Background and Objectives: - Bacterial meningitis is a medical emergency with a potential for serious neurological damage or even death. Rapid diagnosis is important and henceforth critical for the early intervention by antibiotic therapy to prevent complications. Therefore the aim of the present study was to evaluate CSF ferritin levels in children with different etiologies of meningitis. Materials and Methods: - 65 children (1-124 months) with suspected meningitis admitted at Chacha Nehru Bal Chikitsalya hospital were included in the study. CSF sample was analyzed for glucose, protein, cell count, ferritin, gram stain and culture. Results: - Based on the laboratory findings the 65 children were classified into 3 groups: 21 cases had bacterial meningitis, 18 had aseptic (viral) meningitis and 26 cases as the no-meningitis group. A significant relationship was observed between age and ferritin level in the non-meningitis group (p<0.05). CSF ferritin in bacterial meningitis group was 34.80 ± 11.20 ng/mL and was significantly higher than the aseptic meningitis group. Cut off value of ferritin to differentiate meningitis vs. no-meningitis group was estimated at 18.2ng/ml with a sensitivity of 94.9% and specificity of 96.2 %. However on differentiating bacterial from aseptic meningitis cutoff value was 20.3 ng/mL with a sensitivity of 98% and specificity of 33.3%. Conclusion: - CSF ferritin levels were found to be significantly different between the meningitis and the no-meningitis groups. However due to low specificity it may not prove useful for the early differentiation of different types of meningitis. Further studies are required on a larger sample size before we can substantiate our findings.          

Background and Objectives: - Bacterial meningitis is a medical emergency with a potential for serious neurological damage or even death. Rapid diagnosis is important and henceforth critical for the early intervention by antibiotic therapy to prevent complications. Therefore the aim of the present study was to evaluate CSF ferritin levels in children with different etiologies of meningitis. Materials and Methods: - 65 children (1-124 months) with suspected meningitis admitted at Chacha Nehru Bal Chikitsalya hospital were included in the study. CSF sample was analyzed for glucose, protein, cell count, ferritin, gram stain and culture. Results: - Based on the laboratory findings the 65 children were classified into 3 groups: 21 cases had bacterial meningitis, 18 had aseptic (viral) meningitis and 26 cases as the no-meningitis group. A significant relationship was observed between age and ferritin level in the non-meningitis group (p<0.05). CSF ferritin in bacterial meningitis group was 34.80 ± 11.20 ng/mL and was significantly higher than the aseptic meningitis group. Cut off value of ferritin to differentiate meningitis vs. no-meningitis group was estimated at 18.2ng/ml with a sensitivity of 94.9% and specificity of 96.2 %. However on differentiating bacterial from aseptic meningitis cutoff value was 20.3 ng/mL with a sensitivity of 98% and specificity of 33.3%. Conclusion: - CSF ferritin levels were found to be significantly different between the meningitis and the no-meningitis groups. However due to low specificity it may not prove useful for the early differentiation of different types of meningitis. Further studies are required on a larger sample size before we can substantiate our findings.          

Background: The age of nulliparous women has increased in developed countries and the 5-year survival rate for the late stage does not exceed 58%. Moreover, as more women are delaying child-bearing, preservation of fertility and reproductive function is a major concern when young women are counseled with regard to the effects of treatment for cervical cancer. Objective: To determine the effect of the combination chemotherapy on serum levels of Anti-Mullerian Hormone (AMH) and inhibin B. Methods: This study is a prospective cohort study in 16 cervical cancer patients aged 28-48 years who received Paclitaxel-Cisplatin chemotherapy. AMH and inhibin B levels were examined before and after third series chemotherapy. Statistical analysis used the Wilcoxon test with a level of significance selected at 0.05. Results: There is a significant decrease in median serum levels of AMH and inhibin B patients between before and after Paclitaxel–Cisplatin chemotherapy with p=0.000 (P <0.05). Similarly, a decrease in the median value of serum levels of AMH and inihibin B after Paclitaxel-Cisplatin chemotherapy in each series of chemotherapy was significant with p=0.000 (P <0.05). Conclusions: Serum levels of AMH and inhibin B in cervical cancer patients who received the combination chemotherapy decreased dramatically after 3 months of chemotherapy and the factors that contribute to the diminution is age.

