Demographic characteristics, risk factors and immunocytochemistry of p16INK4a, Ki-67, MCM5, and survivin as predictors for the progress of cervical precancer lesion.

Aim To identify the predictive factors and biomarkers in the progression of cervical precancer lesion or Cervical Intraepithelial Neoplasia (CIN). Methods The study was conducted from August 2007 to September 2008. Design of the study was case-control with stratifications of test dose response. The cases were patients with CIN. Control patients were non CIN patients. Bivariate analysis followed by multivariate analysis was conducted. Results There were 130 patients, consisting of 124 CIN patients divided into CIN 1, CIN 2 and CIN 3, with the following numbers of patients: 30, 41, and 33, respectively and 26 patients without CIN (non CIN). Bivariate analysis showed that age < 41 years, education ≥ 13 years, sexual partner ≥ 2, first sexual relationship at age < 22 years, smoking, the presence of sexuallly transmitted infections, positive HPV DNA, high p16INK4a, Ki-67, MCM5 and Survivin expression constituted independent variables for the occurrence of CIN with P value of < 0.05. However, on multivariate analysis, independent variables that emerged were age, education ≥ 13 years, sexual partner ≥ 2 persons, positive HPV DNA, and over expression of p16INK4a, Ki-67 and Survivin that showed a P value of < 0.005. Conclusion Younger ages, education age ≥ 13 years, sexual partner ≥ 2 persons, positive HPV DNA, high p16INK4a, Ki-67 and Survivin expression constituted the risk factors for the occurrence of the progress of CIN, and was used in the equation to predict the progress of cervical precancer lesion.

Interleukin-10 serum level in acute coronary syndrome patients.

Aim To compare plasma IL-10 concentrations in patients with Acute Coronary Syndrome (ACS) with those in Coronary Artery Disease (CAD). Methods ACS patients hospitalized in intensive coronary care unit (ICCU) of Cipto Mangunkusumo Hospital/Faculty of Medicine University of Indonesia (CMH/FMUI), Persahabatan Hospital, MMC Hospital, and Medistra Hospital, Jakarta, between May 2005 and May 2006, were included in this study. The ambulatory CAD patients were taken as comparator. The serum IL-10 level was measured by immunoassay method, and compared by using Independent Student’s t-test. To investigate whether IL-10 serum level could predict ACS, the sensitivity and specifi city of this parameter towards SKA in various IL-10 serum levels were calculated as well. Results In this observational study, as many as 146 subjects were analyzed, consisting of 84 ACS patients, and 62 coronary artery disease (CAD). The IL-10 level was higher in the group of ACS patients (7.37 pg/mL + 7.81, CI 95% 5.68-9.07) than that in CAD patients (1.59 pg/mL + 1.55, CI 95% 1.2-1.98). The optimal cut-off point for serum IL-10 level is >1.95 pg/mL, with 79.76 % sensitivity and 77.42 % specifi city. Conclusion The IL-10 level was higher in the ACS patients compared to that in CAD patients. Serum IL-10 measurement is a quite superior method to distinguish acute and stable condition, eventhough it is not as good as hsCRP for the same purpose.

Expression of NF-kB and COX-2 in Young Versus Older Patients with Sporadic Colorectal Cancer.

Aim: to distinguish the expression of NF-kB and COX-2 between young and older group of sporadic colorectal cancer patients. Methods: this was a comparative study between sporadic CRC patients aged 40 years or younger and patients aged 60 years or more. Expression of NF-kB and COX-2 were assessed by immunohistochemical method using rabbit polyclonal antibodies against human p65 NF-kB and COX-2 proteins. Results: there were 98 cases of sporadic colorectal cancers between 1999 and 2007 obtained from the Department of Anatomical Pathology, Faculty of Medicine University of Indonesia, Jakarta and Department of Anatomical Pathology, Faculty of Medicine Padjajaran University, Bandung. There were 60 patients aged 60 years or more and 38 patients aged 40 years or less. Most tumors were located in the distal colon. Positive expression of NF-kB was found in 72 (73.5%) cases, whereas COX-2 expression was found in 48 (49.0%) cases. No significant difference of NF-kB and COX-2 expression between young and older patients. Conclusion: the expression of nuclear factor kB (NF-kB) in Indonesian patients with sporadic colorectal cancer was high. However, cyclooxygenase-2 (COX-2) was only expressed in half of patients. There was no significant difference of NF-kB and COX-2 expressions between patients aged 40 years or less and patients aged 60 years or more. Further studies are needed to elaborate the role of inflammation in sporadic colorectal carcinogenesis.

The effect of curcumin on lipid level in patients with acute coronary syndrome.

