Neuropathic pain in HIV patients receiving ART without stavudine in an Indonesia Referral Hospital

Lower limb neuropathic pain in HIV patients is a common manifestation of sensory neuropathy (HIV-SN), but can be seen in patients who do not meet standard definitions of HIV-SN. The drug stavudine is a risk factor for HIV-SN, but some patients treated without stavudine experience HIV-SN, and the prevalence and risk factors influencing neuropathic pain in this setting are unknown. A cross sectional study at Cipto Mangunkusumo Hospital Jakarta tested 197 HIV patients treated for >12 months without stavudine. HIV-SN was defined using the AIDS Clinical Trial Group Brief Peripheral Neuropathy Screening Test (ACTG-BPNST). A validated Indonesia translation of Douleur Neuropathique en 4 (DN4) questionnaire was used to assess lower limb neuropathic pain. Nerve conduction studies assessed large nerve fiber function and Stimulated Skin Wrinkle (SSW) tests were performed to assess small nerve fibers. The prevalence of neuropathic pain was 6.6%. BPNST + HIV-SN was diagnosed in 14.2% of the cohort and 38.5% of patients with pain. Use of protease inhibitors and ART duration <2 years associated with neuropathic pain in univariate (p =.036, p =.002, resp.) and multivariable analyses (model p <.001). SSW tests were abnormal in 53.8% of subjects with neuropathic pain and only 25.5% without pain (p =.05). Patients with pain without BPNST + HIV-SN had begun ART more recently than those with both diagnoses. Overall this preliminary study showed that neuropathic pain associated with protease inhibitors and a shorter duration of ART in Indonesian HIV patients, and may be an early symptom of small fiber neuropathy in this context

Faktor Pengaruh Gadget terhadap Kecerdasan Motorik Siswa SD melalui Regresi Logistik Ordinal

Gadget is an electronic device that has a specific function and widely used by all people, without exception for kid. Use of gadgets positively has helpful children for homework and as entertaiment. However, without realizing that overusing gadgets have a negative effect.Therefore, the research will be conducted to determine the factors affecting of using gadgets early on the development of motoric intelligence elementary students using ordinal logistic regression. Source of data used are primary data obtained from the survey, the sampling unit are all mothers who have children in grade 1 SDN Klampis Ngasem I Surabaya. The response variable (Y) is the level of intelligence of the child's motor development (1 = poor, 2 = fair, 3 = good). The results of the analysis, can be concluded that the factors that influence the development of motor 120 students of SDN Klampis Ngasem I Surabaya is long child recognize and use of gadgets every day

Modification of Materials and Thickness Layer of Radial Piercing Beamport (RPB) Reflector on Kartini Reactor for Boron Neutron Capture Therapy (BNCT)

Modification of materials and thicknesses reflector RPB of Kartini reactor has been done to support cancer therapy with BNCT method. Modifications have been investigated by computer simulation method based on software MCNP5. Neutron beam for BNCT must be fulfill the criteria recommended by International Atomic Energy Agency (IAEA), two of which are  n.cm-2.s-1 and  . Before the modification of the neutron beam done, the measurements in the end of the RPB indicate that  n.cm-2.s-1 and  . These conditions were not fulfilling the requirements of the IAEA, so that the modification of the reflector material and thickness layer of RPB should be done. Those modifications were done by varying the materials PbF2, Pb-nat, 209Bi, Ni-nat (95%) and Fe-nat. The simulation result showed if the material Ni-nat (95%) on the thickness 1.5 cm was use as a coating material reflector optimally. The results after the modification showed that  increased 7,54% with the increase amounted to n.cm-2.s-1.  decrease 21,45%, then decreasing the value of       became 1,70.  After the modification the results has not yet fulfill the criteria of the IAEA. Because of the reflector was not the only guide neutron beam. Moderator and filter have not been optimized to deliver results for files that match the criteria of the IAEA for BNCT. Therefore, in future studies modified with the addition of a neutron moderator and also filter is expected to help increasing the quantity of  and decreasing of

Ex-vivo expression of chemokine receptors on cells surrounding cutaneous nerves in patients with HIV-Associated sensory neuropathy

Objective: HIV-Associated sensory neuropathy (HIV-SN) remains common in HIV+ individuals receiving antiretroviral therapy (ART), even though neurotoxic antiretroviral drugs (e.g. stavudine) have been phased out of use. Accumulating evidence indicates that the neuropathy is immune-mediated. We hypothesize that chemokines produced locally in the skin promote migration of macrophages and T cells into the tissue, damaging cutaneous nerves causing HIV-SN. Design: We assessed chemokine receptor expression on infiltrating CD14 + and CD3 + cells around cutaneous nerves in standardized skin biopsies from HIV-SN+ patients (n = 5), HIV-SN-patients (n = 9) and healthy controls (n = 4). Methods: The AIDS Clinical Trials Group Brief Peripheral Neuropathy Screen was used to assess Indonesian HIV+ patients receiving ART without stavudine (case definition: bilateral presence of at least one symptom and at least one sign of neuropathy). Distal leg skin biopsies were stained to visualize chemokine receptors (CCR2, CCR5, CXCR3, CXCR4, CX3CR1), infiltrating CD3 + and CD14 + cells, and protein-gene-product 9.5 on nerves, using immunohistochemistry and 4-colour confocal microscopy. Results: Intraepidermal nerve fibre density was variable in patients without HIV-SN and generally lower in those with HIV-SN. CX3CR1 was more evident on CD14 + cells whereas CCR2, CCR5, CXCR3 and CXCR4 were more common on CD3 + cells. Expression of CX3CR1, CCR2 and CCR5 was more common in HIV-SN+ patients than those without HIV-SN. CXCR3 and CXCR4 were upregulated in all HIV+ patients, compared with healthy controls. Conclusion: Inflammatory macrophages expressing CX3CR1 and T cells expressing CCR2 and CCR5 may participate in peripheral nerve damage leading to HIV-SN in HIV+ patients treated without stavudine. Further characterization of these cells is warranted