ISOLATION OF ACTIVE COMPOUND FROM RED POMEGRANATE (PUNICA GRANATUM L.) SEEDS ETHANOLIC EXTRACTS

Objective: Pomegranate (Punica granatum L.) is rich in antioxidants and antibacterials, lending itself to beneficial effects on health improvement. The seeds contain a variety of active compounds. The purpose of this research was to isolate the active compound of red pomegranate seeds through ethanolic extraction. Methods: Pomegranate seeds were extracted into 24 hexane fractions of the concentrated crude extract and left in open vials until all the solvent evaporated, leaving behind crystals. Crystals in vials 11, 12, and 13 were purified using n-hexane, ethyl acetate, methanol, chloroform, acetone and isopropyl alcohol as the solvents. The crystals were monitored with Thin Layer Chromatography (TLC) on a Kiesel gel 254 GF plate (e. Merck) using the developing system of hexane: ethyl acetate: formic acid (1:1:0.1) mixture and a UV light spot viewer with 366 wavelength emissions. Purification test with TLC two directions using hexane: ethyl acetate: formic acid (1:1:0.1) mixture as the eluents for the first development, continued with the second development using chloroform: methanol: acetate acid (9:0.5:0.5) mixture. The Retention Factor (Rf) value for the spot was measured. Results: Chromatogram showed only 1 spot with Rf value 0.88. Conclusion: There is one pure (active) isolate in red pomegranate seeds ethanolic extract

MANAGEMENT OF ORAL LESIONS ASSOCIATED WITH CARBAMAZEPINE RELATED STEVENS-JOHNSON SYNDROME / TOXIC EPIDERMAL NECROLYSIS OVERLAP PATIENT: PENATALAKSANAAN LESI ORAL TERKAIT DENGAN PASIEN SINDROM STEVENS-JOHNSON DENGAN CARBAMAZEPINE-RELATED / NEKROLISIS RACUN EPIDERMAL YANG TUMPANG TINDIH

Stevens–Johnson syndrome (SJS)/ Toxic Epidermal Necrolysis (TEN) are acute, self-limited, potentially life-threatening mucocutaneous disease. Oral mucosal involvement manifest as extensive erosions and haemorrhagic crusting, which can interfere oral functions causing odynophagia, inability to tolerate solid foods, and increased aspiration risk. A 40-year-old female patient was referred from Dermatology and Venereology department with diagnosis SJS/TEN overlap. The patient complained mouth opening difficulty due to mouth and lip sores. Drug history revealed positive intake of carbamazepine. Extraoral examination revealed multiple diffuse discrete facial lesions, conjunctival hyperemia, erosions and hemorrhagic crusting lips. Intraoral examination revealed white yellowish plaque, and erosions on buccal mucosa, palate, floor of the mouth, dorsal, ventral, and lateral tongue. Laboratory investigation revealed decrease of haemoglobin, hematocrite, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), thrombocyte, eosinophil, band of eosinophil, lymphocyte, natrium, potassium, and calcium. Oral lesions associated with SJS/TEN overlap diagnosis was made. Chlorhexidine gluconate 0,1%, nystatin oral suspension, vitamin B12, folic acid, and corticosteroid unguent compounding were given, which showed improvement of oral lesions in 3 weeks. SJS/TEN are the same disease spectrum of delayed hypersensitivity reaction leading to keratinocyte apoptosis through cytotoxic T-cell mediated Fas-Fas ligand, perforin/ granzyme B, and granulysin, which distinguished primarily by severity and percentage of total body surface area involved.Currently, an optimal treatment standard for SJS/TEN patients remains unavailable. Oral lesions management play significant role in enhancing patients’ quality of life and achieving better prognosis in SJS/TEN overlap patients through multidisciplinary approach

