Amertha Manuaba - Academia.edu (original) (raw)
Papers by Amertha Manuaba
Indonesia Journal of Biomedical Science : IJBS, Apr 18, 2023
Indonesia Journal of Biomedical Science
The coronavirus disease (COVID-19) pandemic affects various aspects of human life. To minimize th... more The coronavirus disease (COVID-19) pandemic affects various aspects of human life. To minimize the impact of lockdown, medical schools used online learning systems. However, online education also impacts student readiness, especially last year's medical students who will soon undergo clinical rotation. Therefore, this article aims to discuss the impact of the COVID-19 pandemic on the readiness of last year's medical students for clinical rotation. This study was a literature review that used several databases and online sources: Google Scholar, ScienceDirect, Pubmed (MEDLINE), and Cochrane Library, to search relevant journals related to the topic. Based on the literature search, the transition from student to doctor has been severely impacted by the COVID-19 pandemic, which had a substantial impact on medical student education, especially on interruptions of student assistantship that disturb students’ preparation, self-assurance and professional identity. The online educati...
Indonesia Journal of Biomedical Science : IJBS, Jan 25, 2022
Intisari Sains Medis
Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as... more Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as a form of adult learning. To train these skills, students need tutors to stimulate students' SDL abilities. Methodology: This study was conducted quantitatively using a Dolman and Ginns questionnaire on third-year medical students. Results: Tutors in the Medical Emergency block were able to provide a good explanation of the issues in the case and stimulate students to look for other learning resources. Conclusion: Tutors with academic backgrounds that match the discussion material can be considered as one of the factors that can stimulate students' SDL. Latar Belakang: Self-directed learning (SDL) merupakan keterampilan yang harus dimiliki oleh mahasiswa kedokteran sebagai bentuk pembelajaran dewasa. Untuk melatih keterampilan ini mahasiswa memerlukan tutor dalam menstimulasi kemampuan SDL mahasiswa. Metodologi: penelitian ini dilakukan secara kuantitatif dengan menggunakan ku...
PLOS ONE
Background The adaptation process for first-year medical students is an important problem because... more Background The adaptation process for first-year medical students is an important problem because it significantly affects educational activities. The previous study showed that 63% of students had difficulties adapting to the learning process in their first year at medical school. Therefore, students need the most suitable learning style to support the educational process, such as Problem-based learning (PBL). This method can improve critical thinking skills, problem-solving and self-directed learning. Although PBL has been adopted in medical education, the effectiveness of PBL in first-year medical students is still not yet clear. The purpose of this meta-analysis is to verify whether the PBL approach has a positive effect in improving knowledge, problem-solving and self-directed learning in first-year medical students compared with the conventional method. Methods We searched PubMed, ScienceDirect, Cochrane, and Google Scholar databases until June 5, 2021. Search terms included p...
Open Access Macedonian Journal of Medical Sciences
Background. Coronavirus disease 19 (COVID-19) infection has been a global pandemic since late 201... more Background. Coronavirus disease 19 (COVID-19) infection has been a global pandemic since late 2019. Clinical manifestation ranges from mild to severe. Even though most COVID-19 patients recover fully from the disease, approximately 5–10% experience prolonged symptoms for several months following the acute COVID-19 phase, defined as long COVID-19 syndrome. Rehabilitation therapy is needed for them to overcome their symptoms and improve their functional capacity. This systematic review aims to discuss rehabilitation therapy for a patient with long COVID-19 syndrome. Method. A systematic review using PubMed and Google Scholar was conducted based on PRISMA guidelines. Inclusion criteria were study about rehabilitation therapy for long COVID-19 patients. Exclusion criteria were letters to the editor, editorial or commentary reports, and studies not available in full-text and not in English or Bahasa. Result. Nine studies are included in this systematic review consisting of two consens...
Bali Medical Journal, 2021
One Health concept is composed of a collaborative strategy approach in conducting program impleme... more One Health concept is composed of a collaborative strategy approach in conducting program implementations, policies, legislative aspects, and research studies that involve active participation from various sectors to achieve global public health goals better. It represents a collaborative implementation between clinical, veterinary and government to overcome a specific illness. In Avian influenza, clinical networks should monitor risk factors and clinical signs of severe avian influenza to be controlled or eliminated effectively and quickly. Also, active laboratory surveillance should be conducted, rather than just passive one. Veterinary surveillance possesses high importance in controlling transmission and eliminating avian influenza disease. Well coordination, collaboration, cooperation concerning animal and human surveillance, and disease management involving various health professionals in every sector should be implemented and expanded simultaneously.
