Scoping the context of programs and services for maintaining wellness of older people in rural areas of Indonesia.

INTRODUCTION: Ageing and problems concerning the aged are an increasing and concerning reality in developing and underdeveloped countries such as Indonesia. Improving service quality is important to promote and maintain wellness of older persons, especially in rural areas. AIM: To explore programs and services offered to the elderly in a rural area of Indonesia to support them in promoting and maintaining their wellness. To describe roles and practices of health professionals and teams responsible for delivering services to older people. METHODS: Action research was used with mixed method data collection (interview and survey). RESULTS: Results demonstrated that activities related to the elderly health programs were limited due to budget and facilities. Practices of health staff for elderly in the community focused on intervention tasks, rather than prevention. LIMITATION: Lack of available information on the range of programs and services implemented in Indonesia for the elderly in community settings was a limitation of this study. CONCLUSION: Programs and services for older people have been implemented in Indonesia. However, these do not yet meet their needs, especially in rural areas. There is a need for greater focus on health promotion and illness prevention. IMPLICATION FOR NURSING AND HEALTH POLICY: Findings contribute to development of international knowledge in community health nursing, as these issues may not be only relevant to Indonesia. It is timely for governments, including in Indonesia, to evaluate health workforce needs in the community and appropriate educational qualifications for delivering optimal health services for older people.

Immunomodulatory and potential therapeutic role of mesenchymal stem cells in periodontitis.

Periodontitis is a chronic inflammatory disease leading to alveolar bone destruction, and eventually tooth loss. In genetically or environmentally predisposed individuals periodontopathogenic bacteria trigger an inflammatory immune response where activated macrophages secrete inflammatory cytokines and T helper 17 cells produce interleukin-17, receptor activator of nuclear factor kappa B ligand (RANKL) and tumor necrosis factor-α. Inflammation and the production of RANKL, the key cytokine responsible for osteoclast activation, cause excessive activation of osteoclasts. This results in a decoupling between bone formation and resorption, leading to bone loss. As conventional treatment does not target the inflammatory response and osteoclast activation, its effectiveness is limited. Novel treatments are thus required if we are to cure this disease. Mesenchymal stem cells (MSCs), including those of dental origin, are potent immunomodulators and are known to be suitable for tissue regeneration. MSCs can inhibit the immune response by suppressing T cells, inducing regulatory T cells and converting dendritic cells and macrophages into a regulatory phenotype. Additionally, genetic modulation may enhance the therapeutic potential of MSCs. In the present review the authors describe the potential use of MSCs, either unmodified or engineered for therapeutic purposes in periodontitis, with special emphasis on MSCs from dental pulp and periodontal ligament. The paper envisions that multiple targeting of this inflammatory disease by modulating the immune response, promoting bone regeneration and inhibiting bone resorption might yield significantly improved treatment outcomes when combined with conventional treatment modalities.

Anxiolytic action of urocortin 3 fragments in mice.

In the present experiments, the anxiolytic action of Ucn 3 fragments were studied in an elevated plus maze in mice following icv administration in an attempt to identify the biologically active center of the molecule. Ucn 3, Ucn 3 (18-38), Ucn 3 (19-27), Ucn 3 (28-38), Ucn 3 (34-38), and Ucn 3 (36-38) but not Ucn 3 (34-36), demonstrated anxiolytic action by increasing the time the mice spent in open arms, and Ucn 3 and Ucn 3 (34-38) did so by increasing the number of entries into open arms. The shortest molecule which elicited anxiolytic effects was the tripeptide Ucn 3 (36-38), H-Ala-Gln-Ile-NH(2). The results indicate that the total sequence of Ucn 3 is not necessary for the anxiolytic action of Ucn 3. Establishment the smallest active sequence of Ucn 3 will allow the synthesis of analogs or mimetics for anxiolytic action.

Antidepressant-like effects of urocortin 3 fragments.

