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BACKGROUND: The administration of high-fat and high-glucose in diet followed by a low-dose streptozotocin injection in rats could mimic hyperglycemia, prediabetic, or diabetic conditions in humans. However, whether the rat model may lead to early liver impairment was still unclear. AIM: This study was aimed to investigate the possible changes in liver functions and morphology in the rat model of prediabetes after a short-term administration of a high-fat and high-glucose diet followed by low-dose streptozotocin injection. METHODS: Eighteen male Wistar rats were divided into nine rats in the control group and nine in the prediabetic group. To induce prediabetic rats, high-fat high-glucose in daily diets for 3 weeks continued with once to twice low-dose streptozotocin was given. Rats in control groups were fed with a standard diet for 2 months. Afterward, we analyzed glucose control parameters, liver functions, and liver histology of the rats. RESULTS: High-fat, high-glucose diet combined with a low dose of streptozotocin successfully caused prediabetics in the rats. There was a significant increase in several liver enzymes, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). However, no significant changes were found in the serum lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) levels. The histological changes in the liver confirmed the increase in liver enzymes. CONCLUSION: Short-term administration of high-fat high-glucose in combination with low-dose streptozotocin triggers alterations in liver functions marker and liver morphology.

Ketut Suastika,1 Fatimah Eliana,2 Ida Ayu Made Kshanti,3 Mardianto Mardianto,4 Sony Wibisono Mudjarnako,5 Nanny Natalia,6 Heri Nugrohom HS,7 Roy Panusunan Sibarani,8 Pradana Soewondo,9 Soebagijo Adi Soelistijo,5 Tri Juli Edi Tarigan,9 Hendra Zufry10 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital Denpasar, Bali, Indonesia; 2Faculty of Medicine, Yarsi University, Jakarta, Indonesia; 3Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Fatmawati General Hospital, Jakarta, Indonesia; 4Faculty of Medicine, University of Sumatra Utara/Adam Malik Central Hospital, Internal Medicine, Medan, Indonesia; 5Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; 6Faculty of Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia; 7Faculty of Medicine, Diponegoro University, Central General Hospital Dr. Kariadi, Semarang, Indonesia; 8Endocrinology and Diabetes Center EMC Hospital Sentul City, Bogor, Indonesia; 9Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 10Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, School of Medicine Universitas Syiah Kuala/Dr. Zainoel Abidin General Teaching Hospital, Banda Aceh, IndonesiaCorrespondence: Ketut Suastika, Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University-Sanglah Hospital, Kamboja Street, Dangin Puri Kangin, No. 8, 80233, Denpasar, Bali, Indonesia, Tel +62 81 138 0916, Email ksuas@unud.ac.idAbstract: Indonesia is struggling with a rapidly growing burden of diabetes due to rapid socioeconomic transition. People with type 2 diabetes mellitus (T2DM) need appropriate treatment strategies to maintain glycemic control. New modalities with simplicity, such as fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA), further referred to as FRC, have proven to be an effective and practical therapeutic approach that may address this issue. In January 2021, a scientific expert meeting was held with the participation of endocrinologists from Indonesia to provide expert opinions regarding the optimal practical use of the FRC basal insulin/GLP1-RA. Topics discussed in the meeting included the challenges in diabetes management, clinical inertia with insulin therapy, local and international guideline positioning, initiation, titration, and switching of basal insulin and GLP-1 RA, including FRC, and the management of T2DM.Keywords: fixed-ratio combination, basal insulin, GLP1 RA, type 2 diabetes mellitus

BACKGROUND: Chronic limb ischemia (CLI) is strongly associated with increased mortality in diabetes patients. OBJECTIVE: The aim of this study was to evaluate factors affecting mortality within 1 year after endovascular revascularization in CLI patients. METHODS: This retrospective cohort study was based on medical records from the Integrated Cardiovascular Centre of Dr. Cipto Mangunkusumo National General Hospital, a tertiary care hospital in Jakarta, Indonesia. The study included 199 CLI patients with type 2 diabetes mellitus (T2DM) who underwent endovascular revascularization from January 2008 to June 2018. The patients were followed up for 1 year after endovascular revascularization. Kaplan-Meier and Cox proportional hazard analysis was used to analyze the data. RESULTS: 1-year survival probability was 58.8%. Cox proportional hazard analysis showed that duration of diabetes (HR 3.52; 95% CI 1.34-9.22), anemia (HR 2.59; 95% CI 1.47-4.56), and smoking (HR 2.49; 95% CI 1.46-4.27) were significantly associated with mortality within 1 year after endovascular revascularization. CONCLUSIONS: In T2DM patients with CLI, duration of diabetes, anemia and smoking were associated with a higher risk of mortality within 1 year post endovascular revascularization

