The compatibility measurement of Mentzer, England & Fraser, Shine & Lal, and Srivastava indices to the hemoglobin electrophoresis result for beta thalassemia trait screening

Background: Thalassemia is an autosomal recessive disease. It occurs due to abnormalities in hemoglobin synthesis, causes the imbalance of globin production. Identification of thalassemia’s carrier plays a role to prevent disease’s inheritance. Diagnostic approaches regarding anemia, especially in families are important because they are prone to inherit the disease. This study was aimed to know the compatibility of Mentzer, England & Fraser, Shine & Lal, and Srivastava indices with hemoglobin electrophoresis in transfusion-dependent thalassemia patient’s family.

Methods: This was a cross sectional study by obtaining routine hematology and hemoglobin electrophoresis from thalassemia major patient’s family screening. The data then analyzed with Kappa and chi-square to get the compatibility and significance between variables. Data were analyzed using Microsoft Excel and SPSS version 17 for Windows

Results: From 99 subjects, most of them are women aged 18-55 years. Beta thalassemia trait based on Mentzer, England & Fraser, Srivastava, and Shine & Lal was in 46,5%, 55,6%, 55,6%, and 54,5% research subjects respectively. Hemoglobin electrophoresis results showed that beta thalassemia trait was in 47.5% subjects. Kappa test showed good and significant compatibility result of hemoglobin electrophoresis with Mentzer (k=0,663,p= 0,0001) and England & Fraser (k=0,636,p=0,002)  indices, also moderate and significant compatibility for Srivastava (k=0,558,p=0,018) and Shine & Lal indices(r=0,527,p= 0,015) with hemoglobin electrophoresis

The Correlation between CD64 Leukocyte, Immature Granulocyte and Presepsin with Procalcitonin in Bacterial Sepsis Patient

Background: Sepsis is a critical emergency that causes morbidity and mortality worldwide. The latest sepsis diagnosis is made by using quick Sepsis-Related Organ Failure Assessment (qSOFA). Cluster of Differentiation 64 (CD64) is a surface antigen leukocyte that is deregulated during infection and sepsis. The percentage of immature granulocyte (IG) could rise in patients with infection and sepsis, mainly in severe circumstances. Procalcitonin (PCT) is a calcitonin prohormone that increases in sepsis and is already known as a bacterial infection marker. Presepsin (CD14) is a glycoprotein that is known to increase in bacterial infection. This study aimed to determine the correlation of CD64 leukocyte, IG, and presepsin with PCT in bacterial sepsis patients.

Method: This cross-sectional study was performed from June to September 2018 at Dr. Soetomo Hospital. Twenty-five patients who met the qSOFA criteria with positive bacterial blood cultures were included. All samples underwent examinations of CD64 leukocyte, IG, presepsin, and PCT. The correlation of CD64 leukocytes, IG and presepsin with PCT was analyzed using Spearman correlation.

Results: The samples comprised 17 males (68.0%) and 8 females (32.0%). The mean age was 51.24 ± 14.85 years. The mean ± SD of CD64 leukocyte was 6.95 ± 2.13%, the median (min-max) of IG, presepsin and PCT was 3.67 (0.33–17.33)%, 2,641(487-20,000) pg/mL and 5.96 (0.39–181.5) ng/mL respectively. There was no correlation between CD64 leukocytes with PCT (p = 0.281). There was a significant correlation between IG and presepsin with PCT (p < 0.0001).

Conclusions: Presepsin and IG can be used as alternative bacterial sepsis markers that are supported by other examinations. CD64 leukocyte still needs to be studied further before it can be used as a bacterial sepsis marker.

The Correlation between total lymphocyte count, hemoglobin levels, lymphocyte/leukocyte ratio (LLR), and lymphocyte/neutrophil ratio (LNR) to CD4 levels in patients with Human Immunodeficiency Virus infection at Sanglah Hospital

Background. Acquired immunodeficiency syndrome (AIDS) is caused by the Human immunodeficiency virus (HIV) infection and characterized by a progressive decrease in the immune system function which eventually leads to the development of opportunistic infections and other complications. In order to monitor the disease progression the CD4 examination and additional Complete Blood Count (CBC) were commonly used.

Objectives. To determine the correlation of total lymphocyte count, hemoglobin level, lymphocyte/leukocyte ratio (LLR) and lymphocyte/neutrophil ratio (LNR) to CD4 levels in patients with HIV infection.

Methods. This a retrospective cross-sectional analytic study conducted from July to August 2017. The total lymphocyte count, hemoglobin level, lymphocyte/leukocyte ratio (LLR) and lymphocyte/neutrophil ratio (LNR) and CD4 level were measured in the study. The data normality and the correlation were analyzed using the Kolmogorov-Smirnov test and the Pearson Correlation test, respectively, performed in SPSS version 14. The p-value less than 0.05 was considered significant for the results.

