Plasmodium Ovale Malaria: Endemic Areas in Indonesia

Plasmodium ovale consists of two subspecies - P. ovale wallikeri and P. ovale curtisi. Increased reports of imported malaria ovale in non-endemic regions and mixed infection of P. ovale with other Plasmodium species suggest that P. ovale might be under-detected during routine surveillance. Areas endemic with P. ovale have mostly been reported in African and Western Pacific countries. A recent case report in Indonesia indicated that regions with P. ovale endemicity are not only distributed in Lesser Sunda and Papua, but also in North Sumatra.

Identifying Adult Population at Risk for Undiagnosed Diabetes Mellitus in Medan City, Indonesia Targeted on Diabetes Prevention

Background

Diabetes mellitus is a health problem in Indonesia, where its prevalence rises annually. The condition may negatively impact one's quality of life and lead to significant complications-over 50% of patients with type 2 diabetes mellitus, the most common diabetes type worldwide. To implement diabetic prevention interventions and achieve effective diabetes mellitus control, screening for undiagnosed diabetes mellitus in high-risk populations is essential.

Objective

This study aimed to identify people at risk for undiagnosed diabetes mellitus using the Finnish Diabetes Risk Score (FINDRISC) and oral glucose tolerance test (OGTT).

Methods

This cross-sectional study was carried out, which involved 300 people in Medan City between the ages of 30-75. The study was conducted between July 14 and October 20, 2020. The Finnish Diabetes Risk Score and anthropometric measurements (weight, height, and waist circumference) were used to evaluate each respondent. Low, medium, and high-risk outcome categories were created. All responders underwent oral glucose tolerance tests, with results classified as normal, prediabetes, or diabetes. The Chi-square test was used to examine the data and identify potential risk variables for diabetes mellitus.

Results

Of 300 individuals, 91.7% were female, and 8.3% were male. 33.7% of participants had a low risk of acquiring diabetes, 55.0% had an intermediate risk, and 11.3% had a high risk. 70% of participants who took an oral glucose tolerance test had blood glucose levels that were normal (less than 100 mg/dl), 18.7% had blood glucose levels suggestive of prediabetes (between 100 and 125 mg/dl), and 11.3% had blood glucose levels suggestive of diabetes (126 mg/dl or higher). Ages 54 to 64 years and older, high body mass index and central obesity, a lack of vegetables and fruits in the daily diet, inactivity, uncontrolled hypertension, a history of hyperglycemia, and a family history of diabetes were all linked to a significant increase in the risk of developing diabetes. Most respondents at low risk of developing type 2 diabetes had normal blood sugar levels, while those at high risk of developing type 2 diabetes had high blood glucose levels (p = 0.005).

Conclusion

Oral glucose tolerance testing and the FINDRISC questionnaire may be used to identify individuals who are at high risk for developing diabetes and to encourage them to adopt healthy behaviours.

Open Clinical Trial of Sambiloto (Andrographis paniculata) Ethanolic Extract Capsules in Treatment of Malaria Patients in Batubara District, Indonesia

Introduction

Malaria infection is still a public health problem in Indonesia. One of the problems in combating malaria in Indonesia is the limited kind of antimalarial drugs provided by the government. Sambiloto (Andrographis paniculata) extract has been shown to have antimalarial activity in human clinical trials.

Aim

To assess the ability of a single A. paniculata ethanolic extract capsule to treat malaria in humans caused by Plasmodium falciparum or P. vivax alone or mixed infections of both.

Methods

An open clinical trial was conducted in Batubara District, Sumatra Utara Province, Indonesia, a malaria-endemic area. Sixty-nine malaria patients found in the field were diagnosed microscopically as malaria vivax, malaria falciparum, and mixed infections uncomplicated malaria with 12 years old and above. Previously all patients signed informed consent. All patients have been treated with A. paniculata ethanolic extract capsules 250 mg thrice a day for five days. Parasite density was calculated from D0, D1, D2, D3, D7, D14, and D28.

Results

The efficacy of A . paniculata ethanolic extract capsules 250 mg thrice a day for five days against malaria vivax, malaria falciparum, and mixed malaria patients was 94.2%. There are no side effects were found during treatment.

Conclusion

A. paniculata ethanolic extract can be used as an alternative antimalarial candidate derived from native Indonesian medicinal plants or as an adjunct in standard treatment for malaria.

Morphology of Taenia Asiatica Simalungun, Indonesia

Background:

One of the methods to identify Taenia species that infect humans morphologically is microscopic examination of the gravid proglottid and the scolex. By counting the number of uterine branches in a gravid proglottid, the species of Taenia can be identified. According to literatures, the number of uterine branches of proglottid varies between 11 – 31 and the scolex has a rostelum and apical pit without hooklet.

Objective:

The aim of this study was to identify the morphology of scolex, to see the presence of rostelum, hooklet, oral sucker, and apical pit using SEM.

