Biomolecular and Health Science Journal

Cognitive Behavioral Therapy for Chronic Pain

Riska Afrina — 2019-10-31

Introduction: Pain is a complex stressor that has a major influence on several aspects of a person's physical, psychological, work and financial functions, especially in the form of chronic pain. The approach to chronic pain medically can sometimes not solve the problem as a whole, so that in its management psychological approaches such as cognitive and behavioral therapy (CBT) are needed.

Methods: We searched PubMed, Science Direct, and Google Scholar for search articles in English terms "chronic pain", "cognitive behavioral therapy", "pain management", and "efficacy". Searching using the keywords above showed 40 articles, but which were taken were 8 articles from the last 5 years.

Results: The method of intervention was carried out with a cognitive-behavioral approach in the form of traditional CBT, telephone-based CBT, coping skills training, cognitive-behavioral based physical therapy or CBT-based self-management. The research parameters used to measure the success rate of the interventions were pain intensity, physical function, psychological pressure, disability, fatigue, quality of life, coping strategies, catastrophization, and depression. The duration of the study varied from 5 weeks to 10 weeks, with a variation of 20-60 minutes per therapy session, except in studies using group therapy can take up to 5-7 hours per day. Some studies also conducted evaluation at the third and six months after treatment. The aim of the CBT approach was to independently improve self-efficacy in pain management.

Conclusion: Cognitive behavioral approaches combined with other therapeutic modalities can improve the physical function of patients with chronic pain.

The Unusual Presentation of Acute Pericarditis Mimicking Acute Coronary Syndrome

Ryan Enast Intan — 2019-10-31

Pericarditis is a common disorder that might present in various settings, including primary-care and emergency department. However, the clinical features in some cases did not match with the written theory, which could lead to a misdiagnosis. A 46-year-old man presented to the emergency room with progressive tightness chest pain, epigastric pain, nausea, and vomiting in the past 2 days. Based on the clinical, electrocardiograph (ECG), and laboratory evaluation, the patient was diagnosed with unstable angina pectoris and treated accordingly but did not showed an improvement. Clinical re-examination and echocardiography evaluation showed a pathognomonic finding of pericarditis feature. Combination therapy of colchicine and ibuprofen was given for 3 weeks. One-month follow-up evaluation showed normal ECG and echocardiography result without any remaining symptoms. Acute pericarditis does not always show typical finding. Therefore, clinician must always aware with other differential diagnosis of chest pain and ECG variation of acute pericarditis.

Back Matter Volume 2 No. 2, 2019

Back Matter — 2019-10-30

Cognitive flexibility and problem-solving in patients with bipolar disorder

Maria Yosepha Safira Nugroho — 2019-10-31

Introduction: This study focuses on the cognitive impairment in patients with bipolar disorder and also the distribution of cognitive flexibility and problem-solving by degree of education, chronicity, and episode of patient is in at the time of evaluation.
Methods: This was a cross sectional descriptive study with purposive sampling method. The population was the Harmony in Diversity Group in Surabaya, Indonesia. Twenty-two patients agreed to be subjects and each of them finished the Wisconsin Card Sorting Test (WCST) to measure cognitive flexibility and the Tower of London (TOL) to measure problem-solving.
Results: The WCST score are below normal for 90.9% of the patients. Higher cognitive flexibility is found in patients with bachelor's degree and euthymic patients, while lower cognitive flexibility is found in patients in depression episode, manic episode, and mixed episode. No patients could finish the TOL within the minimum required steps. Better problem-solving is found in patients in manic episode and euthymic patients while lower problem-solving is found in mixed episode and depressive episode.
Conclusion: The cognitive flexibility and problem-solving in patients with bipolar disorder are lower than the normal cut off. The type of episode and chronicity are contributing factors. Euthymic patients tend to have better cognitive flexibility and manic patients tend to have better problem-solving ability.

Anti-eczema Mechanism of Action of Nigella sativa for Atopic Dermatitis: Computer-aided Prediction and Pathway Analysis Based on Protein-chemical Interaction Networks

