Aktivitas Membran Bakiko (Bayam-Kitosan-Kolagen) terhadap Ekspresi Matriks Metaloproteinase-9 pada Luka Bakar Derajat II

Matrix metalloproteinase-9 (MMP-9) plays an important role in regulating the degradation and deposition extracellular matrix (ECM) that are important for wound reepithelization. However, excessive protease activity can lead to delayed wound healing. Kaemferol in spinach can inhibit the activity of MMP-9. Chitosan and collagen can help tissue growth and have an antimicrobial effect. Chitosan-collagen membranes have been widely used for wound healing but, the results are unsatisfactory. Therefore, the researcher wanted to know the activity of bakiko (Spinach-Chitosan-Collagen) membrane to MMP-9 expression on second degree burn with immunohistochemical method. This research was true-experimental laboratories design with post test only control group design. The experimental animals used were 36 white wistar rats (Rattus novergicus) male, divided into 4 groups ie control group, negative control, positive control (bioplacenton), and treatment (bakiko membrane). Data were obtained by calculating MMP-9 using ImageJ software. The analysis using anova test showed that p value less than 0.05 indicated a significant difference. This study showed that there was a decrease in MMP-9 activity by bakiko membrane in grade II burn with immunohistochemical method in wistar rats

Utilization Of Indole-3-Carbinol As Flavin Monooxygenase 3 (Fmo3) Inhibitor In Aterosklerotic Prevention

Cardiovascular disease is the leading cause of death in the world, reaching 30% of all mortality. The most common cause of cardiovascular disease is the formation of atherosclerotic plaque in blood vessels. Treatment has been done to overcome atherosclerosisonly curative and still no preventive. Processes that play a role in the formation of atherosclerotic plaque is very complex and one of the causes deposition of plaques is the formation of the compound trimethylamine oxide (TMAO) in the body. TMAO that has produced can increase the accumulation of cholesterol in macrophages so that increasing the formation of foam cells in the arterial wall. These compounds are derived from trimethylamine (TMA), which is converted into TMAO by enzyme flavin monooxygenase (FMO). FMO enzyme that is able to make an impact in the formation of TMAO is flavin monooxygenase 1 (FMO1) and flavin monooxygenase 3 (FMO3). However, FMO3 showed activity ten times greater than FMO1 in turning TMA into TMAO. Indole-3-carbinol can be a role for this enzyme inhibitor so that the therapeutic use of indole-3-carbinol is expected to inhibit TMAO. Therefore, the authors propose the use of research in the form of indole-3-carbinol as an inhibitor of flavin monooxygenase 3 (FMO3) in atherosclerosis prevention efforts. The study design used was pure experimental research design (true experimental design) with post test only randomized control group design. Mice (Mus musculus) males were treated indole-3-carbinol and then is given atherogenic diet for the provision of intravenous adrenaline 0.00084 mg / 20 gBW and egg yolks 0.2 cc / day. The treatment group consisted of a positive control, negative control, treatment A (10 mg / kg BW of indole-3-carbinol), B (200 mg / kg BW I3C), and C (500 mg / kg BW I3C). The data observed in the form of cholesterol, foam cell histopathological picture of the aorta and the density of the band FMO3 activity. Blood cholesterol levels showed a decrease in accordance with increase in dose. Cholesterol control of negative group, positive, A, B and C respectively of 119.4 28.94 mg / dL, 246 8.52 mg / dL, 224 15.30 mg / dL, 170.6 12.54 mg / dL, and 154.8 14.46 mg / dL (p <0.05). Histopathologic features foam cell in the aorta of mice showed an improvement with the increase in dose. FMO3 enzyme activity also showed a decrease when compared to the positive control in the optical density relative scale along with rising doses of indole-3-carbinol given. This shows that the use of indole-3-carbinol is very effective in atherosclerosis prevention efforts

