Hypertension is one of the most commonly encountered problems in primary health care and a major risk factor for other lethal diseases. Obesity, another arising problem in developing and developed countries, is another major risk factor for metabolic disease. However, studies about both diseases and their intercorrelation in rural areas are still limited. Therefore, we conducted this study to investigate the correlation between body mass index (BMI) and blood pressure in a rural area. This study was an observational, cross-sectional study performed in outpatients at Community Health Care of Ngronggot, a rural area in East Java for one month with inclusion criteria aged 18 years old, systole blood pressure (SBP) ≥140 and/or diastole blood pressure (DBP) ≥90, or a history of anti-hypertensive treatment. Information including age, gender, SBP, DBP, mean arterial pressure (MAP), body weight, and height was collected and calculated for its distribution and correlation using the Spearman rank-order correlation test. There were 201 subjects in this study, 65.7% of which were female, while 34.3% of which are male, and the median age was 59 years old. We also found that more than 60% of our participants were overweight and obese. The results of the Spearman test showed that BMI significantly correlated with SBP (p=0.029), DBP (p=0.016), and MAP (p=0.008). In conclusion, BMI had a positive correlation with blood pressure, and obesity was prevalent in our rural area population.
Background: Tuberculosis (TB) is a high burden disease in Indonesia with multidrug-resistant (MDR) TB incidence started to increase. Treatment success of MDR-TB globally was low in number than it was targeted which was especially caused by fluoroquinolone resistance. One of the fluoroquinolone is levofloxacin, an antibiotic that has been widely used irrationally as antimicrobial treatment. Therefore, this study investigated the sensitivity and MBC of MDR Mycobacterium tuberculosis isolates against Levofloxacin. Method:The susceptibility test for MDR-Mycobacterium tuberculosis on levofloxacin by standard method with levofloxacin were on concentrations 0,5 μg/ml, 1 μg/ml, and 2 μg/ml. Sample of 8 strains MDR-Mycobacterium tuberculosis were cultured with each concentrations on Middlebrook 7H9 for 1 week incubation. Next, each of the incubated concentration was subcultured on solid media Middlebrook 7H10 for 3 weeks incubation. Colonized agar plates after 3 weeks incubation were confirmed with acid-fast stain. Results: On MB 7H10 with levofloxacin concentration 2 μg/ml showed bactericidal effect 100% by no MDR Mycobacterium tuberculosis colony grew (0/8) while the MB 7H10 with levofloxacin concentration 1 μg/ml and 0,5 μg/ml showed the bactericidal effect 37,5% and 25% respectively. The colonized agar plate implied that the MDR Mycobacterium tuberculosis with levofloxacin concentration 1 μg/ml (5/8) and 0,5 μg/ml (6/8) grew well. Conclusion: Levofloxacin concentration 2 μg/ml was susceptible on MDR Mycobacterium tuberculosis. The concentration 2 μg/ml of levofloxacin could be considered asMBC.
Small intestinal bacterial overgrowth (SIBO) is a condition that is characterized by an increased number of bacteria in the small intestine or an existence of bacteria type that generally should not be in the small intestine. In SIBO, the number of bacteria found in culture was more than 105 CFU (Colony-Forming unit) per ml. The fundamental problem in which SIBO occurred was the disruption in defensive mechanisms to prevent bacteria from overgrowing, including gastric acid juice, intestine motility, competent immune function, and intact anatomy. Disruption of this defensive mechanism will lead to SIBO, which furthermore will result in not only mild complications, such as abdominal complaints, but also severe complications, such as maldigestion/malabsorption, nutrient deficiency, or even systemic infection and acidosis. The manifestations of SIBO were often unclear so that it is hard to distinguish with other diseases, which much lead to misdiagnosis or underdiagnosis. Diagnosis of SIBO should be conducted very meticulously regarding underlying diseases that resulted in gastrointestinal defensive mechanism disturbance and malassimilation syndrome. Additional examinations for SIBO currently were jejunal aspiration and breath test, but both of them had their limitations in sensitivity and specificity. Therapeutical management consisted of treating the underlying diseases, eradicating bacteria with the antibiotic, particularly rifaximin, and improving nutritional deficiency.
Constipation is a gastrointestinal disorder commonly found in the community, especially in the elderly with various comorbidities. This problem culminates with the increasing incidence along with aging, increasing therapeutic cost, and decreasing the quality of life in this population. Some of the underlying causes are the difference in the terminology of constipation, shallow understanding of its pathophysiology, and poor management. The pathophysiology, including slow transit constipation, dyssynergic defecation, and normal transit constipation, is the most critical foundation in managing constipation accordingly. Diagnostic approaches should be made by history taking, including complaints based on Rome III, lifestyle, contributing factors, past medical history, and medications. Physical examination is considered incomplete without rectal examination. Thorough history taking and comprehensive physical examination have more diagnostic value than additional physiological workup. Management of constipation consists of non-pharmacological and pharmacological approaches, such as conventional laxative or more recent agents with better efficacy. Therapeutical management should correspond to the underlying pathophysiology. Therefore it is important to be able to recognize constipation and make the right management approach in the elderly.
Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies globally, while its mortality rate is the second-highest in the world. HCC has mostly been involved by some underlying issues, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol, and non-alcohol fatty liver disease (NAFLD). Metabolic syndrome and diabetes mellitus currently are independent risk factors to develop HCC in these patients by chronic inflammation and insulin resistance. The next issues following HCC were lack of a good surveillance system, which will result in delayed diagnosis establishment, limited therapeutical option, poor prognosis, and poor survival rates. These problems allow chemoprevention can be a worth to try option in the management of chronic hepatitis patients. Metformin has been known as one of the most often used anti-diabetic agents worldwide and provided many benefits. Based on several recent studies, metformin induces the prevention effect toward the development of HCC with several mechanisms either by the AMPK-dependent or AMPK-independent pathway. In this review article, we will discuss metformin as a promising chemoprevention agent against HCC from mechanisms, current limitations, and future prospects.
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