SUCCESSFUL NON-OPERATIVE TREATMENT IN MICROCYSTIC LYMPHATIC MALFORMATION OF THE TONGUE: A CASE REPORT

Background: Microcystic lymphatic malformation (MLM) is an abnormal congenital growth of lymphatic vessels. It may occur in any part of the human body, with 75 % cases found in the head and neck, including in oral cavity. This case report aimed to describe a case of MLM in a child who was successfully treated non-operatively with antibiotics and corticosteroid.Case Report: A 4-year-old child came to Oral Medicine Clinic of Dr. Hasan Sadikin General Hospital, Bandung, with a chief complaint lesions of the tongue since a year ago, accompanied by bleeding in the affected areas but not pain. Patient gave history of recurrent episodes of the symptoms since 7 months old. Result : Ultrasonography was performed and diagnosis of microcystic lymphatic malformation was established. Systemic oral corticosteroid, antibiotics, and multivitamins were given and the lesions showed significant improvement after 2-weeks treatment. Conclusion: Therapy of MLM with antibiotics and systemic oral corticosteroid significantly improved patient’s condition, and ultrasonography may be used as a diagnostic modality in MLM diagnosis

Allergenic food as a triggering factor of oral pemphigus vulgaris recurrence

chronic autoimmune disease with blisters and erosions in the skin and or mucous membranes as its clinical manifestation. The ruptured blisters, followed by erosions and ulcerations, in oral mucous can be painful and interferes the oral function. Spices and seasoning, rich in thiols and isothiocyanates group (garlic, red chillies, black pepper, coriander and cumin seeds), able to trigger the recurrence of pemphigus vulgaris. This case report discussed the allergenic food to tigger the oral lesions in a 49 years old male patient with the diagnosis pemphigus vulgaris who was referred from The Dermatolgy Department. Since about 4 days before admitted to the hospital, the patient complained of painful ulcerations and blisters in the oral cavity that appeared after consuming the spices and seasoning food. Oral lesions caused difficulty in speaking, eating, and drinking, thus led to weight loss. The patient was uncooperative during treatment. Extraoral examination revealed painful erosions and crust on lips which tend to bleed easily. Intraoral examination revealed painful multiple erosions which interfered oral function. The oral lesions showed improvement after being treated using topical corticosteroid, topical antiseptic, antifungal suspension, and multivitamin. Pemphigus vulgaris caused by acantholysis due to autoantibodies IgG against desmogleins 1 and or 3. Tiol and isothiocyanates compound in spices and seasonings of food is one of the triggering factor of recurrence in oral lesions of pemphigus vulgari

Oral Manifestations of Systemic Lupus Erythematous and Its Comprehensive Management: Two Case Reports

Systemic lupus erythematous (SLE) is an autoimmune collagen-vascular disease involving mucocutaneous and musculoskeletal systems as well as blood vessels that is characterized by diverse clinical manifestations, making it necessary to use a comprehensive multidisciplinary approach. Oral manifestations of SLE include oral ulcer, discoid lesions, oral lichen planus-like-lesion, oral candidiasis, and xerostomia. This study reports two cases of 19-year-old and 41-year-old female patients visiting the Oral Medicine Department Dr. Hasan Sadikin General Hospital in October 2016. These patients were referred by the Internal Medicine Department with SLE diagnosis, involving hematological, musculoskeletal and mucocutaneous systems. Extraoral examination revealed moon face in the first patient and malar rash and lips exfoliations in the second  patient. Intraoral examination revealed oral ulcers on buccal and labial mucosa as well palate in both patients. Both patients were given methyl prednisolone, calcium, and folic acid by the Internal Medicine Department. Oral ulcers were treated with prednisone mouthwash, nystatin oral suspension, and vitamin B12. The oral ulcer on palate was considered very difficult to resolve so that topical corticosteroid was required. Prednisone mouthwash was chosen as drug of choice due to its efficacy on oral mucosa and its ability to minimize the systemic adverse effects which were resolved in 6 week after starting treatment. Comprehensive multidisciplinary approach associated with oral manifestation of SLE has significant effects in decreasing disease severity and improving the quality of life in patients with SLE.Key words: Oral ulcers, prednisone mouthwash, systemic lupus erythematosus Manifestasi Oral Lupus Eritematosus Sistemik dan Manajemen Komprehensifnya: Dua Laporan KasusSistemik lupus eritematosus (SLE) adalah penyakit kolagen-vaskular autoimun, yang melibatkan sistem mukokutan, muskuloskeletal, dan pembuluh darah yang ditandai dengan manifestasi klinis yang bervariasi, sehingga diperlukan pendekatan multidisiplin yang komprehensif. Manifestasi oral SLE meliputi ulkus mulut lesi diskoid, lichen planus-like lesion, kandidiasis oral, dan serostomia. Pasien wanita berusia 19 tahun dan 41 tahun yang dirujuk dari departemen Penyakit Dalam pada Oktober 2016 dengan diagnosis SLE yang melibatkan hematologis, muskuloskeletal, dan mukokutan. Pemeriksaan ekstraoral menunjukkan moon face pada pasien pertama, dan malar rash serta pengelupasan bibir pada pasien kedua. Pemeriksaan intra oral mengungkapkan ulkus oral, mukosa labial, dan palatum pada kedua pasien. Kedua pasien diberikan metil prednisolone, kalsium, dan asam folat dari departemen Penyakit Dalam. Ulkus oral diobati dengan obat kumur prednison, suspensi oral Nistatin, dan vitamin B12 yang diberikan dalam 6 minggu pengobatan. Ulkus oral adalah salah satu manifestasi oral yang umum pada pasien SLE. Ulkus oral pada palatum dianggap sangat sulit diatasi sehingga dibutuhkan kortikosteroid topikal. Prednisone mouth wash dipilih sebagai obat pilihan sebagai anti-inflamasi pada mukosa oral dan meminimalkan efek samping sistemik. Pendekatan multidisiplin komprehensif yang terkait dengan manifestasi oral SLE memiliki efek signifikan dalam menurunkan tingkat keparahan penyakit dan meningkatkan kualitas hidup pada pasien SLE.Kata kunci: Lupus eritematosus sistemik, ulser oral, obat kumur predniso