Meidyta Sinantryana Widyaswari — 2019-10-31

Introduction: Black cumin (Nigella sativa) is widely used to treat various diseases. It is also believed to relief skin conditions accompanied by itching symptom, such as atopic dermatitis (AD) or eczema. However, the anti-eczema mechanism of action is still unclear. The aims of this syudy was to identify anti-eczema mechanism of action of N. sativa for AD using computer aided prediction and pathway analysis based on protein-chemical networks.
Methods: We utilized dataset consisting chemical compounds of N. sativa from KNApSAcK. It is a comprehensive species-metabolite relationship database. Using canonical SMILES strings that encode molecular structures of each compound, we predicted the probabilities of activity (Pa) for anti-eczema effect based on PASS algorithms. The compounds with Pa >0.7 were included for pathway analysis based on protein-chemical interaction networks in STITCH database. We selected interactomes built by experimental data, gene co-expression, closest gene position, fusion, co-occurence, computational prediction, and other secondary data.
Results: Thirty-five active compounds of N. sativa have been utilized and 19 of them have potential anti-eczema effects. Oleic acid and lauric acid were predicted with Pa-value of 0.947 and 0.920 for anti-eczema effect, respectively. However, only lauric acid was confirmed having a plausible mechanism of action via LY96-TLR4- PIK3R1 pathway for lipopolysaccharide receptor activity (false discovery rate [FDR] = 0.0243) and low-density lipoprotein particle receptor binding (FDR = 0.0118).
Conclusion: Lauric acid in N. sativa has potential antieczema effect to prevent relaps in AD patients by controlling opportunistic bacterial infection that aggravates itching symptom in this condition.

Analgesic Effect of Bangle Rhizome Ethanol Extraction on Thermally Induced Pain in Mus musculus

Margareth Ayu Caroline Pangkerego — 2019-10-31

Introduction: Pain causes deterioration of quality of life. Nonsteroidal anti-inflammatory drug (NSAID) is used to relieve pain with upper gastrointestinal side effects. Zingiber cassumunar Roxb. (known as bangle) is commonly used to relieve pain, but no study has been proved to have analgesic effect. In empirical study, bangle is a potential analgesic due to its bioactive compound named zerumbone. The aim of this study was to investigate the analgesic effect of bangle rhizome ethanol extraction on thermally induced pain.
Methods: Five groups of male Mus musculus consisting of 6 mice each were used. A single dose of bangle extract 2 mg/20 g, 4 mg/20 g, 8 mg/20 g, aspirin 1.82 mg/20 g, and aquadest 0.2 ml were administrated. The analgesic effect was evaluated by hot plate test. The test was evaluated at 15th, 30th, 45th minute. Latency period was observed when mice showed pain responses including hind paw shaking, hind paw licking or jumping. The data was analyzed by paired T-test and one-way ANOVA.
Results: Results showed that all doses of bangle extract and aspirin 1.82 mg/20 g produced significant latency period (p<0.05) compared to baseline in each group using paired T-test. Latency period of bangle extract 8 mg/20 g was more significant than bangle extract 2 mg/20 g and 4 mg/20 g. One-way ANOVA showed no significant difference in latency period (p=0.1) between bangle extract and aspirin (p>0.05).
Conclusion: Bangle extract has analgesic effect on thermally induced pain. The minimum dose for analgesic is 2 mg/20 g or potentially less.

Association of Serum Magnesium Levels with Matrix metalloproteinase-9 (MMP-9) Urine in Patients with Diabetic Kidney Disease Stage 1 and 2

M. Hashemi Rafsanjani — 2019-10-31

Introduction: The progressiveness of stage 1 and 2 kidney disease is indicated by an increase in matrix metalloproteinase-9 (MMP-9). Development of diabetic kidney disease (DKD) is characterized by a thuckening of the glomerular basement membrane followed ultimately by progression to glomerular sclerosis and fibrosis. One of the factors that contribute is magnesium levels. This study aimed to determine the association between serum magnesium levels and MMP-9 urine in patients with stage 1 and 2 DKD.

Methods: This was a cross sectional study from stage 1 and 2 DKD patients. Patients were examined for serum magnesium levels and urine MMP-9. Urine MMP-9 examination was taken from the middle portion urine collection and examined using Sandwich-ELISA method then normalized with urine creatinine. The correlation between magnesium and MMP-9 urine was analyzed by the Spearman rank test.

Results: This study involved 56 subjects. The mean serum magnesium level was 1.8 ± 0.26 mg/dL. The mean MMP-9 was 120 ng/g creatinin. The mean value of FBG (fasting blood glucose) in patients in the study was 153.29±50.22 mg/dL. The mean value of PPG (post prandial glucose) was 233.61±71.3 mg/dL. The mean HbA1c value was 7.6±1.13%. The mean creatinin serum value was 1.1±0.43 mg/dL. There was a significant negative relationship with a moderate correlation between serum magnesium levels and urine MMP-9 (p = 0.000, r -0.512).

Conclusion: There was a significant negative relationship between serum magnesium levels and urine MMP-9 in stage 1 and 2 DKD patients.