Results. A total of 60 samples conducted CD4 and complete blood counts (CBC) examinations during the period July-August 2017. The mean CD4 levels were 341.73 ± 243.48 cells/µL, the total leukocyte count was 6.98 ± 2.93 x 10³/µL, the total lymphocyte count was 2.09 ± 0.87 x 10³/µL, hemoglobin level 13.38 ± 2.09 g/dL, lymphocyte/leukocyte ratio (LLR) 0.31 ± 0.11, lymphocyte/neutrophil ratio (LNR) 0.67 ± 0.40. Statistical analysis showed that data is normally distributed. Pearson correlation analysis showed that there was a significant relationship between CD4 levels with total lymphocytes counts, hemoglobin levels, RLL, RLN with correlation coefficients of 0.571 (p = 0.000), 0.324 (p = 0.012), 0.509 (p = 0.000), 0.463 (p = 0.006), respectively. There was no significant correlation between CD4 levels and total leukocytes with a correlation coefficient of 0.171 (p = 0.19).

The description of corrected count increment on one hour and 24 hours after platelet apheresis transfusion in Sanglah General Hospital Denpasar

Introduction: Evaluating the response after platelet transfusion is vital to measure the success rate of the therapy and plan the subsequent management of patients. The evaluation can be done by calculating the corrected count increment (CCI) at 1 hour and 24 hours after transfusion. The purpose of this study was to determine the therapeutic response to apheresis platelet transfusion by measuring the CCI at 1 hour and 24 hours after transfusion.

Methods: This study was a cross-sectional descriptive study of patients who received apheresis platelet transfusions. In total, 35 samples were examined for platelet counts before and after transfusion. The CCI was measured at 1 hour and 24 hours after transfusion. Descriptive statistical analysis was performed to calculate the percentage and mean count.

Result: The mean count of transfused platelets was 2.7 × 10¹¹ / unit. The mean platelet count before transfusion was 18.5 × 10³ / μL. The mean platelet increment at 1 hour was 25.4 10³ / μL and 24 hours was 22.6 × 10³ / μL. The mean CCI ± SD at 1 hour and 24 hours was 15,036.63 ± 13,709.73 and 13,625.60 ± 13,580 respectively. A total of 63% of samples reached the target CCI at the 1-hour measurement, while the remaining 37% did not. Meanwhile, 60% of the samples reached the CCI target at the 24-hour measurement, while 40% did not.

Levels of protein C, protein S, and anti-thrombin III in acute ischemic stroke patients at Haj Adam Malik Hospital, Medan

Background: Ischemic stroke is a clinical syndrome with rapid brain function loss due to a disturbance of blood supply to the brain. The role of natural anticoagulants protein C, protein S and antithrombin III (AT III) in ischemic stroke is still unknown. This study aimed to determine the differences in the levels of protein C, protein S and AT III, which were examined on days 1, 3 and 7 of acute ischemic stroke during treatment.

Methods: This was a longitudinal prospective study carried out in Haj Adam Malik General Hospital Medan, from January to May 2018. This study included 21 acute ischemic stroke patients with three times of sampling (day 1, 3 and 7). Protein C, protein S and AT III were examined using the Coatron A4 device. Protein C and AT III were examined using chromogenic assay principles and protein S using clotting assay principles.

Results: Twenty-one patients who participated in this study were 12 men (57.1%) and nine women (42.9%). There was no significant difference in the level of protein C (p = 0.980), protein S (p = 0.680) and AT III (p = 0.872) between day 1, 3, and 7. There was a positive correlation in protein C, protein S and AT III levels between day 1, 3, and 7. There was a negative correlation between protein C and AT III levels on day 3 (r: - 0.498; p: 0.022).

The stability of sample storage for complete blood count (CBC) toward the blood cell morphology

Background: Peripheral blood smear examination had a pivotal role in determining diagnosis and as confirmation of the automatic hematology analyzer results. The storage process was highly influential on the morphological stability of the cell. This study aimed to assess the morphological changes in blood cells stored at certain period and temperature.

Method: Sample of 30 blood specimens of healthy people with dipotassium ethylenediaminetetraacetic acid (K₂EDTA) anticoagulants. The specimens were stored at room temperature (18-25ºC) and refrigerator temperature (2-8ºC) and were analyzed at the preliminary examination i.e., 8 hours, 16 hours, 24 hours, 48 hours, 72 hours, and 96 hours. Kappa test was used in validating the reading of PBS (Peripheral Blood Smear). The discrimination testing used were paired t-test and Kolmogorov Smirnov test with p value <0.005, which stated to be significant. 