Aim: to evaluate the effects of curcumin on total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride in acute coronary syndrome patients. Methods: this study were conducted at Dr. Cipto Mangunkusumo General Hospital (RSUPN-CM), Persahabatan Hospital, MMC Hospital and Medistra Hospital, Jakarta. The study started from 1 May 2005 to 5 May 2006. Study Design was an interventional study which was a randomized double blind controlled trial to evaluate the effects of curcumin administration at escalating doses (low dose 3 times 15 mg/day, moderate dose 3 times 30 mg/day, and high dose 3 times 60 mg/day) on total cholesterol level, LDL cholesterol level, HDL cholesterol level, and triglyceride level in ACS patients. Results: a 75 ACS patients undergoing randomization participated in randomized controlled trial (RCT). Of the 75 ACS patients participating in that RCT, 67 received care at RSCM, 6 at Persahabatan Hospital, and 2 at MMC Hospital. As many as 63 patients were able to participate in the RCT up to its conclusion. There was no significant difference in age, sex, risk factor of dyslipidemia, DM, smoking, hypertension, CHD history in family, height, body weight and body mass index, waist circumference, systolic blood pressure, diastolic blood pressure in the four groups of patients. This showed that the randomization performed was reasonably good. There was no significant difference in laboratory parameters, such as total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride, fasting blood glucose, blood glucose 2 hours PP, glyco Hb, triglyceride, Hb, Ht, leukocyte, thrombocyte, ureum, creatinine, SGOT, SGPT, in the four groups. There was no significant difference in types of ACS and locations of ACS in the four groups as well. There was no significant difference in statin medicatios (simvastatin), aspirin ACE inhibitor, and DM medications in the four groups. No patient used tiazolidindion. No significant difference was found in the percentage of compliance in the four groups of patients. The effects of curcumin on total cholesterol level and LDL cholesterol level, there was a trend that the lower the dose of curcumin, the higher the effect of reduction. For HDL cholesterol level, there was also a trend that the lower the dose of curcumin, the higher the effect of increase in HDL cholesterol level. However, for triglyceride the pattern was not the same, and the group of moderate-dose curcumin shoed the minimal effect of increase, followed by the low-dose curcumin and finally the high-dose curcumin that showed the highest effect of increase. Conclusion: the administration of low-dose curcumin showed a trend of reduction in total cholesterol level and LDL cholesterol level in ACS patients.

The cut-off point of interleukin-6 level in acute coronary syndrome.

AIM: this study aimed to observe whether the interleukin-6 level in acute coronary syndrome (ACS) patients were higher than those in coronary heart disease (CHD) patients. In addition, we would like to observe the cut off point of interleukin-6 level in ACS. METHODS: this cross sectional study were conducted at Dr. Cipto Mangunkusumo General Hospital (RSUPN-CM), Persahabatan Hospital, MMC Hospital and Medistra Hospital, Jakarta. The study started from 1 May 2005 to 5 May 2006. RESULTS: in this observational study, as many as 62 CHD patients were collected and 84 ACS that met the study criteria. Demographic analysis showed that there was no difference in ages among the two groups (ACS and CHD). The risk factors of dyslipidemia, hypertension and lipid profile in the two groups did not differ significantly. Waist circumference and IMT, systolic and diastolic blood pressures in the two groups did not also differ significantly. Smoking was more prevalent in the groups of ACS than in the groups of CHD. In this study the IL-6 level in ACS (mean 40.85 pg/mL, SD 41.71, CI 95% 25.63-42.08 was higher than that in CHD (mean 4.58 pg/mL, SD 9.61, CI 95% 2.14-7.02). To identify the IL-6 level as the predictor for the occurrence of ACS, sensitivity and specificity were calculated at various cut-off points of IL-6 level. At cut-off point of IL-6 4.43 pg/mL the highest sensitivity (89.95%) and highest specificity (77.42%) were found with ROC of 0.87. CONCLUSION: it could be concluded that the IL-6 level in ACS were higher that those in CHD. The IL-6 level 4,43 pg/mL could differentiate the acute condition (ACS) and stable condition (non-ACS) with sensitivity of 89.95% and specificity of 77.42%, and ROC of 0.87.

Survival rate and prognostic factors in advanced cervical cancer patients accompanied by renal impairment.

The objective of this study was to obtain information on the survival rate of advanced cervical cancer patients with renal impairment (ACCRI) and its prognostic factors. In addition, it is hoped that by this method the scoring system for predicting the death of ACCRI patients hopetully could be obtained. Design of the study used was retrospective cohort study. Data collected were retrieved from medical records of ACCRI patients from 1 January 1998 to 31 December 2003 at Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, with a total sample of 70 cases. The results of the study showed that mean survival of all ACCRI patients was 8.2 months, mean survival at sixth month was 39%, and mean survival at one year was 3.2%. Median survival was 5.3 months. Prognostic factors affecting the survival of ACCRI patients included histopathological type (adenosquamous cell and cell differentiation), cortical thickness of the kidney less than 1 cm, and nephrostomy.

Prevalence of hypertension without anti-hypertensive medications and its association with social demographic characteristics among 40 years and above adult population in Indonesia.

