Laboratory Diagnosis of von Willebrand's Disease

von Willebrand's disease (vWD) is an autosomally inherited bleeding disorder caused by a deficiency or abnormality of von Willebrand factor (vWF). vWF is a multimeric adhesive protein that plays an important role in primary hemostasis by promoting platelet adhesion to the subendothelium at the sites of vascular injury. It is also the carrier of factor VIII (FVIII), thus indirectly contributing to the coagulation process. Bleeding symptoms are usually mucocutaneous and postsurgical with varying severity. The diagnosis of vWD requires a personal and family history of bleeding and confirmation by laboratory analysis involving vWF antigen level, vWF ristocetin cofactor, FVIII activity, ristocetin-induced platelet aggregation, and vWF multimer analysis.KEYWORDS: von Willebrand's disease, von Willebrand facto

Pathomechanism of Renal Damage in Type 2 Diabetes Mellitus Patients

BACKGROUND: Hyperglycemia in diabetic patients cause both chronic inflammation and extracellular matrix accumulation that can lead to progressive renal damage. Albumin, Gammaglutamytransferase (GGT) and clusterin in urine are markers to detect damage in glomerulus, cell of the tubules and proximal tubules, respectively.METHODS: This study aimed to evaluate the pathomechanism of haemoglobin A1c (HbA1c), albumin, GGT, clusterin, type IV collagen in urine, and high sensitivity C-reactive protein (hsCRP) in type 2 diabetes mellitus (DM) patients. The study was a cross sectional study involving 82 subjects consisting of 36 males and 46 females, 35-65 years old, divided into 3 groups: uncontrolled DM, controlled DM and non DM. Data were obtained from interviews, physical examinations (weight, height, blood pressure) and laboratory examinations (HbA1c, serum glutamic oxaloacetic (SGOT), serum glutamic pyruvic (SGPT), creatinine, hsCRP, urinary albumin, urinary GGT, urinary clusterin, and urinary type IV collagen). Statistical analysis was performed for correlation, difference and cross tabulation tests.RESULTS: The study results showed there were significant differences (p<0.05) between uncontrolled DM group compared with controlled DM and non DM groups in HbA1c, ratio of urinary type IV collagen and ratio of urinary albumin. However, there were no significant differences between controlled DM and non DM groups. There were positive significant correlations between HbA1c with hsCRP (r=0.223, p<0.05), HbA1c with ratio of urinary type IV collagen/creatinine (r=0.563, p<0.001), HbA1c with ratio of urinary albumin/creatinine (r=0.263, p<0.05), and ratio of urinary type IV collagen/creatinine with ratio urinary albumin/creatinine (r=0.613, p<0.001).CONCLUSION: Results of this study indicated that albumin and type IV collagen in urine play a role in renal damage caused by uncontrolled glucose level in subjects with type 2 DM. The increased concentration of both HbA1c and urinary type IV collagen indicates increased risk factor of glomerulus damage. Urinary type IV collagen is likely to be future potential marker for early detection of renal damage.KEYWORDS: renal damage, HbA1c, hsCRP, type IV collagen, GGT, clusterin, diabetes mellitu

Correlation Between Onset of Diabetes Mellitus and Nitric Oxide Levels in Patient with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (DM) is associated with increased risk of endothelial dysfunction if it lasts a long time without control. This study aims to connect the Onset of Diabetes Mellitus (DM) with Nitric Oxide levels in patients of type 2 diabetes mellitus. The study used cross-sectional study method. The samples were 86 subjects, consisting of 38 subjects of Type 2 DM controlled and 48 subjects of Type 2 DM uncontrolled. The results of the Kruskal-Wallis statistical test showed no significant difference between the Onset of DM and Nitric Oxide levels in the categories of 4-6 years (19.4 ± 10.1), 7-9 years (17.3 ± 9.3) and 10-12 years (13.3 ± 8.5) (p=0.06). Furthermore, the Spearman correlation test revealed a negative correlation between the Onset of DM and Nitric Oxide level in patients with Type 2 DM with and without control (r =-0.217). The level of Nitric Oxide (NO) can consider as a predictor of long-term complication in patients with type 2 DM

Incidence of Klebsiella pneumoniae producing Metallo Beta-Lactamase (MBL) at RSUP Dr. Wahidin Sudirohusodo Makassar