Result: The changes in erythrocytes morphology stored at room temperature (18-25ºC) was that the erythrocytes crenation started to happen at 8 hours storage with the grading scale of +2 that were found in 24 (80%) samples, whereas at refrigerator temperature (2-8ºC) the grading scale was +1 and found in 13 (43.3%) samples. Spherocytes on erythrocytes began to form at room temperature (18-25ºC) at 8 hours storage with grading scale of +1 and was found in 2 (6.7%) samples, whereas at refrigerator temperatures (2-8ºC) spherocytes on erythrocytes began to form at 24 hours storage with grading scale of + 2 and was found in 3 (10%) samples.

Conclusion: Peripheral blood smear (PBS) examination shall be done immediately to obtain significant results.

The comparison of blood gas analysis (BGA) parameters in samples transported by the pneumatic tube system and manual transport at Dr. Soetomo Hospital, Surabaya, Indonesia

Background: Pneumatic Tube System (PTS) can reduce the time needed to transport laboratory samples, thus resulting in faster turn-around time. Blood gas analysis (BGA) is a critical laboratory examination, and it would benefit from sending the sample using PTS. Some studies showed the effect of PTS on BGA’s parameters, so the laboratory should validate the usage of PTS before delivering the samples. This study aims to determine the comparison of BGA parameters in Sample Transported by Pneumatic Tube System and Manual Transport at Dr. Soetomo Hospital, Surabaya, Indonesia.

Method: A cross sectional analytic study was conducted among 31 blood patients and divided into two syringes. One syringe was delivered by PTS as well as the other was transported by courier. The delivery distance was 250 meters for both transportations. Both samples then were examined by qualified laboratory analyst. The pH, pCO₂, and pO₂ were compared. Data were analyzed using SPSS version 17 for windows.

Result: The result of pH, pO₂ and pCO₂ in PTS samples was not significantly different compared to manual transportation (p=0,799; p=0,955 and p=0,856 respectively). Bland-Altman plot was found a good agreement between both types of transportation method.

Correlation between verruca vulgaris and superoxide dismutase

Background: Verruca vulgaris is a form of benign tumors that infected epidermal cells caused by Human papillomavirus (HPV). In several studies states that imbalances in oxidant and antioxidant systems play an important role in HPV infection. SOD is a potent protective enzyme that selectively cleanses radicals of antioxidants by catalyzing dismutation to hydrogen peroxide.

Aim: The study aimed to determine the correlation between SOD level and verruca vulgaris.

Methods: This was an analytic study with a cross sectional design involving 35 subjects with verruca vulgaris and 35 healthy controls. Diagnosis of verruca vulgaris was made based on history and clinical examination. The authors conducted blood sampling and measurement of plasma SOD level to the patients and controls.

Results: The study found that the mean of SOD levels in verruca vulgaris patients were higher (49.27 ± 100.47 U/L) than controls (35.12 ± 50.44 U/L), but it didn’t find a correlation between verruca vulgaris and SOD with p = 0.511. The mean level of ≥ 6 months were higher (59.69 ± 140.85 U/L) than < 6 months (39.43 ± 36.09 U/L) with p = 0.369. The mean multiple lesion levels were higher (62.12 ± 140.76 U/L) than the SOD level of patients with a single lesion (37.14 ± 34.89 U/L) with p = 0.405. The mean of SOD levels of patients who had previously experienced verruca vulgaris was higher (72.79 ± 151.73 U/L) than those who had not it (31.63 ± 18.26 U/L) with p = 0.961.

Conclusion: We didn’t found a correlation between verruca vulgaris and SOD.

The different effects of banana juice and sport drink on lactic acid among volleyball students in Surakarta

Introduction: The response of lactic acid as a result of exercise in recent times has received considerable attention from physiologists, particularly in term of sports aspect. Lactic acid level is one of the most common measured parameter to determine the performance of athletes. Provision of supplements containing potassium for athletes is usually given such fruit juice or sport drink to prevent muscle fatigue. This study examined the effect of the banana juice and sport drinks to lactic acid in volleyball students.

Methods: The study was a randomized experimental trial using pre-post test with control group. The study populations were all volleyball students aged 15-17 years in Pundong Senior High School. The subjects divided into three equal group, 10 subjects in each group treated with either banana juice, sport drink and mineral water as a control group. Sampling was done by a double-blind method.

Results: The results of the paired sample T-Test showed a significantly difference of lactic acid levels by intervention with banana juice and sport drink compared to control group with mean difference the mean were 4.43, 3.59, 2.68 respectively (p<0.05).

Conclusions: Intervention of banana juice significantly decreased the lactic acid levels compared to sport drinks in volleyball students.