Urocortin 3 (Ucn 3) and various Ucn 3 fragments were tested with regard to antidepressive action in a modified forced swimming test following icv administration to mice. The fragment Ucn 3 (34-36) proved ineffective, whereas Ucn 3 (18-38), Ucn 3 (19-27), Ucn 3 (28-38), Ucn 3 (34-38), and Ucn 3 (36-38) demonstrated antidepressive-like action by shortening the immobility time and increasing the climbing and swimming times. The shortest molecule which elicited most of the antidepressive effects was the tripeptide Ucn 3 (36-38), H-Ala-Gln-Ile-NH(2). The results indicate that the total sequence of Ucn 3 is not necessary for the antidepressive action of Ucn 3. Furthermore, the antidepressant actions of Unc3 (19-27) and Ucn 3 (36-38) can be blocked by the CRF2 receptor antagonist Astressin 2ß. Establishment of the smallest active sequence of the molecule may allow the synthesis of analogs or mimetics for antidepressive drugs.

Computer method for perinatal screening of cardiac murmur using fetal phonocardiography.

The main purpose of this paper is to demonstrate the capability of fetal phonocardiographic measurements to indicate some congenital heart defects. It deals with the results of investigations carried out during the last four years involving 820 pregnant women. During the investigations fetal cardiac murmurs presenting typical waveforms and incidences of acoustic signals were recorded. Causes of these murmurs are suggested based on comparison with the well-known waveforms of infants and children. A sophisticated signal processing method for murmur discovery is presented, that is also useful for automatic perinatal screening after the 28th week of gestation. By these means low-risk population may also be fully tested for cardiac malfunctions.

Differentiation potential of stem cells from human dental origin - promise for tissue engineering.

Recent studies have revealed the existence of stem cells in various human tissues including dental structures. We aimed to establish primary cell cultures from human dental pulp and periodontal ligament, to identify multipotential adult stem cells in these cultures, and to study the differentiation capacity of these cells to osteogenic and to neuronal fates. Dental pulp and the periodontal ligament were isolated from extracted human wisdom teeth. The extracellular matrix was enzymatically degraded to obtain isolated cells for culturing. Both dental pulp and periodontal ligament derived cultures showed high proliferative capacity and contained a cell population expressing the STRO-1 mesenchymal stem cell marker. Osteogenic induction by pharmacological stimulation resulted in mineralized differentiation as shown by Alizarin red staining in both cultures. When already described standard neurodifferentiation protocols were used, cultures exhibited only transient neurodifferentiation followed by either redifferentiation into a fibroblast-like phenotype or massive cell death. Our new three-step neurodifferentiation protocol consisting of (1) epigenetic reprogramming, then (2) simultaneous PKC/PKA activation, followed by (3) incubation in a neurotrophic medium resulted in robust neurodifferentiation in both pulp and periodontal ligament cultures shown by cell morphology, immunocytochemistry and real time PCR for vimentin and neuron-specific enolase. In conclusion, we report the isolation, culture and characterization of stem cell containing cultures from both human dental pulp and periodontal ligament. Furthermore, our data clearly show that both cultures differentiate into mineralized cells or to a neuronal fate in response to appropriate pharmacological stimuli. Therefore, these cells have high potential to serve as resources for tissue engineering not only for dental or bone reconstruction, but also for neuroregenerative treatments.

Experiences with fetal phonocardiographic telemonitoring and future possibilities.

Phonocardiography (PCG) makes possible the examination of some fetal cardiac anomalies which otherwise usually remain undetected during pregnancy. The application of PCG in a telemonitoring system enhances its diagnostic capabilities, allowing long-term measurements even at home. The paper summarizes the intensive fetal monitoring campaign carried out in Hungary during the last three years that yielded useful experience regarding recent and future possibilities of fetal monitoring. Results collected from a large number of measurements suggest that PCG home monitoring may be a suitable screening method for fetal congenital heart diseases, even if surgical intervention in this phase of pregnancy is not easy.

Successful treatment of chronic disseminated candidiasis with fluconazole and a granulocyte-macrophage colony-stimulating factor combination.

We report a case of chronic disseminated candidiasis in a patient with acute non-lymphoid leukaemia. After 12 months of combined therapy with fluconazole and granulocyte-macrophage colony-stimulating factor, lesions in the liver and spleen resolved completely. The patient has given birth to a healthy baby and has been in complete hematological remission for 3 years.

Rapid recurrence of an inflammatory myofibroblastic tumor in the right ventricular outflow tract.