Bacterial resistance to antibiotic is one of the factors triggering infection therapy failure. This study was conducted to determine the prevalence of carbapenem-resistance Klebsiella pneumoniae infection and the phenotype of carbapenem-resistant Metallo-Beta-Lactamase (MBL)-producing Klebsiella pneumoniae isolates at RSUP Dr. Wahidin Sudirohusodo Makassar. This study included Klebsiella pneumoniae identification on each infectious patient’s isolates. The sensitivity test of antibiotics, phenotype confirmatory test, and MBL phenotypic test were conducted using agar diffusion Kirby-Bauer, Vitek-2-Compact, and Double Disc Synergy Test (DDST) method, respectively. As the result, the antibiotic sensitivity test using the Vitek-2-Compact method on 50 clinical samples (pus, sputum, blood. tissue, urine, brain fluid, and feces) found that 10 isolates (20%) were resistant to carbapenem.  The phenotypic test using the Double Disc Synergy Test (DDST) method found that carbapenem-resistant isolates caused by the production of Metallo Beta Lactamase (MBL) enzymes were 2 isolates or 20% of the total carbapenem-resistant isolates

Correlation between Extracellular Heat Shock Protein 60 (exHSP60) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) in Non Diabetic Men

BACKGROUND: Adipose tissue expansion in obesity leads to abnormal adipocyte function, chronic low grade inflammation, primary reticulum stress, and mitochondrial stress. This induces mitochondrial unfolded protein response (UPRmt) that selectively upregulates mitochondrial chaperone protein. Heat shock Protein 60 (HSP60) is the primary chaperone in mitochondrial matrix. Inflammatory stress promotes HSP60 released from adipocytes and induces insulin resistance. In this study we attempted to investigate the correlation between exHSP60 and HOMA-IR in men with different ranges of waist circumference (WC).METHODS: This study was an observational cross sectional study carried out on 141 non diabetic men, aged 30-55 years old, who were divided into three groups based on WC; WC ≤90 cm, 90 cm 100 cm. Fasting plasma glucose, triglyceride, HDL-C, hsCRP, HSP60 serum and anti-HSP60 antibody, serum IL-1β serum, insulin, were examined. For statistical analysis, Kolmogorov-Smirnov and Spearman’s correlation analysis were conducted.RESULTS: There were a significant correlation between exHSP60 and HOMA-IR (r=0.281; p=0.041) in WC ≤ 90 cm group; and a negative significant correlation between exHSP60 and HOMA-IR (r=-0.508; p=0.007) in WC > 100 cm group.CONCLUSION: This study showed that there was a dynamic correlation between exHSP60 and HOMA-IR in WC ≤ 90 cm group compared with WC > 100 cm group. We also found inverse correlation patterns between exHSP60 and HOMA-IR, and between anti-HSP60 antibody and HOMA-IR in non diabetic subjects.KEYWORDS: obesity, insulin resistance, mitochondrial stress, exHSP60, hsCRP, HOMA-I

Estimated Blood Loss in Craniotomy

Introduction: Estimated blood loss is an estimation of how much blood is loss during surgery. Surgical procedure requires a preparation of blood stock, but the demand for blood often larger than the actual blood used. This predicament happens because there is no blood requirement protocol being used. This study aims to determine the estimated blood loss during craniotomy procedure and it's conformity to blood units ordered for craniotomy procedure. Methods: This study is a retrospective study using data from Wahidin Sudirohusodo General Hospitals' medi- cal records in the period of January 2010-December 2012. We found 89 craniotomy patients that meet the inclusion criteria comprise of 66 men and 23 women. Results: This study showed that the average estimated blood loss in craniotomy was 3.20 units of whole blood (1120 ml) and the average of the demand of blood ordered was 4.0 units of whole blood (1400 ml). There was no mismatch between the amount of blood ordered for surgery and estimation of blood loss (p=0.73). Conclusion: Estimated blood loss in craniotomy procedure in Wahidin Sudirohusodo hospital, Makassar is 3.20 units of whole blood (1120 ml) was in accordance with amount of blood ordered for surgery

Habitual Coffee Consumption Does Not Correlate with Blood Pressure, Inflammation and Endothelial Dysfunction But Partially Correlates with Oxidative Stress

BACKGROUND: Coffee is the most widely consumed beverage in the world and has been known to have effects on cardiovascular system. Many researchers have examined the effects of coffee consumption on blood pressure (BP) and risk of cardiovascular disease (CVD), but their results were inconsistent and still remain a subject of controversy. Oxidative stress, inflammation, and endothelial dysfunction have been known as risk factors of hypertension and CVD. Those factors are also known to be affected by coffee consumption. The aim of this study was to examine the relationship between the effects of habitual coffee consumption on BP and to examine the role of oxidative stress (F2 isoprostane), inflammation (high sensitive C-reactive protein (hsCRP)) and endothelial dysfunction (asymmetric dimethylarginine (ADMA)).METHODS: This was a cross-sectional study in which 47 healthy, non-smoking men aged 30-60 years with varying coffee-drinking habits were enrolled. BP and blood/urine analysis of biomarkers were measured in the morning before activity. Coffee consumption was assessed using a questionnaire. The differences among variables were analyzed using ANOVA and the correlations between variables were analyzed using Kendall's Tau correlation analysis.RESULTS: Habitual coffee consumption did not correlate with systolic/diastolic BP (r=-0.02; p=0.856 and r=0.15; p=0.230, respectively). Concentrations of ADMA and hsCRP were also not correlated with coffee consumption (r=0.03; p=0.764 and r=0.04; p=0.701, respectively). Coffee consumption only showed significant correlation with F2 isoprostane (r=0.34; p=0.004).CONCLUSION: BP was not affected by coffee consumption although coffee consumption has a significant correlation with F2 isoprostane. These findings suggest that correlation between coffee consumption and BP might be explained by other factors that were not included in this study