Intraarterial heparin flushing effect on motor evoked potentials in chronic ischemic stroke patients

Background: Stroke has always been a complicated disease which affects not only the patient quality of life but also the patient family. In ischemic stroke patients, one of the most complicated outcomes was the disruption of motor function. Increased motor function is a visible positive outcome of stroke patients.

Aim: This study aims to measure the motor evoked potentials values which the results might give us more insights into how this disease affects the motor neuron pathway.

Methods: This study was an experimental pre-posttest study involved 75 patients diagnosed with chronic ischemic stroke (onset of more than 30 days). The MEPs value was measured by adjusting the IAHF procedure in 2015.

Results: There was no significant difference between motor evoked potential value (amplitude, latency, central motor conduction time) pre and post intraarterial heparin procedure (IAHF) (p>0.05). Occasionally, there was a significant difference in latency value in lacunar, subcortical, and cortical-subcortical area after IAHF (p<0.05).

Conclusion: This study shows that the size and localization of the affected area might determine the results of IAHF.

The characteristics of mandibular fractures among patients attending Plastic Surgery Unit in Sanglah General Hospital, Bali, Indonesia: A preliminary study

Background: Trauma is the fourth leading cause of death in the world and occurs at all ages. The high incidence of traffic accidents is equivalent to the increasing incidence of maxillofacial trauma, especially mandibular fracture. This study aims to determine the characteristics by age, gender, mechanism of injury and anatomical site of mandibular fractures among patients attending the Plastic Surgery Unit of Sanglah General Hospital as a preliminary study

Methods: A descriptive cross-sectional study was enrolled among 45 patients attending plastic surgery who recorded in medical records from January 2014 until December 2016 as well as met the inclusion criteria. Data were analyzed using SPSS version 17 and presented in percentage regarding Age, mechanism of injury, gender, and fracture site

Results: There were 45 patients with 61 mandibular fracture sites. Most of the patients were male (84.4%). Based on age, the mandibular fracture is most common in the productive age (20-30 years old) at 22 cases (36.1%). Majority cause of fractures was road traffic accident (82.2%). Parasymphysis region was the most common site of fracture (39.3%).

Conclusion: The characteristics of mandibular fracture patients describe trauma patterns in the community. This finding is similar with some readily available literature with RTAs was the most common etiology and parasymphysis was the most common fracture site.

An Efficient Polymerase Chain Reaction (PCR) Enhancer for Highly Guanine-Cytosine (GC)-Rich DNA Sequences

Background: Polymerase chain reaction (PCR) has become a fundamental technique in molecular biology. Nonetheless, PCR amplifications are frequently impaired by high GC content of the target sequence, leading to low yield and specificity of products, with no product at all in the worst cases. Locally high-temperature melting regions within the template can act as permanent termination sites.

Method: Here we designed and tested an effective and low-cost PCR enhancer, a combination of dimethyl sulfoxide (DMSO) 10% (v/v) and magnesium chloride (MgCl2) 1,5 mM that broadly enhanced the qualitative output of PCRs. We used Mycobacterium tuberculosis strain H37vR as a PCR template.

Result: It was found that PCR enhancer containing 10% (v/v) of DMSO and 1,5 mM of MgCl2 improved the amplification of GC-rich template of M. tuberculosis gene other than without the PCR enhancer.

Conclusion: Therefore, this PCR enhancer could be widely useful to improve the amplification of GC rich construct from another genome.

Desperately needed in Indonesia: Basic Epilepsy Surgery Centers with Simple but Reliable pre-surgical investigations, based on Semarang’s Experience

Background: Even with optimized anti-epileptic medications, 30% of epilepsy patients will be refractory and this condition leads to cognitive and psychosocial decline, resulting in worse quality of life and higher mortality. With 0,75% prevalence, there are more than 2.0 million epileptic in Indonesia, about 360.000 will be refractory, and half of them are potential candidates for epilepsy surgery (ES). After 17 years since the first ES on July 1999, number of ES increases every year reaching around 50 cases per year. By the end of 2017,  the total number reached 615 and most was temporal lobe epilepsy (TLE) cases. Pre-surgical investigations were compared in relation to the seizure free results between the first five-year and the recent twelve-year. Despite the excellent result shown, all of these ES were still performed in Semarang (Diponegoro University), and demographic analysis showed that 80% patients came from Java-Bali area. So that new basic centers capable of performing ES for simple TLE cases are desperately needed to improve treatment for refractory epilepsy cases elsewhere.

