Biomarkers Utility for Sepsis Patients Management

Sepsis is a global problem in either developing or developed countries and it is expected that the number of patients with sepsis and septic shock will tremendously increase in next decades also because of the antibiotic resistance growing issue worldwide. Criteria for sepsis diagnosis and prognosis have been recently established, but still a further understanding of the role of biomarkers in this setting is needed. Better utilization of biomarkers such as white blood cell count, CRP, lactate, procalcitonin, presepsin and bioadrenomedullin in sepsis patients, a state of the art on how to use them is needed. This review will focus on the actual recognized role of sepsis biomarkers not only for diagnosis purpose but also to improve patients treatment results in order to reduce mortality, hospital length of stay and cost related

Treatment-resistant major depressive disorder: Canadian expert consensus on definition and assessment

Background: Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD. Methods: This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement. Results: Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance. Conclusions: TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

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

Mendidik dan Mengader: Mama Kristina Kaka dari Kadoki Horo

Mama Kristina Kaka adalah salah satu dari pendidik PAUD yang juga merangkap sebagai kader Posyandu di desa Kadoki Horo, Sumba Barat Daya. Beberapa hal telah berubah sejak Mama Kristina mengikuti pelatihan rutin yang dilakukan oleh Australian Council for Educational Research (ACER) Indonesia lewat dukungan penuh dari William & Lily Foundation (WLF) dan Yayasan Adaro Bangun Negeri.https://research.acer.edu.au/indonesia_pp/1004/thumbnail.jp

Acute toxicity test of ethanol extract of djenkols (Archidendron pauciflorum) fruit peel against female Wistar rat

Abstract. Madihah, Ratningsih N, Malini DM, Faiza AH, Iskandar J. 2017. Acute toxicity test of ethanol extract of djenkols (Archidendron pauciflorum) fruit peel against female Wistar rat. Pros Sem Nas Masy Biodiv Indon 3: 33-38. Ethanol extract of djenkol (Archidendron pauciflorum (Benth.) I. C. Nielsen) fruit peel at a dose 150 mg/kg BW has been shown to decrease blood glucose level in hyperglycemic rats. The next preclinical step in the development of djenkol as antidiabetic herbal medicine is acute toxicity test. The purposes of this study were to obtain the lethal dose 50 (LD50) of ethanol extract djenkol fruit peel and to observe the histopathology of rat liver as the result of the toxicity. Acute toxicity test method was adapted from OECD 423:2001 guideline and the limit dose was 5000 mg/kg bb. The animals (female Wistar, Rattus norvegicus Berkenhout, 1769) were orally administered a single dose of the extract at 5500, 6900, 8200, 9100, 12900, and 17500 mg/kg BW. Symptoms of toxicity, weight change, and mortality were noted for 14 days, whereas liver histopathology was observing at the end of test periods. The result showed that ethanol extract of djengkol fruit peel treatment up to dose 9100 mg/kg BW did not cause symptoms of toxicity and weight loss. Probit analysis of the mortality estimated that the LD50 was 15.382,412 mg/kg BW, thus categorized as a practically nontoxic substance. Lowest observed adverse effect level (LOAEL) was detected at dose 5.500 mg/kg BW, which caused mild damage to liver tissue, in the form of necrosis of hepatocytes and widening of central vein diameter, but the arrangement of hepatocytes and sinusoids were normal. Therefore, it can be concluded that the use of ethanol extract of djenkol fruit peel under dose 5500 mg/kg BW was safe to be used, so it can be developed as standardized herbal medicine for anti-diabetes

Association Between the Effectiveness and Immunogenicity of Inactivated SARS-CoV2 Vaccine (CoronaVac) with the Presence of Hypertension among Health Care Workers

Objective This study aimed to observe the association between the presence of hypertension with Covid-19 vaccine effectiveness among healthcare workers who received CoronaVac vaccination. Methods We conducted a prospective cohort study in Saiful Anwar General Hospital, Malang, Indonesia on 155 healthcare workers aged 18–59 years old who already received twice of the CoronaVac (Sinovac Life Science, Beijing, China) injection with 14-day intervals. Hypertension was diagnosed according to the 2020 International Society of Hypertension. Subjects were monitored for six months. The primary outcome was the rate of Covid-19 diagnosed by the pharyngeal swab for the real-time reverse transcription-polymerase chain reaction (RT-PCR) examination. The secondary endpoints were: (1) severity of Covid-19 among infected participants; (2) rate of hospitalizations; and (3) anti-SRBD antibody levels measured by ECLIA. Results Among 155 participants, 18.7% of them were diagnosed with hypertension, and 31.0% had the desirable BP target according to the current guidelines. Subjects with hypertension, especially those with uncontrolled blood pressure, had a higher incidence of Covid-19 infection than subjects without hypertension. Subjects with symptomatic Covid-19 and hospitalized because of Covid-19 were higher in participants with hypertension. The anti-SRBD antibody levels were lower in the second month after CoronaVac vaccination in hypertensive subjects. In contrast, comparable anti-SRBD levels were seen from both groups at sixth months after vaccination. Conclusion Hypertension was associated with lower vaccine effectiveness in healthcare workers. Subjects with hypertension had a higher risk of being infected with Covid-19 despite getting a complete dose of vaccination and lower antibody production