Background: Diabetic foot ulcer is a problem in patients with diabetes mellitus (DM). One adjuvant therapy that can enhance wound healing is Low-Level Laser Therapy (LLLT), but there is no established guideline regarding the dosage. In Indonesia, there has been no study comparing the energy density of LLLT on diabetic ulcer healingMethods: This is an experimental study on 28 subjects with a randomized diabetic foot ulcer. Group A received standard treatment of ulcer and LLLT 5J/cm2. Group B received standard treatment of ulcer and LLLT 10J/cm2.Results: The difference in wound size between group A and group B were 4.15 mm2 and 7.5 mm2 (p=0.178). The healing rate of group A and group B were 4.15 (-10-34.5) mm2/4 weeks and 7.5 (-2.8-34) mm2/4weeks (p=0.168). Conclusions: There was no statistically significant difference between the group receiving LLLT 5J/cm2 or 10 J/cm2 in diabetic foot ulcer healing.

Background. The extract of Andrographis paniculata (Burm. F.) Wall. Ex. Nees. (sambiloto) (穿心蓮 chuān xīn lián) has been reported to have an antidiabetic effect on mice models and has been used traditionally in the community. The exact mechanism of sambiloto extract in decreasing plasma glucose is unclear, so we investigated the role of sambiloto extract in the incretin pathway in healthy and prediabetic subjects. Methods. This study was a randomized, placebo-controlled, crossover, double-blind trial. It included 38 people who were healthy and 35 people who had prediabetes. All subjects were randomly assigned to receive either the intervention sambiloto extract or a placebo. All subjects were randomly assigned to receive the first intervention for 14 days. There was a washout period between subsequent interventions. The primary outcome was glucagon-like peptide 1 (GLP-1) concentration, and secondary outcomes were fasting insulin, 2-hour postprandial insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glucose, 2-hour postprandial blood glucose, dipeptidyl peptidase-4 (DPP-4), and glycated albumin before and after the intervention. Result. After the intervention, GLP-1 concentration significantly increased in prediabetes by 19.6% compared to the placebo ( p = 0.043 ). There were no significant differences in the changes of fasting insulin, 2-hour postprandial insulin, HOMA-IR, fasting blood glucose, 2-hour postprandial blood glucose, DPP-4, and glycated albumin levels after the intervention. Sambiloto extract did not inhibit the DPP-4 enzyme in healthy and prediabetic subjects. Conclusion. Sambiloto extract increased GLP-1 concentration without inhibiting the DPP-4 enzyme in prediabetic subjects. This trial is registered with ClinicalTrials.gov (ID: NCT03455049), registered on 6 March 2018—retrospectively registered (https://clinicaltrials.gov/ct2/show/NCT03455049).

Metabolic Syndrome (MS) prevalence is increasing worldwide in line with the growing prevalence of obesity. The underlying mechanism of MS is insulin resistance which can be diagnosed by measuring Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Triglyceride/Glucose (TyG) Index. This review will focus on comparing studies assessing the HOMA-IR and TyG index cut-off points.We carried out a comprehensive review of the literature using suitable keywords on the search engines of PubMed, Scopus, Research Gate, and Google Scholar in the month of October 2020.There is a high degree of variability in determining threshold levels of HOMA-IR for defining insulin resistance. The distribution of the HOMA-IR varies according to the demographic characteristics of the subjects, such as age, sex, and race, making it difficult to estimate the optimal cut-off point. Another simpler method without requiring the use of insulin assays is TyG Index. Similar to HOMA-IR, the TyG Index cut-off point from existing data shows varying results.The HOMA-IR and the TyG index are simple and widely used methods for determining insulin resistance. However, an issue that arises is determining the insulin resistance cut-off point for both methods. Further studies are needed to assess the cut-off point of insulin resistance for various ethnicities associated with the risk of developing MS later in life.

