Introduction: Organ involvement may influence the severity of systemic lupus erythematosus (SLE). Ultrasound (US) can detect organs morphological changes in SLE patients. Lack of data about US-detected lupus organs involvement triggered a research that explored the US findings of nephritis, hepatic steatosis, and knee joint effusion in Balinese women with SLE. Method: This was an analytical cross sectional study to discover the prevalence of US-detected nephritis, hepatic steatosis, and knee joint effusion in Balinese women with SLE, and determined their association with clinical and laboratory findings. Anamnesis, physical, laboratory and US examination were performed. Correlations between clinical and laboratory results with US findings were tested using Spearman’s correlation, linear regression and binary logistic regression tests (α = 0.05). Result: From 57 subjects, US nephritis was determined in 19 (33%) subjects, hepatic steatosis in 31 (54.5%) subjects, right knee joint effusion in 12 (21.1%) subjects, and left knee joint effusion in 14 (24.6%) subjects. No significant correlation between dyslipidemia and hepatic steatosis (p>0.05), but significant correlations between knee pain and knee joint effusion (p<0.001), between decreased of renal function with right and left nephritis (p<0.05) were noted. After adjusted with laboratory indicators, only the right nephritis showed significant association with decreased of renal function (p<0.05). Conclusion: Nephritis, hepatic steatosis, and knee joint effusion were identified in Balinese women SLE patients using US. Some clinical and laboratory indicators had a significant correlation with knee joint effusion and nephritis, but most of the laboratory parameters demonstrated no significant association with hepatic steatosis.

Introduction: Organ involvement may influence the severity of systemic lupus erythematosus (SLE). Ultrasound (US) can detect organs morphological changes in SLE patients. Lack of data about US-detected lupus organs involvement triggered a research that explored the US findings of nephritis, hepatic steatosis, and knee joint effusion in Balinese women with SLE. Method: This was an analytical cross sectional study to discover the prevalence of US-detected nephritis, hepatic steatosis, and knee joint effusion in Balinese women with SLE, and determined their association with clinical and laboratory findings. Anamnesis, physical, laboratory and US examination were performed. Correlations between clinical and laboratory results with US findings were tested using Spearman’s correlation, linear regression and binary logistic regression tests (α = 0.05). Result: From 57 subjects, US nephritis was determined in 19 (33%) subjects, hepatic steatosis in 31 (54.5%) subjects, right knee joint effusion in 12 (21.1%) subjects, and left knee joint effusion in 14 (24.6%) subjects. No significant correlation between dyslipidemia and hepatic steatosis (p>0.05), but significant correlations between knee pain and knee joint effusion (p<0.001), between decreased of renal function with right and left nephritis (p<0.05) were noted. After adjusted with laboratory indicators, only the right nephritis showed significant association with decreased of renal function (p<0.05). Conclusion: Nephritis, hepatic steatosis, and knee joint effusion were identified in Balinese women SLE patients using US. Some clinical and laboratory indicators had a significant correlation with knee joint effusion and nephritis, but most of the laboratory parameters demonstrated no significant association with hepatic steatosis.

Recalcitrant regeneration is one of the bottlenecks for plant improvement, especially in monocotyledonous species. In this research, plantlet regeneration of a native rice cultivar Oryza sativa ‘Barak Cenana’, high-value local Balinese red rice was successfully demonstrated. Compact nodular calli were induced from excised seed-derived mature embryos of ‘Barak Cenana’ rice. Although 2,4-D was necessary for callus induction, a combination of 2,4-D in regeneration medium caused reduction of green spot and shoot meristemoid differentiation. Root differentiation was firstly regenerated where meristematic shoots were thereafter developed from calli. The highest number of shoot regeneration regenerated from green spots and numbers of plantlet with complete shoot/root development were observed when transferred calli to Murashige and Skoog (MS) medium containing 5 mgL-1. Multiple shoot formation of regenerated plantlets revealed for efficient regeneration system, which was firstly reported in this present study and will potentially serve for plant improvement of this native rice, Barak Cenana. 

