The Effect of Vitamin E on Oral Mucositis Induced by Chemotherapy in Non-Hodgkin Lymphoma Patients Receiving Chemotherapy

Chemotherapy-induced mucositis is a side effect of chemotherapy that often occurs in patients with solid tumors and lymphoma. Oral mucositis can affect nutritional status and the risk of infection, both local and systemic. Antioxidant Vitamin E is beneficial for the prevention and therapy of both oral and gastrointestinal mucositis. Aim: To determine the effect of vitamin E therapy on the incidence of oral mucositis in non-Hodgkin lymphoma (NHL) patients receiving chemotherapy. Methods: This is a single-blind experimental study in 62 NHL patients undergoing chemotherapy who meet the inclusion criteria. Patients who met the inclusion criteria were randomly divided into 2 groups, namely 31 patients (treatment group) received vitamin E 400 mg / IU per day for 7 days and 31 patients in the placebo group. The incidence and grade of oral mucositis were observed on day 7. Statistical analysis used Chi-Square and Mann Whitney test according to the data type. Results: a total of 67% NHL patients were male, most of whom were over 46 years of age and as many as 50% of patients used chemotherapy regimens RCHOP and CHOP. There was an incidence of oral mucositis in 35% in the placebo group and 12.9% in the treated group (p = 0.038). In the placebo group, there were 4.8% of patients with grade 2 and 3 oral mucositis, which was not found in the therapy group. Conclusion:  treatment with vitamin E in NHL patients undergoing chemotherapy can prevent chemotherapy-induced oral mucositis and prevent its severity

Renal Artery Stenosis: Diagnostic and Management Problems

Renal artery stenosis is one common clinical problem. It has wide spectrum of pathophysiology with 3 most common clinical syndromes, ischemic nephropathy, hypertension, and cardiac destabilization syndrome. Aim: To date there was not any specific diagnostic criteria for renal artery stenosis. Method: Clinicians only used some clinical syndromes to guide the diagnostic possibility of renal artery stenosis. RADUS as one sensitive and specific diagnostic method, still had some disadvantages. Results: it gives false negative results in 10-20% of patients due to confounding factors such as operator capability, obesity, or abdominal gas distribution. CTA and MRA was excellent, but possessed some risks for the patient. Therefore, CTA was mostly recommended in patient with the planning of revascularization. Management of renal artery stenosis was still debated between optimal medical management and revascularization because the complexities of mechanisms underlying the renal artery stenosis. Because of the complicated pathophysiology of renal artery stenosis, revascularization could not entirely improve renovascular hypertension and nephropathy. Revascularization offered best results in fibromuscular dysplasia, although procedure related complication was still high. Revascularization, even though it might have high success rate in atherosclerotic renal artery stenosis, but the incidence of re-stenosis was also fairly high. Conclusion: Overall, revascularization was recommended in FMD, but should only be preserved for atherosclerotic renal artery stenosis after the failure of optimal medical management

Lean Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-Alcoholic Fatty Liver Disease (NAFLD) is a condition that can develop into advanced liver disease. The NAFLD spectrum includes simple steatosis, non-alcoholic steatohepatitis (NASH), liver fibrosis, and liver cirrhosis to hepatocellular carcinoma. One of the underlying pathophysiologies is insulin resistance found in metabolic syndrome. People with metabolic syndrome are not always obese, and NAFLD can also be found in this group, known as lean NAFLD, which has different metabolic characteristics. Metabolic characteristics of lean NAFLD include high levels of transaminases and insulin, low insulin sensitivity, low fasting glucose, low necroinflammatory activity, and liver fibrosis. Some related factors are methionine and choline deficiency, excessive acyl-coA expression, and PNPLA3 gene polymorphism. Lean NAFLD is an interesting topic to discuss because practitioners\u27 awareness of lean NAFLD is lower compared to obese patients. NAFLD is a risk factor for chronic diseases such as cardiovascular disease, kidney disease, colorectal, atrial fibrillation, and hypothyroidism, so it is essential to be recognized by clinicians. To date, there are no guidelines or recommendations that discuss specific treatments in this lean NAFLD population. Â

Fork Rib: A Rare Musculoskeletal Etiology of Chest Pain

Chest pain is a common clinical presentation in daily practice. Musculoskeletal origin is a rare etiology of chest pain, compared to a cardiorespiratory problem and often underrecognized. Fork-rib or bifid-rib is a rare anomaly which uncommonly present with clinical symptoms since in most cases fork-rib incidentally found during cadaveric dissection. Here we report a 27 years old man presenting with chest pain and radiographic examination showing bifid rib of the fifth left rib, without any abnormalities from physical examination and electrocardiography. The patient treated with intravenous painkiller and anticonvulsants. Fork-rib should be considered as a differential diagnosis for chest pain of musculoskeletal origin especially in young adults or chest pain precede with minor trauma.Â

Comparison of Diagnostic Value between Point of Care Testing (POCT) and Standardize HbA1c Testing in Primary Health Care

