EFFICACY OF ORAL GLUTATHIONE ADDITION IN LUTEIN SUPPLEMENTATION ON CONTRAST SENSITIVITY IMPROVEMENT IN DRY AGE-RELATED MACULAR DEGENERATION: A RANDOMIZED CONTROLLED TRIAL

Objective: Age-related macular degeneration (ARMD) is the macular abnormality causing central vision loss in the elderly. One prevention for ARMD is the provision of antioxidants, such as lutein. Reduced form of glutathione (GSH) is a source of cysteine and sulfhydryl, playing a role in detoxification, transport, and metabolic processes. Both are prospected to have a synergistic effect in the prevention of ARMD. This study aimed to determine the efficacy of GSH addition in lutein supplementation to improve the contrast sensitivity of dry type ARMD patients. Methods: This randomized controlled trial was conducted at an eye hospital and a tertiary general hospital from April 2016 to June 2016. This study involved 22 dry ARMD patients. Subjects were randomized and divided into treatment groups with 20 mg lutein with the addition of 500 mg GSH and 20 mg lutein only, for 30 days. Contrast sensitivity measurement was performed with Lea Numbers® Low Contrast Flip Chart before and after the treatment. Contrast sensitivity was analyzed comparatively with paired t-test. Results: Contrast sensitivity improvement was observed in both the groups. Contrast sensitivity improvement of the group with additional GSH (3.62±1.44, p<0.05) was a 3-fold of the lutein group only (1.25±0.44, p>0.05). The result was statistically significant for the group treated with GSH addition. Conclusion: GSH addition in lutein supplementation provoked better contrast sensitivity improvement in dry ARMD patients

Kemajuan Visus Penderita Retinopati Diabetik yang Diterapi dengan Laser Fotokoagulasi dan atau Injeksi Intravitreal di Rumah Sakit Mohammad Hoesin Palembang

Retinopati diabetes adalah kelainan retina yang ditemukan pada penderita diabetes melitus. Insiden retinopati diabetik mencapai 40-50% penderita diabetes dan prognosisnya yang kurang baik terutama bagi tajam penglihatan. Penelitian ini bertujuan untuk mengetahui kemajuan visus penderita retinopati diabetik berdasarkan penatalaksanaan dengan laser fotokoagulasi dan atau injeksi intravitreal anti VEGF. Penelitian ini adalah penelitian deskriptif observasional. Penelitian dilaksanakan di Bagian Mata RSUP Dr. Mohammad Hoesin Palembang dengan data yang berasal dari Bagian Rekam Medik Rawat Jalan periode Januari 2012 sampai Juni 2014. Dari 155 arsip pasien retinopati diabetik diperoleh 43 penderita retinopati diabetik yang memenuhi kriteria. Perempuan adalah kelompok yang paling banyak menderita retinopati diabetik 62,8%. Kelompok usia yang paling banyak menderita retinopati diabetik adalah 46-58 tahun (69,8%). Pasien terbanyak didiagnosis dengan PDR (64,3%). Penderita banyak dilakukan tindakan injeksi intravitreal anti VEGF meskipun persentase kemajuan visus lebih besar pada tindakan laser fotokoagulasi

CORRELATIONS OF DEOXYRIBONUCLEIC ACID METHYLATION, HISTONE ACETYLATION, AND MICRORNA‑320 WITH SORBITOL DEHYDROGENASE IN DIABETIC RETINOPATHY

Objective: Prolonged and persistent hyperglycemia in diabetes mellitus (DM) leads to a variety of vascular complications, including the retinal disorder of diabetic retinopathy (DR). The mechanism of fructose formation of sorbitol assisted by sorbitol dehydrogenase (SDH) causing the loss of pericytes in the blood vessel is affected by epigenetic work comprised of deoxyribonucleic acid (DNA) methylation, histone acetylation, and microRNA‑320. This study aimed to determine the correlation of DNA methylation, histone acetylation, and microRNA‑320 with SDH in DR. Methods: This case–control study was conducted at a tertiary general hospital from July 2014 to June 2016. Study subjects were type 2 DM patients with and without DR, over 40 years old, suffered from DM for > 10 years. DNA methylation, histone acetylation, and microRNA‑320 were examined by real‑time quantitative polymerase chain reaction, while SDH level examination was carried out by enzyme‑linked immunosorbent assay. Analyses were performed with independent t‑test, Mann–Whitney, Spearman correlation, and multiple linear regression. Results: With respect to SDH, DNA methylation showed no significant correlation so as histone acetylation, in contrary to microRNA‑320 with a very strong negative correlation (r=−0.968, P < 0.005). Conclusion: MicroRNA‑320 was correlated to SDH in a manner of protective properties against the occurrence of DR. Involvement of DNA methylation and histone acetylation was perceptible in influencing SDH enzyme despite their insignificance if they took place individually