Association of Metabolic Syndrome with Albuminuria in Diabetes Mellitus Type 2

Husin Thamrin — 2019-10-31

Background : Metabolic syndrome is a risk factor for cardiovascular disease as well as the occurrence of chronic kidney disease. According to the IDF, the metabolic syndrome is diagnosed when central obesity obtained with 2 or more metabolic abnormalities that include impaired glucose metabolism, increased blood pressure, hypertriglyceridemia, and low HDL-C. Several previous studies reported an significant association found between the metabolic syndrome with albuminuria. In Indonesia, the association of metabolic syndrome with albuminuria in type 2 diabetes have not been.reported.

Objectives : To investigate the association of metabolic syndrome with albuminuria in type 2 diabetes patients.

Methods : This is an analytic observational study, cross-sectional design in type 2 diabetes mellitus patients and we studied 131 subjects. Criteria metabolic syndrome according to IDF consensus and albuminuria assessed using the ACR method and the classification of albuminuria was based on consensus of Perkeni 2006. As for Statistical analysis using spearman correlation and Mann-whitney test. Significance level used was 0.05.

Results : Of the 131 type 2 diabetes patients with metabolic syndrome were found normoalbuminuria proportion 65.4%, microalbuminuria 27.1% and macroalbuminuria 7.5%. Obtained a significant association between systolic blood pressure with albuminuria, p = 0.000, r = 0.325. Fasting blood sugar with albuminuria, p = 0.01, r = 0.223. But not found significant association between diastolic blood pressure with albuminuria, p = 0.153, r = 0.125, waist circumference with albuminuria, p = 0.311, r = 0.089, low HDL with albuminuria p = 0.771, r = -0.025. Hypertriglyceridemia with albuminuria, p = 0.727 and r=0,031

Conclusion : The results of this study indicate a strong association between the components of metabolic syndrome, systolic blood pressure with albuminuria, and fasting blood sugar with albuminuria. Whereas diastolic blood pressure, waist circumference, low HDL, and hypertriglyceridemia were not found significant associations.

‘Wanting' and ‘Liking' Brain Mechanisms in Coaching: A qEEG Study using the CARE Coaching Model

Lyra Puspa — 2019-10-31

Introduction: Coaching has become increasingly popular for leadership development and behavioral change in organizations. Recent studies suggest that motivation is essential in enhancing the effectiveness of workplace coaching. A number of studies revealed that delta and beta-gamma oscillations are associated with the human motivational process through ‘wanting' and ‘liking' mechanisms. However, the brain mechanisms of motivation in coaching have not been studied. This preliminary study is the first attempt to explore the ‘wanting' and ‘liking' mechanism of coaching, by investigating the activity of the delta and beta oscillations during a face-to-face coaching session through quantitative electroencephalogram (qEEG).
Methods: Six male, right-handed, middle managers of an organization (mean age = 31.6) were recruited voluntarily as participants. A multichannel EEG (19 electrodes, 10/20 System) was used to record brain activity in both the resting state and the continuous 45-minute coaching session whilst using the CARE Model. The artifact-free EEG data were then quantified using wavelet analysis to obtain induced band power.
Results: Significant increase was shown in delta and beta-gamma activities throughout the coaching session. Increased delta absolute power was found in the frontal, parietal, and occipital regions, whilst increased beta-gamma activity was significantly detected in the frontal, posterior temporal, and occipital regions.
Conclusion: This preliminary result suggests that coaching, with regard to the CARE Model, induces both ‘wanting' and ‘liking' mechanisms simultaneously. Thus, the present findings provide the first preliminary neuroscientific underpinnings of the role of motivation in enhancing the effectiveness of workplace coaching through induced ‘wanting' and ‘liking' mental processes.

Association between Serum Magnesium Level with Acute Coronary Syndrome (ACS) in Diabetes Mellitus (DM) Patients

Ratih Wulansari — 2019-10-31

Introduction: Until now, cardiovascular complications are still the highest cause of death and disability in DM patients. Hypomagnesemia in DM accelerate atherosclerosis and can cause instability and plaque rupture which can lead to acute coronary syndrome.

Methods: Design of this study was observational analytic using a "case control" study involved 76 samples of DM patients, consisting of 38 samples with SKA (+) and 38 samples with SKA (-). Subjects of this study were all DM patients in the period July-December 2018 in the Emergency Room (ER) and Outpatient Installation of Endocrine at the RSUD Dr. Soetomo Surabaya, which fulfills the criteria for inclusion and exclusion. Demographic data and clinical characteristics are presented descriptively. If data is normally distributed then an unpaired t test is carried out and if the data is not normally, distributed with Mann Whitney test is performed. The statistical test was stated to be significant if p <0.05. The association between hypomagnesemia and the incidence of ACS a multivariate logistic regression test was performed, the risk number was in the form of odds ratios (OR).