Background: Spinal cord injury (SCI) is the cause of severe neurological disability, and no satisfactory treatment is currently available. Evidence suggests that omega-3 polyunsaturated fatty acid (PUFA)  could target some of the pathological mechanisms that underlie damage after SCI. In parallel, promising effect of alpha-tocopherol (vitamin E) also shown as a potent antioxidant to prevent lipid peroxidation on SCI. Therefore, we aim to investigate the combined effect of omega-3 PUFA and vitamin E supplementation in improving motor function of weight dropped induced SCI in rats. Methods: Twenty-five rats randomly divided into the five groups. SCI was induced in the rats by using a weight dropped model around T9-T11 vertebra level. Omega-3 PUFA and vitamin E was administered orally on each day for two weeks of treatment. The sham group underwent laminectomy without spinal cord compression and treatment. Motor function was measured at the 1st, 7th and 14th day. Results: We found the significant difference of motoric function between omega-3 PUFA group and combination treatment group compared to the control (p<0,05). The highest BBB score on the first week was found in combination treatment group (mean 16±2.3), but no significant difference was found compared to the omega-3 PUFA group. On the subsequent week, combination treatment was showing marked improvement compared to the omega-3 PUFA group (p<0,05). Conclusion: These finding had demonstrated the effect of Omega-3 PUFA as a neuroprotective agent to prevent the secondary injury in SCI-induced rats. The combination of omega-3 PUFA with vitamin E improves its efficacy to become a promising novel therapy for SCI.

Introduction: cancer is still a health problem worldwide. Cervical cancer is the second most common cancer in women in developing countries. High-risk Human Papillomavirus (HPV) is well recognized as the causative agent of cervical cancer. Squamous cell carcinoma and adenocarcinoma are the most and the second most common histopathological type. HPV genotypes probably correlate to histopathological type. This study aims to prove that infection by HPV-18 gives a greater risk for the occurrence of cervical adenocarcinoma compared with infection by other high-risk HPV types. Methods: This study was case control study that used adenocarcinoma with HPV-18 positive patients as the case group and adenocarcinoma with positive with other high-risk HPV types as the control group. Histopathological diagnosis performed on H & E stain. Genotyping of HPV used SPF-10 and specific E7-primer by LiPA. Bivariate analysis was employed to calculate odds ratios (ORs) and Pearson’s X² test was applied. Result: Total number of adenocarcinoma observed in this study were 42 patients, consisted of 12 cases and 30 controls. The most prevalence adenocarcinoma occurred in the age group 41-50 years. The risk of adenocarcinoma in patients with HPV-18 infection was 2.88 fold compared with infection by other high-risk HPV types (95% CI = 1.12-7.38; p = 0.024). Conclusion: HPV-18 infection caused cervical adenocarcinoma is 3.0 more than other high-risk HPV types

Background: Today is an era of personalized medicine where treatment is tailored and personalized according to patient status. Assessment of K-ras mutation is one of the routine molecular examination in colorectal carcinoma, and the result will determine the treatment decision particularly, avoidance of using anti-EGFR in such patients. This study was a preliminary research to determine the profile of K-RAS mutation in colorectal carcinoma in Bali. Methods: Formalin-fixed paraffin embedded tissue of 23 colorectal carcinoma patients in Sanglah Hospital which admitted in 2016 were collected from Anatomical Pathology Department and sent to Laboratory of Molecular Pathology of Dr. Cipto Mangunkusumo Hospital and Kalgen for K-RAS mutation examination. All of H-E slides were examined, and the specimen with well-preserved tumor cells were selected. The PCR was performed to determine K-RAS mutational status.  Result: From 23 samples, 70% was male, and 30% was female with a mean age 48.3 years. Fourteen cases (60.9%) had K-ras mutation (9 cases with codon 12 mutation, 4 cases with codon 13 mutation, 1 case with codon 59 mutation and 1 case with codon 117 mutation). Conclusion: It is found that K-RAS mutation was quite common in colorectal carcinoma in Bali with two most common mutations observed in codon 12 and 13. 