Anti-receptor Advanced Glycation End Products Decreases Inflammatory Pathways in Retinopathy Diabetics: In vivo Study

BACKGROUND: Diabetic retinopathy is an emerging microvascular complication of diabetes mellitus and a causes of blindness in individuals between ages 30 and 70 years, which is characterized by increased proliferation of blood vessels, vascular occlusion, angiogenesis, loss of pericytes from retinal capillaries, microaneurysms, retinal bleeding, increased retinal capillary permeability, thickening of capillary basal membranes, and infarcts that affect the retina, induced to permanent blindness. AIM: This study aimed to find the role of receptor advanced glycation end products (RAGE) inhibition in lowering the vascularization process which causes a decrease in retinal function on diabetic retinopathy. MATERIALS AND METHODS: This research was an in vivo experimental study. A total of 30 male Wistar rats (200 ± 20 g) were obtained from Eureka Research Laboratory (Palembang, Indonesia). Experimental animals were placed in cages under controlled conditions (12 h of light/dark cycles with temperatures of 22 ± 1°C and humidity of 40–60%), fed and drank ad libitum. White rats were induced by diabetes mellitus using alloxan at a dose of 120 mg/kgBW, intraperitoneally, accompanied by drinking 10% glucose solution for 140 days. Furthermore, experimental animals were grouped into five groups (at eight animals per group), Group 1: Normal control, Group 2: Negative control (induced diabetics retinopathy and given intravenous aquadest), Group 3: Given anti-RAGE 1 ng/mL, Group 4: Given anti-RAGE 10 ng/mL, and Group 5: Given anti-RAGE 100 ng/mL. Giving anti-RAGE was done in a single dosage and intravitreal. After the rats were sacrificed by intraperitoneal injection of 10% chloral hydrate, the evacuation of the eye’s retinal tissue was then carried out, fixed in a 4% paraformaldehyde buffer for immunohistochemistry examination of the eye’s retinal tissue. Evaluation of the expression of nuclear factor-κβ (NF-kB) and intercellular adhesion molecule-1 (ICAM-1) used Image J Software so that the percentage of NF-kB and ICAM-1 expression would be obtained. RESULTS: Negative control group showed an increase in NF-kB expression in the retinal tissue of diabetic retinopathy rats. Administration of anti-RAGE showed its potential to suppress NF-kB expression in retinal tissue of diabetic retinopathy white rats as well with an increase of anti-RAGE dose from 1 ng/mL to 100 ng/mL. Activation of NF-kB causes activation of the inflammatory cascade, which is characterized by the production of pro-inflammatory cytokines, one of which is ICAM-1. Giving anti-RAGE could suppress the expression of ICAM-1 along with an increase in anti-RAGE dose. CONCLUSION: Anti-RAGE is able to block the inflammatory process, by inhibiting the expression of NF-kB and ICAM-1 in the retinal tissue of diabetics retinopathy in white rats

Penilaian Sensitivitas Makula pada Pasien Diabetes Melitus dengan MetodePhototest Recovery TIME Test

Angka kejadian diabetes melitus di Indonesia semakin meningkat tiap tahunnya sehingga angka mortalitas akibat komplikasi diabetes melitus pun meningkat. Salah satu komplikasi dari diabetes melitus (DM) adalah makulopati diabetes. Pada makulopati diabetes akan terjadi penurunan sensitivitas makula. Penurunan sensitivitas makula dapat dinilai dengan menggunakan metode photostress recovery time test. Tujuan dari penelitian ini adalah untuk menilai rata-rata photostress recovery time (PRT) pada pasien DM. Penelitian ini merupakan studi potong lintang yang dilakukan pada pasien DM di RSUP Moh. Hoesin Palembang pada bulan September sampai Desember 2013. Besar subjek penelitian yang didapat adalah 24 orang pasien DM, yang terdiri dari 9 orang laki-laki dan 15 orang perempuan dengan jumlah mata yang diteliti sebanyak 48 mata. Rata-rata PRT pada pasien DM dengan retinopati diabetes adalah 50 detik (SD ±18,318). Rata-rata PRT pada pasien dengan makulopati diabetes adalah 60,83 detik (SD ± 19,783). Kedua mata yang mengalami retinopati diabetes maupun makulopati diabetes memiliki nilai PRT yang lebih panjang dibandingkan dengan pasien DM tanpa retinopati diabetes maupun makulopati diabetes

