Journal of the Medical Sciences (Berkala ilmu Kedokteran)
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Sensitivity and specificity of serum procalcitonin level compared to leucocyte count for diagnosis surgical site infection on patients undergoing major surgery in Dr. Sardjito General Hospital Yogyakarta
No full textSurgical site infection (SSI) is one of the most serious complications on sugical procedure. However, its diagnosis is still based on the clinical and laboratory examination that take more time and less sensitive and specific. Therefore, early diagnosis that is more accurate and precise is needed. Some biomarker such as serum procalcitonin (PCT) is promoted for diagnosis SSI. The aim of the study was to evaluate the sensitivity and specificity of serum PCT compared with leucocyte for diagnosis SSI on patients undergoing major surgery. This was a descriptive analytical study with a prospective observational design. Patients who underwent a major surgery between October 30th and December 31rt, 2011 and fulfilled the inclusion and exclusion criteria were recruited. Clinical and laboratory examinations including leucocyte count were conducted presurgery. On 3rd day postsurgery, blood sample was taken for PCT and leucocyte count measurement. A blood bacterial culture was performed on patients suffering from SSI according to Centers for Disease Control (CDC) criteria. Patients were then followed until 30 days postsurgery. A total of 49 patients consisting of 22 men and 27 women were involved in this study. Surgical site infection was found in 16 patients consisting of 8 (50%) patients with clean surgical wound, 3 (19%) patients with clean surgical contamination wound, 4 (25%) patients with surgical contamination wound and 1 (6%) patient with dirty surgical wound. Furthermore, laboratory examination found that 9 patients had abnormal leucocyte with 5 of them suffering from SSI, whereas from 14 patients with serum PCT abnormal, 11 patients suffered from SSI. Diagnostic test showed that the sensitivity and specificity of serum PCT for diagnosis SSI were 68.75 and 90.90%, respectively, whereas the sensitivity and specificity of leucocyte were 31.25 and 87.87%, respectively. In conclusion, serum PCT has better sensitivity and specificity compared with leucocyte for the diagnosisof SSI in patients with major surgery.
Risk factors in childrenwith platelet refractoriness
No full textPlatelet transfusions are often performed in pediatric patients. Nevertheless, platelet transfusion has its own risk and it alsoincrease the cost of care. Therefore,its effectiveness needs to be evaluated. This study aimed to assess the clinical risk factors namely sepsis, splenomegaly, DIC, severe bleeding and the history of platelet transfusion in the incidence of refractory platelets. This was a case-control study conducted during the period of August 2010 to September 2011.From a total of 1403 cases of transfusion, there were 86 incidences of refractory and 86 of nonrefractory. From the bivariate analysis, it was obtained that sepsis [OR 5.91 (2.90-12.05)], p = 0.000], splenomegaly [OR 2.82 (1.32-6.04.12), p = 0006] heavy bleeding [OR 8:41 (4.19-16.871), p = 0.000 ], DIC [OR 22.96 (6.73-78.35), p = 0.000] and the history of platelet transfusions [OR 5:33 (2.78-10.23), p = 0.000] increase the risk of refractory platelets. On multivariate analysis, sepsis (OR 2.96 [95% CI: 1:19 to 7:32], p = 0019), splenomegaly (OR 3.94 [95% CI: 2:21 to 16:00], p = 0.000), severe bleeding (OR 3:53 [95% CI : 1.40-8.89], p = 0.008), DIC (5:54 OR [95% CI: 1.29-22.75], p = 0021) and platelet transfusion the history (OR 2.84 [95% CI: 2.74-9.77], p = 0.001) were the independent risk factors for the occurrence of children refractory. In conclusion, sepsis, splenomegaly, severe bleeding, DIC, andthe history of platelet transfusion are the risk factors in pediatric patients refractory platelets. ABSTRAKTransfusitrombositseringdilakukanpadapasienanak.Transfusitrombositsendirimemilikirisikoterhadappasiendanmenambahbiayaperawatan, sehinggaperludievaluasiefektifitasnya.Menilaifaktorrisikoklinisyakni sepsis, splenomegali, DIC, pendarahanberatdanriwayattransfusitrombositterhadapkejadianrefraktertrombosit.Penelitianinimerupakanpenelitiankasuskontroluntukmenilaifaktorrisikoterjadinyarefraktertrombositseperti sepsis, DIC, splenomegali, pendarahanberat, riwayattransfusitrombosit.SelamaperiodeAgustus 2010 sampai September 2011 terdapat 1403 kasustransfusi, darikeseluruhankasustersebutdiambil 86 kejadianrefrakterdan 86 non refrakter. bivariatdidapatkan sepsis [OR 5.91 (2.90-12.05)], p = 0.000], splenomegali [OR 2.82 (1.32- 6.04.12), p = 0.006] pendarahanberat [OR 8.41(4.19-16.871), p = 0.000], DIC [OR 22.96 (6.73- 78.35), p = 0.000] riwayattransfusitrombosit [OR 5.33(2.78-10.23), p = 0.000] meningkatkanrisikorefraktertrombosit. Padaanalisismultivariat sepsis (OR 2.96 [95%IK; 1.19-7.32], p = 0.019), splenomegali (OR 3.94 [IK 95%;2.21-16.00], p = 0.000), pendarahanberat (OR 3.53 [95% IK; 1.40-8.89], p = 0.008), DIC (OR 5.54 [95% IK; 1.29-22.75], p =0.021) danriwayattransfusitrombosit(OR 2.84 [95% IK; 2.74-9.77], p =0.001) merupakanfaktorrisikoindependenterjadinyarefrakterpadaanak. Sepsis, splenomegali, pendarahanberat, DIC danriwayattransfusitrombositmerupakanfaktorrisikoterjadinyarefraktertrombositpadapasienanak