Purpose: Gastrointestinal symptoms affect 50-70% of diabetic patients, resulting in a microbiota composition imbalance. Autonomic neuropathy is irreversible, resulting in diabetic enteropathy and sometimes even small intestine bacterial overgrowth (SIBO). SIBO can result in bile acid deconjugation, diarrhea, steatorrhea, vitamin and micronutrient malabsorption, weight loss, mucosal injury, bacterial translocation, and worsened intestinal motility. Carbohydrate malabsorption is related to the pathogenesis of diabetic macrovascular complications. The goal of this study is to find out how prevalent SIBO is in type 2 diabetes patients. Methods: "Small intestinal bacterial overgrowth," "small bowel bacterial overgrowth," “SIBO,” "type 2 diabetes mellitus," and "type 2 DM," are the keywords used. We searched Proquest, CINAHL, SCOPUS, ScienceDirect, PubMed/MEDLINE, and manual searches through world diabetes associations such as ADA, EASD, EFSD, IDF, FASEB, and PERKENI using the keywords. We use the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for bias risk assessment, and for data analysis, we use STATA 16. Results: Six articles covered 1072 type 2 diabetes patients in clinics and hospitals. With a minimum score of 7.42% and a maximum value of 53.85%, 95% CI 9.97-38.86, and an I2 of 97.17%, the pooled prevalence was 24.39% SD 15.31. HbA1c levels were higher (p=0.02) in type 2 DM patients with SIBO, and blood insulin levels were lower (p=0.001) in type 2 DM patients with SIBO. Each study was pretty varied, and there was evidence of publication bias. Assessment of findings based on GRADE is moderate. Conclusion: According to this study, SIBO is present in 24.39% of type 2 diabetes patients. SIBO conditions exacerbate the morbidity of patients with type 2 diabetes, as indicated by lower insulin levels and a higher HbA1c. In type 2 diabetes patients, a hydrogen breath test (HBT) is recommended to be performed regularly, especially in those who have had DM for more than 5 years.

Thyroid nodule is a common health problem in endocrinology. Thyroid fine-needle aspiration biopsy (FNAB) cytology performed by palpation guided FNAB (PGFNAB) and ultrasound-guided FNAB (USGFNAB) are the preferred examinations for the diagnosis of thyroid cancer and part of the integration of the current thyroid nodule assessment. Although studies have shown USGFNAB to be more accurate than PGFNAB, inconsistencies from several studies and clinical guidelines still exist.The purpose of this study is to compare the diagnostic accuracy of Palpation versus Ultrasound-Guided Fine Needle Aspiration Biopsy in diagnosing malignancy of thyroid nodules.The systematic review and meta-analysis were prepared based on the PRISMA standards. Literature searches were carried out on three online databases, namely Pubmed/MEDLINE, Embase, Proquest, and other literature sources. Data extraction was carried out manually from various studies that met the eligibility, followed by analysis to obtain pooled data on sensitivity, specificity, Diagnostic Odds Ratio (DOR) and Area Under Curve (AUC), and the comparison of the two methods. Total of 2517 articles were obtained, with 11 studies were included in this systematic review. The total sample was 2382, including 1128 subjects using PGFNAB and 1254 subjects using USGFNAB. The risk of bias was assessed using QUADAS-2 with mild-moderate results. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using PGFNAB were 76% (95% CI, 49-89%), 77% (95% CI, 56-95%), 0.827 and 11.6 (95% CI, 6-21) respectively. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using USGFNAB were 90% (95% CI, 81-95%), 80% (95% CI, 66-89%), 0.92 and 40 (95% CI, 23-69), respectively the results of the comparison test between PGFNAB and USGFNAB; Tsens USGFNAB of 0.99 (p = 0.023), AUC difference test of 0.093 (p = 0.000023) The diagnostic accuracy of USGFNAB is higher than PGFNAB in diagnosing malignancy of thyroid nodules. If it is accessible, the author recommends using USGFNAB as a diagnostic tool for thyroid nodules.