AKTIVITAS MEMBRAN BAKIKO (BAYAM-KITOSAN-KOLAGEN) TERHADAP EKSPRESI MATRIKS METALOPROTEINASE-9 (MMP-9) PADA LUKA BAKAR DERAJAT II DENGAN METODE IMUNOHISTOKIMIA

Luka bakar merupakan masalah kesehatan global dengan estimasi perhitungan sebesar 265.000 kematian setiap tahunnya. Lebih dari 500.000 luka bakar luka terjadi setiap tahun di Amerika Serikat. Meskipun sebagian besar luka bakar ini ringan, kira-kira 40.000 sampai 60.000 pasien luka bakar memerlukan pertolongan di rumah sakit untuk perawatan yang tepat (Townsend et al., 2012). Prevalensi cedera di Indonesia adalah 8,2% dan 0,7% dari keseluruhan cedera disebabkan karena terbakar. Penyebab cedera karena terbakar ditemukan proporsi tertinggi di Papua (2%) dan terendah (tanpa kasus) di Kalimantan Timur (Trihono, 2013). Luka bakar adalah cedera pada kulit dan jaringan sekitarnya akibat suhu, bahan kimia, listrik, atau radiasi. Menurut Clouatre et al. (2013) di daerah Ontario, Canada, sebesar 32,7% luka bakar disebabkan karena api, 27% karena listrik, dan 19,7% disebabkan oleh air mendidih. Luka bakar membutuhkan perawatan luka yang kompleks karena merupakan luka terbuka yang merusak epidermis dan jaringan-jaringan di bawahnya. Pada luka bakar dapat terjadi proses inflamasi, infeksi, dan pada keadaan yang parah, penguapan cairan tubuh diikuti dengan hilangnya panas dan energi tubuh (Rowan et al., 2015). Oleh karena itu pada luka bakar, dibutuhkan obat-obatan yang dapat mempercepat epitelisasi kulit, memiliki sifat antimikroba, mampu memodulasi inflamasi, dan mencegah penguapan cairan melalui kulit

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Aktivitas Membran Bakiko (Bayam-Kitosan-Kolagen) terhadap Ekspresi Matriks Metaloproteinase-9 pada Luka Bakar Derajat II

Matrix metalloproteinase-9 (MMP-9) plays an important role in regulating the degradation and deposition extracellular matrix (ECM) that are important for wound reepithelization. However, excessive protease activity can lead to delayed wound healing. Kaemferol in spinach can inhibit the activity of MMP-9. Chitosan and collagen can help tissue growth and have an antimicrobial effect. Chitosan-collagen membranes have been widely used for wound healing but, the results are unsatisfactory. Therefore, the researcher wanted to know the activity of bakiko (Spinach-Chitosan-Collagen) membrane to MMP-9 expression on second degree burn with immunohistochemical method. This research was true-experimental laboratories design with post test only control group design. The experimental animals used were 36 white wistar rats (Rattus novergicus) male, divided into 4 groups ie control group, negative control, positive control (bioplacenton), and treatment (bakiko membrane). Data were obtained by calculating MMP-9 using ImageJ software. The analysis using anova test showed that p value less than 0.05 indicated a significant difference. This study showed that there was a decrease in MMP-9 activity by bakiko membrane in grade II burn with immunohistochemical method in wistar rats.</jats:p

Aktivitas Membran Bakiko (Bayam-Kitosan-Kolagen) terhadap Ekspresi Matriks Metaloproteinase-9 pada Luka Bakar Derajat II (Activity of Bakiko Membrane (Spinach-Chitosan-Collagen) to Matrix Metalloproteinase-9 Expression on Grade II Burn Wound)

