bluuebunny/crossref_metadata_2025 huggingface dataset:
NEUROTOXIC EFFECT OF TITANIUM DIOXIDE NANOPARTICLES: BIOCHEMICAL AND PATHOLOGICAL APPROACH IN MALE WISTAR RATS
Authors: Vasantharaja D. , Ramalingam V.
Published: July 2018

Objective: Titanium dioxide nanoparticles (TiO2 NPs) are widely used in pharmaceutical, cosmeceutical, biomedical and industrial applications. The adverse effects of TiO2 NPs are also increasing alarmingly. The purpose of this study is to investigate the toxicity of TiO2 NPs on biochemical and histological changes in different regions of brain in adult male Wistar rats.Methods: Two different doses of TiO2 NPs (50 mg/kg b. w and 100 mg/kg b. w) administered orally for 14 d along with one control group, each group consisting of six animals. Standard biochemical methods were adopted for the estimation of enzymes alkaline phosphatase, 5’ nucleotidase, ATPases and gamma-glutamyl transpeptidase. Trace elements calcium, sodium, potassium and magnesium as well as metals like iron, zinc and copper were also estimated.Results: When compared with the control group, the enzymes ATPases, ALP, 5’-NT and GGT activities were significantly decreased in both the TiO2 NPs treated groups. Ca, Na, Fe, Cu and TiO2 contents were significantly increased in both the experimental groups, while the K, Mg and Zn contents decreased. However, the changes in the parameters studied were more in 100 mg treated group (p<0.001) when compared to the 50 mg treated group (p<0.05and p<0.01). Moreover, it is also evident that different regions responded differently due to TiO2 NPs exposure. The changes were maximum in the cerebral hemisphere (p<0.001) followed by medulla oblongata (p<0.001) and cerebrum (p<0.05).Conclusion: The results clearly imply that TiO2 NPs could impair the electrochemical gradient, ionic homeostasis and membrane stability in different regions of the rat brain.
SOLUBILITY AND THERMODYNAMIC MODELING OF QUETIAPINE FUMARATE IN SELF NANOEMULSIFYING DRUG DELIVERY SYSTEM (SNEDDS)
Authors: Talele S. G. , Derle D. V.
Published: July 2018

Objective: The present study gives emphasis on the development of self-nanoemulsifying drug delivery system (SNEDDS) of poorly water-soluble drug using Apelblat model. Methods: For the development of self-nanoemulsifying drug delivery system (SNEDDS) solubility in surfactant, co-surfactant and in oil phase are considered as an important key to avoid phase separation and precipitation after dilution. The solubility of quetiapine fumarate was determined by the isothermal mechanical shaking method for its individual components in the temperature range from 305.15 to 330.15K was measured. The experimental mole fraction solubility of quetiapine was good correlated with calculated data by using modified Apelblat model. Prepared SNEDDS were evaluated in centrifugation, freeze-thaw cycle study, self-nanoemulsification efficiency test. Physicochemical properties of prepared SNEDDS including particle size, zeta potential, viscosity and refractive index were carried out.Results: The equilibrium saturated and mole fraction solubility of Quetiapine fumarate was found to be high in tween80 than SNEDDS, Labrafac lipophile WL 1349 and capryol 90. Quetiapine fumarate equilibrium saturated solubility, as well as mole fraction solubility, was found to be increased with increase in temperature in SNEDDS as well as in its individual components Prepared SNEDDS was found to be highly stable at centrifugation, heating and cooling cycles and freeze-thaw cycles and shows no sign of precipitation after dilution in water. All physicochemical parameters were observed within specification including droplet size observed as 26.37 nm, polydispersity index 0.0970, zeta potential-14.69 and the refractive index was observed as 1.458 which was nearer to the refractive index of water indicating the isotropic behavior of prepared SNEDDS.Conclusion: The solubility study could be an effective approach for the development of thermodynamically stable SNEDDS formulation of poorly soluble drugs using Apelblat model.
SELF-ASSEMBLED CHITOSAN NANOPARTICLES FOR PERCUTANEOUS DELIVERY OF CAFFEINE: PREPARATION, CHARACTERIZATION AND IN VITRO RELEASE STUDIES
Authors: Abu Hassan Nik Amanina Farhanah , Sahudin Shariza , Hussain Zahid , Hussain Mumtaz , Hussain Mumtaz
Published: July 2018

Objective: Chitosan (CS)–tripolyphosphate (TPP)–nanoparticles (NPs) have been extensively studied during the past few decades due to their well-recognized applicability in various fields. The present study attempts to optimise the development of these nanoparticles to enhance the percutaneous delivery of caffeine.Methods: CS-TPP-NPs were prepared via ionic cross-linking of CS and TPP and were characterized. The influence of several formulation conditions (CS: TPP mass ratio and concentration of caffeine) and process parameters (stirring speed, stirring time and ultra-sonication time) on the colloidal characteristics of CS-TPP-NPs were investigated and the resulting nanoparticles were characterized using scanning electron microscopy (SEM), transmission electron microscopy (TEM), Fourier transform infrared (FTIR) and x-ray diffraction (XRD) analyses. Physicochemical properties, including particle size, zeta potential and polydispersity index (PDI) were examined, and in vitro release studies were conducted to ascertain the release profile of caffeine from the nanoparticles. In addition, the colloidal stability of the prepared NPs was also assessed on storage.Results: Process parameters appeared to exert a significant effect on the physicochemical characteristics of the CS-TPP-NPs. The CS-TPP-NPs prepared under optimum conditions (CS concentration of 0.2 mg/ml, CS: TPP volume ratio of 25:12 ml, stirred at 700 rpm for 60 min, with 0.97 mg/ml caffeine concentration and treatment with low ultra-sonication for 30 min) had shown a mean particle size of ~143.43±1.69 nm, zeta potential of+43.13±1.10 mV, PDI of ~0.30±0.01. A drug loading capacity and encapsulation efficiency of 48.89% and 60.69%, respectively, were obtained. Cumulative release study for drug-loaded CS-NPs was significantly (p<0.001, paired t-test) higher (58.7% caffeine released) compared to control formulation (41.5% caffeine released) after 72 h. Stability studies conducted for 28 d showed that caffeine-loaded CS-NPs degraded much quicker when stored at 25 ⁰C than 4 ⁰C. It was also noted that caffeine-loaded CS-NPs in the freeze-dried form were unstable as the surface charge of nanoparticles dropped from positive zeta potential to-3.55 mV within 2 d at 4 ⁰C and at 25 ⁰C, surface charge dropped to-3.16 mV within 14 d of the experiment.Conclusion: Chitosan (CS)–tripolyphosphate (TPP)–nanoparticles (NPs) appear to be a promising strategy to achieve sustained percutaneous delivery of caffeine.
“EFFECT OF CROSSLINKING AGENT ON DEVELOPMENT OF GASTRORETENTIVE MUCOADHESIVE MICROSPHERES OF RISEDRONATE SODIUM”
Authors: Gedam Shweta , Jadhav Pritee , Talele Swati , Jadhav Anil
Published: July 2018

