A patient with plaque type morphea mimicking systemic lupus erythematosus.

Morphea is an uncommon connective tissue disease with the most prominent feature being thickening or fibrosis of the dermal without internal organ involvement. It is also known as a part of localized scleroderma. Based on clinical presentation and depth of tissue involvement, morphea is classified into several forms, and about two thirds of adults with morphea have plaque type. Overproduction of collagen production by fibroblast is the cause of abnormality in morphea, and the hyperactivity mechanism of fibroblast is still unknown, although there are several mechanisms already proposed. Plaque type morphea is actually a benign and self limited. Plaque type morphea that mimicking systemic lupus erythematosus in clinical appearance, such as alopecia and oral mucosal ulcers, is uncommon. A case of plaque type morphea mimicking systemic lupus erythematosus in a 20 year old woman was discussed. The patient was treated with local and systemic immunosuppressant and antioxydant. The patient's condition is improved without any significant side effects.

Metal fume fever among galvanized welders.

The metal fume fever (MFF) is an inhalation fever syndrome in welders of galvanized steel, who join and cut metal parts using flame or electric arc and other sources of heat. Inhalation of certain freshly formed metal oxides produced from welding process can cause MFF as an acute self-limiting flulike illness. The most common cause of MFF is the inhalation of zinc oxide (ZnO). The inhalation of ZnO particles can provoke a number of clinical responses of which accompanied by changes in composition of bronchoalveolar lavage (BAL) fluid, including early increase in pro-inflammatory cytokines, inflammatory marker, and recruitment of inflammatory cells in the lungs. The MFF is characterized by fever, cough, sputing, wheezing, chest tightness, fatique, chills, fever, myalgias, cough, dyspnea, leukocytosis with a left shift, thirst, metallic taste, and salivations. The diagnosis of MFF diagnosis is based on clinical finding and occupational history. The symptoms resolved spontaneously. The treatment of MFF is entirely symptomatic, no specific treatment is indicated for MFF. The mainstay of management of MFF is prevention of sub-sequent exposure to harmful metals. Including public and physician awareness of MFF may help to reduce the occurrence of the disease.

Transdermal bio-identical progesterone cream as hormonal treatment for osteoarthritis.

Osteoarthritis (OA) is a condition found worldwide, is strongly associated with aging and is the most common type of arthritis. Because of its effect on ambulation and mobility, it has significant functional impact and is associated with considerable medical costs. Because of the aging of the society and the obesity epidemic, the burden of OA can be expected to increase over the next 20 years. Although OA has been regarded primarily as a non-inflammatory arthropathy, symptoms of local inflammation and synovitis are present in many patients and have been observed and even in the absence of classical inflammation, which is characterized by infiltration of neutrophils and macrophages into joint tissue, elevated levels of inflammatory cytokines have been measured in OA synovial fluid. Although the cartilage lesion is present at sites remote from synovium, the fibroblast- and macrophage-like synovial cells, as well as the chondrocytes itself, are potential sources of cytokines that could induce chondrocytes to synthesize and secrete cartilage-degrading proteases, cytokines, and other inflammatory mediators. The bio-identical progesterone shows its anti-inflammatory effects in OA by suppressing gene expressions in the production of inflammatory cytokines through the negative interaction between nuclear transcription factor and the progesterone receptor and/or the progesterone-induced increase of nuclear transcription factor inhibition in the nucleus. The bio-identical progesterone may indirectly regulate bone remodeling and may also play a role in the development and maintenance of cartilage. This review will discuss about transdermal bio-identical progesterone cream as suggested hormonal treatment of OA, based on its pathogenic process.

Typhoid fever as a triggering factor in acute and intractable bronchial asthma attack.

Typhoid fever is an enteric infection caused by Salmonella typhi. In Indonesia, typhoid fever is endemic with high incidence of the disease. In daily practice we frequently have patients with bronchial asthma, and it is becoming worse when these patients get typhoid fever. After oral ingestion, Salmonella typhi invades the the intestine mucosa after conducted by microbial binding to epithelial cells, destroying the microfold cells (M cell) then passed through the lamina propria and detected by dendritic cells (DC) which express a variety of pathogen recognition receptors on the surfaces, including Toll-Like Receptor (TLR). expressed on macrophages and on intestinal epithelial cells inducing degradation of IB, and translocation of NF-B (Nuclear Factor-Kappa Beta). This process initiates the induction of pro-inflammatory gene expression profile adhesion molecules, chemokines, adhesion molecules, and other proteins that induce and perpetuate the inflammation in host cells then will induce acute ant intractable attack of bronchial asthma. The role of typhoid fever in bronchial asthma, especially in persons with acute attack of bronchial asthma, is not well understood. In this article, we will discuss the role of typhoid fever in the bronchial asthma patients which may cause bronchial asthma significantly become more severe even triggering the acute and intractable attack of bronchial asthma. This fact makes an important point, to treat completely the typhoid fever in patients with bronchial asthma.