Material and methods: Until the end of 2017, there were 615 ES cases, including 514 Temporal Lobe Epilepsies (TLEs). Pre-surgical investigations were grouped as Simple (MRI with specific protocol and routine EEG), Difficult (needs long-term ictal EEG, and /or PET CT), and Complex (needs invasive or intracranial/ subdural grid EEG, and or Electrocorticography/ ECoG during the surgery). For the first five year-period, besides seizure semiology, decision to operate were based on MRI and routine EEG (Simple) in 54 out of 56  (96,4%) TLE cases. One patient had long-term ictal EEG and another had subdural grid EEG implanted, both patients showed visually normal MRI. But for the recent twelve-year, Simple TLEs occupy only 234 out of 458 (51%) TLE cases. Long-term ictal EEG were performed in 161 patients (35,2%), PET study in 39 patients (8,5%), subdural grid EEG in 30 patients (6,5%), and ECoG in 61 patients  (13,3%).

Results: As a new ES center performing only simple TLE cases, our surgical results were Class I: 82%, Class II: 11%, and Class III: 7% (9). As a semi advance ES center (after more than 5 years, and only half were simple ES cases), the Class I or seizure free results were 78,7% for simple TLEs, 73,4% for Difficult TLEs, and 65,2% for Complex TLEs.            

Demographic distribution showed that almost 80% of ES patients came from Java-Bali area, and half of them were from Central Java Province with Semarang as its capital. Patients from other parts of the country were scarce, especially from remotely located islands of East Indonesia.

The hypercoagulation state among major β-thalassemia patients at H. Adam Malik Hospital, Medan, Indonesia

Background: Thalassemia is the most common hereditary blood disorder in the world and Indonesia. Major β-thalassemia is classified as Transfusion-Dependent Thalassemia (TDT). Specific changes in the composition of red cell membrane lipids and hemosiderosis may lead to hypercoagulation. This study aimed to determine the difference in Protein C, Protein S, Antithrombin III (AT-III), and D-dimer between major β-thalassemia patients and normal people.

Methods: This was an observational analytical study with a cross-sectional design, including 18 major β-thalassemia patients in H. Adam Malik Hospital Medan who met the study criteria and 18 normal controls. Subjects were examined for Protein C, Protein S, AT-III and D-dimer. The assessment was also carried out among patients based on their transfusion frequency and serum ferritin.

Results: There were significant differences in Protein C, Protein S, and D-dimer levels between major β-thalassemia patients and normal controls (p < 0.05). AT-III level in major β-thalassemia patients was lower than healthy controls, however the difference was not significant. The level of Protein C in patients who infrequently and frequently underwent blood transfusions were 34.88 ± 8.6 and 45.19 ± 7.8 respectively, which was significantly different (p < 0.05). A significant differences in Protein C, Protein S and D-dimer were also found between patients with serum ferritin level < 2,500 ng/ml and  ≥ 2500 ng/ml.

Conclusion: Significant changes were found in anticoagulation proteins of major β-thalassemia patients. Frequent blood transfusions and chelation therapy should be emphasized for major thalassemia patients because they affect anticoagulation protein levels.

Hemostasis changes and its relationship with SOFA score in sepsis patients

Introduction: Sepsis is a major health problem, and the incidence is still increasing. Generally, sepsis occurs in about 2% of all inpatients in developed countries. The immunologic response that causes sepsis is a systemic inflammatory response that causes activation of the inflammatory and coagulation pathways. If sepsis untreated, it can lead to organ failure then death. Organ dysfunction is expressed as an acute change of Sequential Organ Failure Assesment (SOFA) score >2 points as a consequence of infection.

Methods: This is a cohort prospective’s study. Prothrombin time (PT), activated partial thromboplastin time (aPTT), Thrombin time (TT), Fibrinogen, D-dimer were examined 3 times (first, second, third day), and then assessed to see its relation with the corresponding SOFA score. Twenty-four subjects of the study were ICU patients in H. Adam Malik Hospital who matched the inclusion and exclusion criteria.

Results: There were significant differences of PT on the first, second and third day (p =0.03). There were no significant differences in aPTT, TT, Fibrinogen, D-dimer on the first, second, third day. There were no significant correlations of PT, aPTT, TT, Fibrinogen with the corresponding SOFA score on the first, second, third day. There was a moderate positive correlation between D-dimer and SOFA score in the first, second and third day of examinations (p <0.05).

Conclusion: PT changes occurred significantly on the first, second, third day of sepsis and D-dimers can be used to asses the risk of organ failure in septic patients.

Hyperferritinemia and oxidative stress in the kidney of beta thalassemia major

Background: Thalassemia is a genetic disorder which until now has become a global health problem. Regular blood transfusions in managemen of BTM result in iron overload. Free iron in the form of intracellular ferrous (Fe²⁺), in the presence of oxygen, will initiate the formation of reactive oxygen species (ROS), produce another free radical superoxide that will oxidize the lipid and protein compounds of the cell membrane. F₂-IsoPs is the best, most stable and more accurate marker of lipid peroxidation in vivo, found urine. This study aimed to determine the association between hyperferritinemia and lipid peroxidation in kidney reflected as elevated u-F₂IsoPs as controlling several factors affecting oxidative stress in the kidney.