Comparison of giving ephedrine 30 μg/kgbw iv and lidocaine 2% 40 mg iv to educe pain induction propofol 2 mg/kgbw iv in general anesthesia
No full textThe administration of propofol often causes burning sensation in the area of injection. There have been efforts to reduce discomfort, but the result remains unsatisfactory. The main purpose of this study is to find objective evidence of whether the administration of ephedrine 30μg/kgBB IV is more effective than 40mg 2% lidocaine in order to reduce propofol 2mg/kgBB injection pain.This study was conducted in the double blind Randomized Controlled Trial (RCT) to 128 patients, with the range of age 18-60 years, physical status ASA I and II, BMI 17.5 – 24.5 kg/m2 which had been done elective surgery in the Intergrated Surgery Center of Dr. Sardjito Hospital Yogyakarta and other education network (Banyumas Hospital, Panembahan Senopati Bantul Hospital, Orthopedi Solo Hospital, Saras Husada Purworejo Hospital) and carried out in 2-4 months, general anaesthesia has been done with endotracheal intubation technic. Subjects have been divided into 2 groups, group A (lidokain 40 mg) and group B (efedrin 30μg/ kgBB). All of the patients have been given at the vena sefalikabasalika with 18G needle and RL. After one of the drugs has been given, the patient will be inducted with propofol 60 seconds later. The measurement of discomfort caused by propofol injection has been marked with discomfort scoring system (score 0-3), the blood pressure measurement has been taken before and after propofol administration. The results showed no statistically significant difference in the two study groups (2% lidocaine 40 mg IV vs ephedrine 30μg/kgbb IV) on pain response measured when patients received propofol 2mg/kgbb IV, p > 0.05 (P = 0.068) In group A there were 52 patients (81.3%), pain-free, while for group B there were 59 patients (92.2%). The pain response obtained was varies, in group A obtained a scale of 1-3, while in group B obtained a scale of 1-2. It can be concluded that administration of IV ephedrine 30μg/kgBB is not a significantly different effect compared with 2% lidocaine 40 mg IV to prevent response to pain during injection of propofol 2 mg / kg IV, P> 0.05 (P = 0.068), but clinically group B have the ability to eliminate pain in 59 patients (92.2%) compared with group A in 52 patients (81.3%), while the possibility of causing pain in group A were 12 patients (7.8%) and group B were 5 patients (18.7%)
Expression of receptor advanced glycosilation end product (RAGE) and active caspase-3 of the streptozotocin-induced chronic diabetes mellitus Sprague Dawley rats’ sperm with soybean (Glycin max) powder suspension treatment
No full textDiabetes mellitus (DM) affects all the process of spermatogenesis. Chronic hyperglycemia in DM increases the expression of receptor for advanced glycosilation end products (RAGE) that is responsible for the activation of signal production of reactive oxygen species (ROS) and caspase 3. Active caspase 3 plays an important role in cell apoptosis. Soybean (Glycin max) is reported to have antihyperglycemic and antiadvanced glycosilation end products (antiAGE) and antioxidants activities. The aim of this study was to evaluate the effect of soybean powder suspension on the expression of RAGE and active caspase 3 of diabetic rats’ sperm. This was an experimental study with post test only control group design using 30 male Sprague Dawley rats, aged 11-12 weeks old and weighed 200-250g. The rats were divided into five groups with six rats in each group. Group 1 was non diabetic rats and Group 2 was diabetic rats that were given aquadest. Group 3-5 were diabetic rats that were given a soybean powder suspension at dose of 400; 800 and 1600 mg/kg body weight (BW)/day, respectively. Diabetic rats were made by induction of a single intraperitoneal injection of streptozotocin (STZ) at a dose of 60 mg/kg BW. Soybean powder suspension was ingested for four weeks after 14 days STZ induction. Blood glucose levels were monitored before and three days after STZ induction and four weeks after suspension ingestion. The expression of RAGE and active caspase-3 were analyzed using immunohistochemistry method four weeks after suspension ingestion. The results showed that soybean powder suspension ingestion significantly decreased blood glucose level of diabetic rats toward normality (p<0.05). However, the expression of RAGE and active caspase-3 in diabetic rats’ sperm were not significantly lower than those after suspension ingestion. In conclusion, soybean powder suspension does not significantly affect the expression of RAGE and active caspase-3 in diabetic rats’ sperm
Molecular subtypes and clinicopathological features of breastcancer
No full textBreast cancer is a heterogeneous disease with regard to morphological spectrum, clinical presentation and response to therapy. Based on immunohistochemistry detection of estrogen receptor, progesterone receptor, Her-2 status, proliferation rate and clusters of basal gene expression, breast cancers can be classified into luminal A, luminal B, basal-like/triple negative, and Her-2 positive. It was suggested that there was a close relationship between molecular subtypes and clinicopathological features of breast cancer, as they are very important to predict prognosis and therapeutic implications.