Objective: The present investigation was undertaken to develop and evaluate a gastroretentive mucoadhesive microspheres of anti-osteoporosis drug risedronate sodium to enhance the residence time and drug release by studying the effect of the crosslinking agent to obtain the best formulation with reduced particle size and good in vitro mucoadhesion strength.Methods: Selected drug risedronate sodium is a potent pyridinyl bisphosphonate used for the treatment of osteoporosis, and other bone disorders. Microspheres using sodium alginate as a polymer and calcium chloride solution as a cross-linker were prepared successfully by the emulsification crosslinking method. The 23 factorial design was used to study the effects of various variables like a drug: polymer ratio, crosslinking agent concentration and crosslinking time on the particle size and in vitro mucoadhesion strength. All these formulations were evaluated for entrapment efficiency, percentage yield and cumulative drug release. F1 batch was selected as best formulation and evaluated for scanning electron microscopy, fourier transforms infrared spectroscopy, differential scanning calorimetry, stability study.Results: Design batches were evaluated for percent yield (61.29-89.33%), % entrapment efficiency (42.25±0.620-62.58±0.330), mucoadhesion strength (68.15±0.37-82.24±0.72%) and drug release at 12 h (67-84%). Among the microspheres formulation, an F1 batch of (0.5:1) drug: polymer concentration and at 4% concentration of calcium chloride as a crosslinker was considered best formulation with reduced particle size 32.85±0.774μm, % intro mucoadhesion. 82.24±0.72. In vitro mucoadhesion strength was increased with the increasing crosslinking time from 5 min to 10 min. The fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) study showed no interaction between drug and polymer. X-ray diffraction (XRD) spectrum of microspheres indicates that drug particles are dispersed at the molecular level in the polymer matrices so no indication of the crystalline nature of the drug nature. Scanning electron microscopic (SEM) study showed that microspheres were spherical in shape with a smooth surface. F1 batch shows percentage cumulative drug release 84.07%. In vitro dissolution studies indicates that percent cumulative drug release from microspheres follows zero order kinetics plot which indicates controlled-release drug-delivery for 12 h which leads to control of plasma concentration.Conclusion: The results show that the formulation that contains (0.5:1) drug: polymer ratio, calcium chloride in 4% concentration and crosslinking time 10 min is the best one and can be utilized to formulate risedronate sodium mucoadhesive microspheres to enhance gastric residence time, improved patient compliance and reduction in the frequency of drug administration.
COSMECEUTICAL IMPORTANCE OF FERMENTED PLANT EXTRACTS: A SHORT REVIEW
Authors: Sivamaruthi Bhagavathi Sundaram , Chaiyasut Chaiyavat , Kesika Periyanaina
Published: July 2018

Personal care products, especially cosmetics, are regularly used all over the world. The used cosmetics are discharged continuously into the environment that affects the ecosystem and human well-being. The chemical and synthetic active compounds in the cosmetics cause some severe allergies and unwanted side effects to the customers. Currently, many customers are aware of the product composition, and they are stringent in product selection. So, cosmetic producers are keen to search for an alternative, and natural active principles for the development and improvisation of the cosmetic products to attain many customers. Phytochemicals are known for several pharmacological and cosmeceutical applications. Fermentation process improved the quality of the active phytochemicals and also facilitates the easy absorption of them by human system. Recently, several research groups are working on the cosmeceutical importance of fermented plant extracts (FPE), particularly on anti-ageing, anti-wrinkle, and whitening property of FPE. The current manuscript is presenting a brief on cosmeceutical importance of FPE. COSMECEUTICAL IMPORTANCE OF FERMENTED PLANT EXTRACTS: A SHORT REVIEW
FORMULATION AND EVALUATION OF ANTI ACNE GEL CONTAINING CITRUS AURANTIFOLIA FRUIT JUICE USING CARBOPOL AS GELLING AGENT
Authors: Kusuma Agung Fitri , Abdassah Marline , Valas Bobby Ellyas
Published: July 2018

Objective: The objective of this study was to design a product of anti-acne gel containing Citrus aurantifolia fruit juice as an effective antibacterial to treat acne caused by Propionibacterium acne and Staphylococcus epidermidis using carbopol as a gelling agent.Methods: The fresh juice of C. aurantifolia fruit was obtained by juicer and pasteurized for 30 min at 65-70 °C. The minimum inhibitory concentration (MIC) of the fruit juice was determined using the microdilution method. Then, carbopol in different concentration was incorporated in a gel base formula to obtain a stable gel base. The fresh juice in different formulas (F1, F2 and F3) was evaluated for 28 d. The color, pH and viscosity of each formula were observed. In addition, the antibacterial potency of each formula was analyzed using the agar diffusion method against both tested bacteria. Results: The citrus MIC values of both test bacteria showed different results, 20-40 % v/v for P. acne and 5-10 % v/v for S. epidermidis. The MIC values were converted into in vivo concentration and the resulted concentrations for each formula were 25, 50 and 75 % v/v. For supporting the formula, the most stable base gel was achieved using carbopol 1 % as the gelling agent. Among three formulas, the anti-acne gel formula containing 75 % fruit juice with carbopol 1% was the best formula based on the physical and microbiological parameter.Conclusion: Thus, it was concluded that the antiacne gel of fruit juice of C. aurantifolia with carbopol as a gelling agent could produce the effective and stable gel of anti-acne product.
TABLET FORMULATION FROM MENIRAN (PHYLLANTHUS NIRURI L.) EXTRACT WITH DIRECT COMPRESSION METHOD
Authors: Mustarichie Resmi , Priambodo Dradjad
Published: July 2018