We describe an unusual case of rapid recurrence of a previously excised inflammatory myofibroblastic tumor of the right ventricular outflow tract in a 5-month-old infant. The infant is asymptomatic 18 months after the second surgery. The very rare cardiac involvement, and the early relapse of the inflammatory pseudotumor, to the best of our knowledge, is a unique combination. The inflammatory myofibroblastic tumor, as known as a pseudotumor or plasma cell granuloma is an uncommon reactive lesion with unknown aetiology. It is found most commonly in the lung and a number of visceral organs, such as the spleen, liver, ileum, salivary glands, urinary bladder, larynx or brain or in the retroperitoneum and lymph nodes. To our knowledge only 9 cases have been published of such tumor arising within the heart.

[Primary reconstruction of the common truncus arteriosus in infants, using modified pulmonary homograft]. / Truncus arteriosus communis primer rekonstrukciója csecsemökorban, méretre alakított pulmonalis homograft felhasználásával.

Truncus arteriosus communis (TAC) is a complex heart disease, it presents 1% of the congenital heart defects. A 7 weeks old infant with cardiac failure was operated on with TAC. The bicuspidized (14 mm diameter) pulmonary homograft valved conduit was used to reconstruct the right ventricular outflow tract (RVOT). The sternum closure was delayed. The important points of the indications for the surgical management of TAC: 1. Management or prevention of the pulmonary hypertensive crisis. 2. Patient's age. 3. Reconstruction of the RVOT (choices: homograft, dacron valve conduit, autologous pericardial valve conduit, porcine aortic root, direct anastomosis of the pulmonary trunc to the right ventricle). The surgical management is based on the optimal combination of these three important points. This is the first successfully performed primary surgical repair of an infant with TAC using modified pulmonary homograft in Hungary.

[Rhabdomyoma as a first manifestation of childhood tuberous sclerosis]. / Rhabdomyoma mint a gyermekkori sclerosis tuberosa elsö manifesztációja.

Two dimensional echocardiography seems to be the best diagnostic tool for diagnosis of cardiac tumors. In our practice using 2 dimensional echocardiography in pediatric patients from 1984 11 cardiac tumors were diagnosed and followed-up. Four of them the cardiac rhabdomyomata (one of them diagnosed in utero) was the first manifestation of tuberous sclerosis. We summarized the follow-up data from our patients with cardiac rhabdomyomata. The detection of cardiac tumor in the fetal or infant period is of outmost importance in the early diagnosis of tuberous sclerosis and suggest careful follow-up and management. To the best of our knowledge no report of tuberous sclerosis based on echocardiographic diagnosis of cardiac rhabdomyomata has been described in our country.

Candida endocarditis in an infant.

Infective endocarditis is a rare disease in infants. A 1-year-old boy with a large Candida albicans vegetation in the right atrium and superior vena cava was operated on successfully. During the newborn period he had had a right transverse colostomy for Hirschsprung's disease. Ten months later a subsequent rectosigmoidectomy and direct anastomosis were performed, but because of peritonitis that followed a leak at the site of the anastomosis parenteral nutrition was needed for 8 weeks. The probable source of Candida was an infected intravenous line.

Mitral valve anomalies obstructing left ventricular outflow.

This paper reports on two cases of more uncommon types of subaortic stenosis. A 2-year-old boy was found with accessory mitral valve leaflet (AMVL) attaching to the anterior leaflet, ballooning into the subaortic ventricular septum associated with a discrete subaortic membrane. The obstruction was successfully relieved by removal of the AMVL and resection of the membrane. A 19-day-old newborn with accessory tissue on the mitral valve (AMVT) causing subaortic stenosis, subaortic ventricular septal defect (VSD) and patent ductus arteriosus was operated on successfully. Accessory tissue excision through the VSD, VSD patch closure and ductus ligation were performed.

Aortico-left ventricular tunnel: late reoperations.

Aortico-left ventricular tunnel is a rare congenital anomaly that presents as aortic regurgitation in infancy or childhood. Information on late results of surgery, especially with reoperations for progressive aortic regurgitation and recurrences are limited. The case histories of two patients with reoperations following correction of aortico-left ventricular tunnel are reported.

[Genetic diagnosis of Williams syndrome]. / A Williams-szindróma genetikai diagnózisa.

Williams syndrome is a complex developmental disorder. The major cardiovascular component of Williams syndrome is supravalvular aortic stenosis, a progressive disease that may need surgical repair. Williams syndrome is associated with heterozygous microdeletion in the chromosomal region 7q11.23 encompassing the elastin gene. We have identified a new, highly informative tetranucleotide repeat polymorphism within the human elastin gene. This marker together with other, previously described elastin gene markers was used to show deletion of the elastin gene in nine sporadic Williams syndrome patients from Hungary. Application of polymorphisms within and flanking the elastin gene on chromosome 7 provides a fast, polymerase chain reaction based method for mutational analysis of Williams syndrome patients.