Bali Medical Journal, 2021
Background: The coronavirus disease (COVID-19) pandemic has several clinical manifestations from ... more Background: The coronavirus disease (COVID-19) pandemic has several clinical manifestations from asymptomatic to critical condition. Shortness of breath is one of the hallmark symptoms of COVID-19 infection. The main medical management for shortness of breath in COVID-19 infection is oxygen therapy. Physiotherapy and medical rehabilitation such as breathing exercise and chest physiotherapy can be adjuvant therapy that effectively improves breathing effort in COVID-19 patients. This case report will describe breathing exercises and chest therapy done in a patient with a COVID-19 infection. Case: In this study, we presented the case of a 53-year-old female patient with complaints of fever, cough, fatigue, anosmia, shortness of breath, and diagnosis with confirmed COVID-19 infection based on swab PCR result. On admission in the isolation ward, the patient was on non-invasive ventilation (NIV), medical medication, and physical therapy. The physical therapy done in this patient was breathing exercise and chest therapy once daily. After four series of chest therapy and breathing exercise, the shortness of breath and her breathing effort was improved. The patient was discharged after 15 days of hospitalization. Conclusion: This case shows the utility of chest therapy and breathing exercise as a physical rehabilitation treatment for the COVID-19 patient. This physical therapy helps to maximize lung expansion and improve the patient's breathing effort.
Bali Medical Journal, 2022
Journal of Global Pharma Technology, 2018
Post-exercise hypotension (PEH) which means the occurrence of changes in blood pressure after a p... more Post-exercise hypotension (PEH) which means the occurrence of changes in blood pressure after a physical exercise to a lower blood pressure level after the start of physical exercise. The incidence of PEH can be concluded as a benefit when viewed regarding people who experience a state of hypertension, but if in people with normal blood pressure circumstances can cause the risk of a state of hypotension. The purpose of this study was to determine the magnitude of the decrease in post-exercise hypotension in elderly. Study model using a quasi-experimental model with pre-test and post-test group design involving 28 elderly as a research subject. Aerobic exercise in this study was performed through a healthy heart gymnastics exercise with a duration of 45 minutes. Blood pressure measurements were performed before exercise (baseline value), immediately after exercise, 15 minutes, 30 minutes, 45 minutes, and 60 minutes after exercise was done. Statistical analysis using normality and hom...
Open Access Macedonian Journal of Medical Sciences, 2021
BACKGROUND: Elderly patients are at an increased risk of death, particularly those with altered m... more BACKGROUND: Elderly patients are at an increased risk of death, particularly those with altered mental status. AIM: We aimed to develop a scoring model from simple clinical data and routine laboratory testing to aid in predicting in-hospital mortality risk for geriatric patients with delirium. METHODS: A total of 73 hospitalized geriatric patients with delirium were included in the study. A multivariate regression analysis employed to obtain independent risk factors to predict in-hospital mortality. All patients were followed until dead or discharged from hospital. The formula of (B/SE)/lowest B/SE was used to calculate the scores for each variable with strong discrimination power to be included in scoring system. RESULTS: A total of 25 (34.2%) of patients were death when being hospitalized. The mean age of the patients was 73.27 ± 7.8. From a total of 20 probable variables, three variables were then included in constructing the scoring model; no caregiver (p < 0.012), abnormal d...
Open Access Macedonian Journal of Medical Sciences, 2020
BACKGROUND: Single-nucleotide polymorphism in the stromal cell-derived factor-1 (SDF-1)/CXCL12 ge... more BACKGROUND: Single-nucleotide polymorphism in the stromal cell-derived factor-1 (SDF-1)/CXCL12 gene had been associated with an increased risk of coronary artery disease (CAD). However, several published studies have shown inconsistent results. AIM: A meta-analysis was assessed to evaluate the association between SDF-1 3’A-gene polymorphism and CAD in the literature. METHODS: A systematic review was conducted in accordance with PRISMA guidelines and adhering to the Cochrane Handbook for Systematic Reviews. The literature search strategy was carried out on April 3, 2019, from PubMed, EBSCO, Google Scholar, and DOAJ during 2013–2018 period using various keywords related to SDF-1, CXCL12, polymorphism, and CAD. Original data from the group, case-control study, English full-text, and DNA polymorphism assessment using polymerase chain reaction were enrolled. Gene polymorphism in A-base nucleotide among patients with CAD and healthy subjects were evaluated. All data were analyzed using Re...
Bali Medical Journal, 2020
Introduction: The ACL injury has commonly occurred in a greater number of athletes, less publicat... more Introduction: The ACL injury has commonly occurred in a greater number of athletes, less publication is about poor knee function and ACL injury in the patient with non-operative treatment. This study aimed to describe the characteristics of patients with ACL injury non-operative, which are associated with poor knee function on daily living activities. Methods: We included patients with ACL injury that has been diagnosed for ACL injury by an orthopedic surgeon or physiotherapist in a hospital or private clinic. All participants were recruited from February 2019 to April 2019. The inclusion criteria were patients who at least 18 years old. We used the KOOS ADL function cutoff score ≤80 to dichotomous the patient with knee problems, and score >80 have no statistical analysis problem. We calculated using binary logistic regression on the KOOS ADL function for each variable. Results: The mean score of KOOS daily living was 72.8 points, of which 66 participants had poor scores, and 37 were acceptable. Women were 9.2 times more likely to had poor KOOS daily living scores than men in non-operative ACL injury patients (p=0.044), and non-elite athletes had a higher possibility by 8.5 times higher than those who were participated in sports only for leisure or recreation (p=0.002). Conclusion: This study confirmed that patients who did not undergo the ACL reconstruction had a poor knee function in daily living. It was associated with women and non-elite athlete participants, yet the concomitant injuries were possibly confounder for the association.
Bali Medical Journal, 2020
Virtual patient simulation (VPS) is an online computer simulation system that contains patients' ... more Virtual patient simulation (VPS) is an online computer simulation system that contains patients' clinical situation to train and realistically assess clinical abilities with supplemental animation, demonstration of anatomy, ECG tracing, etc. It can be used for teaching, learning, and assessment supports learning. Until now, it is difficult to ascertain how many VPS systems have been used today in the world, both for learning and assessment, especially in cardiology medicine field. We searched for all research using the term "virtual patient in medical education, virtual patient in cardiology & virtual patient simulation in cardiology" in the title or research abstract from 2014 until 2019. In this current review, we will describe the use of VPS for learning and assessment purposes in cardiology medicine field.
Bali Medical Journal, 2019
Background: The modality of therapy in this era is quite sophisticated. The mortality rate of pat... more Background: The modality of therapy in this era is quite sophisticated. The mortality rate of patients diagnosed with glioblastoma multiforme is still high. It might be due to the late diagnosis of the tumors since most in the early stages some tumors do not show any significant symptoms or the symptoms usually misdiagnosed with another disease. Nowadays there is an uptrend of therapeutic methods called immunotherapy which declared as the fourth approachment for glioblastoma multiforme (GBM). In RSPAD Gatot Soebroto Jakarta, the author starts this approach using dendritic cell vaccines in the specialized department called the Indonesia Army Cell Cure Center. Aim: The report aims to describe a case of GBM treated by dendritic cell vaccines. Case Report: A 52-year-old woman had weakness in her left extremities and visual impairment in the left eye since 2016. The patient was brought to RSPAD in August 2016 with a history of cerebral hemorrhage, then already underwent a craniotomy at the right temporoparietal region. After biopsies and tissues examination, the patient later diagnosed with GBM. As for judging the natural history of the diseases, the team decided to counsel the patient and her family conducting a new treatment strategy for GBM, immunotherapy. The immunotherapy approach performed in RSPAD was the dendritic cell (DC) vaccines therapy. As regard to post-DC vaccines therapy, the patient showed a significant improvement in her clinical condition (Karnofsky performance status increased from 30% to 60%). Also, the patient surpassed the average survival rate. Thus, the patient still scheduled for a routine follow up and a round of examinations to preserve the patient improved condition. Conclusion: The patient who has immunotherapy strategy especially dendritic cell vaccines therapy has shown an improved clinical status and survival rate for GBM, more than the average survival rates. These findings might give us more insights into how dendritic cell vaccines therapy can be involved as the fourth therapeutic strategies on treating patients with GBM.
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2020
Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are lim... more Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are limited to curing the symptoms and have not been able to restore insulin sensitivity in insulin-sensitive tissues that have become resistant. In the past decade, some studies have shown the significant role of a chaperone family, heat shock protein 70 (HSP70), in insulin resistance pathogenesis that leads to T2DM. HSP70 is a cytoprotective molecular chaperone that functions in protein folding and degradation. In general, studies have shown that decreased concentration of HSP70 is able to induce inflammation process through JNK activation, inhibit fatty acid oxidation by mitochondria through mitophagy decrease and mitochondrial biogenesis, as well as activate SREBP-1c, one of the lipogenic gene transcription factors in ER stress. The overall molecular pathways are potentially leading to insulin resistance and T2DM. Increased expression of HSP70 in brain tissues is able to improve insulin sensitivity and glycemic control specifically. HSP70 modulation-targeting strategies (including long-term physical exercise, hot tub therapy (HTT), and administration of alfalfa-derived HSP70 (aHSP70)) in subjects with insulin resistance are proven to have therapeutic and preventive potency that are promising in T2DM management.