Matriks metalloproteinase-9 (MMP-9) memainkan peran penting dalam mengatur degradasi dan deposisi extracellular matrix (ECM) yang penting untuk reepitelisasi luka. Namun, aktivitas protease yang berlebih dapat menyebabkan penyembuhan luka terhambat. Kaemferol dalam bayam dapat mengendalikan aktivitas MMP-9. Kitosan dan kolagen menyerupai komponen ECM sehingga dapat membantu pertumbuhan jaringan dan bersifat sebagai antimikroba. Membran kitosan-kolagen telah banyak dimanfaatkan untuk penyembuhan luka namun, hasilnya kurang memuaskan. Oleh karena itu, peneliti ingin mengetahui aktivitas membran bakiko (bayam-kitosan-kolagen) terhadap ekspresi MMP-9 pada luka bakar derajat II dengan metode imunohistokimia. Penelitian ini dilakukan secara true-experimental laboratories design dengan rancangan post test only control group. Hewan coba yang digunakan adalah tikus putih (Rattus novergicus) galur wistar jantan sebanyak 36 ekor, dibagi menjadi 4 kelompok yakni kelompok kontrol, kontrol negatif, kontrol positif yang diberikan bioplacenton, dan perlakuan yang diberikan membran bakiko. Data diperoleh melalui penghitungan MMP-9 menggunakan software ImageJ pada sediaan imunohistokimia. Analisis dengan menggunakan uji anova didapatkan nilai p kurang dari 0,05 yang menunjukkan adanya perbedaan yang signifikan. Penelitian ini menunjukkan bahwa terjadi penurunan aktivitas MMP-9 oleh membran bakiko pada luka bakar derajat II dengan metode imunohistokimia pada tikus wistar

KANDUNGAN FITOESTROGEN EKSTRAK ETANOLIK AKAR RAMI (Boehmeria nivea) MENURUNKAN KADAR KOLESTEROL TIKUS YANG DIOVARIEKTOMI

Latar Belakang: Dislipidemia merupakan salah satu penyebab utama morbiditas, mortalitas dan biaya pengobatan yang tinggi. WHO menyebutkan dislipidemia berhubungan dengan kejadian penyakit jantung koroner (PJK) yang menyebabkan 4 juta kematian setiap tahun. Estrogen, hormon yang diproduksi wanita selama menarche melindungi wanita dari PJK. Saat menopause terjadi penurunan produksi estrogen sehingga resiko dislipidemia dan PJK semakin tinggi. Terapi fitoestrogen digunakan untuk mencegah dislipidemia dan PJK saat menopause. Fitoestrogen merupakan senyawa mirip estrogen dan terdapat pada akar tanaman Boehmeria nivea yang digunakan dalam penelitian ini. Efek estrogenik akar tanaman Boehmeria nivea terutama disumbang oleh kandungan isoflavon dan lignannya. Tujuan: Penelitian ini bertujuan membuktikan kandungan fitoestrogen ekstrak akar Boehmeria nivea untuk meningkatkan berat uterus dan memperbaiki dislipidemia tikus yang diovariektom dan diinduksi diet aterogenik. Metode: Desain penelitian menggunakan eksperimental semu dengan rancangan post test only. Tikus putih betina diovariektomi kemudian diberi diet aterogenik berupa kuning telur 3,5 cc/hari disertai injeksi adrenalin intravena 0,006mg/200gBB. Sampel dibagi menjadi 6 kelompok terdiri atas kontrol negatif, kontrol ovariektomi, kontrol ovariektomi dengan induksi diet aterogenik, kelompok perlakuan ekstrak etanolik B.nivea (EBN) dosis 125 mg/kgBB, 250 mg/kgBB, dan 500 mg/kgBB. Hasil: Berat uterus kelompok ovariektomi mengalami penurunan signifikan dibanding kelompok kontrol, sedangkan berat uterus kelompok perlakuan EBN meningkat signifikan dibanding kelompok ovariektomi. Kadar kolesterol darah menunjukkan penurunan akibat perlakuan EBN, sedangkan kadar trigliserida mengalami peningkatan akibat perlakuan EBN. Simpulan: Kandungan fitoestrogen ekstrak akar rami meningkatkan berat uterus dan menurunkan hiperkolesterolemia pada tikus yang diovariektomi

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally