Combination of Glasgow Coma Scale, Age, and Systolic Blood Pressure in Assessing Patients' Outcomes with Decreased Consciousness

Glasgow Coma Scale (GCS) is commonly used to assess outcomes of patients with loss of consciousness, but it is insufficient in predicting the outcome of some cases. This study aimed to assess the combination of GCS, systolic blood pressure and age to predict the outcome of patients with decreased consciousness. This was a retrospective cohort observational study of 76 loss of consciousness patients that comes into the Emergency Department of Dr. Cipto Mangunkusumo General Hospital in June-August 2014. Data was obtained from the medical records . GCS, systolic blood pressure and age were recorded when patients were admitted to the triage. Outcome was assessed two weeks after admission in the emergency department. Bivariate analysis on the GCS and age showed significant different between patients with poor outcome group with good outcome group (p<0.05) and no significant different of the systolic blood pressure between both groups (p>0.05). Multivariate analysis on the GCS and age showed good probability equation based on the calibration test and discrimination. The combination of Glasgow Coma Scale and age was accurate in assessing the outcomes of patients with loss of consciousness. &nbsp

Nilai Rerata Vascular Pedicle Width, Vascular Pedicle-Cardiac Ratio Vascular Pedicle-Thoracic Ratio Orang Dewasa Normal Indonesia Studi Di RS Dr. Cipto Mangunkusomo

Vascular pedicle width (VPW) adalah jarak tepi luar vena kava superior ke tepi luar arteri subklavia kiri. Pemeriksaan VPW di foto toraks bersifat non-invasif, cepat dan mudah untuk memprediksi hipervolemia.Penelitian ini bertujuan untuk mengetahui rerata nilai VPW orang dewasa normal Indonesia. VPW diukurdengan dua metode: pertama pengukuran VPW tunggal yang akurasinya terbatas di foto toraks digital karenarelatif tidak dipengaruhi faktor magnifikasi. Metode kedua untuk foto toraks nondigital yaitu pengukuranrasio:vascular pedicle-cardiac ratio (VPCR) dan vascular pedicle-thoracic ratio (VPTR). Pengukuran serupadilakukan terhadap  topogram CT scan toraks AP terlentang dan CT scan toraks lalu dibandingkan akurasipengukuran di topogram dengan CT scan  toraks sebagai standar baku. Sampel terdiri atas 104 foto toraksPA subyek normal dan 103 CT scan  toraks subyek terpilih. Pada pemeriksaan toraks PA didapatkan rerata VPW 48,0±5,5mm, rerata VPCR 40,3±4,6%, dan rerata VPTR 17,2±1,7%. Pada pemeriksaan topogram CTscan didapatkan rerata VPW 50,3±6,2mm, rerata VPTR 45±5,1%, dan rerata VPTR 19,8±2,5%. Rerata VPWpada CT scan toraks 50,4±6,1mm. Pengukuran di foto toraks AP 10% lebih besar dibandingkan pada fototoraks PA dan pengukuranVPW di foto toraks terbukti memiliki akurasi  tinggi. Kata kunci: fototoraks, vascular pedicle width, vascular pedicle-cardiac ratio, vascular pedicle-thoracic ratio, hipervolemia.   The Mean Value of Vascular Pedicle Width, Vascular Pedicle-Cardiac Ratio,Vascular Pedicle-Thoracic Ratio of Normal Indonesian Adult Study In dr. Cipto Mangunkusomo Hospita

Thoracic epidural anesthesia attenuates hemorrhagic-induced splanchnic hypo-perfusion in post-resuscitation experimental hemorrhagic shock

<p>The purpose of present study was to assess the effects of thoracic epidural anesthesia on splanchnic perfusion, bacterial translocation and histopathologic changes in experimental hemorrhagic shock in short-tailed macaques (<em>Macaca nemestrina</em>). Sixteen<em> Macaca nemestrinas</em> were randomly assigned to one of two groups i.e. the lidocaine group (n = 8), receiving general anesthesia plus lidocaine thoracic epidural anesthesia; and the saline group (n = 8), receiving general anesthesia alone as control. Hemorrhagic shock was induced by withdrawing blood gradually to a mean arterial pressure (MAP) of 40 mm Hg, and maintained for 60 minutes. Animals were then resuscitated with their own blood and ringer lactate solution (RL). After resuscitation, epidural lidocaine 2% was given in the lidocaine group and saline in the control group. Resuscitation that was performed after one hour hemorrhagic shock, with hemodynamic variables and urine output returned to normal, revealed there was no improvement of splanchnic perfusion. PgCO2, P(g-a)CO2, and pHi remained in critical value and tended to deteriorate in the saline group. Contrast to saline group, splanchnic perfusion in lidocaine group tended to improve. This condition was supported by the finding of less bacterial translocation and better histopathologic changes in lidocaine thoracic epidural anesthesia group than in saline group. This study concludes that lidocaine thoracic epidural anesthesia attenuates splachnic hypoperfusion in post-resuscitation hemorrhagic shock in <em>Macaca nemestrina</em>. <em><strong>(Med J Indones 2008; 17: 73-81)</strong></em></p><p><strong>Keywords:</strong> <em>thoracic epidural anesthesia, lidocaine, hemorrhagic shock, splanchnic hypoperfusion, bacterial translocation</em></p