Methods:

We investigated 19 gravid proglottids of T. asiatica from Simalungun District, North Sumatra Province using dissecting microscope examination and one scolex using light microscope and scanning electron microscope (SEM).

Results:

The findings showed that the number of uterine branches of the gravid proglottid was 16, and neither rostelum nor apical pit in the scolex was found. However, a curved shape at the apex of the scolex was identified and named as snout

Conclusion:

The number of uterine branches of T. asiatica that was found in Simalungun District, North Sumatra Province was 16 and the morphology of the scolex was slightly different from that was reported previously. We suggest that the morphology of Taenia asiatica should be further reviewed, probably of the differences in morphology of Taenia asiatica according to its endemic area.

Abstract MP243: Detection Of Mesenchymal Stem Cells In Mobilized Autologous Peripheral Blood Transplantation From Patients With Ischemic Heart Disease

Background: Mesenchymal stem cells (MSCs) improve the cardiac function and remodeling in patients with ischemic heart disease. However, their presence in the circulating peripheral blood and post-transplantation has not been fully elucidated. We aimed to investigate the effects of intravenous transplantation of mobilized autologous peripheral blood on the number of MSCs in patients with ischemic heart disease.

Methods: Granulocyte-colony stimulating factor (G-CSF, 5.0 μg/kg/day) was given subcutaneously once a day for five days to 7 patients (4 women and 3 men, aged 54-69 years) with ischemic heart disease. Leukapheresis procedure was started on the day 5 of G-CSF using the Spectra Optia cell separator. Circulating and intravenous transplantation of autologous MSCs after leukapheresis were analyzed by flow cytometry. MSCs were identified on the basis of dual positive cells (CD73 + /CD105 + or CD90 + /CD73 + or CD90 + /CD105 + ) and detected as MSCs if a cluster of at least 10 cells could be found.

Results: MSCs in the circulating peripheral blood and after transplantation were detected in 2 (28%) and 6 (85%) patients, respectively. The frequency of intravenous peripheral blood MSCs increased significantly after transplantation (from 32.57 ± 22.76 x10 -4 % to 58.57 ± 28.49 x 10 -4 % , p<0.001). Moreover, there were significant rise in the total white blood cells count (from 10.25 ± 4.86 x 10 3 /μl to 35.81 ± 7.07 x 10 3 /μl, p<0.001) and the levels of CD34 + cells (from 1.17 ± 0.93 cells/μL to 138.30 ± 11.26 cells/μL, p<0.001) after the infusion.

Conclusions: The results show that intravenous transplantation of mobilized autologous peripheral blood increases the number of MSCs in patients with ischemic heart disease. Leukapheresis product of peripheral blood MSCs could therefore be a potential source for autologous transplantation in ischemic heart disease.

Human Tapeworm from Simalungun, Indonesia

A 46-years-old man from Indonesia, resides in Nagori Dolok Village, Silau Kahaean Subdistrict, Simalungun District, Sumatra Utara Province, had of spontaneous discharge of tapeworm segments (proglottids) from anus almost every day for ten years. There were 1-5 segments which can move actively discharge per day. Although he feels embarrassed about the condition, no significant symptoms were found, and physical examination was within normal limits. Clinical diagnosis of Taeniasis was made on October 20, 2017, and subsequently received oral Praziquantel 600 mg tablet single dose and 5 mg of oral Bisacodyl. Four hours later, the patient was defecated. The stool was collected in plastic and filtered with a filter device to collect any tapeworm segments.A full segment of tapeworm as long as 2.86 meters were found. Microscopic examination was done to identify the egg worms, proglottids, and scolex. Dye substance was injected into a mature gravid proglottid through the genital pore and pressed in two object-glasses to identify the reproductive organs. Microscopic examination (400x magnification) of this sample revealed that the number of uterine branches and testes in a proglottid were 16 pairs. The number of uterine branches in T. solium are 8-12 pairs and T. saginata are 18-32 pairs.The filtered stool was moved into a container and carefully observed. A soft yellowish-white material of 1.5 mm in diameter was found, which turned out to be the head of the tapeworm called Scolex. Microscopic examination of scolex revealed that the rostellum was absent. A segment called 'snout' was found at the apex. The functions were probably as a sense of smell and vacuum organ.The patient was lived in Simalungun, North Sumatera, some tribe in that area has a long tradition of culinary called 'Hinasumba', consist of raw pork liver and meat, and 'Naiholat' consist of poorly cooked pork.Even though pig was determined as an intermediate host, the type of tapeworm was not consistent with T.solium. The patient had the long history of infection but never had sign or symptoms of neurocystecercosis. Based on etno-geographical condition, the patient was infected by T.asiatica. Microscopic examination of the uterus and scolex indicate that the tapeworm had most similarity to T.asiatica.Amin et al.8 from Bangladesh in 2009 reported a case of T. asiatica in human with total strobila length was 1.5 meters. Macroscopic morphology (length:width) of gravid proglottid segment of T.saginata is 3:1, T. solium 1.5:1. The tapeworm that we discovered had 1-1.5:1 ratio (2.5 cm length and 2 cm width).Some features of the tapeworm (no rostellum, present of the snout, and fix number of theuterus in every proglottid) were not found in three existing type of Taenia species. Further microscopic and molecular study should be done to determined type or subtype of the tapeworm. A case of taeniasis asiatica who had completed treatment was reported. Macroscopic and microscopic was done to support the clinical diagnosis.