Diabetes Mellitus is one of the biggest health problems. HbA1c is used to diagnose, to monitor treatment and treatment adjustment. High Performance Liquid Chromatography (HPLC) and electron spray mass spectrometry are recommended to measure HbA1c. But both methods need expensive cost, facility, and potentially increase health cost burden. HbA1c measurement using Point of Care Testing (POCT) is developed in Indonesia. POCT is more comfortable, has lower cost and easily brought to primary health care. Aim: to assess the clinical efficacy of POCT compared with a standard examination by HPLC. Methods: It is a cross-sectional observational study conducted at a first-level health facility (FKTP) in Malang. The subject population was patients who went to an outpatient unit in FKTP with inclusion criteria aged 20-75 years, were participants in the chronic disease management program (PROLANIS), both diabetes and non-diabetes. Results: Three hundred and thirty eight subjects were participated in this study. Five subjects were excluded because the presence of anemia. We used Wilcoxon test to compare HbA1c level between two methods and Rank Spearman correlation test to find correlation between two methods. This study showed measurement HbA1c level using POCT method had good accuracy (>80%). Other than diagnosis value, increased utilization of POCT HbA1c might also be caused by its portability and patient’s comfort. Conclusions: This study showed a strong correlation (R=0.016) between POCT HbA1c and standardized measurement. POCT HbA1c also showed good accuracy in all HbA1c groups

Differences in Carotid Intima-Media Thickness (CIMT) In Patients With Newly Diagnosed Hypertension, and Chronic Hypertensive Patients Treated by Calcium Channel Blockers (CCB) or Angiotensin Converting Enzyme (ACE)-Inhibitors

 Hypertension is a significant risk factor for cardiovascular diseases. It closely related to the inflammatory process and resulting in chronic inflammation, which had a critical role in the progression of atherosclerosis. Carotid Intima-Media Thickness (CIMT) was known as a surrogate marker of atherosclerosis. Anti-hypertensive drugs are expected to affect CIMT. Aim: to examine the difference CIMT between newly diagnosed hypertension and chronic hypertensive treated by ACE-I or CCB. Method: this cross-sectional study was conducted on 12 newly diagnosed hypertensive patients (control or group 1), 9 hypertensive patients treated by CCB (group 2), and 9 hypertensive patients treated by ACE-I (group 3). Their hypertensive condition was controlled at least for 6 months. We compared CIMT of patients and Tumour Necrosis Factor Alfa (TNF-α) also Interleukin-6 (IL-6) among the groups. Result: there was a significant difference in CIMT between the group 1 and 2 (0.86 vs 0.70; p = 0.027), group 1 and 3 (0.86 vs 0.69; p = 0.018). There was no significant difference between group 2 and 3 (0.70 vs 0.69; p = 0.88). There was no association between CIMT and TNF-α, IL-6, Low-Density Lipoprotein (LDL), triglycerides (TGs) levels, and body mass index (BMI), systolic blood pressure. Conclusion: we found that the CIMT of the control group was thicker than those of the treatment groups. Moreover, differences in the thickness of CIMT of the three groups were not associsted with level of TNF-α, IL-6, TG, and LDL, also BMI, and systolic blood pressure

The Impact of Subchronic Soybean Milk and Genistein Supplementation on Pancreatic Fatty Infiltrations of Sprague Dawley Male Mice

Isoflavones (genistein, daidzein) on soybean milk have phytoestrogenic properties. In Asia, the blood phytoestrogen levels can reach 160 ng/ml (80 times higher than Western). This may potentially disrupt endocrine functions regarding its binding with estrogen receptors.. Since the function and distribution of adipose tissues are regulated by estrogen receptors, the reduction of estrogen receptor-α(ERα) results in ectopic fats distribution around visceral tissues, such as the pancreas. Aim: To investigate the impact of subchronic soybean milk and genistein supplementation on pancreatic fatty infiltrations in mice. Methods: The experiment used 35 Sprague dawley male mice under 7 treatment groups within 60 days: negative control with standard rationed food, 3 groups with a variable dose of soybean milk: 100 mg, 200 mg, and 400 mg, and 3 groups with a variable dose of genistein: 0.4 mg, 0.8 mg, and 1.6 mg. Histological measurements on the level of pancreatic fatty infiltrations were conducted after. Analyses used Kruskal-Wallis and post-hoc Mann-Whitney. Results: Medium to a high level of pancreatic fatty infiltrations were found at the control group while there is a decreasing trend on the level of pancreatic fatty infiltrations on groups with soybean milk and subchronic genistein compared with the control group, proportional to higher dosage supplementation. The reduction of pancreatic fatty infiltration levels on groups with soybean milk and subchronic genistein supplementation is not statistically significant compared to control. Conclusion:  Supplementation of soybean milk and subchronic genistein do not significantly reduce the levels of pancreatic fatty infiltrations in Sprague dawley male mice