Background: Cervical cancer is one of the most common gynecological malignancies worldwide including Indonesia which leads to high morbidity and mortality rate. Cisplatin is the first line chemotherapy for treating cervical cancer, but its use is limited because of serious side effects. Our previous study showed that metformin enhanced the anti-proliferative effect of cisplatin in cervical cancer cell line (HeLa). This study aimed to investigate whether or not HeLa cells treated with metformin and cisplatin enhances cell apoptosis. Methods: HeLa cells were cultured with DMEM medium for 24 hours and then treated with either 60 mM metformin, 40 µM cisplatin, a combination of 30 mM metformin and 6.25 µM cisplatin or 7.5 mM metformin and 12.5 µM cisplatin for 48 hours. Apoptotic and necrotic cells were measured using flow cytometer. Data were analyzed using Kruskal-Wallis test, and the significant value was set up at p < 0.05.  Results: As compared to control group, HeLa cells treated with 30 mM metformin and 6.25 µM cisplatin had higher apoptosis than cells treated with 7.5 mM metformin and 12.5 µM cisplatin. However, apoptosis induction by metformin and cisplatin combination was much lower than that of 60 mM metformin or 40 µM cisplatin alone. Conclusion: In conclusion, administration of 30 mM metformin and 6.25 µM cisplatin induces higher apoptosis than that of 7.5 mM metformin and 12.5 µM cisplatin in HeLa cells.

Background. Obesity fuelled an epidemic of type 2 diabetes mellitus, globally. Controlling pre diabetic state in an obese person is important to prevent the type 2 diabetes. PUFAs (n-6 and n-3) have a role in controlling insulin resistance. The aim is to elucidate the effect of the linoleic acid (LA) and alfa linolenic acid (ALA) supplementation to fasting plasma glucose in young women obese patients. Material and Method. In totally, 45 young obese women in Denpasar Bali, randomized into two group; 22 participants were supplemented with 2000mg and 1000mg of LA and ALA (Intervention), and 23 participants were given placebo (Control), for 12 weeks. Both groups were recommended to restrict their daily energy intake <1500 kcal, during the study. The data namely; dietary, anthropometric, blood triglyceride, plasma fasting glucose was assessed at baseline and end-line of study. Results. Both groups restricted their energy intake less than 1500 kcal in the end line assessment. All of the body fat parameters (BMI, triglycerides, waist circumference, conicity index, waist to height ratio, and lipid accumulation product; p=0.003, p=0.049, p<0.001, p=0.002, p=0.001, and p= 0.001, respectively) decreased in the Intervention group. However, only the conicity index decreased (p=0.025) in the Control group. In the Intervention group no significant change in fasting plasma glucose, contrary it increased (p=0.007) in the Control group. The impaired plasma glucose increased in the Control group (OR=8, p=0.039), but not in the Intervention group (p=0.508). Conclusion. Restriction energy intake with supplementation 2000mg and 1000mg of LA and ALA control pre diabetes of young obese women.

Backgrounds: Flavonoids prevent cholesterol rising in blood and has antioxidant effects. The purpose of this study is to prove the hypolipidemic and antioxidant effect of purple sweet potato tuber extract with the natural honey combination, which contains flavonoids. Methods: this is an experimental study using randomized pre-post-test control group design. The total of 28 adult male Wistar rats, were divided into four groups. During the four weeks of treatment, Group 1 was given high-cholesterol feed. Group 2 were given high-cholesterol feed and water extract of purple sweet potato tubers 200 mg/day. Group 3 were given high-cholesterol feed and natural honey three cc/day. Group 4 were given high-cholesterol feed and water extract combination of purple sweet potato tuber with natural honey. Before the treatment, lipid profiles, malondialdehyde (MDA), and superoxide dismutase (SOD) were examined as a pre-test data. After the treatment, the blood was examined again as the pre-test data. Results and conclusion: the obtained data were tested using t-test and ANOVA. The results showed a significant increase in total cholesterol, LDL, and MDA in the blood (p <0.05), and significantly decrease HDL in group 1 (p <0.05). In group 2, 3, and four there was no significant difference in these parameters (p> 0.05), but significantly different with group 1 (p <0.05). In conclusion, the combination of water extract of purple sweet potato tuber with honey can maintain lipid profile and MDA in the normal range, in rats with high cholesterol feed.

