Sapporo Medical Journal

Abstract : COVID-19 pandemic has an impact on the sustainability of hospitals, with the number of patient visits decreased, due to the implementation of health protocols, restrictions on mobility, public fear of visiting hospitals, and health worker's concerns infected with COVID-19. It also impacts the implementation of hospital services, Simpangan Depok Hospital (SDH) was experiencing changes in the service flow and restrictions on types of services. The purpose of this study is to analyze the performance optimization of Medical Rehabilitation Polyclinic (MRP) services at SDH during the pandemic, in cases of knee osteoarthritis (OA). Mixed methods research with design study is a case study (qualitative), the samples are staff of MRP and knee OA patients, then cross-sectional (quantitative), the sample is knee OA patients. The results showed the adequacy of human resources (HR) at the beginning of the pandemic, did not experience problems because the number of patient visits decreased. However, at the beginning of 2022, patient visits have begun to increase, so the adequacy of HR needs to find a solution. According to patient perceptions, the service performance of MRP during pandemics remains optimal. However, assessment of supporting facilities is still lacking, namely convenience of the waiting room, completeness of toilet facilities, and availability of canteens.

Abstract : My paper about androgen receptor and autism which discuss one of many causes of autism which is low levels of gamma aminobutyric acid(GABA) neurotransmitter that result from low production of glutamic acid decarboxylase 65&67 enzymes from the expression process of GAD1&2 genes that needed in catalyzing glutamate to form GABA.plus how using acetyl L-carnitine will affect on androgen receptors number. Discussion: Androgen receptor is found in the brain,upon activation by binding of androgen hormones and by taking acetyl l-carnitine, the number of activated AR will increase.The DNA-binding domain of activated androgen receptors will act as transcription factors(zinc finger domain) that regulate the expression of GAD1-2 genes by binding to the regulatory region of GAD1&2 genes(DNA) which called enhancer during the transcription process that leads to enhancing the transcription process of GAD1-2 genes in order to increase the amount of GAD65&67 proteins (enzymes) produced from translation process of m-RNA to protein in order to use these enzymes to catalyse enough amount of glutamate to produce enough amont of GABA neurotransmitter to help in treating or reducing symptoms of autism.

Abstract : Paraoxonase 1 (PON 1) is an enzyme synthesized in the liver and is associated with high density lipoprotein (HDL) in the systemic circulation. It is an antioxidant in which prevents oxidative stress and inflammation. Since oxidative stress had been proven to be the complication of hyperthyroidism due to increase metabolic rate, this study is trying to look for the association between PON1 activities and phenotype in untreated hyperthyroid Malay patients. A total of 107 Malays subjects consisting of 55 untreated hyperthyroid patients (TSH<0.01 mU/L) and 52 healthy subjects were included.. The phenotype of the serum was determined by using the ratio of salt stimulation PON 1 activity to the arylesterase activity. The median difference of basal PON 1 activities level between untreated hyperthyroid compared to the healthy control was not statistically significant (p=0.23). There is no correlation between PON 1 activity and TSH (r=0.18, p=0.899) and free T4 (p=0.130). The most common PON 1 phenotype was AB followed by BB and then AA phenotype in Malay population. There is no significant correlation between free T4 and TSH with PON 1 activity in untreated hyperthyroid hence, PON 1 activity is not affected by thyroid status. AB is the most common phenotype in Malay population followed by BB phenotype in Malay population in Kelantan.

Abstract : The aims of this study was to compare effectiveness of combination therapy metformin+dipeptidyl peptidase-4 inhibitor (DPP-4i) and metformin+sulfonylurea in terms of the achievement level of the HbA1c in Indonesian type 2 diabetes mellitus patients at Hospital. This study was an cohort retrospective with primary data obtained from electronic medical record and semi structured questionnaire prospectively. Propensity score matching (PSM) was used to generate comparable cohorts to perform outcome analysis. Generalized Linear Model-Repeated Measure (GLM-RM) analysis were used to examine the effect of combination therapy on HbA1c in each observation period. Total sample of 90 outpatients with T2DM fulfill inclusion criteria and based on PSM analysis showed that intervention (60 patients) and comparator (30 patients) groups are matching. GLM-RM analysis showed that there was an effect of the two drug groups on the HbA1c level in T2DM patients. The Partial Eta Squared level indicates that the multivariate analysis carried out can explain the variation of HbA1c by 87.2%. DPP-4i produce 0.63% reduction in HbA1c level compared to sulfonylurea as add-on therapy to metformin among Indonesian T2DM patient, in baseline without covariate. This DPP-4i effectiveness is followed by a lower incidence of hypoglycemia and weight loss.

Abstract : The field of telemedicine is developing rapidly with teleneurology being one of the branch. The use of teleneurology has helped patients gain easier access to medical care. Various studies have studied the effect of teleneurology on medical care. Thus, this systematic review is created to evaluate the outcome of teleneurology usage. Literature search was performed via PubMed, Cochrane Library, ScienceDirect, Wiley Online Library, and EBSCOhost databases. Studies selected were studies that evaluated the outcome of teleneurology from inception to June 11, 2022. Five studies were selected from literature search. Three of the studies found that teleneurology helps patient gain easier access and reduction of cost usage. The studies also found that teleneurology satisfies patients’ and caregivers’ needs. Teleneurology helps with easier access to healthcare, reduction of cost in healthcare, and fulfills the needs of patients and caregivers.