Herbal-induced Stevens-Johnson syndrome with oral involvement and management in an HIV patient

Background: Stevens-Johnson syndrome (SJS) is an immune complex-mediated hypersensitivity reaction affecting the skin and mucous membranes. Patients infected with human immunodeficiency virus (HIV) are at increased risk of developing SJS which is predominantly caused by an adverse reaction to medications, including herbal varieties. In recent years, the consumption of herbal medicines has increased, while their safety remains a matter for investigation. Purpose: The purpose of this case report is to explain the occurrence of SJS caused by herbal medicine. Case: A 43-year-old male patient with body-wide skin erosion was referred to the Department of Oral Medicine and subsequently diagnosed with Stevens-Johnson syndrome due to his consumption of a herbal medicine containing zingiber rhizoma, coboti rhizoma, asari herbal and epimedi. The patient’s chief complaints included difficulty when opening the mouth, dysphagia and excessive production of saliva continuously contaminated with blood and sputum. Extraoral examination showed a sanguinolenta crust on the lips. Intra oral examination of oral mucous showed erosive lesions with bleeding and pain. A HIV test performed at a Clinical Pathology Laboratory was positive for antibodies against HIV with a CD4 cell count of 11 cells/ml. Case management: Treatment consisted of the administering of NaCl 0.9 %, hydrocortisone 0.1% and Chlorhexidine digluconate 0.12% for 12  days. Conclusion: SJS can be caused by herbal medicine and it is essential to be aware of the latter’s potential adverse effects, especially in immunocompromised patients. Symptomatic management of oral lesions should be planned as an early intervention in order to decrease morbidity and mortality in SJS patients

Oral mucositis severity in patient with head and neck cancer undergoing chemotherapy and/or radiotherapy

Oral mucositis is an inflammatory process and ulcerative of the oral mucosa due to chemotherapy and/or radiotherapy. The incidence and severity of oral mucositis might be influenced by a variety of risk factors, related to the host and treatment of the cancer. This aim of the case report is to evaluate risk factors that affect the severity of oral mucositis in two patients with nasopharyngeal cancer undergoing chemotherapy and/or radiotherapy. The first case, oral mucositis grade III and oral candidiasis to a 54-year old woman undergoing 16 times radiotherapy for nasopharyngeal cancer stage IV. The second case, oral mucositis grade I and oral candidiasis were found in a 55-year old man suffering from nasopharyngeal cancer stage IV who has been treated 10 times with chemotherapy and radiotherapy. Both patients had a similar age range and cancer stage. The differences of severity oral mucositis in both cases were suspected due to the host factors-related that are gender and nutritional status. In addition, intra-oral condition (poor oral hygiene, xerostomia), smoking habits and patient compliance may also affect the severity of oral mucositis in the second case. Treatment factors such as the type, dose and duration of chemotherapy t, might also affect the severity in both cases. Both patients were given chlorhexidine gluconate 0.2%, nystatin oral suspension, vitamin B12, and folic acid for treating oral mucositis. In conclusion, the understanding of risk factors oral mucositis is deemed necessary to control the severity and to provide an appropriate management to improve the quality of patients’ life