Background: Anemia chronic disease (ACD) is an anemia found in certain chronic disease states, typically marked by the disturbance of iron homeostasis or hypoferremia. This condition leads to shortage of iron for hemoglobin synthesis but the iron storage in bone marrow is left undisturbed. The discovery of hepcidin and its role in iron metabolism has given new insights in anemia chronic disease management. Consecutive sampling method was applied to choose ACD patients at Sanglah General Hospital, Bali-Indonesia. Questionnaire was constructed to note demographic aspect and disease or clinical condition underlies ACD (inflammation, infection, malignancy and others). Hepcidin, Serum IL-6 and CRP level were measured. Sample size and Path analysis mediation method were used to define hepcidin’s role on mechanism how anemia develop in ACD patients in which the direct and indirect effects of IL-6 and CRP to hemoglobin (Hb)  were counted partially or combined through hepcidin mediation variable. The cumulative influence of IL-6, CRP and hepcidin on anemia (Hb) was only 0.12 or about 12% of hemoglobin level was influenced by IL-6, CRP and hepcidin together whereas the other 93% was influenced by another unknown and unclear factors. Hepcidin could be used as a mediation variable for the development of anemia because the direct influence of IL-6 as exogenous factor was less than its indirect influence through hepcidin. It was not proven for CRP as exogenous variable because the direct influence of CRP to hemoglobin was stronger than the influence of CRP through hepcidin.

Background: Anemia chronic disease (ACD) is an anemia found in certain chronic disease states, typically marked by the disturbance of iron homeostasis or hypoferremia. This condition leads to shortage of iron for hemoglobin synthesis but the iron storage in bone marrow is left undisturbed. The discovery of hepcidin and its role in iron metabolism has given new insights in anemia chronic disease management. Consecutive sampling method was applied to choose ACD patients at Sanglah General Hospital, Bali-Indonesia. Questionnaire was constructed to note demographic aspect and disease or clinical condition underlies ACD (inflammation, infection, malignancy and others). Hepcidin, Serum IL-6 and CRP level were measured. Sample size and Path analysis mediation method were used to define hepcidin’s role on mechanism how anemia develop in ACD patients in which the direct and indirect effects of IL-6 and CRP to hemoglobin (Hb)  were counted partially or combined through hepcidin mediation variable. The cumulative influence of IL-6, CRP and hepcidin on anemia (Hb) was only 0.12 or about 12% of hemoglobin level was influenced by IL-6, CRP and hepcidin together whereas the other 93% was influenced by another unknown and unclear factors. Hepcidin could be used as a mediation variable for the development of anemia because the direct influence of IL-6 as exogenous factor was less than its indirect influence through hepcidin. It was not proven for CRP as exogenous variable because the direct influence of CRP to hemoglobin was stronger than the influence of CRP through hepcidin.

Objective: Kidney stones are one of the causes of obstructive nephropathy and chronic kidney disease (CKD), characterized by the presence of hydronephrosis and kidney dysfunction. The histhopathologycharacteristics of CKD is kidney fibrosis, which consists of glomerulosclerosis (GS), tubulointerstitial fibrosis (TIF) and tubular atrophia (TA).This research aims to find out that the role of caspase-3, TGF-β and TNF-α as risk factors for kidney fibrosis in obstructive nephropathy of kidney stone. Methode: A total of 82 samples of kidney biopsy patientsduring kidney stone surgery in Sanglah General Hospital Denpasar-Bali from February antil December 2013 wereapplied match paired based on age and sex divided in to 41 samples as case and 41 samples as control. Determination of caspase-3, TNF-α and TGF-β1 were carried out using Kit Methode and kidney fibrosis stained with Masson's Trichrome. Results: Bivariate analysis test indicates that OR caspase-3 activity and kidney fibrosis were 3.50; 95%CI (2.95-4.19); p=0.001, OR levels of TGF-β and kidney fibrosis were 2.00; 95% CI (1.72-2.34); p=0.04 andOR levels of TNF-α and kidney fibrosis were 0.60; 95% CI (0.53-0.68); p=0.14. On the other hand, multivariate analysis test OR for caspase-3 activity , levels of TGF-β, levels of TNF-α and kidney fibrosis after adjustment of hydronephrosis, eLFG, and Hb were 2.43; 95% CI (0.86 – 6.90); p=0.09,  2.14; 95% CI (0.74-6.18); p=0.16 and 1.12; 95% CI (0.40-3.16); p=0.82. Conclusion: In obstructive nephropathy of kidney stone patients with high activity of caspase-3 have 3.5 fold risk to gain kidney fibrosis and with high levels of TGF-β have a 2 fold risk to gain kidney fibrosis. However, high levels of TNF-α was not as a risk factor to gain kidney fibrosis. These results can be used as a based data to run further research for obtaining new strategy for managing kidney fibrosis.  

Background: The objectivity in management of renal bleeding is to preserve a significant renal parenchyma tissue and prevent associated morbidities like anemic shock or renal impairment from substantial nephron demise or obstructed uropathy. Trans-arterial embolization therapy by interventional radiology offers a high success rate with potential of reserving normal renal tissue. The selection material for renal arterial embolization largely depends on vasculature anatomy and end-point of procedure. N-butyl cyanoacrylate glue in our experience is applied in lesion supplied by small size of end-artery.