Thyroid nodule is a common health problem in endocrinology. Thyroid fine-needle aspiration biopsy (FNAB) cytology performed by palpation guided FNAB (PGFNAB) and ultrasound-guided FNAB (USGFNAB) are the preferred examinations for the diagnosis of thyroid cancer and part of the integration of the current thyroid nodule assessment. Although studies have shown USGFNAB to be more accurate than PGFNAB, inconsistencies from several studies and clinical guidelines still exist.The purpose of this study is to compare the diagnostic accuracy of Palpation versus Ultrasound-Guided Fine Needle Aspiration Biopsy in diagnosing malignancy of thyroid nodules.The systematic review and meta-analysis were prepared based on the PRISMA standards. Literature searches were carried out on three online databases (Pubmed/MEDLINE, Embase, and Proquest) and grey literatures. Data extraction was carried out manually from various studies that met the eligibility, followed by analysis to obtain pooled data on sensitivity, specificity, Diagnostic Odds Ratio (DOR) and Area Under Curve (AUC), and the comparison of the two methods.Total of 2517 articles were obtained, with 11 studies were included in this systematic review. The total sample was 2382, including 1128 subjects using PGFNAB and 1254 subjects using USGFNAB. The risk of bias was assessed using QUADAS-2 with mild-moderate results. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using PGFNAB were 76% (95% CI, 49–89%), 77% (95% CI, 56–95%), 0.827 and 11.6 (95% CI, 6–21) respectively. The results of sensitivity, specificity, AUC and DOR in diagnosing thyroid nodules using USGFNAB were 90% (95% CI, 81–95%), 80% (95% CI, 66–89%), 0.92 and 40 (95% CI, 23–69), respectively the results of the comparison test between PGFNAB and USGFNAB; Tsens USGFNAB of 0.99 (p = 0.023), AUC difference test of 0.093 (p = 0.000023).The diagnostic accuracy of USGFNAB is higher than PGFNAB in diagnosing malignancy of thyroid nodules. If it is accessible, the author recommends using USGFNAB as a diagnostic tool for thyroid nodules.

Patients with diabetes mellitus may experience peripheral neuropathy and extremity system impairment, which may lead to ulceration if the treatments are delayed. Diabetic ulcers, unfortunately, are chronic, which require proper treatments, including debridement and bacterial removal using an irrigation device. To date, commercial irrigation devices included pulsed-lavage, bulb syringe, and gravity bags. Unfortunately, the devices have limitations in terms of portability, measurability, controllability, and disposability. To tackle the limitations, this study aims to design, fabricate, and characterize an automated portable wound irrigation device (Apdice), which is controllable non-disposable, and portable. The device was designed and fabricated using a lightweight construction, a rechargeable battery, and non-disposable materials to support the portability and non-disposable means. Meanwhile, the proportional-derivative-integral controller with its peripheral components were featured to enable controllability. Furthermore, the device was also tested regarding the contamination using a particle counter, and appeared to be contamination free. In short, Apdice showed a robust technological performance. However, it is also worth the try to test the contamination test against biological agents to guarantee the biocompatibility of the device.

PURPOSE: Diabetic foot ulcer (DFU) is a common chronic complication of type 2 diabetes mellitus (T2DM) in Indonesia, with a prevalence of 7.3%. However, the characteristics of these patients remain unclear. We investigated the characteristics of patients with DFU without peripheral arterial disease (PAD) and analyzed non-vascular factors related to severity of DFU in a tertiary care national referral hospital in Indonesia. METHODS: This was a cross-sectional study including 123 hemodynamically stable DFU patients without PAD recruited from Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia from 2010–2015. RESULTS: DFU patients were predominantly over 50 years old (75.6%) and diagnosed with T2DM for 5 years with poor glycemic control (82.7%) and peripheral neuropathy (91.3%). Most patients had anemia (86.7%), leukocytosis (84.6%), and were undernourished, as characterized by a low lipid profile (90.8%) and hypoalbuminemia (83.7%). Most had extensive size of ulcer at the initial visit, with a median size of 16.23 (2.92–60.16) cm(2). Ulcers were mostly located of the forefoot (62.5%) and were caused by mechanical trauma (46.2%). Bivariate analysis revealed that significant factors for the development of DFU were related to DFU size, including duration of T2DM (p = 0.04), leukocyte levels (p =