Objective: The aim of the present study was to obtain an optimized formula of meniran (Phyllanthus niruri L.) extract tablets that fulfilled the requirements as a good pharmaceutical preparation based on Indonesian Pharmacopoeia IV and USP XVII.Methods: P. niruri plant was collected and determined at the Laboratory of Plant Taxonomy, Universitas Padjadjaran. First performed phytochemical screening to determine the content of secondary metabolites. Then designed five kinds of tablet formulas of P. niruri extract using a direct compressed method with a variation of concentration of filler. Each formula contains a similar concentration of P. niruri extract as the active ingredient, avicel PH 102 and amprotab with varying concentrations as filler, talcum, and magnesium stearate as a lubricant and Aerosil®200 vv as an adsorbent. Tablet print mass and quality of the resulting tablets were then evaluated. Also, check whether the resulting tablets still contain P. niruri extract as the active substance or not.Results: The results of phytochemical screening of simplicia and viscous plant extract showed the presence of alkaloids, polyphenols, tannins, and flavonoids as secondary metabolites. The five formulas made contain avicel PH 102 and amprotab as binders and crushers and the expected results such as shape and durability as desired. The results of examination of shrinkage rate of mass drying of tablet prints from the above five formulas indicated an increase of value from formula A (5.4609 %) to formula E (5.8600%). This was because avicel PH 102 and amprotab had a considerable moisture content, so with the combination of both fillers could increase the water content from mass print tablets. Real density, compact density, and true density decreased from formula A to formula E. The amount of these densities were influenced by the shape and size of the particles. Flowability increased from formula A (23.7124°) to formula E (26.4210°) whereas compressibility increased from formula A (21.7222%) to formula E (29,4121%). Flowability and compressibility increase might be due to the uniformity of the particle size between the amprotabs and the other additives which could cause electrical charges to the print mass affecting the speed and flow of the print mass. All quality testing results including Weight (mg), Thickness (mm), Diameter (mm), Hardness (N), Friability (%) and Disintegration time (min.) had met the requirements. Thin Layer Chromatography showed that the resulting tablets still contain P. niruri extract as the active substance.Conclusion:. Overall results showed that the formulation fulfilled the requirements as a good pharmaceutical preparation based on Indonesian Pharmacopoeia IV and USP XVII.
ARTRITIS GOUT DAN PERKEMBANGANNYA
Authors: Wahyu Widyanto Fandi
Published: July 2018

Artritis Gout dan Perkembangannya. Latar Belakang. Artritis gout merupakan istilah yang dipakai untuk kelompok gangguan metabolik, yang ditandai oleh meningkatnya konsentrasi asam urat (hiperurisemia). Setiap tahun penderita artritis gout meningkat jumlahnya dan merupakan bagian dari masalah utama kesehatan bagi usia lanjut di Indonesia maupun seluruh dunia. Oleh karena itu, penatalaksanaan artritis gout harus dilakukan dengan cermat agar tidak menimbulkan kecacatan yang lebih parah. Obat yang dipakai untuk artritis gout akut ialah kolkisin, obat antiinflamasi non-steroid atau kortikosteroid. Kolkisin juga dipakai sebagai terapi pencegahan. Diet dan perubahan cara hidup merupakan komponen yang penting dalam penatalaksanaan gout karena menurunkan kadar asam urat serum. Dengan pengobatan dini, pemantauan yang ketat disertai pendidikan terhadap penderita, prognosis umumnya baik.
EFEK ANTIMIKROBA EKSTRAK ETANOL DAUN PEPAYA (CARICA PAPAYA L) TERHADAP SHIGELLA DYSENTERIAE SECARA IN VITRO DENGAN METODE DILUSI TABUNG DAN DILUSI AGAR
Authors: Ristya Hertanti Senja , Suswati Irma , Setiawan Indra
Published: July 2018

Efek Antimikroba Ekstrak Etanol Daun Pepaya (Carica papaya, L.) terhadap Shigella dysenteriae secara In Vitro dengan Metode Dilusi Tabung dan Dilusi Agar. Daun pepaya merupakan salah satu tanaman yang mengandung zat aktif, terdiri dari asam organic dan fitosterol, alkaloid, saponin, flavonoid, tannin, dan polifenol berfungsi sebagai antimikroba terhadap bakteri, salah satunya adalah Shigella dysenteriae. Tujuan untuk membuktikan efek antimikroba ekstrak etanol daun pepaya terhadap pertumbuhan bakteri Shigella dysenteriae secara in vitro. Penelitian memakai rancangan true experiments dengan menggunakan Post Test Only Control. Konsentrasi ekstrak daun pepaya yang digunakan adalah 5%, 10%, 15%, 20%, 25%,30% dan 2 kontrol (kontrol bahan dan kontrol kuman). Analisa data menggunakan one way ANOVA, korelasi, dan regresi. Hasil: Nilai KBM (Kadar Bunuh Minimal) pada konsentrasi 30% Hasil uji one way ANOVA menunjukkan adanya perbedaan yang sangat signifikan antar perlakuan (p=0,004). Semakintinggi konsentrasi ekstrak etanol daun pepaya, semakin besar kemampuan menghambat dan membunuh bakteri Shigella dysenteriae (r=-0,472). Pemberian konsentrasi ekstrak etanol daun pepaya berpengaruh terhadap penurunan jumlah koloni bakteri Shigella dysenteriae per ml (106) (R2= 22,3%). Nilai KHM (Kadar Hambat Minimal)pada konsentrasi 10%. Hasil uji one way ANOVA  (p=0,066), pada uji korelasi (r=-0,564) dan pada uji regresi didapatkan (R2= 31,9%). Kesimpulan: Ekstrak etanol daun pepaya memiliki efek antimikroba terhadap pertumbuhan koloni Shigella dysenteriae.Kata kunci: Ekstrak etanol daun pepaya, Shigelladysenteriae, KBM, KHM
PERBANDINGAN PENGGUNAAN FIKSASI HAIR SPRAY DENGAN FIKSASI RUTIN PADA PAP SMEAR DENGAN METODE BETHESDA
Authors: Yuliartha Lestari Dian
Published: July 2018