Correlation of Ferritin and Transferrin Serum with hsCRP and F2-Isoprostane in Metabolic Syndrome

BACKGROUND: The low inflammatory state that accompanies the Metabolic Syndrome (MetS) associates with the overexpression of oxidative stress. Ferritin and Transferrin serum are often used to measure iron status and their concentrations are altered in several metabolic conditions. We hypothesized that concentration of Ferritin and Transferrin serum increase in Metabolic Syndrome (MetS) and correlate with the inflammation and oxidative stress.METHODS: We studied 65 male MetS patients, aged 43.26±7.16 years. Iron metabolism was measured by concentration of Ferritin and Transferrin serums, while inflammatory and oxidative stress by high sensitivity C-reactive Protein (hsCRP) and F2-Isoprostane.RESULTS: Concentration of Ferritin 315.70±188.63 ng/L and Transferrin 2.36±0.31 g/L increased along with increasing components of MetS. Concentration of Ferritin serum had a positive correlation with hsCRP (r=0.220) and F2-Isoprostane (r=0.023).CONCLUSION: Serum concentration of Ferritin increased in the MetS and correlates with hsCRP and F2-Isoprostane

The Analysis of Asymetric Dimethylarginine and Homocysteine in Patients with Chronic Kidney Disease

BACKGROUND: Asymmetric dimethylarginine (ADMA) is a competitive inhibitor of nitric oxide synthase (NOS). ADMA reduces NO synthesis when its concentration elevates. ADMA is a novel risk factor for cardiovascular disease. Plasma ADMA accumulates in patients with endstage renal disease, due to reduced renal clearance. Hyperhomocysteinemia is often found in patients with chronic kidney disease (CKD). Homocysteine may cause ADMA to accumulate; however, the mechanism by which ADMA level elevates in hyperhomocysteinemia is still unclear. Objective of this study was to analyze the concentrations of homocysteine and ADMA and to assess the correlation between homocysteine and ADMA concentrations with the severity of chronic kidney disease.METHODS: This was a cross-sectional study on 75 patients with CKD, comprising men and women aged 40-70 years. Assessments were done on the concentrations of creatinine, homocysteine, ADMA, fasting blood glucose, cholesterol HDL and triglyceride.RESULTS: In later stage of CKD there was significantly higher tHcy concentration as compared with the earlier stage of CKD (p=0.0000). In CKD stage 2 to 4 there was a tendency for ADMA concentration to increase to a significant average (p=0.210), but ADMA concentration was lower at stage 5. There was increased ADMA along with increased tHcy concentration of around 20μ mol/L, and this then decreased. The inverse correlation between tHcy and ADMA concentrations started to appear in CKD stage 4, but this correlation was statistically insignificant (r2 =0.19; p=0.499).CONCLUSIONS: This study showed there was a correlation between homocysteine and ADMA concentrations in patients with CKD stage 2 to 5, although statistically not significant

Association of Obesity and Breast Cancer Risk: the Role of Estrogen, Tumor Necrosis Factor-alpha, and Adiponectin as Risk Factors (Preliminary Study)

BACKGROUND: Breast cancer is the most frequent cancer diagnosed among women. Many factors influence the carcinogenesis of breast cancer. The aim of this study to analyze the role of obesity (waist circumference and body mass index), serum Estradiol levels, TNF-α, and Adiponectin in the occurrence of breast cancer.METHODS: This was observational study with casecontrol design. Eleven breast cancer patients as cases and twelve Fibroadenoma Mammae (FAM) patients as controls were analyzed. The serum Estrogen, TNF-α and Adiponectin were examined in their association with breast cancer risk.RESULTS: Women with breast tumor and waist circumference > 80 cm have significantly higher breast cancer risk than women with breast tumor and waist circumference 2.30 pg/ml) have higher breast cancer risk (19.25 times) than women with breast tumor and have lower serum TNF-α levels (95% CI=1.77-209.55, p=0.015). Whereas, women with breast tumor and lower Adiponectin/TNF-α ratio (80 cm and low Adiponectin/TNF-α ratio in women with breast tumor are significantly associated with an increased risk for breast cancer