Chronic autoimmune urticaria.

Chronic urticaria is common and patients may present with transient eruption of itchy, eruthematous, edematous swellings of the dermis, which lasts more than six weeks. One type of chronic idiopathic urticaria, and part of it, is the chronic autoimmune urticaria. The chronic autoimmune urticaria is caused by high affinity of IgE receptors (anti-FcRI) and less frequently by anti-IgE autoantibodies, also the role of complement activation, that leads to mast and basophil activation. Despite many recent advances in the understanding of chronic autoimmune urticaria, this condition remains a major challenge in the terms of its etiology, investigations, and management.

A patient with allergic bronchopulmonary mycosis caused by Aspergillus fumigatus and Candida albicans.

Allergic Bronchopulmonary Mycosis (ABPM) is an exagregated immunologic response to fungal colonization in the lower airways. It may cause by many kinds of fungal, but Aspergillus fumigatus is the most common cause of ABPM, although other Aspergillus and other fungal organisms, like Candida albicans, have been implicated. Aspergllus fumigatus and Candida albicans may be found as outdoor and indoor fungi, and cause the sensitization, elicitation of the disease pathology, and its clinical manifestations. Several diagnostic procedurs may be impicated to support the diagnosis of ABPM caused by Aspergillus fumigatus and Candida albicans. A case of allergic bronchopulmonary mycosis caused by Aspergillus fumigatus and Candida albicans in a 48 year old man was discussed. The patient was treated with antifungal, corticosteroids, and antibiotic for the secondary bacterial infection. The patient's condition is improved without any significant side effects.

Allogenic hematopoietic stem cell as curative treatment in myelofibrosis.

Myelofibrosis (MF) is one of the Philadelphia chromosome-negative clonal myeloproliferative disorders or chronic myeloid disorders, and it is caused by much deposit of collagen substances in bone marrow, definitely is classified as hematopoietic stem cells clonal abnormality, and related to chronic myeloproliferative disorders characterized by striking figure of extra-medullary hematopoiesis. Symptoms and signs of MF are included the variable degree of cachexia and marked extra-medullary hematopoiesis. The results of laboratory studies at presentation include anemia, leukocytosis or leucopenia, a left-ward shift in the granulocyte count, increased or decreased platelet count. Many conventional treatment modalities have been used in the MF treatment as supportive treatments. There is only one curative treatment in MF patients using allogenic hematopoietic stem cell transplantation (HSTC). The umbilical cord blood (UCB) as the source of stem cell has increased recently and gives promising results on MF.

The efficacy of Bacillus Calmette-Guerin vaccinations for the prevention of acute upper respiratory tract infection in the elderly.

AIM: to study the efficacy of BCG vaccinations, once a month for 3 consecutive months, in elderly on the prevention of acute upper respiratory tract infection (AURTI), interferon - gamma (IFN-γ) and interleukin (IL)-10 level in the BCG and placebo group and their comparison in the period of the study. METHODS: an original, experimental, prospective study with randomly pre-test and post-test design. Subjects were 60-75 years old, divided into BCG and placebo groups. The subjects in the BCG group received BCG vaccination, meanwhile the subjects in the placebo group received solvent for BCG vaccine, once a month for 3 months in succession at the deltoid region for each group. The subjects in both groups were evaluated every 2 weeks for the infiltrate diameter, on the 8th and 12th week for the scar measurements, and every 4 weeks for the prevalence of AURTI. The levels of IFN-γ and IL-10 were done at the initial and the end of the study. Data obtained were the prevalence of AURTI, the infiltrate and scar diameters at the site of BCG vaccination, and the levels of IFN-γ and IL-10. Data collected from January 2010 to June 2010 (6 months) at Internal Medicine Policlinics, Prof.Dr.RD Kandou General Hospital, Manado, North Sulawesi, Indonesia. Statistical analysis was performed using descriptive subject's characteristics, paired and unpaired T test and non-parametric test (Mann-Whitney and Wilcoxon test), and Spearman non-parametric test. RESULTS: in comparison between two groups in the period of the study, we found a significant reduction in the BCG group on the prevalence of AURTI and significant increase of IFN-γ level in BCG group compared to the placebo group. There were significant increase of IFN-γ and IL-10 levels in the BCG group compared to the placebo group. There were insignificant increase of IFN-γ and IL-10 levels in the pre- and post-BCG group. The increase of IFN-γ level was positively significant correlated with the increase of the infiltrate and scar diameters in the BCG group. CONCLUSION: BCG vaccinations in elderly, once a month for 3 consecutive months, significantly prevent the AURTI and can increase the IFN-γ level as Th1 response and IL-10 as Treg response in the period of the study.

The role of omega-3 fatty acids contained in olive oil on chronic inflammation.