Results: This study involved 76 subjects with diabetes mellitus with SKA and non SKA 38 subjects. The mean serum magnesium level in the ACS group was lower than non ACS (1.9 mg / dL vs. 2.1 mg / dL), hypomagnesemia cut-off of <2.08 mg / dL. In this study hypomagnesemia as a risk factor for the incidence of ACS in DM patients with OR 2.8 (CI 1.1-7.6; p = 0.039).

Conclusion: Magnesium levels in the ACS group were lower than the non ACS group. Hypomagnesemia Increase The Incidence of Acute Coronary Syndrome in Diabetes Mellitus Patients.

Association Between Neopterin Levels and Outcome in 30 Day HIV/AIDS Naive Patients

Lydia Juanita — 2019-10-31

Introduction: HIV/AIDS is still a major problem throughout the world even in Indonesia. Some markers can provide information regarding the description of immune activity in HIV/AIDS. Neopterin produced by macrophages as a catabolic result of Guanosine Triphosphate (GTP) is one of them. Neopterin has been widely studied as a prognostic indicator of the course in HIV/AIDS. Until now there have been no studies examine the association between neopterin levels and outcomes in 30 days of HIV/AIDS patients.

Methods: A prospective longitudinal analytic study involved 56 samples of HIV/AIDS naive patients from January to April 2019. Serum neopterin levels were measured by the Enzyme Linked Immunosorbent Assay (ELISA) method. Outcome is a living condition or death within the first 30 days of the patient being treated. Discriminant function analysis was used to determine the association between variable and controlling confounding factors using the "R" program. Outputs of p value was significant if <0.05.

Results: The average age of the study subjects was 39.7 ± 11 years old with predominantly male gender (71.4%). The median serum neopterin level of the study subjects was 168.13 nmol/L with the lowest levels of 11.78 nmol/L and the highest level of 196.95 nmol/L. Outcomes were grouped live and died, each group at 50%. There was a significant positive association between serum neopterin levels and outcomes in 30 days (p=0.02)

Conclusion: Role of neopterin levels still need to be proven as a prognostic factor by evaluating other factors that influence the outcome of HIV/AIDS patients.

Correlation between Serum IL-6 Level and Th17/Treg Ratio with Systemic Lupus Erythematosus Disease Activity

Adidia Carina Familia — 2019-10-31

Introduction: SLE pathophysiology shifted to a new paradigm which emphasizing the imbalance between Th17 and Treg. IL-6 is the main cytokine believed as the regulator of the balance between Th17 and Treg which play a big part in SLE pathophysiology and disease activity. The aim of this study was to determining the correlation between serum IL-6 level and Th17/Treg ratio with SLE disease activity on SLE inpatients of RSUD Dr. Soetomo Surabaya.

Methods: This cross sectional study included newly diagnosed SLE patients based on American College of Rheumatology (ACR) 1997 revised criteria and confirmed by rheumatologist. All subjects underwent the same examination and assessment such as SLE disease activity was scored according to SLAM score, serum IL-6 level measured using ELISA, and Th17/Treg ratio where the expression Th17-Treg detected by flowcytometry method.

Results: Thirty female subjects with active SLE had mean age 31,3 ± 10,46 years. The most frequent clinical manifestations were hematologic disorders and arthritis. Serum IL-6 level was significantly elevated in SLE patients compare to healthy subjects (200,61 pg/ml versus 45,9 pg/ml, p =0,028). Th17/Treg ratio were also significantly higher in SLE patients compared to healthy subjects (2,49 versus 1,20, p = 0,31). Th17/Treg ratio significantly correlated with SLE disease activity (r = 0,988; p<0,05). There were no significant correlation between serum IL-6 level with Th17/Treg ratio (r = -0,095; p>0,05) or even SLE disease activity (r = 0,066 ; p>0,05).

Conclusion: Serum IL-6 level had no significant correlation with Th17/Treg ratio or SLE disease activity. We found significant correlation between Th17/Treg ratio with SLE disease activity.

THE USE OF KINSHIP ANALYSIS ON PATERNITY TESTING THROUGH CODIS STR LOCI ‘CSF1PO' AND ‘THO1'

Dwi Fitrianti Arieza Putri — 2019-10-31

Introduction: Paternity tests compare a child's DNA pattern with the possible father to examine the DNA heritage in ensuring kinship. If there is no information from the father and mother or the child that can be used as a comparison in the forensic DNA examination process (paternity test), there must be a comparison from a close relative as an alternative to obtain the forensic DNA examination. This experiment's purpose is to analyze the use of kinship analysis in forensic identification especially in a paternity test.