Combination of Glasgow Coma Scale, Age, and Systolic Blood Pressure in Assessing Patients’ Outcomes with Decreased Consciousness

Glasgow Coma Scale (GCS) is commonly used to assess outcomes of patients with loss of consciousness, but it is insufficient in predicting the outcome of some cases. This study aimed to assess the combination of GCS, systolic blood pressure and age to predict the outcome of patients with decreased consciousness. This was a retrospective cohort observational study of 76 loss of consciousness patients that comes into the Emergency Department of Dr. Cipto Mangunkusumo General Hospital in June-August 2014. Data was obtained from the medical records . GCS, systolic blood pressure and age were recorded when patients were admitted to the triage. Outcome was assessed two weeks after admission in the emergency department. Bivariate analysis on the GCS and age showed significant different between patients with poor outcome group with good outcome group (p&lt;0.05) and no significant different of the systolic blood pressure between both groups (p&gt;0.05). Multivariate analysis on the GCS and age showed good probability equation based on the calibration test and discrimination. The combination of Glasgow Coma Scale and age was accurate in assessing the outcomes of patients with loss of consciousness. &nbsp

The Effect of Intravenous Vitamin C on Urine Neutrophil Gelatinase-Associated Lipocalin Among Septic Patients: A Randomised Control Trial

Background The role of vitamin C to decrease organ dysfunction in sepsis was still controversial. This study aimed to explore the effect of intravenous (IV) vitamin C on urine NGAL (uNGAL) levels among septic patients in ICU. Methods This study was a randomized clinical trial held in Cipto Mangunkusumo Hospital from April to July 2019 with consecutive sampling method. Patients aged &gt; 18 years with sepsis based on the criteria of sepsis-3 who were admitted to the ICU were included in this study. Exclusion criteria were those with chronic kidney problems, with kidney stones, undergo renal replacement therapy in the ICU. All subjects were divided into: Group A was treated&nbsp; with combination of vitamin C and thiamine while Group B was given thiamine only. The uNGAL level was measured at baseline, 24, 48 and 72 h after treatment. Anova for repeated measurement using General Linear Model for Repeated Measurement was used with level of significant at p-value &lt;0.05. Results Total of 33 subjects were included. In Group A we found uNGAL (ng/ mL) were 74.5 (13.3-102.9), 77.3 (15.2-98.4), 67.2 (22.6-100.6), 77.2 (17.0-100.5) for baseline, 24 h, 48 h, and 72 h respectively. While in Group B uNGAL were 57.7 (11.5-94.5), 57.1 (6.4-97.7), 53.7 (13.3-99.6), 47.6 (4.5-100.9). No significant difference in terms of uNGAL between two groups at each hour was found. Conclusions This study showed that intravenous vitamin C administration had no effect on uNGAL among septic patients. Need more study to investigate approaches to improve kidney and inflammatory biomarker among septic patients

The effects of colloids or crystalloids on acute respiratory distress syndrome in swine (<em>Sus scrofa</em>) models with severe sepsis: analysis on extravascular lung water, IL-8, and VCAM-1

Background: Acute respiratory distress syndrome (ARDS) is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW) elevation and levels of interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been studied as indicators playing a role in the pathogenesis of ARDS. The aim of the study was to determine the effects of colloid or crystalloid on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis. Methods: This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, IPB, using 22 healthy swine models with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Analysis of data using the Wilcoxon test , Kolmogorov-Smirnov test, Mann-Whitney test, unpaired t test. Results: Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. EVLW elevation was lower in the colloid compared to the crystalloid group. There was no significant difference in IL-8 and VCAM-1 levels between the two groups. Conclusion: The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI, but not with IL-8 or VCAM-1 levels

Nilai Rerata Vascular Pedicle Width, Vascular Pedicle-Cardiac Ratio Vascular Pedicle-Thoracic Ratio Orang Dewasa Normal Indonesia Studi di RS dr. Cipto Mangunkusomo