Vascular Health and Risk Management, 2019
Introduction: Diabetes is often accompanied by undiagnosed dyslipidemia. The aim of the study is ... more Introduction: Diabetes is often accompanied by undiagnosed dyslipidemia. The aim of the study is to investigate the clinical relevance of lipid profiles and lipid ratios as predictive biochemical models for glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods: This is a retrospective study recruiting 140 patients with T2DM during a one-year period, 2018-2019, at the Diabetic Center Sanglah General Hospital and Internal Medicine Polyclinic Puri Raharja General Hospital. Demographic characteristics, glycosylated hemoglobin (HBA1c) , and lipid profile were recorded and analyzed using SPSS version 25.0 for Windows. The sample is then classified into good (HBA1c≤7) and poor (HBA1c>7) glycemic control. Risk analysis model, receiver operator characteristics (ROC) analysis, and correlation test were used to evaluate the association of HBA1c level with lipid profile and lipid ratio parameters. Result: Lipid profile findings such as total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) , triglycerides (TG), and lipid ratio parameter (LDL-C to high-density lipoprotein cholesterol (HDL-C) ratio) were higher in patients in the poor glycemic control group (p<0.05) and HDL-C was significantly lower in patients with poor glycemic control (p=0.001). There is a significant positive correlation between LDL, total cholesterol, LDL-C, TG, and TC to HDL-C ratio, triglycerides, and TC/HDL-C ratio with HBA1c level. Meanwhile, a negative correlation was observed on HDL-C with the HBA1c level. Only TC/HDL-C ratio and LDL-C/HDL-C ratio parameters may be used as predictive models (AUC>0.7), with cutoff point, sensitivity, and specificity of 4.68 (77%; 52%) and 3.06 (98%; 56%) respectively. A risk analysis model shows that the LDL-C/HDL-C ratio parameter is the most influential risk factor in the occurrence of poor glycemic control (adjusted OR =38.76; 95% CI: 27.32-56.64; p<0.001). Conclusion: Lipid profiles (LDL-C) and lipid ratios (LDL-C/HDL-C and TC/HDL-C ratio) show potential markers that can be used in predicting glycemic control in patients with T2DM.
Family Medicine and Community Health, 2018
Background: An increasing number of valid and well-designed trials have demonstrated a positive c... more Background: An increasing number of valid and well-designed trials have demonstrated a positive correlation between visit-to-visit variability (VVV) in systolic blood pressure (SBP) and increased risk of stroke and coronary heart disease among hypertensive patients. Methods: A cross-sectional study was conducted that involved 74 patients who visited the outpatient clinic at the Tabanan III Primary Health Care Service during April to May 2017. Blood pressure was retrospectively obtained from medical records. VVV was classified as low or high on the basis of the standard deviation of SBP. Antihypertensive medication adherence was expressed as the percentage of days covered, and sodium intake was measured with 24-hour food recall. Bivariate analysis was performed, followed by multivariate analysis for significant variables. Results: Among the participants, 67.6% were female, with a mean (standard deviation [SD]) age of 62.70 (10.00) years. Blood pressure was measured 4.82 ± 0.78 times during the period, and the mean (SD) SBP was 139.65 (10.57) mm Hg. Nonadherence and sodium intake were significantly higher in the high-VVV group than in the low-VVV group (nonadherence 13.5% vs. 37.8%, P = 0.033; sodium intake 1278.44 ± 43.02 mg vs. 1495.85 ± 45.26 mg, P = 0.038). After adjustment for other covariates, the differences remained significant only for nonadherence (model I exp β = 3.89 [95.0% confidence interval 1.23-12.34, P < 0.05], model II exp β = 3.9 [95.0% confidence interval 1.12-14.15, P < 0.05]). The area under the curve was 0.636 (P < 0.05), with sensitivity of 67.6% and specificity of 51.4%. Conclusion: Nonadherence to antihypertensive medication was significantly associated with higher VVV of SBP. Further study is needed to assess whether improving adherence could reduce VVV and improve cardiovascular outcomes.
Recent Advances in Biology and Medicine, 2017
The amount of glycosylated hemoglobin (HbA1c) reflects the long-term glycemic control of patients... more The amount of glycosylated hemoglobin (HbA1c) reflects the long-term glycemic control of patients with diabetes. HbA1c also predicts the risk for the development of diabetic complications such as cardiovascular disease (CVD). Patients with type-2 diabetes and the characteristic of dyslipidemia are frequently found. Also, dyslipidemia plays as an independent risk factor for CVD. This study was aimed to evaluate the relationship between glycemic control status with serum individual lipid profiles and lipid ratios in patients with type-2 diabetes. This cross-sectional study consisted of 80 patients. Depending on the HbA1c level, the patients were divided into two groups, good glycemic control group (HbA1c < 7.0%, n = 15) and poor glycemic control group (HbA1c ≥ 7.0%, n = 65). The association of HbA1c with individual lipids (TC, TG, HDL-C, LDL-C, Non- HDL-C) and lipid ratios (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, monocyte/HDL-C) were analyzed. The value of individual lipids and lipid rati...
Indonesia Journal of Biomedical Science : IJBS, Apr 18, 2023
Indonesia Journal of Biomedical Science
The coronavirus disease (COVID-19) pandemic affects various aspects of human life. To minimize th... more The coronavirus disease (COVID-19) pandemic affects various aspects of human life. To minimize the impact of lockdown, medical schools used online learning systems. However, online education also impacts student readiness, especially last year's medical students who will soon undergo clinical rotation. Therefore, this article aims to discuss the impact of the COVID-19 pandemic on the readiness of last year's medical students for clinical rotation. This study was a literature review that used several databases and online sources: Google Scholar, ScienceDirect, Pubmed (MEDLINE), and Cochrane Library, to search relevant journals related to the topic. Based on the literature search, the transition from student to doctor has been severely impacted by the COVID-19 pandemic, which had a substantial impact on medical student education, especially on interruptions of student assistantship that disturb students’ preparation, self-assurance and professional identity. The online educati...
Indonesia Journal of Biomedical Science : IJBS, Jan 25, 2022
Intisari Sains Medis
Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as... more Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as a form of adult learning. To train these skills, students need tutors to stimulate students' SDL abilities. Methodology: This study was conducted quantitatively using a Dolman and Ginns questionnaire on third-year medical students. Results: Tutors in the Medical Emergency block were able to provide a good explanation of the issues in the case and stimulate students to look for other learning resources. Conclusion: Tutors with academic backgrounds that match the discussion material can be considered as one of the factors that can stimulate students' SDL. Latar Belakang: Self-directed learning (SDL) merupakan keterampilan yang harus dimiliki oleh mahasiswa kedokteran sebagai bentuk pembelajaran dewasa. Untuk melatih keterampilan ini mahasiswa memerlukan tutor dalam menstimulasi kemampuan SDL mahasiswa. Metodologi: penelitian ini dilakukan secara kuantitatif dengan menggunakan ku...
PLOS ONE
Background The adaptation process for first-year medical students is an important problem because... more Background The adaptation process for first-year medical students is an important problem because it significantly affects educational activities. The previous study showed that 63% of students had difficulties adapting to the learning process in their first year at medical school. Therefore, students need the most suitable learning style to support the educational process, such as Problem-based learning (PBL). This method can improve critical thinking skills, problem-solving and self-directed learning. Although PBL has been adopted in medical education, the effectiveness of PBL in first-year medical students is still not yet clear. The purpose of this meta-analysis is to verify whether the PBL approach has a positive effect in improving knowledge, problem-solving and self-directed learning in first-year medical students compared with the conventional method. Methods We searched PubMed, ScienceDirect, Cochrane, and Google Scholar databases until June 5, 2021. Search terms included p...
Open Access Macedonian Journal of Medical Sciences
Background. Coronavirus disease 19 (COVID-19) infection has been a global pandemic since late 201... more Background. Coronavirus disease 19 (COVID-19) infection has been a global pandemic since late 2019. Clinical manifestation ranges from mild to severe. Even though most COVID-19 patients recover fully from the disease, approximately 5–10% experience prolonged symptoms for several months following the acute COVID-19 phase, defined as long COVID-19 syndrome. Rehabilitation therapy is needed for them to overcome their symptoms and improve their functional capacity. This systematic review aims to discuss rehabilitation therapy for a patient with long COVID-19 syndrome. Method. A systematic review using PubMed and Google Scholar was conducted based on PRISMA guidelines. Inclusion criteria were study about rehabilitation therapy for long COVID-19 patients. Exclusion criteria were letters to the editor, editorial or commentary reports, and studies not available in full-text and not in English or Bahasa. Result. Nine studies are included in this systematic review consisting of two consens...
Bali Medical Journal, 2021
One Health concept is composed of a collaborative strategy approach in conducting program impleme... more One Health concept is composed of a collaborative strategy approach in conducting program implementations, policies, legislative aspects, and research studies that involve active participation from various sectors to achieve global public health goals better. It represents a collaborative implementation between clinical, veterinary and government to overcome a specific illness. In Avian influenza, clinical networks should monitor risk factors and clinical signs of severe avian influenza to be controlled or eliminated effectively and quickly. Also, active laboratory surveillance should be conducted, rather than just passive one. Veterinary surveillance possesses high importance in controlling transmission and eliminating avian influenza disease. Well coordination, collaboration, cooperation concerning animal and human surveillance, and disease management involving various health professionals in every sector should be implemented and expanded simultaneously.
