Susceptibility of Neisseria gonorrhoeae against a dual treatment antibiotics regimen in primary health centres in Surabaya, Indonesia.

BACKGROUND AND OBJECTIVES: There were 82.4 million new gonorrhoea cases worldwide in 2020. Dual treatment with ceftriaxone or cefixime and azithromycin or doxycycline is currently recommended for gonorrhoea in Indonesia. However, reduced susceptibility and resistance to cephalosporins and azithromycin are increasing. We evaluated the susceptibility pattern of Neisseria gonorrhoeae to cefixime, ceftriaxone, azithromycin and doxycycline. METHOD: N. gonorrhoeae isolates were obtained from 19 male participants with clinically and laboratory-confirmed gonorrhoea. Antibiotic susceptibility testing was conducted by disc diffusion and interpreted according to Clinical and Laboratory Standards Institute and Centers for Disease Control and Prevention criteria. RESULTS: Reduced susceptibility or resistance was observed against doxycycline in 19 isolates (100%), cefixime in six (31.6%), ceftriaxone in three (15.8%) and azithromycin in zero (0%) isolates. DISCUSSION: A dual treatment regimen with ceftriaxone and azithromycin can still be recommended as first-line therapy for gonorrhoea in Indonesia. Antibiotic susceptibility surveillance of N. gonorrhoeae should be routinely conducted.

Evaluation of Wrinkle and Dermal Thickness in the Forearm before and after Picosecond Laser Therapy.

Background: Skin wrinkles are generated as a result of the aging process. Dermal thickness underneath a wrinkle decreases absolutely. Approximately 20% of dermal thickness disappears as people become elderly. In recent times, people have attempted to reduce wrinkles using various procedures. Currently, available picosecond lasers in dermatology can create mechanical stress and the energy can be fractionated via diffractive lens arrays (DLA). An emerging indication for the picosecond laser includes photorejuvenation. Non-ablative laser skin rejuvenation therapy demonstrates the dermis can be safely reconstructed by only irradiating the skin surface with a laser. The clinical effects of picosecond pulse laser have been frequently reported, but few studies have included histological investigation. Aims and Objectives: This study aimed to evaluate wrinkle and dermal thickness in the forearm before and after picosecond laser therapy. Materials and Methods: Twenty healthy male and female subjects between 36 and 55 years old with wrinkles in the forearm who met the sample requirements and were willing to participate were recruited in this study. Clinical examination and biopsy for histopathological examination were carried out before and 4 weeks after therapy, then treatment was carried out using a picosecond laser. Results: At 1-month follow-up, a significant improvement was noted in wrinkle and dermal thickness (P < 0.05). Conclusions: This picosecond 755 nm alexandrite laser with DLA was found to be very effective in treating wrinkles, which was confirmed by a dermatologic assessment from forearm photographic assessment scaled and dermal thickness improvement.

Combination of Fractional Er:YAG Laser, Pulsed Dye Laser, and Intralesional Triamcinolone With 5-Fluorouracil for Keloid Treatment.

Introduction: Benign fibroproliferative scars that are larger than the initial lesion are called keloids. Keloids treatment in clinical practice is still difficult. Although there are various therapy choices, none is embraced by everyone or is relapse-free. Various treatment modalities such as intralesional corticosteroid injection with 5-fluorouracil (5-FU), fractional Er:YAG laser, pulsed dye laser (PDL), and others can be used either as monotherapies or combined therapies. Therefore, efforts should be made to select the treatment that will provide the best results. Case Presentation: A 6-year-old boy with keloids on the lower lips extending to the chin was successfully treated with a 2940-nm fractional Er:YAG laser alternated with a 595-nm long-PDL followed by the combined intralesional injection of corticosteroid and 5-FU. The patient was followed up for 1 year with no lesion recurrence. Conclusion: Our case supports a combined therapy to successfully treat a patient with a keloid on the chin. Therapy using a combination of these four modalities seems safe and effective and may have a synergistic effect with minimal downtime.