Methods: This is a descriptive experiment using a cross-sectional design through locus analysis of DNA forensic examination in paternity test using the kinship analysis through STR CODIS loci: CSF1PO and THO1. The variables of this experiment were ‘locus' as the independent variable and ‘allele number' as the dependent variable. This experiment conducted a paternity tests to 8 samples in which the subjects were siblings; the test was administered on the CSF1PO and TH01 loci.

Results: This experiment displayed similar allele numbers on the same locus, both in 50% and 100% allele numbers; the research showed similarity in allele numbers of both siblings of which ¼ were inherited from the parents (for 50% allele number similarity), and ½ were inherited from the parents (for 100% allele number similarity).

Conclusion: This proves that a paternity test using siblings as the closest kin (kinship analysis) can be used as an alternative if no comparison is obtained from both the parents.

Relationship between HbA1c Levels with eGFR and Blood Pressure in Type 2 Diabetes Mellitus Patients in the Department of Internal Medicine Dr. Soetomo General Hospital Surabaya

Alexander Tikara Sugondo — 2019-10-31

Introduction: Diabetes mellitus is a non-transmitted pandemic disease which had spreaded on a global scale. The prevalence of diabetes mellitus in the world according to the International Diabetes Federation (IDF) is 1.9% and diabetes mellitus is ranked seventh as the cause of death in the world, around 95% in the world is type 2 diabetes mellitus. According to Riset Kesehatan Dasar (Riskesdas) in 2013, the prevalence of diabetes mellitus in Indonesia is 6,9%. Type 2 diabetes mellitus that is not well controlled will increase the risk of chronic complications, both microangiopathies such as nephropathy, and macroangiopathy such as hypertension. The aim of the study was to determine correlation between HbA1c levels with eGFR (Estimated Glomerulus Filtration Rate) and blood pressure (systolic and diastolic).

Methods: An analytic observational cross-sectional study, collecting the data from 94 patients with type 2 diabetes mellitus, Dr. Soetomo General Hospital, Surabaya, from January to May 2018. The variables were collected from patient's medical records. Analysis using Spearman's Rank Correlation test. To determine normality of the data, we use Kolmogorov-smirnov test.

Results: The results showed that there are 134 (57,8%) patients with type 2 diabetes mellitus are female more than male. Patients with greater than or equal to 45 years old were 203 (87,5%) patients, more than under 45 years old. The correlation test showed that there was no significant correlation between HbA1c and systolic blood pressure (r=-0,127; p=0,054). Also there was no significant correlation between HbA1c and diastolic blood pressure (r=-0,111; p=0,093). Analysis on other factor showed a significant correlation between HbA1c and eGFR (r=0.341; p=0.000).

Conclusion: There was no significant correlation between HbA1c and systolic blood pressure, also there was no significant correlation between HbA1c and diastolic blood pressure. But, there was a significant correlation between HbA1c and eGFR. This is because the data retrieval does not consider the drug consumption and therapy that has been done by the patient, as well as examination of HbA1c, serum creatinine eGFR, and blood pressure not at the same time.

The Comparison of Breast milk from Mother with Preterm Infant at 4o C Temperature in 0, 24 and 48 Hours on Bacterial Growth

Pandit Bagus Tri Saputra — 2019-10-31

Introduction: Preterm and fullterm breast milk has different leukocyte and bioactive concentration, which affect it's bactericidal activity and storage duration. The preterm breast milk potentially has longer storage duration than fullterm breast milk The research and guideline about the acceptable of storage duration of preterm breast milk at 4^o C was limited. The objective of this study was to assess the correlation of storage duration of preterm breast milk preterm baby at 4^o C temperature on bacterial growth.

Methods: The study design was experimental using pre-post control groups design. We used 9 samples of breast milk which met the inclusion criteria divided into 3 groups. The first, second and third groups was storage in 4^o C for 0, 24 and 48 hours respectively before the inoculation to the culture media.

Results: After the samples were kept at 4^o C temperature for 0, 24 and 48 hours, the mean bacterial colony forming unit for each group were 92 (±SD 112), 79 (±SD 97) and 63 (±SD 73) CFU respectively. Compared to the first group, the second and third group has lower bacterial colony forming unit but no significant differences statistically (P= 0.214 and P=1.39 respectively). Likewise there was no significant bacterial colony forming unit between second and third group (P=0.086).

Conclusion: Storage of preterm breast milk in 4^o C for 24 and 48 hours show no change in total bacterial colony count (TBCC)..

Front Matter Volume 2 No.2, 2019

Front Matter — 2019-10-31