Bali Medical Journal, 2021
Background: The coronavirus disease (COVID-19) pandemic has several clinical manifestations from ... more Background: The coronavirus disease (COVID-19) pandemic has several clinical manifestations from asymptomatic to critical condition. Shortness of breath is one of the hallmark symptoms of COVID-19 infection. The main medical management for shortness of breath in COVID-19 infection is oxygen therapy. Physiotherapy and medical rehabilitation such as breathing exercise and chest physiotherapy can be adjuvant therapy that effectively improves breathing effort in COVID-19 patients. This case report will describe breathing exercises and chest therapy done in a patient with a COVID-19 infection. Case: In this study, we presented the case of a 53-year-old female patient with complaints of fever, cough, fatigue, anosmia, shortness of breath, and diagnosis with confirmed COVID-19 infection based on swab PCR result. On admission in the isolation ward, the patient was on non-invasive ventilation (NIV), medical medication, and physical therapy. The physical therapy done in this patient was breathing exercise and chest therapy once daily. After four series of chest therapy and breathing exercise, the shortness of breath and her breathing effort was improved. The patient was discharged after 15 days of hospitalization. Conclusion: This case shows the utility of chest therapy and breathing exercise as a physical rehabilitation treatment for the COVID-19 patient. This physical therapy helps to maximize lung expansion and improve the patient's breathing effort.
Bali Medical Journal, 2022
Journal of Global Pharma Technology, 2018
Post-exercise hypotension (PEH) which means the occurrence of changes in blood pressure after a p... more Post-exercise hypotension (PEH) which means the occurrence of changes in blood pressure after a physical exercise to a lower blood pressure level after the start of physical exercise. The incidence of PEH can be concluded as a benefit when viewed regarding people who experience a state of hypertension, but if in people with normal blood pressure circumstances can cause the risk of a state of hypotension. The purpose of this study was to determine the magnitude of the decrease in post-exercise hypotension in elderly. Study model using a quasi-experimental model with pre-test and post-test group design involving 28 elderly as a research subject. Aerobic exercise in this study was performed through a healthy heart gymnastics exercise with a duration of 45 minutes. Blood pressure measurements were performed before exercise (baseline value), immediately after exercise, 15 minutes, 30 minutes, 45 minutes, and 60 minutes after exercise was done. Statistical analysis using normality and hom...
Open Access Macedonian Journal of Medical Sciences, 2021
BACKGROUND: Elderly patients are at an increased risk of death, particularly those with altered m... more BACKGROUND: Elderly patients are at an increased risk of death, particularly those with altered mental status. AIM: We aimed to develop a scoring model from simple clinical data and routine laboratory testing to aid in predicting in-hospital mortality risk for geriatric patients with delirium. METHODS: A total of 73 hospitalized geriatric patients with delirium were included in the study. A multivariate regression analysis employed to obtain independent risk factors to predict in-hospital mortality. All patients were followed until dead or discharged from hospital. The formula of (B/SE)/lowest B/SE was used to calculate the scores for each variable with strong discrimination power to be included in scoring system. RESULTS: A total of 25 (34.2%) of patients were death when being hospitalized. The mean age of the patients was 73.27 ± 7.8. From a total of 20 probable variables, three variables were then included in constructing the scoring model; no caregiver (p < 0.012), abnormal d...
Open Access Macedonian Journal of Medical Sciences, 2020
BACKGROUND: Single-nucleotide polymorphism in the stromal cell-derived factor-1 (SDF-1)/CXCL12 ge... more BACKGROUND: Single-nucleotide polymorphism in the stromal cell-derived factor-1 (SDF-1)/CXCL12 gene had been associated with an increased risk of coronary artery disease (CAD). However, several published studies have shown inconsistent results. AIM: A meta-analysis was assessed to evaluate the association between SDF-1 3’A-gene polymorphism and CAD in the literature. METHODS: A systematic review was conducted in accordance with PRISMA guidelines and adhering to the Cochrane Handbook for Systematic Reviews. The literature search strategy was carried out on April 3, 2019, from PubMed, EBSCO, Google Scholar, and DOAJ during 2013–2018 period using various keywords related to SDF-1, CXCL12, polymorphism, and CAD. Original data from the group, case-control study, English full-text, and DNA polymorphism assessment using polymerase chain reaction were enrolled. Gene polymorphism in A-base nucleotide among patients with CAD and healthy subjects were evaluated. All data were analyzed using Re...
