Introduction: Cholecystokinin (CCK) and peptide YY (PYY) are satiety-stimulating hormones that are released during eating. As such, their levels may be used useful in obesity intervention. The aims of this study were to determine the optimal cutoff values, sensitivity and specificity of plasma CCK and PYY in adult men, in order to determine hormonal dysfunction in obesity. Methods: We investigated 16 obese [body mass index (BMI) ≥25.1)] and 16 normal weight (BMI 18.5–22.9) men. They ate isocaloric fast-food for breakfast. Blood for the determination of the hormones was collected at 0 (before), 30, 60, and 120 minutes after consumption. The data that was obtained were analysed using an independent t-test or the Mann– Whitney U-test. The receiver operating characteristic (ROC) curve was drawn and the trapezoidal rule analysis was performed to determine the area under the curve, to determine the optimal cut-off values, sensitivity and specificity. Results: In obese subjects, CCK was lower compared with normal weight subjects at any time (p<0.05). There were no major differences in PYY among subject groups. ROC curve analysis demonstrated that the plasma CCK had an optimal cut-off of 6,310 pg/ ml at 120 minutes after eating, with 0.97 area under curve (AUC), sensitivity was 94%, and specificity was 94%. The cut-off for optimal PYY was an average of 294.5 pg/ml at 120 minutes after eating (AUC 0.74; sensitivity 75%; specificity 75%). Conclusion: Our findings suggest that the plasma CCK level is a better potential predictor of obesity and constantly decreased over time compared to PYY.

Objective: To provide real-world data on hypoglycaemia incidence in patients with type 1 (T1D) or type 2 diabetes (T2D) from the Southeast Asian cohort of the International Operations Hypoglycaemia Assessment Tool (IO HAT) study. Methodology: IO HAT was a non-interventional, multicentre, 6-month retrospective and 4-week prospective study of hypoglycaemic events among insulin-treated adults with T1D or T2D, including four countries in Southeast Asia (Singapore, Philippines, Indonesia, and Bangladesh). Data were collected using a two-part self-assessment questionnaire (SAQ1 for retrospective and SAQ2 for prospective). The primary endpoint was the percentage of patients experiencing at least one hypoglycaemic event during the 4-week prospective observational period (ClinicalTrials.gov Identifier: NCT02306681). Results: A total of 2594 patients completed SAQ1. Nearly all patients reported experiencing any hypoglycaemic event in the 4-week prospective period (T1D, 100%; T2D, 97.3%), with all patients reporting higher rates in the prospective versus retrospective period. Severe hypoglycaemia was also reported higher prospectively (57.2% and 76.9%) than retrospectively (33.9% and 12.2%) in both T1D and T2D, respectively. Nocturnal hypoglycaemia was reported higher retrospectively than prospectively. Conclusion Incidence of any and severe hypoglycaemia in the Southeast Asian cohort of IO HAT was higher prospectively versus retrospectively, suggesting hypoglycaemia has previously been under-reported in this region.
Insulin

Acute adrenal insufficiency (AI) is a life-threatening condition. While Addison’s disease (AD) is rare, in developing countries, tuberculosis (TB) still remains as the primary cause in 7 to 20% of cases. Urinary TB is also the third most common form of extrapulmonary disease. We report a case of 37-year-old male who presented with weakness, anorexia, weight loss, dysuria, flank pain and low grade fever. Examination revealed hypotension, hyperpigmentation, hyponatremia, hypoglycemia and low serum cortisol. He was diagnosed to have adrenal crisis due to Addison’s disease and extrapulmonary TB manifesting as urinary tract infection (UTI). He was treated with corticosteroids and anti-TB medications. Urologic reconstructive surgery was subsequently planned.
Addison Disease ; Tuberculosis

Objective: To identify the bioactive compounds in catechins isolation and its compo-nents from green tea GMB-4 clone.
Methods: Green tea GMB-4 clones were extracted with distilled water at 90 ? C. Samples were eluted into the column with 10%ethanol. Subsequently, the column was eluted with 95% ethanol and evaporated separately. Green tea extract was identified by thin layer chromatography. Catechins were separated by the stationary phase in column chroma-tography using polyamide with 10% ethanol eluent and 95% ethanol. The results of isolations were analyzed by high performance liquid chromatographic (HPLC) and LC-MS/MS. Analysis of catechins by HPLC was done by external standard.
Results: Fraction from 10% ethanol showed that four major peaks at retention time of 1.663, 2.367, 2.950 and 4.890, indicated the presence of four catechins components including catechin, epicatechins, gallocatechin and epigallocatechin. Whereas, fraction from 95% ethanol showed two main peaks at retention time of 5.167 and 9.82, which indicated the presence of epigallocatechin gallate (EGCG) and epicatechin gallate (ECG). EGCG (m/z 459), epigallocatechin (m/z 307), ECG (m/z 443), and epicatechin (m/z 291) were isolated and separated successfully using HPLC and LC-MS/MS.
Conclusions: The HPLC and LC-MS/MS methods were successfully tuned for the qualitative analysis of green tea extract with EGCG and ECG. Four major catechins were separated and identified by LC-MS/MS, such as EGCG, epigallocatechin, ECG and epicatechin. The result of HPLC analysis showed that EGCG and ECG were main components from catechins isolation of green tea GMB-4 clone.