Tri Juli Edi Tarigan,1 Adisti Dwijayanti,2 Susie Setyowati,3 Melva Louisa4 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 2Department of Medical Pharmacy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 3Division of Endocrinology, Department of Internal Medicine, Gatot Soebroto Presidential Hospital, Jakarta, Indonesia; 4Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Tri Juli Edi TariganDivision of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, IndonesiaTel +62 21-3907703Email tri.judi@ui.ac.idPurpose: To compare the immunogenicity and efficacy of insulin glargine biosimilar Ezelin (EZL) versus originator insulin glargine Lantus (LAN) as a reference basal insulin in patients with type 2 diabetes (T2D).Patients and Methods: This was a randomized, multicenter, open-label, 24-week study in insulin-naïve patients with T2D, with HbA1c of > 7.0%. We randomly assigned 133 eligible patients to receive either EZL or LAN. Baseline characteristics, including insulin autoantibody (IAA), zinc transporter 8 (ZnT8) antibody, HbA1C, fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPPG), AST, ALT, BUN, eGFR, and oral antidiabetic drugs, were obtained before starting insulin treatment. After starting treatment, insulin dose was titrated to achieve FPG target along with oral antidiabetic drugs. Patients were given home glucometer and assisted to record plasma glucose measurement and adverse event (AE). Every month, patients came to the diabetes clinic and performed a regular physical examination and intensifying treatment if needed. Out of the 133 randomized patients, only 122 completed the study and can be examined for their IAA and ZnT8 after 6 months of treatment. The study was registered in clinicaltrials.gov, NCT03352674.Results: There is a similar proportion of patients with changes of IAA from baseline: 1 out of 58 (1.7%) patients receiving EZL versus 1 out of 64 (1.6%) patients receiving LAN (p = 1.000). One patient in the EZL group (1.7%) versus none in the LAN group experienced a change of ZnT8 antibody from baseline. Similar glucose control in EZL versus LAN was determined by the change in HbA1c, FPG, and 2hPPG (− 2.0%, − 67.46 mg/dL, and − 76.51 mg/dL in the EZL group versus − 1.7%, − 58.11 mg/dL, and − 70.03 mg/dL in the LAN group). There were six events of documented hypoglycemia in the EZL group versus five events in the LAN group. No patients experienced diabetic ketoacidosis during the study.Conclusion: Overall, insulin glargine biosimilar EZL and originator insulin glargine LAN have shown a similar immunogenicity profile, as well as efficacy in providing glucose control and safety findings in T2D populations.Keywords: biosimilar, insulin autoantibody, zinc transporter 8 antibody, hyperglycemia

Fasting lipid profile does not necessarily illustrate the exact lipid dynamic in 24 h as human spends most of their time in postprandial state. Postprandial triglyceride (TG) has been reported to have advantages compared to fasting TG in terms of practicality and ability to predict cardiovascular events. This study aims to assess the determinant of postprandial TG in healthy young adults.This is a quasy-experimental study that involved 200 healthy young adults. This study compared fasting with postprandial TG and analyzed the relationship between postprandial TG with various demographic and metabolic parameters after ingestion of standardized high fat liquid meal.There was an upward trend from fasting TG to 2 h postprandial TG and 4 h postprandial TG. There was strong correlation between fasting TG and 2 h postprandial TG with 4 h postprandial TG (r = 0.731; p 0.0001 dan r = 0.669; p 0.0001, respectively). Whereas body mass index (BMI) and age showed weak correlation with 4 h postprandial TG (r = 0.141; p 0.0001 dan r = 0.0747; p 0.0001), fasting TG was the strongest predictor of 4 h postprandial TG (r = 0.669, B = 1.722 (95% CI 1.552 to 1.892), p 0.0001).Fasting TG was the strongest determinant of 4 h postprandial TG in healthy young adults. We also observed strong correlation between 4 h postprandial TG and fasting TG. Hence, 4 h postprandial TG might potentially replaced fasting TG when measurement of fasting TG is not feasible.

One of the neglected complications of patients with HIV/AIDS is primary adrenal insufficiency also known as Addison’s disease. This condition can be caused by several mechanisms, such as tuberculosis, CMV, cryptococcal, or HIV-related adrenalitis, and also drugs commonly used for HIV/AIDS especially antifungal therapy. This is a case report of a man infected with HIV/AIDS and multiple opportunistic infections. He reported darkening of the skin and reduction of body hair 4 months after diagnosis of HIV/AIDS. From the clinical features and laboratory examinations, he was diagnosed as having primary adrenal insufficiency and was then treated with longterm corticosteroids.

