International Medical Journal

Abstract : The prevalence of diabetes is increasing worldwide including Indonesia. The major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) is cardiovascular disease (CVD). The underlying pathophysiology that increases CVD risk in T2DM is atherosclerosis. Arterial stiffness is associated with atherosclerosis through vascular damage, aging, and endothelial dysfunction. Besides insulin resistance and hyperglycemia, fibrinogen as a marker inflammation and procoagulant state is also an important risk factor in progressing atherosclerosis. We investigated the correlation between fibrinogen as an inflammatory and risk factors of CVD with brachial-ankle pulse wave velocity (baPWV) as a non-invasive method represent arterial stiffness in type 2 diabetes mellitus (T2DM) patients. This study was an observational analytic cross-sectional study involved 40 patients with T2DM in Diabetes Outpatient Clinic, Dr. Soetomo general hospital, a tertiary referral hospital in Surabaya, Indonesia. We performed interviews, physical examination, and collected laboratory data including fasting and postprandial glucose, HbA1c, lipid profile, and fibrinogen level. We measured arterial stiffness by calculating the mean of right and left baPWV. The average fibrinogen level in this study was 456.75 ± 142.60 mg/dL and the mean of baPWV was 16.61 ± 2.53 m/s. Patients with HbA1c > 8% had higher fibrinogen levels than patients with HbA1c  8%. There was a positive correlation between fibrinogen level and arterial stiffness in T2DM patients in a tertiary referral hospital in Surabaya, Indonesia.
Full article

Abstract : Musculoskeletal pain is a major problem among adults and workers at a higher rate these days. It may be severe enough to interfere with your day-to-day life. The purpose of the study to assess the effectiveness of phonophoresis among patients with musculoskeletal pain. A quasi-experimental design was conducted on 41 patients with musculoskeletal pain. Data were collected using a self-reported questionnaire with three parts: First part Demographic data, the second part was the characteristics of pain: location of pain, type of pain, pain frequency and pain severity by a Visual Analog Scale (VAS) and The third part was the ultrasound parameters selected by the physiotherapist. An independent t-test and ANOVA was used to determine the effectiveness of Phonophoresis on musculoskeletal pain between patients The research results showed that ultrasound phonophoresis had a positive influence on pain and function in patients with moderate to severe musculoskeletal pain. The treatment was continued for 6 consecutive sessions. However, the improvement was significantly greater in the first three sessions. The current study concluded that Ultrasound and Phonophoresis both are beneficial for reducing pain with patients who have musculoskeletal pain.
Full article

Abstract : Andrographis paniculata (AP) is a medicinal herb claimed to possess various pharmacological activities. As the AP extracts were widely used for medicinal purposes, the present study was embarked to evaluate the best extraction methods among AP ethanol, methanol and aqueous extracts, to determine its phytochemical compound and cytotoxicity effect. The toxicity effect of AP extract was evaluated using brine shrimp lethality assay. Finally, the chemical compounds of AP extracts were also identified using Thin Layer Chromatography (TLC) and High Performance Liquid Chromatography (HPLC). AP ethanol extraction resulted in the highest yield, demonstrated the superiority of the method. The AP ethanol extract was subjected to a subsequent study of brine shrimp cytotoxicity assay and demonstrated the non-toxic effect of this extract. The chemical evaluation of AP extracts showed the presence of andrographolide and neo-andrographolide in methanol and ethanol extract, while AP aqueous extract only contained andrographolide. Therefore, the findings in this study support the safety and potential use of AP ethanol extract as a novel agent for medicinal purposes. Further laboratory and clinical trial studies are needed to establish the use of AP ethanol extract as an alternative medicine.
Full article

Abstract : The medical staff remains liable to COVID-19. Healthcare institutions must give offer to the supply of personal protective equipment (PPE) to them, with the prolonged contact with this equipment that may cause a variety of skin diseases. The study is shed light on the cutaneous abnormal reactions to the PPE among the medical staff and offers solutions. This cross-sectional study conducted for the medical staff that involved doctors, dentists, pharmacists, and nurses in the high-risk Ramadi General Teaching Hospital and low-risk Private Clinics, Anbar governorate, Iraq. between 4 July till 10 August 2020. A quantitative descriptive research included age, gender, the duration and type of used masks, gloves, Goggles/face shield, and/or gown. About 23 questions described the adverse skin reactions chiefly that involve the skin. A total of 196 participants were recruited for the online questionnaire, including (49.5%) doctor, (15.3%) dentist, (16.8%) pharmacist, and (18.4%) nurse, with a significant involvement between 20-29 years old age. The use of the mask and glove were associated significantly with an adverse skin reaction, like a wound, dry lips, Acne and/or folliculitis, hand dryness, erythema, itching, wrinkle, nail fracture. While workers who regularly used gowns had a negative correlation with adverse skin reactions including erythema with pruritus of trunk and shoulders, miliaria, and pityriasis versicolor. In conclusions, the medical staff uses PPE that may develop mild dermatological adverse effects. It needs early diagnosis and treatment. There is dermatological advice that may be helpful to avoid these unwanted effects.
Full article

Abstract : Two methods of repair are currently available for an abdominal aortic aneurysm (AAA), open aneurysm surgery, and endovascular aneurysm repair (EVAR). The purpose of this article is to investigate the morbidity and mortality of all cases of open surgery versus EVAR conducted from 2011 to 2019 at Sina Medical Research and Training Hospital. This research is a retrospective cross-sectional study. The study population consisted of all abdominal aortic aneurysm patients who were treated at Sina Hospital in Tehran from September 2011 to December 2019. All patients who met the inclusion criteria participated in the study. A checklist of required data was prepared and used to extract data from patients' medical case files. Morbidity and mortality information of patients was completed via telephone contact with patients or their families. Analyses were performed using SPSS software with a 5-percent error rate. The sample consisted of 194 patients who were divided into two groups. 73 patients (37.6%) underwent open surgery and 121 patients (62.4%) underwent EVAR. Rates of blood loss and blood transfusion, length of stay in the intensive care unit (ICU), a total length of postoperative hospitalization for patients who underwent open surgery were significantly higher than for those who underwent EVAR (P-value <0.001). Patients who underwent open surgery experienced more renal and cardiac morbidities than those who underwent EVAR (P-value <0.05). Morbidities associated with grafting were significantly greater in patients undergoing EVAR than in those undergoing open surgery (P-value = 0.011). Moreover, the need for intervention for postoperative morbidities was higher in the open surgery repair (OSR) group compared with the EVAR group (P-value = 0.030). The frequency of reoperation was about 3 times higher in the EVAR group in comparison with the OSR group. The frequency of death was higher in the OSR group compared to the EVAR group, so that36.6 and 25.9 of patients in OSR and EVAR groups died, respectively, although this difference was not statistically significant (P-value = 0.123). The mortality probability of patients with a history of CVA and smoking was 3.47 and 2.66 times higher than patients with a negative history of these cases, respectively. The main morbidities of open surgery include renal and cardiac complications, longer hospitalization, and need for more amounts of blood transfusion, while main morbidities of EVAR include graft thrombosis and EVAR associated morbidities (e.g. graft and endoleak migration). However, there is no difference in mortality rates of these two methods.
Full article