AIM: To find out the prevalence of hypertension without anti-hypertensive medication and its social demographic risk factors among adult population in Indonesia. METHODS: Random samples of 3080 subjects aged 40-94 years were obtained from various districts in every big island in Indonesia. Blood pressure measurements, as well as assessment on history of hypertension, use of anti-hypertensive medications, and social demographic characteristics were performed. Blood pressure measurements were obtained by trained doctors with the subjects in supine position. Stepwise multiple logistic regression was used to determine variables which were most associated with treatment without anti-hypertensive medication in hypertensive subjects. RESULTS: The prevalence of hypertension without anti-hypertensive medication among 40 years and above adult population in Indonesia was 37.32% (677 our of 1814 hypertensive subjects). From bivariate analysis, we found that male sex, older age, informal education and unemployment were associated with the use of anti-hypertensive medication. Multivariate analysis shows that male sex (OR=1.33), education level of elementary school (OR=1.50), and government employment (OR=1.24) are significantly as risk factors for not taking anti-hypertensive medication. Age more than 60 years old (OR=0.49) and unemployment (OR=0.70) are protective factors for not taking anti-hypertensive medication. CONCLUSION: The prevalence of hypertension without anti-hypertensive medication in this study is higher than the prevalence found in some other studies, and due to several social demographic risk factors, such as low level education, male sex, and being government employees. On the other hand, older people and those who have no formal occupation are protective factors.

The prevalence of orthostatic hypotension and its risk factors among 40 years and above adult population in Indonesia.

Factors associated with orthostatic hypotension such as age, drug induced hypotension, hypertension and diabetes mellitus have still been debatable. Most of previous studies were conducted in subjects 65 years or older, only a few were done in subjects from younger to older adults. The purpose of this study is to find the prevalence and predictor factors of orthostatic hypotension among adult population aged 40 years and above in Indonesia. This study is a part of Indonesian Hypertension Epidemiologic Survey. A random sample of 4436 subjects aged 40–94 years was obtained from various municipalities in every big island in Indonesia. Orthostatic testing, assesment of history of medical conditions (diabetes mellitus, stroke, and hypertension), blood pressure measurement and use of anti-hypertensive medications were performed. A stepwise logistic regression was used to determine the significant predictor of orthostatic hypotension. A total of 561 persons (12.6%) experienced orthostatic hypotension. Central α2-agonist and other centrally acting drug is the only anti hypertension medicine which influences orthostatic hypotension. Multivariate analysis showed that high systolic and diastolic blood pressures were predictor factors of orthostatic hypotension. The use of anti-hypertensive medicine was a protective factor for orthostatic hypotension. This study confirms the conclusion that age is not a predictor factor for orthostatic hypotension. In fact, the existence of comorbidities in the subjects such as hypertension (high systolic and diastolic blood pressure) is a predictor factor, while the use of anti-hypertensive medication is a protective factor.

Clinical-pathologic factors, as predictor of lymph nodes metastasis in cervical cancer stage IB and IIA.

The aim of this study was to identify possible predictor factors of lymph node metastases in patients with cervical cancer stage IB and IIA. Study was conducted between May 1996 and December 2001. There were 183 patients of cervical cancer with FIGO Stage IB and IIA who were underwent radical hysterectomy and lymphadenectomy. From those 158 patients could be evaluated, consisting 43 patients with node metastases 115 patients without metastases. Research design was case control study. Case was patients with node metastases and control was those without node metastases. Multivariate analysis was made after bivariate analysis. On bivariate analysis age < 39 years, diameter of lesion > 4 cm, stage IIA > 4 cm, histopathology moderate and poor differentiation, blood and lymphatic vessel invasion were independent variables for node metastases with p value ≤ 0.05. However, on multivariate analysis younger age, parity ≥ 4, diameter of lesion, histopathology adenosquamous, and lymph vascular invasion (+) as independent factors for node metastases with p value ≤ 0.05. Conclusion: Younger age, parity ≥ 4, stage IIA > 4 cm, diameter of lesion, histopathology adenosquamous, and lymph vascular invasion (+) were risk factors for node metastases and can be used as predictors.

Survival of borderline tumors of the ovary and its prognostic factors at Dr. Cipto Mangunkusumo hospital from 1990 to 1999.

Sixty-two patients with borderline tumors of ovary were historical cohort analyzed for survival characteristics. There were 9 patients with FIGO stage IA, 9 with stage IC, 3 with stage IIIA, 2 with stage IIIB, 4 with stage IIIC, 1 with stage IV and 34 with inadequate stage tumors. Twenty one patients had surgical staging with radical surgery, 10 patient had at least a total abdominal hysterectomy and bilateral salpingo-oophorectomy, 6 patient had surgical staging with conservative surgery, 24 patient had at least a unilateral salphingo-oophorectomy or ovarian cystectomy and 1 patient had biopsy. Sixteen patients received cisplatin-based combination chemotherapy, that were 8 with inadequate stage tumors, 7 with stage III tumors and 1 with stage IV tumor. Follow-up range from 0.02 to 10.48 years, with a median of 3.5 years. Fifty nine patient were alive. Three patients died, all of disease. Recurrence were found in 4 patients. The overall 2-years survival rate was 96% and 10-years survival rate was 94%. In log rank test, residual disease and histology type were significant predictor of survival.