Methods: This cross sectional study was conducted between May and June 2016. Thirty subjects of BTM admitted to pediatrics unit of Dr. Moewardi Hospital Surakarta who met the inclusion and exclusion criteria were enrolled. The data were analyzed to calculate prevalence ratio and 95%CI for each variable, followed by multivariate analysis with logistic regression.

Results: The prevalence of lipid peroxidation in kidney, characterized with elevated u-F₂IsoPs of > 2 ng/mg urine creatinine, was 67%. Age, hyperferritinemia status and duration of illness did not associate with lipid peroxidation in the kidney. Transfusion volume of ≥25 unit/year showed statistically significant association with lipid peroxidation (PR 24.10; 95%CI 2.16-268.42; p=0.010).

Conclusion: Transfusion volume, rather than hyperferritinemia, independently associated to oxidative stress and lipid peroxidation of the kidney in BTM.

The correlation between caspase-9 and caspase-3 on sepsis case: an experimental study on the Balb/C Mice induced by lipopolysaccharide

Introduction: Sepsis mortality rate in Indonesia reaches over 50 %, hence, acknowledgement of its pathophysiology need to be elucidated, including the pathway of apoptotic. The objective of this study was to describe the lipopolysaccharide (LPS)-induced sepsis in which triggers intrinsic apoptotic pathways in terms of the expression of caspase-9 (Cas9) and caspase-3 (Cas3).

Method: By experimental with time series randomized post test-only control group design, 48 Balb/C mice divided into 2 groups (control and treatment). Each group was injected intra-peritoneally with saline 250 µL/mice and saline 250 µL + 0.1 mg E. coli LPS/mice. Each group divided into 4 termination time (12^th, 24^th, 36^th and 48^th hours), examined by immunohistochemistry (IHC) for Cas9 and Cas3 expression, and analyzed by mean difference test (Mann-Whitney and t test) and correlation test (Spearman’s test).

Results: The LPS-induced sepsis in the treatment group revealed increasing number of caspase-9 compared to control group (2.34+0.24 vs 0.82+0.08; p<0.001. There were increasing trends in the treatment group compared to control group includes for: all groups Cas3 (1.54+0.10 vs 0.48+0.05; p<0.001), t12 Cas3 (3.25+0.22 vs 0.50+0.06; p<0.001), t24 Cas3 (1.37+0.27 vs 0.45+0.05; p=0,002), and t36 Cas3 (1.03+0.20 vs 0.52+0.22; p=0,002). Instead, there were no difference between treatment group and control group for t48 Cas3 (0.50+0.14 vs 0.43+0.10; p=0,485). There was decreasing pattern on serial time 12, 24, 36 and 48 hours for Cas9 (p<0,001) and Cas3 (p=0,002). There was a correlation between Cas9-Cas3 (r_s=0.835;p=0.001).

Conclusion: The LPS-induced sepsis caused an increase of caspase-9 and caspase-3, strongly correlated with decreasing pattern on time serial.

Analysis of nerve growth factor serum levels in psoriasis vulgaris patients

Background: Psoriasis is a complex chronic inflammatory skin disease with multifactorial mechanism affected by immunological, genetic, environmental and nervous system factors which its mechanism is still unknown. The involvement of nervous system in psoriasis is ruled by nerve growth factor (NGF). Increased levels of NGF serum are expected occurring in psoriasis vulgaris.

Aim: To determine the differences between NGF serum levels in psoriasis vulgaris patients and controls

Methods: This study is an analytic study with cross sectional design involving 30 psoriasis vulgaris patients and 30 healthy controls. Diagnosis of psoriasis vulgaris was made based on history and clinical examination; we conducted blood sampling and measurement of NGF serum level to the patients and controls. The differences between NGF serum levels in psoriasis vulgaris patients and controlled is analyzed by independent-t test. This research approved by the health research ethics committee of the Faculty of Medicine of Sumatra Utara University/ H. Adam Malik  Medan General Hospital.

Results: In this study, we found the mean NGF serum level of female psoriasis vulgaris patients (810.30 ± 299.97 pg/ml)  was higher compared to male (806.70 ± 256.04 pg/ml).  The mean NGF serum of psoriasis vulgaris patients were highest on ages group 15 – 23 years (930.14 ± 69.03 pg/ml). The mean NGF serum level of psoriasis vulgaris without family history (875.38 ± 203.91 pg/ml) was higher compared to patient with a maternal history (600.87 ± 387.45 pg/ml) and paternal history (477.88 ± 406.97 pg/ml). The mean NGF serum level in the psoriasis vulgaris group (808.38 ± 272.48 pg/ml) was higher compared to the control group (524.92 ± 281.22 pg/ml) dengan with p=0.0001.

