH)D level by electrochemiluminescence immunoassay. Multivariate linear regression was used to analyze the data. Results The data showed that BMI, BF, and WC were higher than recommended, while SMM and serum 25(OH)D were lower. When the analysis was done based on sex, there were significant differences in BF, SMM, WHtR, and serum 25(OH)D. In the linear regression multivariate analysis of log 25(OH)D with age and body anthropometric measurements, only SMM reached significance level (ß=0.019; p=0.025). Conclusions This study demonstrated a positive association between skeletal muscle mass and serum levels of vitamin D in elderly.

Antibiotic is one of the hallmarks of modern medicine. Antibiotics have saved many lives that was unthinkable prior to the discovery of antibiotic. Yet, antibiotic use is associated with the danger of resistance of bacteria. Resistance of bacteria to antibiotics means simply that antibiotics cannot be used to treat infection, that a simple skin and soft tissue infection may lead to death. Already in 1945, when Alexander Flemming received his Nobel Prize in 1945 for his part in the discovery of penicillin, he delivered a speech where he warned about this danger 1. In his speech, he mentioned the problem of underdosage of antibiotics. As the time passed by, we know that the problem is not only related to underdosage but also to other aspects of inappropriate use of antibiotics such as unnecessary use (for example when the infection is due to a virus), and extended duration of antibiotics

Background Macular hole surgery can be done under general or local anesthesia, and general anesthesia is still the standard procedure. The objective of this study was to investigate the results of macular hole surgery under local anesthesia. Methods A retrospective study on medical records of patients who had undergone macular hole surgery under local anesthesia. Funduscopic examination of macular hole had been performed and all other diseases with deterioration of visual acuity eliminated. Surgery was performed under retrobulbar local anesthesia, using 2 ml of 2% lidocaine mixed with 3 ml bupivacaine in one syringe. Vitreous tamponade used 20% sulfur hexafluoride (SF6). Demographic and clinical characteristics, visual acuity before and after surgery, and improvements that occurred were assessed. Results No significant interruption occurred during surgery. Mean age of the patients was 53.89 ± 13.3 years (22-74 years), with mean duration of symptoms of 48.83 ± 100.51 weeks (1-560 weeks). The patients comprised 20 males (55.6%) and 16 females (44.4 5). There were improvements in visual acuity after surgery in 31 patients (86.1%), the rest (13.9%) had identical or lower visual acuity after surgery. A total of 20 patients (55.6%) had postoperative visual acuity of 6/18 or better. Initial mean preoperative visual acuity was 0.08 ± 0.08 (0.01 - 0.29) and improved after the surgery to 0.38 ± 0.26 (0.00 - 1.00), the improvement being statistically significant (p=0.000). Conclusion Retrobulbar anesthesia is an effective and safe method in macular hole surgery. Macular hole surgery can be done well under local anesthesia, and visual acuity improved significantly.