Density and morphology of corneal endothelial cell after phacoemulsification using ringer lactate versus balanced salt solution as irrigating solutions

AIM: To compare the difference in corneal endothelial cell density and morphology after phacoemulsification using ringer lactate (RL) and balanced salt solution (BSS) irrigating solutions. METHODS: The prospective randomized controlled trial study was conducted between February 2017 and April 2017 in Dr. YAP Eye Hospital, Yogyakarta, Indonesia. There were a total of 52 subjects (52 eyes) who were senile cataract patients further grouped into two, 26 patients undergoing the phacoemulsification procedure using RL irrigating solution and the other 26 patients with BSS irrigating solution, both conducted by one operator. On the 1, 7, and 28d post operative, an evaluation was done to measure the density and corneal endothelial cell morphology, as well as the variable of inflammation in the two groups. RESULTS: Fifty-two eyes had undergone phacoemulsification with posterior intraocular lens implantation. Both groups were evaluated for the endothelial cell reduction and corneal endothelial cell morphology change, along with postoperative inflammation. On the 28d postoperative, endothelial cell reduction in the BSS group (173.96 cell/mm2, 8.12%) was lower than the RL group (253.20 cell/mm2, 10.25%), percentage of corneal endothelial cell variation coefficient increase in the BSS group (2.92%, 8.36%) was lower compared to the RL group (3.42%, 9.96%), decrease of hexagonal cells of corneal endothelium cells presentation percentage in the BSS group (4.30%, 8.17%) was lower compared to the RL group (4.84%, 8.97%), and the percentage increase of central corneal thickness in the BSS group (4.69 μm, 0.89%) was almost equal to the RL group (4.53 μm, 0.90%). All of the results regarding difference in density and corneal cell endothelium morphology between the two groups did not reveal any statistically significant difference (P>0.05). Inflammatory variable in the two groups were even. CONCLUSION: BSS and RL were equal in their capability of maintaining endothelial cell loss and endothelial cell morphologic change in senile cataract patients after phacoemulsification.     

Pharmacokinetics of L-arginine in adults with moderately severe malaria

Severe malaria is associated with decreased nitric oxide (NO) production and low plasma concentrations of L-arginine, the substrate for NO synthase. Supplementation with L-arginine has the potential to improve NO bioavailability and outcomes. We developed a pharmacokinetic model for L-arginine in moderately severe malaria to explore the concentration-time profile and identify important covariates. In doses of 3, 6, or 12 g,L-arginine was infused over 30 min to 30 adults with moderately severe malaria, and plasma concentrations were measured at 8 to 11 time points. Patients who had not received L-arginine were also assessed and included in the model. The data were analyzed using a population approach with NONMEM software. A two-compartment linear model with first-order elimination best described the data, with a clearance of 44 liters/h (coefficient of variation [CV] = 52%) and a volume of distribution of 24 liters (CV = 19%). The natural time course of L-arginine recovery was described empirically by a second-order polynomial with a time to half recovery of 26 h. The half-life of exogenous L-arginine was reduced in patients with malaria compared with that for healthy adults. Weight and ethnicity were significant covariates for clearance. MATLAB simulations of dosing schedules for use in future studies predicted that 12 g given over 6, 8, or 12 h will provide concentrations above the K(m) of endothelial cell CAT-1 transporters in 90%, 75%, and 60% of patients, respectively.     

Consensus guidelines for the management of atopic dermatitis: An Asia–Pacific perspective

Atopic dermatitis (AD) is a relatively common disease in patients in the Asia–Pacific region. It presents a particular clinical challenge and requires careful clinical management. The chronic nature of AD characterized by flares, exacerbations and periods of quiescence requires a multipronged approach aimed at reducing itch, inflammation and the appearance of secondary lesions. In addition, varying levels of maintenance therapy may be required to avoid exacerbations. Survey data from the region indicate that there is significant variation across the Asia–Pacific with regard to current treatment practices. The management of AD may also be influenced by differing health‐care systems, variable climate, access to medical care and cultural diversity. The current consensus guidelines have been developed to provide up‐to‐date and concise evidence‐ and experience‐based recommendations directed towards general practitioners and general dermatologists in the Asia–Pacific region on the management of pediatric and adult AD.     