Bali Medical Journal, 2020
Introduction: The ACL injury has commonly occurred in a greater number of athletes, less publicat... more Introduction: The ACL injury has commonly occurred in a greater number of athletes, less publication is about poor knee function and ACL injury in the patient with non-operative treatment. This study aimed to describe the characteristics of patients with ACL injury non-operative, which are associated with poor knee function on daily living activities. Methods: We included patients with ACL injury that has been diagnosed for ACL injury by an orthopedic surgeon or physiotherapist in a hospital or private clinic. All participants were recruited from February 2019 to April 2019. The inclusion criteria were patients who at least 18 years old. We used the KOOS ADL function cutoff score ≤80 to dichotomous the patient with knee problems, and score >80 have no statistical analysis problem. We calculated using binary logistic regression on the KOOS ADL function for each variable. Results: The mean score of KOOS daily living was 72.8 points, of which 66 participants had poor scores, and 37 were acceptable. Women were 9.2 times more likely to had poor KOOS daily living scores than men in non-operative ACL injury patients (p=0.044), and non-elite athletes had a higher possibility by 8.5 times higher than those who were participated in sports only for leisure or recreation (p=0.002). Conclusion: This study confirmed that patients who did not undergo the ACL reconstruction had a poor knee function in daily living. It was associated with women and non-elite athlete participants, yet the concomitant injuries were possibly confounder for the association.
Bali Medical Journal, 2020
Virtual patient simulation (VPS) is an online computer simulation system that contains patients' ... more Virtual patient simulation (VPS) is an online computer simulation system that contains patients' clinical situation to train and realistically assess clinical abilities with supplemental animation, demonstration of anatomy, ECG tracing, etc. It can be used for teaching, learning, and assessment supports learning. Until now, it is difficult to ascertain how many VPS systems have been used today in the world, both for learning and assessment, especially in cardiology medicine field. We searched for all research using the term "virtual patient in medical education, virtual patient in cardiology & virtual patient simulation in cardiology" in the title or research abstract from 2014 until 2019. In this current review, we will describe the use of VPS for learning and assessment purposes in cardiology medicine field.
Bali Medical Journal, 2019
Background: The modality of therapy in this era is quite sophisticated. The mortality rate of pat... more Background: The modality of therapy in this era is quite sophisticated. The mortality rate of patients diagnosed with glioblastoma multiforme is still high. It might be due to the late diagnosis of the tumors since most in the early stages some tumors do not show any significant symptoms or the symptoms usually misdiagnosed with another disease. Nowadays there is an uptrend of therapeutic methods called immunotherapy which declared as the fourth approachment for glioblastoma multiforme (GBM). In RSPAD Gatot Soebroto Jakarta, the author starts this approach using dendritic cell vaccines in the specialized department called the Indonesia Army Cell Cure Center. Aim: The report aims to describe a case of GBM treated by dendritic cell vaccines. Case Report: A 52-year-old woman had weakness in her left extremities and visual impairment in the left eye since 2016. The patient was brought to RSPAD in August 2016 with a history of cerebral hemorrhage, then already underwent a craniotomy at the right temporoparietal region. After biopsies and tissues examination, the patient later diagnosed with GBM. As for judging the natural history of the diseases, the team decided to counsel the patient and her family conducting a new treatment strategy for GBM, immunotherapy. The immunotherapy approach performed in RSPAD was the dendritic cell (DC) vaccines therapy. As regard to post-DC vaccines therapy, the patient showed a significant improvement in her clinical condition (Karnofsky performance status increased from 30% to 60%). Also, the patient surpassed the average survival rate. Thus, the patient still scheduled for a routine follow up and a round of examinations to preserve the patient improved condition. Conclusion: The patient who has immunotherapy strategy especially dendritic cell vaccines therapy has shown an improved clinical status and survival rate for GBM, more than the average survival rates. These findings might give us more insights into how dendritic cell vaccines therapy can be involved as the fourth therapeutic strategies on treating patients with GBM.
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2020
Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are lim... more Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are limited to curing the symptoms and have not been able to restore insulin sensitivity in insulin-sensitive tissues that have become resistant. In the past decade, some studies have shown the significant role of a chaperone family, heat shock protein 70 (HSP70), in insulin resistance pathogenesis that leads to T2DM. HSP70 is a cytoprotective molecular chaperone that functions in protein folding and degradation. In general, studies have shown that decreased concentration of HSP70 is able to induce inflammation process through JNK activation, inhibit fatty acid oxidation by mitochondria through mitophagy decrease and mitochondrial biogenesis, as well as activate SREBP-1c, one of the lipogenic gene transcription factors in ER stress. The overall molecular pathways are potentially leading to insulin resistance and T2DM. Increased expression of HSP70 in brain tissues is able to improve insulin sensitivity and glycemic control specifically. HSP70 modulation-targeting strategies (including long-term physical exercise, hot tub therapy (HTT), and administration of alfalfa-derived HSP70 (aHSP70)) in subjects with insulin resistance are proven to have therapeutic and preventive potency that are promising in T2DM management.