Background: Chronic complications of diabetes mellitus have a significant role in increasing morbidity, mortality, disability, and health cost. In the outpatient setting, the availability of data regarding to the chronic complications of type 2 diabetes is useful for evaluation of prevention, education, and patient’s treatment. This study aimed to describe the characteristic of type 2 diabetes chronic complications in outpatient diabetes clinic.Methods: A cross-sectional study was done using 155 patients in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital (RSCM), Jakarta in 2010. Secondary data were used from medical record based on history taking, physical examination, diabetic foot assessment, laboratory, neurologic, cardiology, opthalmology, ankle brachial index, and electrography of the patients. Characteristic profiles of the subjects, prevalence of the chronic complications, and its association with diabetes risk factors, such as glycemic control using HbA1c, fasting blood glucose, duration of diabetes, and LDL cholesterol were analyzed using chi square test.Results: Among 155 subjects participated in the study, most of them were women (59%) and elderly (46%). The prevalence of diabetes chronic complications was 69% from all subjects. These chronic complications included microangiopathy, macroangiopathy and mixed complications, with prevalence of 56%, 7% and 27% respectively. Microangiopathy included nephropathy (2%), retinopathy (7%), neuropathy (38%) and mixed complications (53%). Macroangiopathy included coronary heart disease (46%), peripheral arterial disease (19%), stroke (18%), and mixed complication (17%). From the analysis, we found significant association between duration of diabetes and diabetic neuropathy (p = 0.003).Conclusion: Prevalence of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, mainly dominated by microvascular-related complications including nephropathy, retinopathy, neuropathy and mixed complications. There was statistical significance between diabetes duration and diabetic neuropathy.

Background: Impaired wound healing is a common complication of diabetes. It has complex pathophysiologic mechanisms and often necessitates amputation. Our study aimed to evaluate the effectiveness of combined laser-puncture and conventional wound care in the treatment of diabetic foot ulcers. Methods: This was a double-blind controlled randomized clinical trial on 36 patients, conducted at the Metabolic Endocrine Outpatient Clinic, Cipto Mangunkusumo Hospital, Jakarta, between May and August 2015. Stimulation by laser-puncture (the treatment group) or sham stimulation (the control group) were performed on top of the standard wound care. Laser-puncture or sham were done on several acupuncture points i.e. LI4 Hegu, ST36 Zusanli, SP6 Sanyinjiao and KI3 Taixi bilaterally, combined with irradiation on the ulcers itself twice a week for four weeks. The mean reduction in ulcer sizes (week 2–1, week 3–1, week 4–1) were measured every week and compared between the two groups and analyzed by Mann-Whitney test. Results: The initial median ulcer size were 4.75 (0.10–9.94) cm 2 and 2.33 (0.90–9.88) cm 2 in laser-puncture and sham groups, respectively (p=0.027). The median reduction of ulcer size at week 2–1 was -1.079 (-3.25 to -0.09) vs -0.36 (-0.81 to -1.47) cm 2 , (p=0.000); at week 3–1 was -1.70 (-3.15 to -0.01) vs -0.36 (-0.80 to -0.28) cm 2 , (p=0.000); and at week 4–1 was -1.22 (-2.72 to 0.00) vs -0.38 (-0.74 to -0.57) cm 2 , (p=0.012). Conclusion: Combined laser-puncture and conventional wound care treatment are effective in accelerating the healing of diabetic foot ulcer.

Background: The aim of this study was to evaluate the RRD’s efficacy in decreasing stump edema and pain compared to elastic bandage for diabetic mellitus patients after transtibial amputation.Methods: Interventional research was using consecutive sampling. Subjects were randomized into two groups: RRD and elastic bandage. Twenty-three subjects were analyzed. Stump edema volume was measured by the amount of water spilled out from volume glass. Elastic bandage was reapplied every 4 hours and RRD was refitted every 7 days during evaluation time. Stump edema volume was evaluated every 7 days during the 8 week observation.Results: There was a significant decrease of stump volume in RRD group during the first and second week (p = 0.03, p = 0.01) and the edema decreasing time was also significant (p = 0.03). The average decrease of edema volume in RRD was 63.85% of second week and in the elastic bandage group was 34.35%. There were a tendency of pain reduction time in RRD group (4.83 ± 1.95 weeks) compared to elastic bandage group (5.18 ± 2.31weeks). Cox regression result of decreasing edema volume time was 3.088 (CI 95%: 1.128 – 4.916).Conclusion: This study found that there was stump edema volume acceleration in RRD group, it was three times faster for stump to become not edematous compared to elastic bandage group. There was a tendency of faster decreasing stump pain in RRD group than elastic bandage group, eventhough this result was not statistically significant. (Med J Indones. 2013;22:16-21)Keywords: Diabetes mellitus, removable rigid dressing, transtibial amputation