Latar belakang. PAP smear merupakan metode deteksi dini yang rutin digunakan untuk lesi peradangan serta kankerserviks di seluruh dunia. Metode fiksasi basah untuk PAP smear saat ini selain menggunakan alkohol, juga menggunakan Hair spray. Tujuan. Untuk membandingkan kualitas fiksasi menggunakan alkohol dan hair spray. Metode. Merupakan penelitian observasional analitik, dengan total sampling dari bulan September-Desember 2014. Variabel yang dinilai adalah adekuat spesimen, kualitas staining, ada tidaknya artefak, serta ada tidaknya sel yang degenerasi. Uji statistik menggunakan Uji Kesesuaian Kappa, dikatakan sesuai jika koefisien kappa >0,6 (p<0,05). Hasil. Didapatkan jumlah sampel sebanyak122 sampel. Hasil koefisien kappa untuk adekuat spesimen sebesar 0,792. Hasil koefisien kappa untuk kualitas staining sebesar 0,627. Hasil koefisien kappa untuk ada tidaknya artefak sebesar 0,196. Hasil koefisien kappa untuk ada tidaknya sel yang degenerasi sebesar 1,000. Kesimpulan. Terdapat kesesuaian antara penggunaan fiksasi menggunakan alkohol maupun hairspray, dalam hal adekuat sel, kualitas staining, maupun ada tidaknya sel yang degenerasi.Keyword : PAP smear, alkohol, hairspray
PENGARUHPEMBERIAN EKSTRAK KUNYIT (CURCUMA LONGA) TERHADAP EKSPRESI SEL GOBLETPADA KONJUNGTIVA TIKUS (RATTUS NOVERGICUS) YANG DIINDUKSI OVALBUMIN
Authors: Puspitasari Wenna , NurHasan Yuliono , Nelasari Halida
Published: July 2018

ABSTRAKKonjungtivitis merupakan sutau peradangan konjungtiva yang ditandai dengan dilatasi pembuluh darah sehingga konjungtiva menjadi hiperemi, edema dan dapat disertai adanya discharge.Curcuminmerupakanbahanaktifdarikunyit yang memilikimanfaatsebagai anti alergi.Penelitian ini bertujuan untuk mengetahuipengaruhpemberianekstrakkunyit (Curcuma longa) terhadapekspresisel goblet padakonjungtivatikus yang diinduksi ovalbumin. PenelitianinimerupakanpenelitianTrue experimentaldenganpost test only group design. Sampeldibagidalamempatkelompokperlakuan yang diberiekstrakkunyitdengandosismasing-masing 35 mg/200grBB, 70 mg/200grBB, 140 mg/200grBB secaraippadaharike 15 dan 18 satu jam sebelumpemberian ovalbumin sertasatukelompokkontrolpositif yang hanyadiberi ovalbumin padaharike 0,7,15 dan 18. Analisis data menggunakanOnewayAnova, bonferonni, kolerasidanregresi.Ekstrakkunyitdapatmenurunkanjumlahsel goblet secarabermakna (ANOVA p=0,000). Terdapathasilujiregresi linier sebesar  70,0%. Dosis minimal yang menunjukkanefeksignifikanadalah 70 mg/kgBB.Ekstrakkunyitberpengaruhterhadappenurunanjumlahsel goblet padakonjungtivatikus (Rattusnorvegicus) yang diinduksi ovalbumin Kata kunci :KonjungtivitisAlergi, Kurkumin, Ovalbumin
HUBUNGAN SKALA KEPRIBADIAN MINESSOTA MULTIPHASIC PERSONALITY INVENTORY TEST-2 (MMPI-2) dengan IPK MAHASISWAKEDOKTERAN DI UNIVERSITAS MUHAMMADIYAH MALANG
Authors: Margarini Nur Aini Yunike Bahari , Prihanti Gita Sekar , Suharto Dr
Published: July 2018

Kepribadian seorang mahasiswa terutama di bidang pendidikan dokter sangat berpengaruh terhadap cara menjalankan tugasnya sebagai mahasiswa dengan baik. Oleh karena itu dilakukan teskepribadian.Salah satunyauntuk mengetahui kepribadiannya, berupa tes Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Tujuan dari penelitian ini adalah untuk mengetahui Hubungan Skala Kepribadian Minessota Multiphasic Personality Inventory Test-2 (Mmpi-2) Dengan IPK Mahasiswa Kedokteran Semester 4 Fakultas KedokteranUniversitas Muhammadiyah Malang. Penelitian ini menggunakan metode analitik observasional dengan pendekatan cross sectional. Teknik pengambilan sampel menggunakan purposive sampling dengan besar sampel sebanyak 112 mahasiswa. Sumber data menggunakan data primer dan analisa data menggunakan uji spearman’s rho. Hasil uji spearman’s rho pada 10 skala kepribadian Minessota Multiphasic Personality Inventory Test-2 (MMPI-2) dengan IPK Mahasiswa Kedokteran menunjukkan seluruh nilai signifikansi lebih dari 0,05 sehingga tidak ada hubungan yang bermakna.Kata kunci : Skala MMPI-2, IPK, Mahasiswa Kedokteran
PENGARUHEKSTRAK DAUN LIDAH MERTUA (Sansevieria trifasciata laurentii) TERHADAP KADAR HEMOGLOBIN TIKUS PUITH JANTAN (Rattus norvegicus strain wistar) YANG DIINDUKSI TIMBAL PER-ORAL
Authors: Ifada Rifatul , Hermayanti Diah , NurHasan Yuliono Trika
Published: July 2018

Logam berat timbal yang masuk kedalam tubuh dalam waktu singkat dan jumlah yang banyak dapat menyebabkan keracunan timbal sub-akut. Di sisi lain, daun Lidah Mertua (Sansevieria trifasciata laurentii) memiliki kandungan pregnane glycoside dan vitamin C sebagai antioksidan yang mampu mengikat logam berat timbal.Tujuan : Mengetahui pengaruh pemberian ekstrak daun Lidah Mertua (Sansevieria trifasciata laurentii) terhadap kadar hemoglobin pada tikus putih jantan (Rattus norvegicus starin wistar) yang telah diinduksi oleh timbal per-oral.Metode Penelitian : Penelitian ini menggunakan desain True Experimental Post Test Only Group Design. Penelitian ini dilakukan selama 15 hari dengan lima kelompok tikus, yaitu kelompok tanpa perlakuan (K-), kelompok yang diinduksi timbal saja (K+), kelompok P1, P2, dan P3 yang diberi ekstrak daun Lidah Mertua dengan dosis 8,3; 41; 83 mg/kgBB/hari, kemudian dilakukan induksi timbal menggunakan larutan timbal asetat dosis 15 mg/100gBB/hari. Pengambilan sampel darah tikus melalui ventrikel kemudian dilakukan uji kadar hemoglobin menggunakan metode cyanomethemoglobin.Hasil Penelitian dan Diskusi : Hasil penelitian 4 minggu didapatkan rerata hemoglobin kelompok K- adalah 12,98 g/dL, kelompok K+ adalah 13,18 g/dL, kelompok P1 adalah 12,16 g/dL, kelompok P2 adalah 12,64 g/dL, dan kelompok P3 adalah 12,96g/dL. Setelah diuji komparasi oneway ANOVA didapatkan nilai signifikansi 0,521 > p (0,05) yang berarti penelitian ini tidak terdapat perbedaan bermakna antara kadar hemoglobin pada seluruh kelompok.Kesimpulan : Pemberian ekstrak daun Lidah Mertua (Sansevieria trifasciata laurentii) tidak berpengaruh terhadap peningkatan kadar hemoglobin tikus putih jantan (Rattus norvegicus strain wistar) yang diinduksi timbal per-oral.
PENGARUH PEMBERIAN RHODAMIN B PERORAL SUBAKUT TERHADAP PERUBAHAN KETINGGIAN MUKOSA GASTER TIKUS PUTIH GALUR WISTAR (Rattus norvegicus Strain Wistar)
Authors: Anjasmara Pravangesta Anggit , Romdhoni Muhammad Fadhol , Purbowati Mustika Ratnaningsih
Published: July 2018

