Polimorfisme Gen Glutamylcysteine Ligase Catalytic (GCLC) Sebagai Deteksi Kerentanan Pasien Tuberkulosis Terhadap Stres Oksidatif Akibat Infeksi Mycobacterium tuberculosis

The important genetic factor about susceptibility of oxidative stress in Pulmonary Tuberculosis (PTB) has not been determined. The aim of this study was to analyse the association between polymorphism glutamatecysteine ligase catalytic subunit (GCLC) genes with susceptibility of oxidative stress in PTB in Makassar population of Indonesian. The Methods use is a case-control study was performed on 25 paired subjects with or without PTB, These subjects were selected from result of BTA stain from sputum subjects. The following polymorphisms were genotyped by PCR-RFLP of −129C/T in the GCLC gene. Genotype frequencies and allelic frequencies were analysed. The Results was found There were significant differences in the distribution of genotype frequencies for polymorphism −129C/T in GCLC gene between PTB and non-PTB subjects. The distribution of the allelic frequencies of these genes also showed significant difference between the two groups. Conclusions is The genetic polymorphisms in GCLC −129C/T are associated with susceptibility of Oxidative stress on PTP subject

Profil Gen Nat2 Pasien dengan Pemberian Obat Anti Tuberkulosis Menggunakan Metode PCR-RFLP

Tuberkulosis disebabkan oleh bakteri Mycobacterium tuberculosis dan pada utamanya diberikan Isoniazid (INH), obat ini dimetabolisme oleh N-asetiltransferase 2 (Nat2) terutama pada fase II. Tujuan penelitian ini yaitu untuk mengetahui profil dari gen Nat2 pada penderita tuberkulosis yang mengkonsumsi obat anti tuberkulosis dengan menggunakan PCR-RFLP. Penelitian ini menggunakan sampel darah pasien tuberkulosis yang diterapi INH, kemudian dilakukan ekstraksi DNA dan PCR dengan primer P1 dan P2. Penentuan profil gen Nat2 berdasarkan hasil visualisasi elektroforesis produk DNA amplifikasi PCR dan RFLP menggunakan enzim restriksi FokI. Hasil penelitian menunjukkan bahwa dari 30 sampel penderita TB terdapat 22 sampel yang dapat teramplifikasi gen Nat2 dan 8 sampel yang tidak teramplifikasi oleh gen Nat2 yang berasal dari sampel DBS. Frekuensi alel C282T pada sampel penelitian ini diperoleh alel CT sebanyak 10, dan CC sebanyak 12 sedangkan untuk alel TT tidak ada. Frekuensi alel CC dan CT berhubungan dengan fenotipe asetilator cepat terhadap isoniazid

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The role of religious loyalty in combating digital piracy: an Islamic perspective

Religiosity has been seen as a powerful determinant of human actions especially in situations of ethical dilemmas such as digital piracy. Thus, it has been addressed as a potential informal institution to curtail the phenomenon. However, previous research indicated a confounding influence of some contextual factors on the anticipated role of religious loyalty such as the dominant secular culture. As such, the main objective of this article is to investigate the role of religious loyalty in combating digital piracy from the Islamic perspective since loyalty is a core aspect of Muslim’s society as directly associated with faith. Additionally, this paper explores the contextual factors in Islamic countries that may influence the role of religious loyalty in fighting digital piracy. This study involved with qualitative data, gathered from journal articles and books, and then the data analysed using content analysis method. The analysis shows that integrating religion within the campaign toward copyright is potentially viable provided that other contextual factors are properly tackle