Avian Influenza (AI) is a zoonotic disease caused by influenza virus A of the family Orthomyxoviridae. The Avian Influenza virus infects various birds and mammals, including humans. Multi species live animal markets, as a meeting places for human, birds, mammals, and reptiles, can potentially transmit the AI virus from animals to humans.  The purpose of this study was to detect the presence of Avian Influenza virus by the detection of Matrix and H5 genes from various bird species sold in a multi species live animal market in Jakarta using real-time Reverse Transcriptase-Polymerase Chain Reaction (rRT-PCR). 862 field samples from 28 families and 96 bird species were collected using a cross-sectional sampling technique. These field samples consisted of 649 fecal samples, 114 cloacal swab samples, and 99 tracheal swab samples. The samples were pooled based on the type of sample and kiosk where the samples were collected. The presence of AI virus was screened using rRT-PCR targeting the matrix gene, followed by further test targeting the H5 gene for AI virus subtyping. Positive AI samples were only detected in 7 out of 649 fecal samples (1.08%); however, all of them were not H5 AI virus. Positive AI samples were detected in four bird species, which were three magpie-robins (Copsychussaularis, family Turdidae), two white-eyes (Zosteropspalpebrosus, family Zostropidae), a Yellow-vented bulbul (Pycnonotusgoiavier, family Pycnotidae), and a robin (Leiothrixlutea, family Sylviidae).

Background: Under normal physiological conditions, the glucose uptake into the cell is regulated by glucose transporter (GLUT4) which is stimulated by insulin to be afterward metabolized into energy and/ or stored as glycogen. The research aimed to determine the expression of glucose transporter (GLUT4), glycogen levels on cells liver and muscle tissues in hyperglycemic and normoglycemic conditions on rats.

Method: A total of 20 rats of Spraque Dawley strain were grouped into two treatment groups. The normal group and the hyperglycemia group. The observations were performed on blood glucose level by glucose oxidase biosensor method by using the Blood Glucose Test Meter of GlucoDrÔ, liver and muscle glycogen levels by spectrophotometry and GLUT4 analysis on cells of liver and muscles tissues by using the immunohistochemical technique.

Results: The results showed that 80% of sucrose administration had caused hyperglycemic rats with the blood glucose levels of 131.2 g/dl.  In hyperglycemic conditions, the levels of liver glycogen (9.4 mg/mg) and muscle (8.68 mg/ mg)  were significantly higher (P <0.05) than in the liver (8.54 mg / mg) and muscle (7.87 mg /mg) in normoglycemic. Meanwhile, the liver glycogen levels were significantly higher (P <0.05) when compared with the muscle glycogen levels in both hyperglycemic and normoglycemic conditions. The expression of GLUT4 in hyperglycemia was significantly higher (P <0.05) in both liver (64.05%) and muscle (56.15%) when compared with the liver (53.21%) and the muscle (48.67% ) in normoglycemic. Between the liver and muscle tissues, the expression of GLUT4 was significantly higher (P <0.05) in the liver when compared with muscle tissue in both hyperglycemic and normoglycemic conditions.

Conclusion: Expression of GLUT4 and levels of glycogen in the hyperglycemic liver is higher compared to the muscles.

Background: Currently, breast cancer is one of the most common cancers among women, surpassing only by cervical cancer. Despite the improvement in terms of survivability as well as prognosis, most patients are coming with advanced disease at the time of diagnosis. Unlike early disease, determining the outcome of advanced disease is still challenging. Initial investigation showed that polymorphism within caveolin-1 gene could also contribute in determining risk as well as prognosis. In our initial study, we investigated the prevalence of two oncogenic polymorphism of Caveolin-1: SNP CAV1 G14713A and T29107A. Method: The samples were obtained by consecutive sampling in Sanglah Hospital from January 2016 to December 2016. The blood samples were collected in EDTA tube and the DNA was isolated using Promega Kyt. Subsequent PCR was conducted to amplify the gene which then sequenced in Genetika Science. Result: We enrolled 43 samples with complete medical records in our analysis. The mean age in our sample was 49.11±10.33 years and mostly stadium III cancer (39.7%) and poorly differentiated. 68% of our sample were luminal types and the rests were HER2 and TNBC with comparable proportion. We only detect one heterozygous sample for G14713A polymorphism in which the patient had Luminal A type but with high Ki67 and poorly differentiated. For T29107A, we detect two heterozygous individuals and one homozygous individual, all with the same characteristics with G14713A. Conclusion: The prevalence of SNP CAV1 G14713A and T29107A were considerably low in breast cancer population in Bali. However, the characteristic of the samples with the polymorphism suggest that further investigation is needed to confirm their effect in brest cancer morphology.