Karakteristik Klinis Pasien Retinopati Diabetik Periode 1 Januari 2014–31 Desember 2015 di RSUP Dr. Mohammad Hoesin Palembang

Retinopati diabetik merupakan suatu komplikasi kronik DM karena mikroangiopati vaskular retina, terkadang tanpa gejala, namun dapat menyebabkan kebutaan pada orang dewasa. Faktor risiko yang sangat berperan dalam kejadian retinopati diabetik yaitu lama menderita diabetes, peningkatan kadar HbA1c, peningkatan tekanan darah sistolik, dan peningkatan kadar profil lipid. Penelitian ini bertujuan untuk mengetahui karakteristik pasien retinopati diabetik di RSUP Dr. Mohammad Hoesin Palembang. Penelitian ini merupakan penelitian deskriptif observasional dengan menggunakan data sekunder. Variabel yang diteliti yaitu usia, jenis kelamin, tekanan darah, GDS, HbA1c, total kolesterol, HDL, LDL dan trigliserid. Sampel yang diambil adalah rekam medik seluruh pasien DM yang didiagnosa retinopati diabetik yang dirawat di RSUP Dr. Mohammad Hoesin Palembang pada periode 1 Januari 2014–31 Desember 2015. Dari 75 pasien yang diteliti, didapatkan paling banyak (82.7%) pada kelompok usia 45-64 tahun. Mayoritas adalah perempuan (64%). Distribusi retinopati diabetik berdasarkan tekanan darah terbanyak adalah prehipertensi (33.3%). Dari 70 pasien, mayoritas adalah (58.7%) dengan kadar GDS ?200 gr/dl. Dari 34 pasien yang data HbA1c ada, yang paling banyak (25.3%) memiliki kadar >8%. Dari 43 pasien retinopati diabetik berdasarkan kadar total kolesterol terbanyak (30.7%) dengan kadar ?240. Pasien retinopati diabetik paling banyak (16%) memiliki LDL >190. Responden yang data trigliserid ada, paling banyak (29.3%) dengan kadar <150. Dari 42 pasien retinopati diabetik paling dominan (32%) memiliki kadar HDL 41-59. Faktor risiko paling banyak ditemui adalah perempuan dengan kelompok usia 45-64 tahun, pasien dengan keadaan prehipertensi, kendali gula darah yang buruk, serta keadaan dislipidemia

Utilization of unmanned aerial vehicle (UAV) in dam disaster management: evacuation planning

With the increase of world population and eventually the increase in populated areas at disaster prone areas, a disaster that previously would have been low in risk, is getting more catastrophic each year. Various counter measures are being undertaken to ensure that the impact of a disaster is being well mitigated to ensure the safety and sustainability of the population at risk. This paper will be looking at more depth on the use of Unmanned Aerial Vehicle (UAV) in emergency preparedness, particularly towards the identification effective evacuation routes, in order for the targeted population to safely reach the identified safe haven

Broad targeting of resistance to apoptosis in cancer

Apoptosis or programmed cell death is natural way of removing aged cells from the body. Most of the anti-cancer therapies trigger apoptosis induction and related cell death networks to eliminate malignant cells. However, in cancer, de-regulated apoptotic signaling, particularly the activation of an anti-apoptotic systems, allows cancer cells to escape this program leading to uncontrolled proliferation resulting in tumor survival, therapeutic resistance and recurrence of cancer. This resistance is a complicated phenomenon that emanates from the interactions of various molecules and signaling pathways. In this comprehensive review we discuss the various factors contributing to apoptosis resistance in cancers. The key resistance targets that are discussed include (1) Bcl-2 and Mcl-1 proteins; (2) autophagy processes; (3) necrosis and necroptosis; (4) heat shock protein signaling; (5) the proteasome pathway; (6) epigenetic mechanisms; and (7) aberrant nuclear export signaling. The shortcomings of current therapeutic modalities are highlighted and a broad spectrum strategy using approaches including (a) gossypol; (b) epigallocatechin-3-gallate; (c) UMI-77 (d) triptolide and (e) selinexor that can be used to overcome cell death resistance is presented. This review provides a roadmap for the design of successful anti-cancer strategies that overcome resistance to apoptosis for better therapeutic outcome in patients with cancer

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112