Tujuan penelitian ini adalah untuk mengetahui peran magnesium pada nefropati diabetes dan mendapatkan proporsi albuminuria pada pasien DM tipe 2 dengan hipomagnesemia dan magnesium normal serta mendapatkan korelasi kadar Mg dengan albuminuria. Penelitian menggunakan desain cross sectional dengan consecutive sampling pada pasien DM tipe 2 yang terdiagnosis nefropati diabetes di Poliklinik Diabetes RSCM pada bulan Maret-Juni 2014. Dilakukan anamnesis faktor risiko, pemeriksaan fisik, kadar magnesium, albumine creatinine ratio dan A1C. Terdapat 38 subjek yang diikutsertakan dalam penelitian yang sebagian besar berusia lebih 50 tahun dan memiliki kontrol glikemik yang buruk (81,6%). Pada subjek penelitian yang memiliki kadar Mg Kata kunci: kadar magnesium, albuminuria, diabetes melitus tipe 2 Correlation between Magnesium Level and Albuminuria in Patients with Type 2 Diabetes Abstract The purposes of this study are to know: the role of magnesium in diabetic nephropathy, the proportion of albuminuria in type 2 DM with hypomagnesemia and normal magnesium level, and correlation between magnesium level and albuminuria. This cross-sectional study was done in Diabetes Clinic RSCM from March to June 2014 with consecutive sampling for type 2 DM patients who had been diagnosed with diabetic nephropathy. History taking, physical exam, albumin creatinine ratio test, and A1c level were done. Thirty eight subjects included in this study were mostly more than 50 years old and had poor glycemic control (81,6%). 80% of subjects with Mg level < 1.7 mg/dl experienced albuminuria and 63.6% of subjects with Mg level ≥ 1.7 mg/dl experienced albuminuria. The coefficient correlation was 0.006, which means that there is weak correlation between blood magnesium level and albuminuria. In conclusion, no correlation between magnesium level and severity of albuminuria were found in this study. Keywords: magnesium concentration, albuminuria, type-2 diabetes mellitus

Introduction: High blood triglyceride (TG) level is a risk factor for cardiovascular disease. Green tea, as a beverage, may reduce postprandial blood TG level through inhibition of fat absorption in the intestinal lumen. The aim of this study was to assess the difference of postprandial blood TG level changes between treatment group (high-fat meal and green tea beverage containing 738 mg of catechins) and control group (high-fat meal and plain water containing 0 mg of catechins).Methods: The study was a randomized, single-blind, parallel-group clinical trial including 40 healthy young women. Blood was collected immediately before the meal and then at 2 and 4 h thereafter of each group. Method of TG measurement: GPO-PAP, using Beckman CX 5-CE machine and Good’s buffer reagent.Results: Postprandial blood TG level at 4 h in the treatment group was significantly lower compared to the control group (1.00 ± 0.27 vs. 1.22 ± 0.34 mmol/L, p = 0.03). The change in blood TG level from baseline to 4 h postprandial was also significantly lower in the treatment group compared to the control group (0.21 ± 0.14 vs. 0.37 ± 0.26 mmol/L, p = 0.02).Conclusion: It was concluded that green tea ingestion during high fat meal suppressed postprandial elevation of TG 4 hour after meal.

To determine the degree of radiographic abnormalities based on Kellgren-Lawrence criteria, to determine posturography features in patients with knee OA.Ninety nine subjects were recruited by consecutive sampling at the outpatient clinic of Internal Medicine in Cipto Mangunkusumo Hospital. History taking and physical examination including rheumatology examination were conducted, followed by knee radiographic examination in weight bearing and 30 degree skyline position. A cross sectional design was performed to evaluate the variable results for degree of radiolographic abnormalites and posturography results.The subjects were 79.8% women and 20.2% men, mostlyor = 60 year-old (78.8%), with low education 76.8%, BMIor = 23 74.7%, mean value of active VAS was 5.4, mean value of passive VAS 2.8. Mild radiographic abnormality was found in 77.8% subjects, and the others were severe, i.e. 22.2%. There were increase in length of postural sway, increase of postural sway velocity, and increase in area of postural sway in patients with knee OA compared with normal subjects with 40-60 years old.There is an increase in nearly all variables of posturography in patients with knee OA.