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"Background. Metformin is the first-line oral antidiabetic agent used in the treatment of diabetes mellitus. One of the adverse reactions of the long term use of metformin is cobalamin malabsorption. Clinical and laboratory findings are important in the diagnosis of cobalamin deficiency.Objective. This study aimed to evaluate the risk of cobalamin deficiency symptoms related to long-term use of metformin in type 2 diabetes mellitus patients at Pasar Rebo General Hospital in Jakarta.Setting. This quantitative, observational study with retrospective cohort design was conducted in outpatient department Pasar Rebo General Hospital November 2015 until January 2016.Methods. 200 subjects were recruited and divided into two groups, patients who had been taking metformin for 1-3 years and patients who had been taking metformin for more than 3 years. Each patient was assessed for thepresence of cobalamin deficiency symptoms. Main outcome measure. Cobalamin deficiency symptoms evaluated were symptoms of neuropathy(measured by DN4 questionnaire) and hematologic abnormalities associated to cobalamin deficiency, i.e. macrocytic erythrocyte, hypersegmented neutrophils, and giant bands.Results. There are significant differences in the proportions of neuropathy symptoms (RR 2.36, 95%, p=0.000) and hematologic abnormalities (RR 1.5, 95%, p=0.007) between the two groups.Conclusions. Long-term use of metformin (≥3 years) may increase the risk of cobalamin deficiency symptoms in type 2 diabetes mellitus patients."

"Hemostatic disorders, which could cause (venous or arterial) thrombosis or bleeding, are often found during hospital care. Common manifestations of thrombosis arc inner vein thrombosis, cardiac infarct, stroke, or even recurrent miscarriage. In addition to hemorrhological detect, certain clinical conditions such as diabetes mellitus or hypercholesteroJemia are risk factors that also play a role in the hemostasis system.The hemostasis system depends on vascular en-dothelial conditions, platelet function (in this case platelet aggregation), coagulation function, anti-coagulation, fibrinolysis, and anti-fibrinolysis. If one of these conditions or functions is disturbed, the hemostatic system may also be disturbed."

"Until now, malaria is still an important community health problem in Indonesia. Prior to the use of DOT in this year 1959, it can be said that there is no region in Indonesia that was free from malaria except for the high lands.

Lampung is a region that is endemic for malaria, but at the peak of eradication in the year 1963, Lampung was protected from malaria, even though in the year 1965 there were still malaria foci in Lampung, with an SPR? Of more than 2%.' Up to the year 1989, for regions outside of Java and Bali, Lampung has the least prevalence for malaria.1

The halt in malaria eradication using DOT was due to a change in the environment due to large developments that resulted in increased vector nesting sites, might have been the cause for the increase in malaria cases lately in Bandar Lampung."

"Phospholipid is a lipoprotein particle that contains a specific protein called apolipoprotein. Apolipoprotein is the outer, exposed portion of negatively charged phos-pholipids (aiiionic phospholipids), which functions as enzyme or specific protein binding agents. The cell wall is formed by phospholipids, while apolipoproteins in the outer portion of the cell wall function as uptake receptors."

"Cardiomyopathy is a primary disease of the myocardium, unrelated to hypertension, congenital defect, or disorders of the valves, coronary blood flow, arteries, or pericardium.

In developing nations, Cardiomyopathy makes up 30% of all deaths due to heart disease, while in developed nations, Cardiomyopathy is not the main cause of heart disease.

Cardiomyopathy is classified according to etiology and clinical findings. From the etiology, Cardiomyopathy is classified into two types, the primary tipe, where the myocardiac disease is unknown/idiopathic, and the secondary type, with a clear cause, or is related with a disease of other organ systems. Based on clinical findings, Cardiomyopathy is classified into dilatation cardiomyopa-thy or congestive, restrictive, and hypertrophic Cardiomyopathy."

"In asthmatic patients, the airway is very sensitive towards exogenous stimuli, a condition known as bronchial hyperreactivity. The definite causative agent for asthma is not known yet, so as bronchial hyperreactivity. Recently it was postulated that there was a role for infection of Chlamydia pneumoniae in the pathogenesis of asthma. This paper will discuss about Chlamydia pneumoniae and its role in asthma, as well as its treatment."