Cytogenetic mutation in a family with sickle-cell beta-thalassemia in North Sumatera, Medan, Indonesia: A preliminary study

Background: The prevalence of  Hb S/β Thalassemia has not been widely reported, and until now, there is a lack of statistical data on the prevalence of the disease in Indonesia. In 1974, cases of β thalassemia with Hb S were found in one family in Jakarta. The aim of this study was to describe the cytogenetic mutation in a family with Hb S/β thalassemia in North Sumatera.

Methods: This was a descriptive study with a cross-sectional design conducted in one family of HbS patients with thalassemia trait, with a total of five samples. Complete blood count, hemoglobin electrophoresis examination, peripheral blood smear, PCR, and amplicon were performed to describe the hematology and cytogenetic profile of samples. Data were analyzed descriptively.

Results : The father (64 years old) suffered from HbS (HbA = 58.3%, HbS = 38.3%, HbA2 = 2.8%) with heterozygote HbS mutation type. The mother (36 years old) suffered from β-thalassemia trait (HbA = 93.8, HbF = 1.2%, HbA2 = 5%) with β-thalassemia heterozygote IVS1-nt5 mutation type. The first child (male, 18 years old) suffered from HbS/β thalassemia (HbA = 25.9%, HbF = 22.4%, HbS = 48.2%, HbF = HbA2 = 3.5%), the second child was normal (HbA = 97.4%, HbA2 = 2.6%) and the third child (female, 10 years old ) suffered from HbS β-thalassemia (HbA = 3.3%, HbF = 25.5%, HbS = 67.6%, HbA2 = 3.6%). The first and third child had β-thalassemia with double heterozygote HbS and IVS1-nt5 mutation type.

Conclusion: Population migration between nations followed by marriage could lead to cytogenetic mutations and cause sickle-cell beta-thalassemia. The finding of double heterozygous HbS mutation and beta thalassemia need to be explored further about the patient’s fathers family.

P2B2 PABI XVI Manado 2019 Continuing Professional Development in Surgery: The Patients and Surgeon in Universal Health Coverage Era

Assalamu’alaikum Wr. Wb.

Shalom.

Friends of PABI members throughout Indonesia, we praise and thank you to the presence of God Almighty because we are still in good health. In favor of God, we will carry out the XVI P2B2 in the City of Manado.

Welcome to Manado City. A city full of natural beauty and culinary delights. In the framework of the XVI P2B2, the event will be held on July 2, 2019 until July 6, 2019 at the Grand Kawanua Ballroom, the Novotel Manado hotel with a theme

"Safety of Patientes of Surgeons in the Age of Universal Health Coverage"

The activities held in the form of panel discussions, symposiums, workshops, tours of the city of Manadoo and its surroundings, and the Family Program. We invite all of you to come and attend the activities we have summarized

Hopefully what we present can be useful for PABI members and other colleagues as well as accompanying families. Enjoy Manado City.

Wassalamu alaikum Wr. Wb

Fery Kalitouw, MD

chairman of the committee

P2B2 PABI XVI Manado         

Increasing the Quality of Life of Post Shackling Patients Through Multilevel Health Promotion of Shackling Prevention

Introduction:  Shackling still poses a significant obstacle to rehabilitate patient with mental disorder and often resorted by family or community. Shackling could have a negative impact toward patient’s mental health and often resorted due to lack of information. Therefore, this study aimed to evaluate the effect of multilevel health promotion to shackling prevention (MHPSP) toward the behavioral component of family/caregivers, neighbors, cadres, and health workers (stakeholders) and also evaluating its effect toward patient’s quality of life.

Method:  This study uses a quasi exeperimental method with pre-test and post-test model with repetead measures design. The research subjects were 32 post-shackling patients lived in Sukoharjo Regency and 31 from Klaten Regency as well as. MHPSP was given to 32 caregivers and stakeholders who come from Sukoharjo Regency as a treatment group and psychoeducation only to 31 caregivers of control group from Klaten Regency. Quality of life measurments were carried out before treatment and four months after giving MHPSP.

Result : The result showed that MHPSP significantly enhance the behavioral component of the family/caregivers as well as neighbors, cadres and health workers (p<0.05). Furthermore, patient quality of life was significantly improved in the treatment group (MHPSP) compared to the control.

Conclusion: It can be concluded that MHPSP could significantly enhance the behavioral aspects of the families, neighbors, and health workers toward post-shackled PMD patients and significantly improved their quality of life. Therefore, MHPSP is needed to be implemented not only to the patient but also to the people that directly interact with them.