Latar Belakang : Rhodamin B merupakan zat pewarna sintetis yang digunakan untuk pewarna tekstil, namun banyak disalahgunakan sebagai zat pewarna makanan. Hal ini sangat berbahaya bagi kesehatan karena Rhodamin B mengandung zat kimia yang berbahaya dan reaktif. Jika di konsumi dalam jangka panjang maka akan menyebabkan iritasi saluran cerna dan mengakibatkan gastritis.Tujuan : Mengetahui pengaruh pemberian Rhodamin B peroral subakut terhadap perubahan ketinggian mukosa gaster tikus wistar.Metode : Penelitian ini merupakan penelitian eksperimental dengan rancangan post test only with control design. Sampel berupa 24 tikus wistar jantan yang memenuhi kriteria inklusi dan eksklusi, kemudian diadaptasi dan dibagi secara acak menjadi 4 kelompok. K merupakan kelompok kontrol hanya diberikan makanan dan minuman standar. P1 diberi Rhodamin B peroral 3,5mg/kgBB, P2 diberi Rhodamin B peroral 7mg/kgBB, P3 diberi Rhodamin B peroral 14mg/kgBB. Setelah 30 hari dilakukan terminasi dan diambil organ gaster untuk dibuat preparat histopatologi.Hasil : Rerata ketinggian mukosa gaster pada kelompok K=987,054µm; P1=732,170µm; P2=587,187µm; P3=525,967µm. Hasil uji One Way Anova didapatkan perbedaan ketinggian mukosa pada semua kelompok (P < 0,05) dan uji Post Hoc menggunakan uji LSD didapatkan perbedaan yang bermakna pada K-P1 (P=0,009), K-P2 (P=0,000), K-P3 (P=0,000), P1-P3 (P=0,025). Tetapi tidak terdapat perbedaan bermakna pada P1-P2 (P=0,103) dan P2-P3 (P=0,479). Uji korelasi Spearman didapatkan hubungan negatif yang sangat kuat antara pemberian Rhodamin B dosis bertingkat terhadap perubahan ketinggian mukosa gaster (r=-0,781).Kesimpulan : Pemberian Rhodamin B peroral subakut berpengaruh terhadap perubahan ketinggian mukosa gaster tikus wistar. Semakin tinggi dosis yang diberikan, semakin rendah ketinggian mukosa gaster.  Kata Kunci : rhodamin b, ketinggian mukosa gaster, peroral
PERAN HEPARIN ANGIOGENESIS EPITELIALISASI DAN PENYEMBUHAN LUKA BAKAR
Authors: Riana A. Ruby
Published: July 2018

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DISTRIBUSI KASUS KEMATIAN AKIBAT ASFIKSIA DI MALANG RAYA YANG DIPERIKSA DI INSTALASI KEDOKTERAN FORENSIK RSSA TAHUN 2006-2007
Authors: Tasmono H
Published: July 2018

Kematian akibat Asfiksia dapat  disebabkan oleh kejadian ke celakaan, bunuh diri atau pemb unuhan. Yang sering menimbulkan permasalahan adalah kejadian gantung diri apakah akibat  bunuh diri atau pembunuhan. Dari beberapa data di beberapa pusat pendidikan kedokteran didapatkan bahwa kejadian as fiksia terbanyak akibat gantung diri kar ena bunuh diri. Pada penelitian Retrospektif  ini dilakukan pendataan dan anal isa selama tahun 2006-2007 tentang ju mlah kejadian gantung diri insiden tentang jenis kelamin, umur  serta lokasi kejadian. Dari pendataan tersebut didapat kan jumlah kejadian tahun 2006 sebanyak 14 kasus, tahun 2007 seban yak 16 kasus dengan kematian terbanyak akibat gantung diri ( hanging ) dibandingkan dengan  burking suffocation maupun penyakit. Pada hanging ( 56% ) korban  jenis kelamin laki-laki lebih banyak daripada wanita ( 59% : 41% ) dengan  usia terbanyak 31 - 40 tahun yang kedua usia 11 – 20 tahun, sedangkan lokasi kejadian terbanyak di Kabupaten Malang.  Kata kunci : Asfiksia, gantung diri ( hanging ).
HUBUNGAN ANTARA BERATNYA MANIFESTASI DERMATITIS ATOPIK DENGAN TINGGINYA SKALA KEPRIBAD IAN CEMAS PADA TES MMPI PADA PENDERITA DERMATITIS ATOPIK WANITA DI RSUD DR. SOETOMO
Authors: Indrawanto Iwan Sis
Published: July 2018

Dermatitis Atopic, a kind of chronic skin disease that happens a lot in the world, tend to be increased in number and relatively difficult to treat. Most of them appear along with another atop ic condition such as Hay and asthma. The cause is not clearly un derstood yet. It’s thought to be the combination of genetics and environment. Many says that ther e’s emotional factor involved. It’s not the cause of the disease but it worsen or triggers the relaps. People of Dermatitis  Atopic with anxious kind of  personality have prone to relaps e easier than those who are not. This study figured out whether the degree of Dermatitits Atopic manifestation is correlated with the score o f anxious scale on MMPI of the Dermatitis Atopic female patien ts in Dr. Soetomo Public Hospital Surabaya.   The method was analytical study with cr oss sectional approach, started from  Juli   2009 until Desember 2009. The datas was taken from policlinics of Skin and Venereal Desease Department of Dr. Sutomo Pu blic Hospital Surabaya. Fivety three samples were taken, while 7 of them were failed due to high invalid MMPI score.  The result showed that there was significant correlation between  the degree of Dermatitits Atopic manifestation with the score   of anxious scale on MMPI of the Dermatitis Atopic female pati ents. The correlation was medium to high.  Keywords: Dermatitis Atopic, Anxious Personality, MMPI
MODEL DIAGNOSTIK STROKE BERDASARKAN GEJALA KLINIS
Authors: Bahrudin Mochamad
Published: July 2018