Objective: To identify the bioactive compounds in catechins isolation and its components from green tea GMB-4 clone. Methods: Green tea GMB-4 clones were extracted with distilled water at 90 °C. Samples were eluted into the column with 10% ethanol. Subsequently, the column was eluted with 95% ethanol and evaporated separately. Green tea extract was identified by thin layer chromatography. Catechins were separated by the stationary phase in column chromatography using polyamide with 10% ethanol eluent and 95% ethanol. The results of isolations were analyzed by high performance liquid chromatographic (HPLC) and LC-MS/MS. Analysis of catechins by HPLC was done by external standard. Results: Fraction from 10% ethanol showed that four major peaks at retention time of 1.663, 2.367, 2.950 and 4.890, indicated the presence of four catechins components including catechin, epicatechins, gallocatechin and epigallocatechin. Whereas, fraction from 95% ethanol showed two main peaks at retention time of 5.167 and 9.82, which indicated the presence of epigallocatechin gallate (EGCG) and epicatechin gallate (ECG). EGCG (m/z 459), epigallocatechin (m/z 307), ECG (m/z 443), and epicatechin (m/z 291) were isolated and separated successfully using HPLC and LC-MS/MS. Conclusions: The HPLC and LC-MS/MS methods were successfully tuned for the qualitative analysis of green tea extract with EGCG and ECG. Four major catechins were separated and identified by LC-MS/MS, such as EGCG, epigallocatechin, ECG and epicatechin. The result of HPLC analysis showed that EGCG and ECG were main components from catechins isolation of green tea GMB-4 clone.

Objective: To monitor the physiological characteristics and genes expression of obesity rat model after rambutan peel extract (RPE) treatment. Methods: Twenty-four 12-week-old male rats were divided into 4 groups: normal, obesity, obesity treated with ellagic acid (O-EA) and obesity treated with RPE30 (O-RPE30). Physiological characteristics were monitored by measuring body weight, calorie intake, size of adipocyte and level of triglyceride. Peroxisome proliferator activated receptor gamma (PPARγ), CCAAT/enhancer-binding proteins α and fatty acid binding protein 4 (FABP4) expression were observed using immunohistochemistry, Western blotting and quantitative RT-PCR methods. Results: Body weight gain of O-EA and O-RPE30 rats were lower than obesity group and size of adipocyte cells were smaller than obesity group ( P < 0.05), but when we compared to normal group, those groups had higher body weight gain and larger adipocyte cells. The level of triglycerides, protein expression of PPARγ and mRNA level of FABP4 genes were significantly downregulated on O-EA and O-RPE30 compared to obesity group ( P < 0.05). Our results indicated that RPE had potential substance as inhibitor of body weight gain, declining of size of adipocyte, level of triglycerides, PPARγ expression and mRNA level of FABP4 gene on obesity rat model. Conclusions: RPE have anti-obesity activity by inhibiting body weight gain, declining size of adipocyte, decreasing triglyceride, PPARγ expression and mRNA level of FABP4 gene on obesity rat model.

Objective: The implementation of guidelines in clinical practice is still facing a lot of obstacles. Although clinical recommendations of dyslipidemia are extant, little is known about how community physicians view guidelines and their implementation. The objective of this study is to assess the acceptance of guideline content and perceived implementation of dyslipidemia guidelines among physicians in Malang, Indonesia. Methodology: Semi-structured validated questionnaires were given to 67 random physicians consisting of general practitioners (GP), internal medicine residents and internists. The questionnaire consisted of 19 questions evaluating four parts: information about access to dyslipidemia training, dyslipidemia guideline-perceived knowledge, level of understanding of dyslipidemia guidelines and application rate of guideline adopted. Evaluation results were scored ordinally and divided into 3 levels; less, enough and good for each part of the questionnaire. Results: 89.2% of samples in the GP group lacked information about dyslipidemia training. The resident group had participated and were involved in dyslipidemia management training (98.3%), followed by the internist group (95.2%). In the GP group, 89.2% never or had less participation in dyslipidemia management training. The GP group (76.2%) also had had poor knowledge in understanding lipid guidelines, in which the least knowledge is known about targets of treatment, non-drug treatment and risk factors. Also, 40.3% of the GP group is still not capable of adopting dyslipidemia guidelines in daily practice. A major barrier was lack of understanding of guidelines (76.3%), followed by failure of adherence to the therapy of patients (12.1%). In the resident group, a major obstacle in the application of the guidelines is education level of the patient (45.5%). In all groups, HMG-CoA Reductase inhibitors are the most commonly used lipid-lowering drugs for treatment of dyslipidemia (98.1% in GP group, 96.3% in resident group, and 97.3% in internist group). Conclusions GPs, as physicians in primary health care system, had poor information and participation in dyslipidemia training, and poor knowledge of dyslipidemia guidelines (AACE, AHA, CCS), as well as understanding and application of the dyslipidemia guidelines (ATP III, PERKENI) to the population, whereas residents and internists had better perception and application of dyslipidemia guidelines.
Dyslipidemias ; Guideline ; Physicians