Vascular Health and Risk Management, 2019
Introduction: Diabetes is often accompanied by undiagnosed dyslipidemia. The aim of the study is ... more Introduction: Diabetes is often accompanied by undiagnosed dyslipidemia. The aim of the study is to investigate the clinical relevance of lipid profiles and lipid ratios as predictive biochemical models for glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods: This is a retrospective study recruiting 140 patients with T2DM during a one-year period, 2018-2019, at the Diabetic Center Sanglah General Hospital and Internal Medicine Polyclinic Puri Raharja General Hospital. Demographic characteristics, glycosylated hemoglobin (HBA1c) , and lipid profile were recorded and analyzed using SPSS version 25.0 for Windows. The sample is then classified into good (HBA1c≤7) and poor (HBA1c>7) glycemic control. Risk analysis model, receiver operator characteristics (ROC) analysis, and correlation test were used to evaluate the association of HBA1c level with lipid profile and lipid ratio parameters. Result: Lipid profile findings such as total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) , triglycerides (TG), and lipid ratio parameter (LDL-C to high-density lipoprotein cholesterol (HDL-C) ratio) were higher in patients in the poor glycemic control group (p<0.05) and HDL-C was significantly lower in patients with poor glycemic control (p=0.001). There is a significant positive correlation between LDL, total cholesterol, LDL-C, TG, and TC to HDL-C ratio, triglycerides, and TC/HDL-C ratio with HBA1c level. Meanwhile, a negative correlation was observed on HDL-C with the HBA1c level. Only TC/HDL-C ratio and LDL-C/HDL-C ratio parameters may be used as predictive models (AUC>0.7), with cutoff point, sensitivity, and specificity of 4.68 (77%; 52%) and 3.06 (98%; 56%) respectively. A risk analysis model shows that the LDL-C/HDL-C ratio parameter is the most influential risk factor in the occurrence of poor glycemic control (adjusted OR =38.76; 95% CI: 27.32-56.64; p<0.001). Conclusion: Lipid profiles (LDL-C) and lipid ratios (LDL-C/HDL-C and TC/HDL-C ratio) show potential markers that can be used in predicting glycemic control in patients with T2DM.
Family Medicine and Community Health, 2018
Background: An increasing number of valid and well-designed trials have demonstrated a positive c... more Background: An increasing number of valid and well-designed trials have demonstrated a positive correlation between visit-to-visit variability (VVV) in systolic blood pressure (SBP) and increased risk of stroke and coronary heart disease among hypertensive patients. Methods: A cross-sectional study was conducted that involved 74 patients who visited the outpatient clinic at the Tabanan III Primary Health Care Service during April to May 2017. Blood pressure was retrospectively obtained from medical records. VVV was classified as low or high on the basis of the standard deviation of SBP. Antihypertensive medication adherence was expressed as the percentage of days covered, and sodium intake was measured with 24-hour food recall. Bivariate analysis was performed, followed by multivariate analysis for significant variables. Results: Among the participants, 67.6% were female, with a mean (standard deviation [SD]) age of 62.70 (10.00) years. Blood pressure was measured 4.82 ± 0.78 times during the period, and the mean (SD) SBP was 139.65 (10.57) mm Hg. Nonadherence and sodium intake were significantly higher in the high-VVV group than in the low-VVV group (nonadherence 13.5% vs. 37.8%, P = 0.033; sodium intake 1278.44 ± 43.02 mg vs. 1495.85 ± 45.26 mg, P = 0.038). After adjustment for other covariates, the differences remained significant only for nonadherence (model I exp β = 3.89 [95.0% confidence interval 1.23-12.34, P < 0.05], model II exp β = 3.9 [95.0% confidence interval 1.12-14.15, P < 0.05]). The area under the curve was 0.636 (P < 0.05), with sensitivity of 67.6% and specificity of 51.4%. Conclusion: Nonadherence to antihypertensive medication was significantly associated with higher VVV of SBP. Further study is needed to assess whether improving adherence could reduce VVV and improve cardiovascular outcomes.
Recent Advances in Biology and Medicine, 2017
The amount of glycosylated hemoglobin (HbA1c) reflects the long-term glycemic control of patients... more The amount of glycosylated hemoglobin (HbA1c) reflects the long-term glycemic control of patients with diabetes. HbA1c also predicts the risk for the development of diabetic complications such as cardiovascular disease (CVD). Patients with type-2 diabetes and the characteristic of dyslipidemia are frequently found. Also, dyslipidemia plays as an independent risk factor for CVD. This study was aimed to evaluate the relationship between glycemic control status with serum individual lipid profiles and lipid ratios in patients with type-2 diabetes. This cross-sectional study consisted of 80 patients. Depending on the HbA1c level, the patients were divided into two groups, good glycemic control group (HbA1c < 7.0%, n = 15) and poor glycemic control group (HbA1c ≥ 7.0%, n = 65). The association of HbA1c with individual lipids (TC, TG, HDL-C, LDL-C, Non- HDL-C) and lipid ratios (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, monocyte/HDL-C) were analyzed. The value of individual lipids and lipid rati...