Abstrak   Latar belakang,  Stroke menimbulkan masalah besar karena menyebabkan kecacatan dan kematian. Tujauan ,  Mengetahui profil gejala klinis dominan guna menentukan model  diagnosa stroke berdasarkan gejala klinis. Metode,  Penelitian dilakukan di RSU Haji Surabaya, RSU jombang  dan RSU dr. Soetoma Surabaya, dilakukan  secara deskriptif analitik  dengan metode cross sectional dan didapatkan sampel penelitian 171  penderita stroke  sesuai kriteria inklusi  dan eklusi yang ditetapkan. Hasil penelitian, Pasien stroke iskemik 59,1%, stroke perdarahan 40,9%).  4 Gejala klinik dominan ( kesadaran menurun, sakit kepala, tekanan darah systole >=180 dan muntah) mengarah  pada stroke perdarahan,  dengan test Chi-Square  didapatkan hasil yang significant  P= 0,000 . Kesimpulan, Pasien  stroke dengan 4,3, gejala klinik dominan mengarah ke stroke perdarahan sedang tanpa, 1 dan 2  gejala klinik dominan mengarah ke stroke Iskemik.   Kata kunci  : stroke, Model  Diagnosis Stroke, Gejala klinik dominan.
Skabies
Authors: Nirainiwati Sri ardila
Published: July 2018

Scabies is a human skin infestation caused by the infestations and sensitization of the parasitic Sarcoptes scabiei var. hominis.Scabies has been spread around in the world especially in the tropics and subtropics. There are several types of clinical manifestation. Thediagnosis is based on a history of itching at night, a typical distribution of lesions, history of similiar complaints in other family members.Diagnosis must be established with the discovery of mites on microscopic examination that can be done in various ways. The are numberof topical treatments for scabies. The selections of drug based on effectivenes potential toxicity of drugs and how to use the proper.
KORELASI BERATNYA KEBIASAAN MEROKOK DENGAN DERAJAT GANGGUAN OBSESIF KOMPULSIF MEROKOK PADA MAHASISWA UNIVERSITAS MUHAMMADIYAH MALANG
Authors: Khairul Afif Muhammad , . Isbandyah , Sis Indrawanto Iwan
Published: July 2018

Korelasi Beratnya kebiasaan merokok Dengan Derajat Gangguan Obsesif Kompulsif Merokok Pada Mahasiswa Universitas Muhammadiyah Malang. Latar Belakang: Kebiasaan merokok merupakan perilaku yang menyenangkan dan bergeser menjadi aktivitas yang bersifat obsesif. Kelainan pada sistem saraf yang menjembatani kontrol perilaku menyebabkan kebiasaan merokok menjadi suatu gangguan obsesif kompulsif merokok. Tujuan: Mengetahui korelasi antara beratnya kebiasaan merokok dengan derajat gangguan obsesif kompulsif merokok pada Mahasiswa Universitas Muhammadiyah Malang. Metode: Observasi analitik dengan pendekatan secara cross-sectional Study, dengan pengambilan data secara cluster sampling, dan besar sampel sebanyak 100 responden mahasiswa Fakultas Teknik UMM. Analisa data dengan menggunakan statistik uji korelasi Spearman dengan =0.05. Hasil Penelitian: Dari 100 orang sampel, jumlah terbanyak yang ditemukan adalah perokok ringan yaitu sebanyak 50 orang (50%), dan lebih banyak yang mengalami gangguan obsesif kompulsif merokok dalam skala ringan yaitu sebanyak 46 orang (46%). Hasil analisis didapatkan Koefisien korelasi = + 0.596 dan p-value < 0,05. Kesimpulan: Terdapat hubungan yang bermakna antaraberatnya kebiasaan merokok dengan derajat gangguan obsesif kompulsif merokok. Dimana semakin berat kebiasaan merokoknya maka akan semakin berat derajat gangguan obsesif kompulsif merokok orang tersebut.
PERBEDAAN PENGARUH OLAHRAGA TERHADAP TOLERANSI STRES PSIKOLOGIS MAHASISWA FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG
Authors: Ibnu Sina Setiawan Yusufa , Djauhari Thonthowi , Hanifwati Anisa
Published: July 2018

Perbedaan Pengaruh Olahraga Terhadap Toleransi Stres Psikologis Mahasiswa Fakultas Kedokteran Universitas Muhammadiyah Malang. Latar Belakang: Stres yang dialami oleh mahasiswa kedokteran disebabkan oleh berbagai penyebab, meliputi metode pembelajaran, materi yang luas dan waktu pendidikan yang cukup lama. Tuntutan tersebut menyebabkan timbulnya stres psikologis dengan tingkatan yang bervariasi, mulai dari stres ringan, sedang dan berat. Olahraga bermanfaat tidak hanya untuk kesehatan fisik tetapi juga bermanfaat untuk kesehatan mental dan melatih respon terhadap kondisi stress. Tujuan: Membuktikan perbedaan aktivitas olahraga terhadap toleransi stres psikologis pada mahasiswa FK-UMM. Metode: Observasional analitik dengan rancangan cross-sectional. Sampel mahasiswa laki-laki FKUMM angkatan 2010 dan 2011 yang masuk dalam kriteria inklusi. Analisis data menggunakan unpaired t-test. Hasil Penelitian dan Diskusi: Hasil uji t-tidak berpasangan, didapatkan perbedaan yang bermakna antara pengaruh olahraga dengan toleransi stres psikologis mahasiswa FK-UMM yaitu dengan nilai sig = 0.001 ( p < 0.05). Faktor BDNF dan Beta-Endorfin memiliki pengaruh yaitu meningkatkan respon seseorang terhadap stres psikologis. Kesimpulan: Terdapat perbedaan pengaruh aktivitas olahraga terhadap toleransi stres psikologis mahasiswa FK-UMM. Kata Kunci: Aktivitas Olahraga, Toleransi Stres Psikologis, Mahasiswa FK-UMM.
POLA BAKTERI PENYEBAB PNEUMONIA NOSOKOMIAL DI RS DR SOETOMO SURABAYA PERIODE JANUARI 2011 - MARET 2012
Authors: . Samirah , . Rahayu , Noerwahyono Abi
Published: July 2018