Pedoman Penelitian Tindakan Kelas (PTK) secara teoretis dan praktis

Buku Pedoman Penelitian Tindakan Kelas (PTK) Secara Teoretis dan Praktis ini dibuat sebagai bahan referensi dan juga memberikan wawasan tambahan lebih rinci dan sistematis mengenai Penelitian Tindakan Kelas (PTK) yang dapat dijadikan tolok ukur pendidikan nasional pada zaman modern seperti ini. Sejalan dengan perkembangan pendidikan dan kemajuan teknologi yang menyertainya, buku ini dapat dijadikan solusi terbaik sehingga tujuan dan manfaat dapat dicapai secara maksimal. Secara detail pembahasan buku ini meliputi: Bab 1 Memahami Penelitian Tindakan Kelas Bab 2 Tujuan, Fungsi, Manfaat, Dan Urgensi Penelitian Tindakan Kelas Bab 3 Jenis-Jenis Penelitian Tindakan Kelas Bab 4 Model-Model Penelitian Tindakan Kelas Bab 5 Karakteristik-Karakteristik Penelitian Tindakan Kelas Bab 6 Prinsip-Prinsip, Persyaratan, Dan Objek Penelitian Tindakan Kelas Bab 7 Cara Memulai Dan Langkah-Langkah Persiapan Penelitian Tindakan Kelas Bab 8 Penetapan Fokus Masalah Penelitian Tindakan Kelas Bab 9 Teknik Dan Analisis Data Penelitian Tindakan Kelas Bab 10 Penyusunan Proposal Dan Laporan Akhir Penelitian Tindakan Kelas

Pedoman Penelitian Tindakan Kelas (PTK) secara teoretis dan praktis

Buku Pedoman Penelitian Tindakan Kelas (PTK) Secara Teoretis dan Praktis ini dibuat sebagai bahan referensi dan juga memberikan wawasan tambahan lebih rinci dan sistematis mengenai Penelitian Tindakan Kelas (PTK) yang dapat dijadikan tolok ukur pendidikan nasional pada zaman modern seperti ini. Sejalan dengan perkembangan pendidikan dan kemajuan teknologi yang menyertainya, buku ini dapat dijadikan solusi terbaik sehingga tujuan dan manfaat dapat dicapai secara maksimal. Secara detail pembahasan buku ini meliputi: Bab 1 Memahami Penelitian Tindakan Kelas Bab 2 Tujuan, Fungsi, Manfaat, Dan Urgensi Penelitian Tindakan Kelas Bab 3 Jenis-Jenis Penelitian Tindakan Kelas Bab 4 Model-Model Penelitian Tindakan Kelas Bab 5 Karakteristik-Karakteristik Penelitian Tindakan Kelas Bab 6 Prinsip-Prinsip, Persyaratan, Dan Objek Penelitian Tindakan Kelas Bab 7 Cara Memulai Dan Langkah-Langkah Persiapan Penelitian Tindakan Kelas Bab 8 Penetapan Fokus Masalah Penelitian Tindakan Kelas Bab 9 Teknik Dan Analisis Data Penelitian Tindakan Kelas Bab 10 Penyusunan Proposal Dan Laporan Akhir Penelitian Tindakan Kelas

A controlled trial of the Litebook light-emitting diode (LED) light therapy device for treatment of Seasonal Affective Disorder (SAD)

Background: Recent research has emphasized that the human circadian rhythm system is differentially sensitive to short wavelength light. Light treatment devices using efficient light-emitting diodes (LEDs) whose output is relatively concentrated in short wavelengths may enable a more convenient effective therapy for Seasonal Affective Disorder (SAD). Methods: The efficacy of a LED light therapy device in the treatment of SAD was tested in a randomized, double-blind, placebo-controlled, multi-center trial. Participants aged 18 to 65 with SAD (DSM-IV major depression with seasonal pattern) were seen at Baseline and Randomization visits separated by 1 week, and after 1, 2, 3 and 4 weeks of treatment. Hamilton Depression Rating Scale scores (SIGH-SAD) were obtained at each visit. Participants with SIGH-SAD of 20 or greater at Baseline and Randomization visits were randomized to active or control treatment: exposure to the Litebook LED treatment device (The Litebook Company Ltd., Alberta, Canada) which delivers 1,350 lux white light ( with spectral emission peaks at 464 nm and 564 nm) at a distance of 20 inches or to an inactivated negative ion generator at a distance of 20 inches, for 30 minutes a day upon awakening and prior to 8 A. M. Results: Of the 26 participants randomized, 23 completed the trial. Mean group SIGH-SAD scores did not differ significantly at randomization. At trial end, the proportions of participants in remission (SIGH-SAD less than 9) were significantly greater (Fisher's exact test), and SIGH-SAD scores, as percent individual score at randomization, were significantly lower (t-test), with active treatment than with control, both in an intent-to-treat analysis and an observed cases analysis. A longitudinal repeated measures ANOVA analysis of SIGH-SAD scores also indicated a significant interaction of time and treatment, showing superiority of the Litebook over the placebo condition. Conclusion: The results of this pilot study support the hypothesis that light therapy with the Litebook is an effective treatment for SAD