Identification of a previously unidentified endemic region for taeniasis in North Sumatra, Indonesia

In North Sumatra, Indonesia, taeniasis has previously been reported solely from Samosir Island located in Lake Toba. In 2014, however, three individuals were identified with taeniasis after voluntarily reporting for treatment, stimulating a subsequent investigation conducted in 2017. This investigation indicated that a previously unidentified endemic area exists in Simalungun District. Molecular analysis showed the worms to be hybrid-derived descendants of Taenia asiatica and Taenia saginata, which is consistent with specimens identified previously from Samosir Island.

Soluble Fas Ligand as a Potential Marker of Severity of Dengue Infection

BACKGROUND

The apoptosis of microvascular endothelial cells causes plasma leakage in dengue haemorrhagic fever patients. The soluble Fas ligand is a protein with molecular weight of 40 kDa that acts as a mediator of apoptosis. This study aimed to prove whether soluble Fas ligand can be used as a potential marker to predict the severity of dengue infection by comparing the soluble Fas ligand levels in dengue fever (DF) and dengue haemorrhagic fever (DHF) patients early in the course of illness.

METHOD

This was a prospective study. It included 42 dengue patients (22 DF patients and 20 DHF patients) and 20 healthy people as a control group. The soluble Fas ligand was measured by the enzyme-linked immunosorbent assay (ELISA).

RESULT

Soluble Fas ligand was increased significantly (P < 0.001) in DHF patients (median = 130.19, IQR = 36.26) compared to DF patients (median = 104.73, IQR = 53.94) and the control group (median = 87.16, IQR = 24.91).

CONCLUSION

Soluble Fas ligand can be used as a potential marker to predict the severity of dengue infection in the early course of the illness. However, a larger sample size and further objective studies are needed to confirm these findings.

An HIV positive man with single erythema skin lesion: a case report of neglected tropical disease

Skin lesion is common in person living with HIV. We reported a 42 years old HIV positive man with single erythema skin lesion on the right foot. Clinical examination, anamnesis and laboratory examination revealed that it was cutaneous larva migrant due to parasitic infection. The cutaneous larva migrant due to hookworms is one of neglected tropical disease that might occur in adult with immunocompromised. This neglected disease is discussed rarely and might not be found in developed country, but it is still a common disease in the tropical region. Patient was treated successfully with albendazole, cetirizine, chlorethyl spray and betamethasone cream.

Comparative study of antimalarial effect of sambiloto (Andrographis paniculata) extract, chloroquine and artemisinin and their combination against plasmodium falciparum in-vitro

AIM

to compare the anti-malarial effect among sambiloto extract, chloroquine and artemisinin-only as well as those of their combination.

METHODS

the study was conducted in Central Biomedical Laboratory, Faculty of Medicine, Brawijaya University, Malang, Indonesia from January to February 2006. Malaria culture used Plasmodium falciparum of Papua strain (2300) that was obtained from Namru-2 Jakarta. Five drugs applied in this test; those were chloroquine, artemisinin, the extract of sambiloto, the combination of sambiloto and chloroquine, and the combination of sambiloto and artemisinin. Parasite density was determined by counting the number of Plasmodium falciparum infected erythrocyte in 5,000 erythrocytes of the culture. Single drug (Chloroquine-only or artemisinin only) and either combination with sambiloto at dose 0.5 ug/ml had killing-effect against the parasite, measured by the appearance of "crisis form" on the infected erythrocytes. This killing-effect was dose dependent, and reached its optimum effect of 200 ug/ml.

RESULTS

treatment of single sambiloto extract with dose 0.5 ug/ml increased the density of the parasite, however after every 1ug increasing dose of sambiloto extract, the killing effect also increased. The reduction of the parasite density was also seen by increasing the Sambiloto dose in the group of combination of sambiloto-chloroquine as well as the group of combination of sambiloto and artemisinin. Statistically, there was no difference in the anti-malaria efficacy among of five test drugs (p=1.00). The correlation between the reduction of the parasite with the increasing of dose in all groups is statistically significance (p=0.001).

CONCLUSION

the extract of sambiloto in a single dose or in a combination evidently has the effect of anti-falciparum malaria.