THE ROLE OF VITAMIN D SUPPLEMENTATION FOR HEAD AND NECK CANCER : A LITERATURE REVIEW

Background: Vitamin D has several roles, namely physiological function of calcium and bone metabolism, cell growth and differentiation, immune and cardiovascular function. Vitamin D deficiency can cause the risk of cancer. Head and neck cancer is one of the cancers that occur due to vitamin D deficiency in the body. This literature review was to asses and evaluate the impact and benefits of vitamin D supplementation for head and neck cancer. Discussion: A study found an association between vitamin D supplementation and a low risk of recurrence in conditions of high total vitamin D levels. Another study found a significant increase in quality of life (QOL). The primary mechanism of vitamin D action is mediated through binding of either 1,25(OH)2D3 (active form) or 25(OH)D (less active form) to the VDR, which is a member of the nuclear receptor superfamily of steroid and thyroid hormones with gene-regulatory and consequent anti-proliferative properties. Conclusions: Vitamin D supplementation provides a role in improving the condition of patients with head and neck cancer. Both in terms of suppressing recurrence and in terms of increasing quality of lif

Identifikasi dan Pengendalian Faktor Risiko Mukositis Oral Selama Radioterapi Kanker Nasofaring

Oral mucositis (OM) is an inflammatory and ulcerative process of the mucosa of the mouth that result from the administration of radiotherapy and/or chemotherapy or blood and marrow stem cell transplant. The incidence and severity of OM will vary from patient to patient, that correlates with the risk factors. The risk factors are patient related factors and therapy related factors. We reported a case in a 33 years old woman patient with OM grade IV accompanied with oral candidiasis who is undergoing radiotherapy in Cipto Mangunkusumo Hospital for her nasopharyngeal cancer. The estimated risk factors of the severity OM in this case are the patient gender, poor oral hygiene, poor nutritional status, decreased saliva production, dose total and fractional radiation, and the staging of cancer. Chlorhexidine gluconate 0.2 % mouthwash and Mycostatin oral supension administration was decreased the severity of OM in this patient, nevertheless not yet totally recovery because another risk factors that can affect OM and dental management can not optimally controlled. It’s concluded that identification and control of oral mucositis risk factors are required for minimize severity of OM, to achieve the better quality of life patient.DOI: 10.14693/jdi.v15i2.7

ASSOCIATION BETWEEN SERUM 25-HYDROXYVITAMIN D LEVELS AND VITAMIN D RECEPTOR POLYMORPHISMS IN HIV-INFECTED CHILDREN

Objective: The clinical and genetic evidence is accumulating that vitamin D may play a role in modulating human immunodeficiency virus (HIV) infection. The aim of this study was to evaluate serum 25-hydroxyvitamin D [25(OH)D] levels in HIV-infected children and its association with vitamin D receptor (VDR) gene Bsml and Fokl polymorphisms. Methods: Serum 25(OH)D levels were measured using 250HD Liaison XL®. The VDR genes were detected by CLART®MetaBone. Results: This study included 34 HIV-infected children on highly active antiretroviral therapy (HAART) for more than a year, aged 6-14 y. The results revealed that the mean of serum 25(OH)D levels were 19.6±7.0 nmol/l. The mean of CD4+T-cell counts was 724 (18–1805) cell/mm3 and CD4 % was 23.72±10.77. The genotypic frequency Bsml and Fokl polymorphisms in HIV-infected children were BB 29%, Bb 41%, bb 29% and FF 47%, Ff 44%, ff 9%, respectively. Serum 25(OH)D levels were associated with Bsml polymorphisms (p<0.05), but not with Fokl polymorphisms (p>0.05). Conclusion: The present study showed that vitamin D deficiency is common in HIV-infected children, and genetic variant could lead to altered activity of vitamin D. Therefore, it is important to consider vitamin D status routinely in preventing the development of opportunistic infections and supplementation of vitamin D is warranted among HIV-infected children on HAART