Profil Kejadian Spotting Akibat Penggunaan Kontrasepsi Depo Medroxi Progesteron Asetat Di Puskesmas Pandan Wangi Malang Periode 1 Januari 2009 – 31 Desember 2011. Latar Belakang: Gangguan haid merupakan keluhan terbanyak yang didapat pada akseptor KB suntik Depo medroxi progesteron asetat Gangguan pola haid inilah yang akhirnya menjadi penyebab utama dari penghentian penggunaan para akseptornya Efek samping yang sering ditimbulkan dari penggunaan kontrasepsi suntik depo medroxi progesteron asetat (DMPA) antara lain gangguan haid berupa perdarahan bercak atau spotting. Tujuan: Mengetahui kejadian spotting akibat penggunaan kontrasepsi depo medroxi progesteron asetat (DMPA) di puskesmas pandan wangi malang periode 1 januari 2009 – 31 desember 2011. Metode: Deskriptif observasional, teknik pengambilan sampel dengan teknik total sampling, dengan jumlah sampel 74 sampel. Hasil Penelitian: karakteristik berdasarkan usia, usia terbanyak pengguna DMPA adalah usia 20-30 tahun yaitu sebesar 40 akseptor atau 54,05%. Kesimpulan: kejadian spotting terbanyak adalah 2x mengalami spotting sebanyak 9 akseptor atau sebesar 12,16%, spotting terbanyak pada penyuntikan ke 3x yaitu sebesar 17 akseptor atau sebesar 22,97%, usia terbanyak pengguna DMPAadalah usia 20-30 tahun yaitu sebesar 40 akseptor atau 54,05%
JUS BELIMBING MANIS (Averrhoa carambola L.) SEBAGAI HEPATOPROTEKTOR PADATIKUS PUTIH (Rattus novergicus strain wistar) YANG DIINDUKSI ANTITUBERKULOSIS RIFAMPISIN DAN ISONIAZID
Authors: Devi Iralawati Antia , Hermayanti Diah , Syafitri Fathiyah
Published: July 2018

Latar Belakang: Rifampisin dan isoniazid merupakan obat yang direkomendasikan dalam pengobatan Tuberkulosis yang memiliki efek samping hepatotoksisitas. Jus belimbing manis diduga mempunyai efek hepatoprotektor karena mengandung flavonoid, tanin, dan vitamin C. Tujuan: Membuktikan efek hepatoprotektor jus belimbing manis terhadap penurunan kadar SGOT, SGPT, dan MDA tikus putih jantan yang diinduksi rifampisin dan isoniazid. Metode: Eksperimental, Post Test Only Control Group Design. Sampel dibagi 5 kelompok perlakuan. Kontrol negatif, kontrol positif diberi rifampisin dan isoniazid masing-masing 200 mg/KgBB/hari, dan 3 kelompok perlakuan yang diberi rifampisin, isoniazid, dan jus belimbing manis dengan dosis 4 ml/hari, 8 ml/hari, 12 ml/hari selama 14 hari. Data dianalisis dengan uji One-Way ANOVA, uji korelasi, dan uji regresi. Hasil Penelitian dan Diskusi: Analisa statistik dilakukan untuk masing-masing variabel dependent SGOT, SGPT, dan MDA. Uji One-Way ANOVA Sig 0,000<p(0,05) menunjukkanadanya perbedaan yang bermakna antar perlakuan. Uji korelasi Sig 0,000< p(0,05) dengan koefisien sebesar -0,827 dan -0,852, dan -0,555 mempunyai korelasi yang sangat kuat, yaitu semakin tinggi dosis jus belimbing manis maka semakin rendah kadar SGOT dan SGPT. Hasil uji regresi menunjukkan jus  belimbing manis berpengaruh terhadap penurunan kadar SGOT , SGPT, dan MDA sebesar 68,4%, 72,6%, dan 27,9%. Dosis jus belimbing manis 12 ml/hari merupakan dosis optimal untuk menurunkan kadar SGOT dan SGPT. Kesimpulan: Jus belimbing manis memiliki efek hepatoprotektor terhadap penurunan kadar SGOT, SGPT, dan MDA tikus putih jantan yang diinduksi rifampisin dan isoniazid.Kata Kunci: Jus belimbing manis (Averrhoa carambola L.), hepatoprotektor, antituberkulosis
EFEK ANTI INFLAMASI EKSTRAK ETANOL WORTEL (DAUCUS CAROTA L.) TERHADAP TIKUS STRAIN WISTAR (RATTUS NOVERGICUS) YANG DIINJEKSI KARAGENAN
Authors: Aulia Yusrin , Safitri Fathiyah , Fadilah Rahmiyah
Published: July 2018

Efek Anti Inflamasi Ekstrak Etanol Wortel (Daucus carota L.) terhadap Tikus Strain Wistar (Rattus Novergicus) yang Diinjeksi Karagenan. Latar Belakang: Inflamasi merupakan respon fisiologis terhadap kerusakan jaringan. Inflamasi biasa diobati dengan golongan NSAID dan kortikosteroid yang memiliki efek samping cukup banyak. Wortel mengandung flavonoid yang menghambat enzim fosfolipase dan cyclooxygenase, serta saponin yang menghambat peningkatan permeabilitas vaskuler. Tujuan: Untuk membuktikan ekstrak etanol wortel (Daucus carota L.) memiliki efek anti inflamasi terhadap tikus strain wistar (Rattus novergicus) yang diinjeksi karagenan. Metode: Penelitian eksperimental dengan The Pre and Post Test Control Group Design, menggunakan 4 kelompok: (1) kontrol, (2) perlakuan dosis 100 mg/kgBB, (3) perlakuan dosis 200 mg/kgBB, dan (4) perlakuan dosis 400 mg/kgBB. Analisis data menggunakan uji One-Way ANOVA, HSD Tukey 5%, korelasi Pearson, dan regresi linier. Hasil dan Diskusi: Ekstrak etanol wortel meningkatkan prosentase reduksi radang secara bermakna (ANOVA p<0,05) dengan signifikansi 0,000. Hal ini diduga karena kandungan flavonoid serta saponin pada wortel. Dosis ekstrak wortel yang memberikan efek anti inflamasi paling besar pada penelitian ini adalah 400 mg/kgBB. Uji regresi linier menunjukkan ekstrak wortel berpengaruh 46,6% terhadap inflamasi. Kesimpulan: Ekstrak etanol wortel memberikan efek anti inflamasi terhadap tikus strain wistar yang diinjeksi karagenan.
Why I Wrote the New Royal College General Internal Medicine Exam: Redefining Our Identity and Revalidation
Authors: Abdullah, MD, Med, FRCPC Nadine
Published: July 2018