Effects of progressive muscular relaxation and stretching exercises combination on blood pressure among farmers in rural areas of Indonesia: a randomized study

Objective: Maintaining blood pressure (BP) could improve the quality of life among farmers in agricultural health. The study aims to evaluate the effects of progressive muscular relaxation and stretching exercises (SEs) for BP in farmer subjects in rural areas.Methods: A randomized controlled design was applied for this study. We performed a method, which is the combination of progressive muscle relaxation (PMR) and SEs for participants (30 in the control group and 60 in the intervention group). The intervention group self-practiced PMR and SEs through a video that providing instructions for 15 min. PMR practiced before going to sleeping in the night,and SEs practiced before going to farms in the morning per day for 3-months. Wilcoxon signed-rank test was performed to measure the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) as one pre- and post-test comparison of baseline and 3 months data in control and intervention groups.Results: There were no significant differences between SBP and DBP pre- and post-test in control group (P > 0.050). Meanwhile, there were significant differences in reducing SBP (M = 126.67; SD = 18.07; 95％ CI = 120–147.5 mmHg) and DBP (M = 80.67; SD = 6.91;95％ CI = 80–90 mmHg) pre- and post-test combination of PMR and SEs in intervention group (P < 0.001). After 3-months of followup data, number type SBP and DBP still remained at the same levels of baseline and 3-month data in control group. While, there was an increased number of normal and prehypertension for SBP and DBP (10％ vs. 10％ and 20％ vs. 31.6％) and reduced of hypertension stage I for SBP and DBP (30％ vs. 41.6％).Conclusions: This pilot study demonstrated effectively to reduce SBP and DBP among farmers using the combination of PMR and SEs in the agricultural health setting.     

Helicobacter pylori infection: prevalence in chronic urticaria patients and incidence of autoimmune urticaria (study in Dr. Cipto Mangunkusumo Hospital, Jakarta)

AIM: To determine the prevalence of Hp infection in patients with chronic urticaria (CU) and to evaluate the result of autologous serum skin test (ASST) in CU patients with Hp infections. METHODS: In this cross-sectional study, 16 patients with chronic urticaria and 16 non-urticaria volunteers were investigated (matched for age and sex). All subjects were examined for Hp infection with the 13C-urea breath test. Autologous serum skin test was performed in patients with proven Hp infection. RESULTS: Helicobacter pylori was detected in 12.5% of patients and 0% of the control group. There was no significant difference between the two groups (p = 0.484 using Fisher exact test). Autologous serum skin test was positive in 1 of 2 CU patients with Hp infection. CONCLUSION: In this study, there was no significant difference in the seroprevalence of Hp infection between CU patients and controls. Autologous serum skin test was positive in 1 of 2 CU patients with Hp infection.     

Differences in pain and inflammation between Diclofenac 0.1% and Nepafenac 0.1% after cataract surgery

AIM: To compare pain level and inflammation between preoperative topical Diclofenac 0.1% and Nepafenac 0.1% in patients undergoing cataract surgery. METHODS: This research was designed as prospective randomized clinical trial and conducted in June to August 2017 at Dr. Yap Eye Hospital. There were 56 subjects underwent phacoemulsification operation (single operator) and diagnosed as senile cataract and no adverse events were found. Subjects were divided into 2 groups according to preoperative eye drop medication, namely Diclofenac group and Nepafenac group. Participants and phaco-surgeon were blind regarding to the treatment. Inflammation parameters (at 1, 7 and 14d follow up) such as pain, conjunctiva hyperemic, blepharospasm, flare and cell in anterior chamber level as the primary outcome, whereas density and morphology of corneal endothelial cells as the secondary outcome. RESULTS: There were no statistically difference in conjunctiva hyperemic and blepharospasm level between 2 groups at 1d (P=0.284, effect size=0.29, 95%CI=-0.09 to 0.31; P=0.254, effect size=0.31, 95%CI=-0.13 to 0.49, respectively) and 7d (P=1.000 and P=0.556, effect size=0.18, 95%CI=-0.08 to 0.16, respectively) postoperatively. The pain scores (during surgery, 1d and 14d postoperative) in Nepafenac group was statistically lower than Diclofenac group (P=0.006, effect size=0.77, 95%CI=0.24 to 1.34; P=0.045, effect size=0.39, 95%CI=-0.10 to 0.62; and P=0.014, effect size=0.69, 95%CI=-0.06 to 0.50, respectively). The degree of flare and cell in Nepafenac group was lower at the 1d after phacoemulsification (P=0.029, effect size=0.59, 95%CI=0.02 to 0.36). Reduction of corneal endothelial density between 2 groups was not statistically significant, however the reduction of hexagonal cell percentage at 7d after phacoemulsification was lower than Nepafenac group (P=0.042, effect size=-0.55, 95%CI=-2.33 to -0.03). CONCLUSION: The pain and flare-cell levels in Nepafenac group are lower when compared with Diclofenac group.