Tono Djuwantono

A comparison of cryopreservation methods: Slow-cooling vs. rapid-cooling based on cell viability, oxidative stress, apoptosis, and CD34+ enumeration of human umbilical cord blood mononucleated cells

BackgroundThe finding of human umbilical cord blood as one of the most likely sources of hematopoietic stem cells offers a less invasive alternative for the need of hematopoietic stem cell transplantation. Due to the once-in-a-life time chance of collecting it, an optimum cryopreservation method that can preserve the life and function of the cells contained is critically needed.MethodsUntil now, slow-cooling has been the routine method of cryopreservation; however, rapid-cooling offers a simple, efficient, and harmless method for preserving the life and function of the desired cells. Therefore, this study was conducted to compare the effectiveness of slow- and rapid-cooling to preserve umbilical cord blood of mononucleated cells suspected of containing hematopoietic stem cells. The parameters used in this study were differences in cell viability, malondialdehyde content, and apoptosis level. The identification of hematopoietic stem cells themselves was carried out by enumerating CD34+ in a flow cytometer.ResultsOur results showed that mononucleated cell viability after rapid-cooling (91.9%) was significantly higher than that after slow-cooling (75.5%), with a p value = 0.003. Interestingly, the malondialdehyde level in the mononucleated cell population after rapid-cooling (56.45 μM) was also significantly higher than that after slow-cooling (33.25 μM), with a p value < 0.001. The apoptosis level in rapid-cooling population (5.18%) was not significantly different from that of the mononucleated cell population that underwent slow-cooling (3.81%), with a p value = 0.138. However, CD34+ enumeration was much higher in the population that underwent slow-cooling (23.32 cell/μl) than in the one that underwent rapid-cooling (2.47 cell/μl), with a p value = 0.001.ConclusionsRapid-cooling is a potential cryopreservation method to be used to preserve the umbilical cord blood of mononucleated cells, although further optimization of the number of CD34+ cells after rapid-cooling is critically needed.

Female genital tuberculosis and infertility: serial cases report in Bandung, Indonesia and literature review

BackgroundFemale genital tuberculosis (FGTB) is a Mycobacterium infection in the reproductive organs which often leads to infertility. FGTB is either asymptomatic or causes uncharacteristic clinical presentations, making an early diagnosis is challenging. Our aims were to evaluate the clinical presentations, the process to confirm the diagnosis and followed-up the patients who had undergone laparoscopy at our center. FGTB has been reported from many countries, but has never been reported from Indonesia. Here we present case studies to document the presence of FGTB in Indonesia.Cases presentationThere were three patients admitted to our center; two patients were admitted with irregular menstrual cycle as their chief complaint, while one patient came due to infertility. The results from laparoscopy were suggestive of FGTB; including the presence of caseating granulomas surrounded by epithelioid cells, lymphocytes, plasma cells, and Langhans giant cells. Additionally, PCR testing confirmed presence of MTB. Subsequent to diagnosis, continuous TB medications was administered with excellent clinical outcome in two patients (pregnant in 18xa0months after under gone laparoscopy). The infertile patient remain in one of the treated patient above.ConclusionIn infertile patients who live in countries where Tuberculosis is an endemic disease, such as Indonesia, a comprehensive history taking, along with ultrasonography results can be used to diagnose FGTB. Confirmation of this diagnosis can be achieved through polymerase chain reactions result. Timely diagnosis and treatment are imperative to prevent any permanent injury to patient’s reproductive organs.

Mother and children health reporting system: Innovative information system application in the rural West Bandung Area, Indonesia, by using multimodal communications systems

Objectives: Digitalization of maternal and post-natal care system (DigiMAPS) is a system consist of electronic medical record for mother and children health (KIA) also for tele-consultation facility called “Tele-Obgyn”. Our project focuses on the development of KIA Online and a cloud computing-based video conferencing as a basis of Tele-Obgyn platform. The web-based network allows online access not only among primary health care but also between government and private institution. DigiMAPS platform is designed to meet the needs of database management and its interphase with other services that are responsible for data acquisition and visualization. Methods: DigiMAPS combines the open-source flexible system design that benefits for implementation and development needs as well as support for mobile devices to enable high quality of patient care. The system has been developed gradually following lean-innovation management concept which focuses on customer-problem-solution matching with rapid prototyping and validation from idea to solution. There was significant effort to establish a close relationship and learning process with prospective users of DigiMAPS, hence in the broader perspective we used a participatory research approach. DigiMAPS act as central-portal and -data base in the communication information system (ICT), designed to compile patient report paperless and equipped with tele-consultation. Results: DigiMAPS developed for a variety of administrative processes. This system will simplify the work process and can be integrated with primary health care system, Health Department and the Ministry of Health. A good ICT will be useful in collecting clinical information than conventional paper-based reporting system and to minimize errors in the reporting chain. Conclusions: By using lean innovation management, several inputs are gathered from prospective users including health authority, head of local clinics, midwifes, obgyn doctors, and public health staffs. Our system may bridging gap between clinical needs and digital documentation, telemedicine-monitoring and improve the quality of patient care, facilitate communication within both the scope of the internal (primary health care) and external (stakeholders and follow-up), increasing productivity and reduce overall expenses.