Efficacy and safety of picosecond laser for wrinkle in Indonesian skin.

Wrinkle is depressions of the skin that appears as a line on the skin, a major sign of skin aging. Laser is widely used for rejuvenation, but few reports that obtained in Indonesian skin. The increased melanin content in Indonesian skin can decrease therapeutic efficacy and promote adverse sequela. The Food and Drug Administration in 2014 gave clearance for picosecond 755 nm laser with diffractive lens array (DLA) in the treatment of wrinkles in skin types I-IV, the safety extends to patients of skin types IV-VI. This study investigated the efficacy and safety of picosecond 755 nm laser with DLA for wrinkle in forearm of the Indonesian patients. Twenty patients with Fitzpatrick skin type III-V were enrolled in this study. Clinical assessment of wrinkles was assessed with a dermatologic assessment form forearm photographic assessment scaled, and patients also rated their overall satisfaction. Evaluation was obtained at baseline and 1 month after treatment. Significant improvement in wrinkle at 1 month was noted (p < .05). Subject satisfaction indicated that 75% and 5% of patients were extremely satisfied and satisfied. No serious adverse events were reported. Picosecond 755 nm laser with DLA is an effective option for wrinkle in Indonesian skin without any adverse event.

Facial Rejuvenation in Indonesian Skin With a Picosecond 755-nm Laser.

Introduction: The aging process in the skin naturally happens over time, affected by several factors, of which ultraviolet irradiation is a major factor, and this leads to the appearance of wrinkles, pigmentations, and textural irregularities. Lasers for facial rejuvenation are very popular in Asian patients, but melanin rick skin types like Asians are more susceptible to pigmentary alterations. Most Indonesians have brown skin, and just a few have light skin. The purpose of this study was to know the efficacy and safety of the picosecond 755 nm laser in facial rejuvenation in Indonesian skin. Methods: This is an analysis of 20 healthy patients with Fitzpatrick skin type III-V with facial photoaging from 36 to 55 years. Examinations were evaluated before therapy and 4 weeks after the second therapy. The front and side of both cheeks were photographed and analyzed by using VISIA. Clinical improvement was categorized as excellent-mild. The patients were also asked and examined about the presence of adverse events. Results: The patients were predominantly female with an average age of 44 years. Sixty percent of the patients had a good improvement and 40% of the patients had a moderate improvement. The VISIA analysis showed a significant improvement in wrinkles, pigments, and textures (P < 0.001). Only mild anticipated adverse events were observed, and there was no post-inflammatory hyperpigmentation or hypopigmentation. Conclusion: the picosecond 755 nm laser is effective and safe for facial rejuvenation in the skin of Indonesian patients without significant adverse events.

A comparison study of the 0.1% tretinoin cream versus fractional microneedle radiofrequency combination with fractional CO2 laser for the treatment of striae alba in Indonesian patients.

Striae distensae (SD) are linear scar tissue in the dermis that arises from stretching the skin. There are two types of SD, striae rubrae and striae albae (SA) which is marked with a line hypopigmentation that cause a psychological problem, especially in the high skin type. The standard therapy is a 0.1% tretinoin cream, but it takes a long time to reach the collagen so it needs invasive measures to reach these targets. This study was comparing 0.1% tretinoin cream with combination therapy of fractional microneedle radiofrequency (FMR) and fractional CO2 laser for SA. The number of subjects in this study was 11 patients each group with Fitzpatrick skin types IV or V. Biopsy was taken before and after therapy. The clinical changes in SA lesions in this study were represented by measurements of the length and width. The percentage of collagen area is the amount of collagen fibers with Masson's trichrome staining. The clinical changes of lesion in the combination therapy decreased. The percentage change in collagen area in the combination therapy group had a higher increase. The side effect experienced by all combination group subjects was postinflammatory hyperpigmentation, two subjects in 0.1% tretinoin cream group experienced irritation.