Vascular pedicle width (VPW) adalah jarak tepi luar vena kava superior ke tepi luar arteri subklavia kiri. Pemeriksaan VPW di foto toraks bersifat non-invasif, cepat dan mudah untuk memprediksi hipervolemia.Penelitian ini bertujuan untuk mengetahui rerata nilai VPW orang dewasa normal Indonesia. VPW diukurdengan dua metode: pertama pengukuran VPW tunggal yang akurasinya terbatas di foto toraks digital karenarelatif tidak dipengaruhi faktor magnifikasi. Metode kedua untuk foto toraks nondigital yaitu pengukuranrasio:vascular pedicle-cardiac ratio (VPCR) dan vascular pedicle-thoracic ratio (VPTR). Pengukuran serupadilakukan terhadap&nbsp; topogram CT scan toraks AP terlentang dan CT scan toraks lalu dibandingkan akurasipengukuran di topogram dengan CT scan&nbsp; toraks sebagai standar baku. Sampel terdiri atas 104 foto toraksPA subyek normal dan 103 CT scan&nbsp; toraks subyek terpilih. Pada pemeriksaan toraks PA didapatkan rerata VPW 48,0&plusmn;5,5mm, rerata VPCR 40,3&plusmn;4,6%, dan rerata VPTR 17,2&plusmn;1,7%. Pada pemeriksaan topogram CTscan didapatkan rerata VPW 50,3&plusmn;6,2mm, rerata VPTR 45&plusmn;5,1%, dan rerata VPTR 19,8&plusmn;2,5%. Rerata VPWpada CT scan toraks 50,4&plusmn;6,1mm. Pengukuran di foto toraks AP 10% lebih besar dibandingkan pada fototoraks PA dan pengukuranVPW di foto toraks terbukti memiliki akurasi&nbsp; tinggi. Kata kunci: fototoraks, vascular pedicle width, vascular pedicle-cardiac ratio, vascular pedicle-thoracic ratio, hipervolemia. &nbsp; The Mean Value of Vascular Pedicle Width, Vascular Pedicle-Cardiac Ratio,Vascular Pedicle-Thoracic Ratio of Normal Indonesian Adult Study In dr. Cipto Mangunkusomo Hospital Abstract Vascular pedicle width (VPW) is the distance, from a perpendicular line at the takeoff point of the left subclavian artery off the aorta to the point at which the superior vena cava. Measurement of VPW on chestx-ray is relatively non-invasive, fast and easy technique as&nbsp; hypervolemia predictor. The purpose of thisstudy is to know the mean VPW value of normal Indonesian adult.&nbsp; There are two measurement methodswas performed, the first is a measurements of single VPW, which its accuracy is limited to digital chest x-ray.The second method for non digital chest x-ray utility is a ratio measurement&nbsp; i.e. the ratio of cardiac vascularpedicle-(VPCR), and vascular pedicle-thoracic ratio (VPTR). Similar measurements method&nbsp; performed onthe thoracic CT scan topogram (AP chest x-ray) and thoracic CT scan, then compared both of measurementto evaluate the accuracy of topogram measurement as thoracic CT scan as gold standard.&nbsp; Data from 104 PAchest x-ray of normal subjects&nbsp; and 103 thoracic CT scan of selected subjects. On PA chest x-ray obtainedmean VPW 48,0&plusmn;5.5mm, mean VPCR 40.3&plusmn;4.6%, and mean VPTR 17.2&plusmn;1.7%. On CT scan topogramobtained mean VPW 50,3&plusmn;6.2mm, mean VPTR 45&plusmn;5.1%, and mean VPTR 19.8&plusmn;2.5%. On thoracic CT scanobtained mean VPW 50.4&plusmn;6.1mm. Measurements on the&nbsp; AP&nbsp; chest x-ray about 10% greater than in the&nbsp; PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved to have high accuracy. Keyword: chest x-ray, vascular pedicle width, vascular pedicle-cardiac ratio, vascular pedicle-thoracic ratio, hypervolemia

MMP-9, brain edema, and length of hospital stay of patients with spontaneous supratentorial intracerebral hemorrhage after hematoma evacuation along with the administration of tigecycline

Background: The high plasma level of matrix metalloproteinses–9 (MMP-9) is believed to disrupt the blood-brain barrier (BBB) and cause brain edema, as well as increase patient’s length of hospital stay (LOS). Tigecycline showed ability to reduce the MMP-9 level on study in animals. This study aimed to evaluate whether tigecycline can reduce the plasma levels of MMP-9; brain edema; and LOS of patients with supratentorial spontaneous intracerebral hemorrhage (SSICH). Methods: A randomized clinical trial (RCT) was conducted on 72 SSICH patients who underwent hematoma evacuation in eleven hospitals in Jakarta; 100 mg tigecycline (n=35) or 2 g fosfomycine (n=37) administered intravenously before skin incision as an prophylactic antibiotics to avoid post-operative infections. Plasma levels of MMP-9 were measured in all subjects before and on the first and seventh day after the surgery. Reduction of brain edema was assessed by comparing the extent of brain edema on computed tomography scan (CT scan) before and CT scan after surgery. The length of stay (LOS) was recorded at the time of hospital discharge either survive or death. Data were analyzed using Mann-Whitney and Chi-Square test. Results: There were non-significant statistical differences between two groups in the proportion of subjects with reduced MMP-9 levels on the first day (48% vs 50%; p=0.902; OR=1.1) and seventh day after the surgery (33% vs 48%; p=0.296; OR=1.9); proportion of the subjects with brain edema reduction (86% vs 80%, p=0.58); LOS (median 12 days vs 13 days, p=0.256; LOS ≥15 days 40% vs 27%; p=0.243; OR=1.81; NNT=8). Conclusion: On SSICH patients who underwent hematoma evacuation, tigecycline did not either reduce MMP-9 levels and brain edema or shorthen LOS