Nowadays, people have been eating lots of unhealthy dietary excesses, that make them have chronic inflammatory diseases or known as chronic diseases. Countless millions of people worldwide can not help eating selectively massive quantities of unhealthy foods, until they become sick, often mortality. The omega-6 fatty acids account for the majority of PUFA (Poly Unsaturated Fatty Acids) in the food supply. They are the pre-dominant PUFA in all diets, especially the western diets, which produce pro-inflammatory metabolic products. The persistent antigenic or cytotoxic effects will lead to chronic inflammation. Olive tree is native to the Mediterranean basin and parts of Asia Minor. Its compression-extracted oil from the fruit has a wide range of therapeutic and culinary applications. It had been used as aphrodisiacs, emollients, laxatives, nutritives, sedatives, and tonics. In the later part of the 20th century, several studies had revealed that the olives in the Mediteranian diet is linked to a reduced incidence of degenerative diseases. It is one of phytomedicine which has omega-3 fatty acid as its constituent, may inhibit inflammation composing chronic inflammatory process in many chronic diseases, such as coronary artery disease, rheumatoid arthritis, hypertension, and even cancer.

Recurrent aphthous stomatitis caused by food allergy.

Recurrent Aphthous Stomatitis (RAS) is one of the most common oral lesions which occur either in single or multiple forms in oral mucosa. The mouth is subjected to a wide spectrum of antigenic agents, including foodstuff, and allergic reactions to such antigens may manifest in a number of diverse ways. Food allergy, however, has not been widely investigated as the cause of RAS. The main complaint of RAS typically is pain, and the main therapy is still corticosteroids, besides avoiding allergenic foodstuff. In RAS, there is often a genetic basis. More than 42 percent of patients with RAS have first-degree relatives with RAS. The likelihood of RAS is 90 percent when both parents are affected, but only 20 percent when neither parent has RAS, and it is also likely to be more severe and to start at an earlier age in patients with a positive family history. The primary goals of therapy of RAS are relief of pain, reduction of ulcer duration, and restoration of normal oral function. The secondary goals include reduction in frequency and severity of recurrences and maintenance of remission. Diagnostic elimination diets are frequently utilized both in diagnosis and management of RAS caused by food allergy. Patients with RAS may have increased levels of CD8+ T-lymphocytes and/or decreased CD4+ T-lymphocytes. There may be a reduced percentage of "virgin" T-cells and an increased of "memory" T-lymphocytes. Patients with active RAS have an increased proportion of gd T-cells compared with healthy control subjects and RAS patients with inactive disease. The gd T-cells may play a role in ADCC and it is believed that gd T-cells play a role in immunological damages. Preventive treatment is a consideration for patients with RAS caused by food allergy who report regular exacerbations of their condition. It focuses on dietary modifications, the earliest stage, the prodromal stage, and attempts to intercept ulcer development again by the use of topical immunosuppressant and particularly corticosteroids.

Efficacy of Nigella sativa on serum free testosterone and metabolic disturbances in central obese male.

AIM: to study the efficacy of Nigella sativa in central obese men on serum free testosterone, body weight, waist circumference, blood sugar, lipid, uric acid, adiponectin, hs-CRP, and side effects in the treatment group compare to control. METHODS: an experimental, clinical test, double blinded with placebo control, pre-test and post-test design. Subjects are 30-45 years old, divided into the treatment and control groups, and evaluated weekly for 3 months. Data obtained were subjective complaints, body weight, waist circumference, and blood pressure, serum free testosterone, fasting blood sugar, triglyceride, HDL-Cholesterol, uric acid, creatinin, SGOT and SGPT, adiponectin, and hs-CRP. Data collected from March 2007 to June 2007 at Prof.Dr.RD Kandou General Hospital, Manado, North Sulawesi, Indonesia. Statistical analysis was performed using descriptive for subjects characteristic and drug's side effect, t independent to compare between two parametric independent variables, Mann-Whitney U to compare between two non-parametric independent variables, and Wilcoxon Signed Ranks test to compare between two non-parametric dependent variables. RESULTS: in the treatment group, complaints related to central obesity disappear in first week, very significant reduction of body weight, waist circumference, and systolic blood pressure, insignificant reduction in serum free testosterone, diastolic blood pressure, fasting blood sugar, triglyceride and cholesterol-HDL, uric acid, hs-CRP, and insignificant increase of adiponectin. On comparison between both groups, we found a very significant reduction on body weight and waist circumference, but the insignificant reduction on serum free testosterone, systolic and diastolic blood pressure, and the unsignificant increase of adiponectin, meanwhile the reduction of serum free testosterone in the treatment group was smaller than the control group, that means Nigella sativa could inhibit the decreasing of serum free testosterone. No side effects were detected in the treatment group. CONCLUSION: although the other variables in the treatment group were not significantly different, we found them better than the control group, which can be a good sign for metabolic restoration in COM. It is suggested that larger dose and longer duration of NS consumption will give better results.