Low plasma levels of IGF-1 and IL-1RA with high plasma levels of IFN-γ as prognostic factor for mortality in hospitalized geriatric patients with delirium

ABSTRACT

Background: Delirium is common and serious problem with high morbidity and mortality, especially in geriatric patients. Decrease in the number of neuroprotective factors (IGF-I and IL-1RA) and increase in IFN-γ had been correlated with the incidence of delirium. This study aims to understand whether these markers can be used as predictors for mortality in geriatric patients with delirium in an effort to prevent the adverse events of delirium.

Methods: In this observational analytic study with prospective cohort design carried out in the Geriatric Installation care room at Sanglah General Hospital in Denpasar in 2018, 76 samples were examined for their IGF-1, IL-1RA, IFN-γ plasma levels. Patients were then followed during their hospital stay until they were declared cured or died due to delirium or its complications. The relationship between each group and mortality rate were then analyzed using univariate, bivariate and multivariate analysis.

Results: In this study, median was used as the cutoff point for IGF-1 levels [21.38 (0.00-91.07)], IL-1RA levels [2,491.48 (193,44-6720,13)] and IFN-γ [194.29 (0.00-2200.96)]. In multivariate analysis, low plasma levels of IGF-1 (HR= 4.12 [95% CI: 1,458 - 11,642, p=0.008]) and IL-1RA (HR=2.91 [95 % CI: 1.037 - 8.154, p= 0.043]) proved to be an independent factor in the occurrence of death in geriatric patients with delirium. However, IFN- γ failed to show any correlations.

Conclusion: Both low plasma levels of IGF-1 and IL-1RA can be used as predictors for mortality in geriatric patients with delirium.

Incidence of deep vein thrombosis in patients with diabetic foot ulcers

The mortality in type-II diabetes mellitus (T2DM) patients relates to the occurrence of thrombosis events in the peripheral vascular, one of which, diabetic foot ulcers (DFU). Theoretically, an increased tendency for thrombosis in patients with DFU will increase the incidence of thrombosis in the lower limbs that are part of the venous thromboembolism, also known as deep vein thrombosis (DVT). This research was a descriptive study, with a cross-sectional design, aimed to investigate the incidence of DVT in DFU patients in Haji Adam Malik Central General Hospital Medan from September to November 2017. A total sample of 45 patients diagnosed as T2DM with DFU, was selected to join the study based on the inclusion and exclusion criteria. All subjects were asked for their consent before being included in the study. The data collected included patients’ personal information, complete diagnosis, hemostatic laboratory results, and doppler USG examination. All data were statistically processed using SPSS software. The results showed that the incidence of DVT in DFU patients was 93.3%  based on physical and radiological examination using doppler USG.

1,4-bis-3,4,5-trimethoxy-phenyl-tetrahydro-furo(3,4-c) furan from mahogany (swietenia macrophylla king) seed significantly reduces glucose and malondialdehyde levels in diabetic wistar rats

Background: Diabetes mellitus (DM) is an urgent global health issue with increased annual prevalence. The uncontrolled hyperglycemia may induce an oxidative stress state which could lead to the development of diabetic related complications. Several studies showed that mahogany seed contains 1,4-bis-3,4,5-trimethoxy-phenyl-tetrahydro-furo(3,4-c) furan which has glucose-lowering properties. However, its efficacy toward oxidative stress condition is yet to be investigated.

Objectives: This study aimed to examine the activity of 1,4-bis-3,4,5-trimethoxy-phenyl-tetrahydro-furo(3,4-c) furan in reducing the malondialdehyde (MDA) level as oxidative stress biomarker and blood glucose levels in diabetic rats.

Method: 36 male Wistar rats were used and divided randomly into six groups: Normal control, DM, DM+glibenclamide, DM+isolate10, DM+isolate20, and DM+Isolate40. The isolate and glibenclamide were given for 21 consecutive days. Streptozotocin and nicotinamide were used to induce the diabetic model. Levels of glucose and MDA were measured in successive phases: Before induced by streptozotocin and nicotinamide; before treatment; and after 7, 14, and 21 days of treatment.

Results: Within 21 days of treatment, mean glucose and MDA levels in each therapy group: (DM+glibenclamide, DM+isolate10, DM+isolate20, and DM+Isolate40) showed significant decreases over time. Mean of glucose and MDA levels in the therapy groups were significantly lower than in DM (diabetic control) group. Mean of glucose level in DM+Isolate40 group was significantly different from the normal control group but the MDA level showed no significant difference. The results between the DM+Isolate40 group and DM+glibenclamide group showed no significant difference.

Conclusion: The 1,4-bis-(3,4,5-trimethoxy-phenyl)-tetrahydro-furo(3,4-c) furan had significant glucose lowering and anti-oxidant effect in diabetic rats.