[Successful multi-step management of developmental heart defects after intrauterine diagnosis]. / Intrauterin diagnosztizált összetett szívfejlódési rendellenesség többlépcsós sikeres sebészi korrigálása.

At 28th week of gestation a conotruncal malformation with ventricular septal defect was diagnosed by fetal echocardiography. Postnatal echocardiographic and angiocardiographic examinations confirmed the diagnosis of conotruncal malformation (pulmonary atresia, ventricular septal defect, patent ductus arteriosus, aortopulmonary collateral arteries). The unifocalization (age: 11 months) and total correction with aortic homograft (age: 7 years) were performed. To our knowledge our case is the first whose intrauterine diagnosis of complex congenital heart disease was confirmed after delivery and had successful two-stage surgical management.

[Intraoperative epicardial echography in infancy and childhood for the evaluation of the results of surgical correction of congenital heart defects]. / Intraoperatív epicardialis echocardiographia csecsemö- és gyermekkorban a veleszületett szívhibák mütéti eredményének megítélésére.

Intraoperative epicardial echocardiography (IEE) is very useful to assess the result of the surgical procedure. In infancy and childhood the authors performed 32 IEE (using high frequency transducer) out of 193 operations with congenital heart diseases. As a result of IEE study the surgical procedure was extended in 5 cases, as follows: closure of patent ductus arteriosus, exchange of transanular patch, repeated mitral repair, prosthetic mitral valve implantation, and correction of residual right to left shunt. No early or late reoperation was necessary in the remaining cases. Follow up echocardiography and autopsy in 4 cases confirmed the diagnosis of the IEE. The results suggest, that IEE will be the standard method for quality control of surgical procedures in congenital heart disease.

[Total cavo-pulmonary anastomosis in heart surgery for the correction of univentricular heart]. / Teljes cavopulmonalis anasztomózis az univentricularis szív sebészi korrekciójában.

The total cavopulmonary anastomosis is one of the alternative surgical procedures which can be performed in the management of the most complicated congenital heart diseases. It was the first time in Hungary that this surgical management was performed successfully in a girl with univentricular heart, pulmonary valve stenosis, malposition of the great arteries, who was operated on palliative procedure previously.

[Non-invasive and invasive assessment of the function of aortic valve homografts in infancy and childhood]. / Homograft aorta billentyü conduit funkciójának noninvazív és invazív vizsgálata csecsemö- és gyermekkorban.

Study population involved 21 pts with complex congenital heart disease after corrective surgery using homografts between the years 1986 and 1992. Diagnoses included double outlet right ventricle, tetralogy of Fallot, transposition of great arteries, truncus arteriosus, pulmonary atresia with VSD, corrected transposition with pulmonary stenosis, and absent pulmonary valve. Pts age at surgery ranged from 18 days--to 15 yrs mean, 6.7 yrs. Time interval between surgery and diagnostic procedures was 8 days--6 yrs (mean 11 months). All pts were studied by Echo/Doppler. 2 pts by TEE and 3 pts by MRI. 6 pts had cardiac catheterisation. Distal (5) or proximal (1) stenosis was present in 6 cases. The severity and the type of stenosis was correctly identified by noninvasive technique compared to invasive findings. Homograft valve regurgitation was mild (4) or moderate (3). In two pts severe insufficiency was associated to homograft endocarditis. Postoperative residual shunts were found in 8 pts. Homograft stenosis can correctly be diagnosed using Echo/Doppler technique. Distal stenosis was more frequent than proximal. Homograft tends to become insufficient, but severe incompetence did not occur except in endocarditis.

[Fetal and neonatal endocarditis]. / Magzati és újszülöttkori endocarditis.

Two infants with endocarditis were diagnosed at our Institute within a six month period. One infant died due to severe aortic valve destruction and ruptured sinus Valsalvae aneurysm both of which developed during fetal life. The other one with tricuspid valve endocarditis was successfully treated after the early echocardiographic diagnosis. To our knowledge this patient is the only survivor with neonatal endocarditis in our country.