In 2010, the Royal College of Physicians and Surgeons of Canada (RCPSC) recognized General Internal Medicine (GIM) as a distinct subspecialty. Soon after this recognition came a new written certificationexam, the successful completion of which awards the applicant the title of General Internist. For those of us who trained prior to the new status and examination, GIM was the default designation after four years of internal medicine training if a subspecialty was not pursued.What does this new subspecialty status mean for our professional identity, qualifications, and public credibility? Twelve years aftermy successful completion of the Internal Medicine (IM) certification exams, I voluntarily applied for consideration to write the first RCPSC exam in GIM, without a clear reason why. My reflection on the days leading up to the exam and writing the exam itself led me to understand why I did it. The process addressed my skepticism around designating GIM as a unique subspecialty, and through this I have come to appreciate the need for our profession to embrace revalidation.
Update on Lung Cancer
Authors: Bouchard MD, FRCPC Nicole , Agulnik MD, CM, BSc Jason Scott
Published: July 2018

Investigation and treatment of lung cancer has changed dramatically since the last articles in this journal in 2008. These changes include a new study on lung cancer staging, a new tumour, node, metastasis (TNM) classification, linear endoscopic ultrasound as a first-line test formediastinal staging, investigation and follow-up of ground glass and mixed-lung nodules, radiosurgery for inoperable patients with localized lung tumours, and molecular tests and targeted therapies for advanced non-small cell lung cancer.
A 21-Year-Old Woman with Hepatomegaly
Authors: Barry MD Caroline R. , Zaki MD Amr M. , Munro MD Vicki , Patriquin MD MSc Glenn , Huang MD Weei-Yuarn , Tennankore MD Karthik
Published: July 2018

We report the case of a 21-year old woman with uncontrolled diabetes mellitus type 1 presenting with tender hepatomegaly and mildy elevated liver enzymes, with negative investigations for common causes. She was diagnosed by liver biopsy with glycogenic hepatopathy, an uncommon and likely under-recognized complication of poor glycemic control. The disease is typically reversible after weeks to months of appropriate insulin therapy and is unlikely to lead to permanent liver disease. Our patient was treated with a new insulin regimen and analgesics and discharged home. Unfortunately, on follow-up imaging in our patient 10 months later, her hepatomegaly persists. Her glycemic control remains unchanged and she has since been admitted to hospital twice for episodes of diabetic ketoacidosis.
CM Tools and Pearls: The Canadian Diabetes Association 2013 Clinical Practice Guidelines
Authors: Gilmour MBChB FRCPC Julie , Yu MD FRCPC MHSc Catherine
Published: July 2018

Diabetes is common in Canada, and over the last decade, the incidence of diabetes has grown rapidly. The Canadian Diabetes Association (CDA) released the 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (CPGs) in April 2013. These internationally recognized guidelines provide recommendations on screening, prevention, diagnosis, education, and management of diabetes. This article summarizes four key messages in diabetes care, including diagnosis, glucose lowering, vascular protection, and organization of care. Information on how to access the CDA’s interactive online and mobile applications is also provided.
Taking Every Opportunity to Reduce Cardiovascular Risk
Authors: Levine Mitch
Published: July 2018

In North America, heart disease is the leading cause of death for both men and women; accounting for approximately 1 in every 4 deaths1,2. Coronary heart disease (CHD) is the most common type of heart disease and two of the key risk factors for CHD are hypertension and diabetes. After smoking cessation programs, the detection and management of hypertension, and of diabetes, may be the next most important interventions that physicians can offer to reduce the risk of cardiovascular morbidity and mortality.
A Review of Non-Alcoholic Fatty Liver Disease: From Obesity to Liver Transplant
Authors: Anyane-Yeboa MD Adjoa , Stewart MD, FACP, AGAF Charmaine A.
Published: July 2018

Non-alcoholic fatty liver disease (NAFLD) is becoming an increasingly common etiology of liver disease in the United States. As the prevalence of diabetes and obesity continues to increase, it will soon surpass hepatitis C as the most common etiology of end stage liver disease in the western world. NAFLD like many liver diseases can progress to cirrhosis, and patients often suffer morbidity secondary to the complications of portal hypertension. The exact percentage of hepatocellular carcinoma (HCC) that occurs in NAFLD patients is unknown, however, unlike many other liver diseases there is small potential for development of HCC independent of cirrhosis. Various conservative and pharmacologic therapies have been studied with varying degrees of efficacy including lifestyle modifications, bile acids, insulin sensitizers, vitamin E, and bariatric surgery. However, the only curative treatment for NAFLD cirrhosis is liver transplant. As the epidemic that is NAFLD continues to grow, more studies will need to be done to develop new therapies and curative treatments.
A 54-Year-Old Female With Fever and Ataxia
Authors: Cadieux-Simard MD Marie-Lie , Green MD Laurence
Published: July 2018

We present the case of a 54-year-old female known for hypertension, alcoholism and occasional cocaine intake. She was brought to the emergency department because of new onset confusion and decreased level of consciousness. The history was taken from a family member. The patient had increased shortness of breath with a cough that started 48 hours prior to her visit. The night prior to presentation, she was intoxicated with cocaine and alcohol and was then found to have slurred speech, gait disturbance and urinary incontinence. The next morning, she was found obtunded, which prompted her family members to seek medical attention.
Handover: The Fragile Lines of Communication
Authors: Smaggus MD Andrew , Weinerman MD Adina S.
Published: July 2018

Handovers have been increasingly recognized as an important determinant of patient safety and quality of care. Changes in patterns of physician and resident work hours have increased the importance of safe handover. The current review summarizes previous literature on deficiencies in current handover practices, consequences of suboptimal handover, and barriers to effective handover. This review concludes by summarizing results of studies that used education, standardization, technology, and bundled interventions to improve handover.
Submucosal Lesions Presenting With Rectal Bleeding-Endometriosis in the GI Tract
Authors: Jowhari MD Fahd , Behl, MD, PhD Pearl , Pritchett, MD, FRCPC Sean
Published: July 2018

Endometriosis is typically marked by the implantation and proliferation of foci of endometrial stroma and glands outside the endometrial cavity and uterine musculature. Extra-gonadal seeding has been observed in sites like the small and large bowel, peritoneum, appendix, pleura, umbilicus, old wound scars, subarachnoid space, inguinal canal, heart and lungs.14,7 The gastrointestinal tract is the third most common localization of endometriosis after the ovaries and the peritoneum, with intestinal involvement being reported in about 12 to 37% of individuals.1,2,5-7 Establishing a diagnosis of intestinal endometriosis can often be a diagnostic challenge. We present an interesting case of sigmoidal endometriosis in a 46-year-old female, whose initial presentation was irregular bowel movements with rectal bleeding.