Background: Citrus plantation has the main disease called citrus greening disease or Huanglongbing or Citrus Vein Phloem Degeneration (CVPD) which in Indonesia is widely known as CVPD disease. The disease caused by Gram negative bacteria called Liberobacter asiaticus. The disease symptom is very similar to plant deficiency of nutrients and can be confirmed by using polymerase chain reaction (PCR).

Objective: This study tried to find the nutrients deficiency, quality of the fruits, and to detect the presence of the pathogenic bacteria, L. asiaticus.

Methods: In the study of nutrients deficiency was done by using AAS technique, while the study of the healthy and consumable fruits was assessed by using AAS and HPLC techniques.  Detection of L. asiaticus we used the PCR method.  

Results:  The results of this study showed that all citrus plants showing the nutrients deficiency were infected by the pathogenic bacteria. Nutrient deficiency of citrus plants was found to be deficient in Fe, Mn, Mg, or Zn and the quality of the fruits, therefore, were physically small and lack of vitamin C and antioxidants.

Conclusion: The results indicated that there is a correlation between the citrus plant’s infected by L. asiaticus caused nutrients deficiency and lead to the quality of the fruits that we consume. 

 

Background: All diabetic patients have 15-20% risk of foot ulcer during a lifetime. Approximately 70% diabetic ulcers heal within five years. However, the healing is often slow, and the ulcer may become a chronic wound. Proper treatment can improve the healing process. It includes autolytic debridement. It is a process in which the body removes the necrotic tissue. Case: A female, 45-year-old complained wound on her right foot since 1.5 months ago. The wound did not heal and became larger with bad odor and pus. She had type 2 diabetes mellitus since five years ago with uncontrolled blood sugar. We performed surgical debridement to extend the wound and to drain the pus. We used a combination of hydrogel and hydrocellular foam to treat h wound. Conclusion: The overall performance of a combination of hydrogel and hydrocellular foam was shown to have clinical advantages such as autolytic debridement. We observed an increase of wound granulation and epithelialization and a decrease of slough and exudates. 

Background: Dengue Hemorrhagic Fever (DHF) is a main health problem in Indonesia, particularly in Bali. World Health Organization (WHO) reported Indonesia as the major contributor of DHF cases in the Southeast Asia and according to Indonesia national statistic report in 2010, Bali was the province with the highest incidence of DHF in Indonesia.

Case presentation: A 28 years old woman gravida 2 (para 0, abortus 1) at near term (35 weeks 2 days) gestational age, with threatened preterm delivery and premature rupture of membrane was admitted to Sanglah Hospital due to high probability of dengue infection (fever day 6) with warning signs (hemoconcentration) and thrombocytopenia (23,000/mm³). The dengue specific IgM and IgG antibodies were positive on the seventh day. On the progress, although the number of the platelet count tended to increase (WBC:9.99/mm³; Hb:14,3g/dL; Hct:44.6%; Plt:49,2x10³/mm³), the patient developed antepartum haemorrhage due to placental abruption grade 2, and decided to have the Cesarean Section (CS) code green. No other maternal complications found, including bleeding from the surgical wound.

A preterm (35-36 weeks) baby was born with birthweight of 2500 gram and moderate asphyxia. On the second day, the baby’s serial blood counts showed a gradual rise in the haematocrit (>20% of baseline value) and a decline in platelet counts. DENV-4 dengue was detected in the infant’s blood (serum) on first day care using the polymerase chain reaction (PCR). The baby’s dengue NS1 antigen and the dengue specific IgG antibodies was positive on first day care while the dengue specific IgM was positive on the seventh day.

            Mother was discharged on the third day post operative, while the baby was discharged on the 10th day, in a good condition.

Conclusion: Symptomatic dengue infection during pregnancy increase the risk of preterm labor, bleeding, and low birthweight newborn. Secondary dengue infection are likely to have severe symptoms than the primary dengue infection. The vertical transmission of Dengue infection is rarely reported and the mechanism of transmission of the infection in the peripartum period remains unclear.