Terapi Ulkus Kaki Diabetes dengan NPWT (Negative Pressure Wound Therapy)

Diabetes melitus (DM) adalah suatu kondisi serius seumur hidup yang merupakan salah satu penyebab utama kematian di dunia. Dokter umum sering menemukan pasien dengan diabetes melitus. Lima belas persen dari pasien dengan diabetes mellitus akan menderita ulkus kaki diabetik. Pasien dengan ulkus di kaki memiliki risiko tinggi untuk amputasi dan angka kematian semakin meningkat. Kaki diabetik berisiko tinggi dapat diidentifikasi dengan pemeriksaan skrining yang sederhana dan ulkus kaki selanjutnya dapat dicegah. Mengenal pasti secara awal dari kaki diabetik berisiko tinggi dan pengobatan yang tepat pada waktunya akan menyelamatkan kaki dan meningkatkan kualitas hidup pasien. Penyakit arteri perifer, neuropati, deformitas, riwayat amputasi sebelumnya dan infeksi merupakan faktor utama yang berkontribusi terhadap perkembangan ulkus kaki diabetik. Mengenal pasti secara awal dari kaki berisiko tinggi penting untuk mengurangi tingkat morbiditas dan mortalitas. Pendekatan interprofesional (yaitu, dokter, perawat, dan spesialis perawatan kaki) sering diperlukan untuk mendukung kebutuhan pasien. Terapi terbaru untuk penanganan ulkus kaki diabetik adalah dengan tekanan negatif yang diaplikasikan pada ulkus kaki diabetik. Dengan alat ini cairan eksudat bisa dihisap secara aktif oleh alat tersebut sehingga sangat membantu proses penyembuhan. Di laporkan tiga serial kasus dari pemakaian tekanan negatif pada ulkus kaki diabetes dengan hasil yang baik Kata kunci: ulkus kaki diabetik, luka kronik, terapi luka tekanan negati

Implikasi Klinis Angiosome pada Revaskularisasi Iskemia Tungkai Kritis

AbstrakIan Taylor memperkenalkan konsep angiosome, membagi  tubuh menjadi blok tiga dimensi berdasarkan  pasokan sumber arteri. Perlunya memahami angiosome dari kaki dan pergelangan kaki serta  interaksi di antara arteri tersebut  secara klinis berguna dalam revaskularisasi iskemia tungkai kristis pada kaki dan pergelangan kaki, terutama bila disertai dengan luka pada kaki yang sulit disembuhkan. Dengan bantuan angiosome, ahli bedah pembuluh darah dapat menentukan target utama dalam revaskularisasi untuk luka kronik pada iskemia tungkai kritis. Ada enam angiosome dari kaki dan pergelangan kaki yang berasal dari tiga arteri utama dengan  cabang-cabangnya di daerah plantar. Tiga cabang A. tibialis posterior masing-masing memasok bagian-bagian yang berbeda dari kaki plantar. Dua cabang A. peroneal memasok bagian anterolateral dari pergelangan kaki dan kaki belakang. Arteri tibialis anterior memasok pergelangan kaki anterior, dan bila diteruskan, arteri pedis dorsalis, persediaan dorsum kaki. Dengan selektif melakukan pemeriksaan USG pembuluh darah (doppler ultrasound)  pada koneksi angiosome ini dapat dengan  cepat memetakan pembuluh darah kaki  yang ada dan arah aliran, sehingga target revaskularisasi dapat ditentukan dengan tepat. Dari beberapa penelitian, revaskularisasi langsung pada angiosome luka kronik sangat berpengaruh pada penyembuhan luka.Pengetahuan rinci tentang anatomi vaskular dari kaki dan pergelangan kaki memungkinkan ahli bedah vaskuler merencanakan revascularisasi  pembuluh darah  kaki dan pergelangan kaki. Ahli bedah vaskuler juga dapat  merancang eksposur yang aman dari kerangka yang mendasari, dan memilih revaskularisasi yang paling efektif untuk luka kronik pada pasien. Kata kunci : Iskemia Tungkai Kritis, Revaskularisasi, Angiosome                                                            AbstractIan Taylor introduced the concept angiosome, dividing the body into three different dimensional blocks of tissue which supply by the artery. Understanding angiosomes of the foot and ankle and the interaction between their source arteries is clinically useful in the surgery of the foot and ankle, especially with the presence of peripheral vascular disease. Based on  angiosome, the vascular surgeon can determine the primary target in the revascularization of the chronic wounds in critical limb ischemia.There are six angiosomes of the foot and ankle, which is derived from the three main arteries and their branches to the foot and ankle. The three branches of the posterior tibia artery supply different parts of the plantar foot. Two branches of the peroneal artery supply the anterolateral part of the ankle and hind legs. The anterior tibia artery supply the anterior ankle, and its continuation, the dorsal pedis artery, supplies the dorsum of the foot. The blood flow to the foot and ankle redundant; because the three main arteries of each legs have some connection..Using selective Doppler examination of this connection, it is possible to  map the existing leg veins and the direction of flow. Some author reported that direct revascularization  of chronic wound angiosome well influence quickly in wound healing. Detailed knowledge of the vascular anatomy of the foot and ankle allows the surgeon to plan the reconstruction the veins of the legs and ankles. Surgeons also can design a safe exposure of the underlying framework, and choose the most effective revascularization of the wound. Keywords : Critical Limb Ischemia, Revascularization, Angiosom

Faktor-Faktor Risiko yang Memprediksi Kematian Satu Tahun Pertama Pasien Gagal Ginjal Kronik dengan Hemodialisis di RS Sumber Waras Periode 2018-2019

Chronic Kidney Disease (CKD) is a global public health problem where the prevalence and incidence of CKD is increasing every year. According Indonesian Renal Registry in 2016 , about 60% of CKD underwent dialysis in the form of hemodialysis (98%) and peritoneal dialysis (2%). The deaths of hemodialysis patients during 2015 were 1,243 people with the most cause of death is  cardiovascular (41%), and unknown (30%). The purpose of this study was to determine the causes of death in the first year of CKD patients undergoing hemodialysis. This study was a descriptive and analytic study with a cross sectional approach. Collecting data by looking at the patient's medical record. The number of samples is 46 people, the sample uses the total sampling method. Univariate data analysis to see the distribution of patient profiles, bivariate analysis with Chi square test and multivariate analysis using logistic regression to see the relationship between variables. The results of the analysis showed that the factors associated with death in the first year of kidney failure patients undergoing hemodialysis were age (p=0.03) and vascular access (p=0.000). The first year of chronic renal failure patients undergoing hemodialysis is age and vascular access.Penyakit Ginjal Kronik (PGK) adalah suatu masalah kesehatan masyarakat global dimana prevalensi dan kejadian PGK tersebut terus meningkat tiap tahunnya. Berdasarkan data dari Indonesian Renal Registry tahun 2016. Penderita Penyakit Ginjal Kronik sekitar 60% yang menjalani dialysis berupa hemodialysis (98%)  dan peritoneal dialisis (2%). Kematian pasien hemodialisis selama tahun 2015 sebanyak 1.243 orang dengan penyebab kematian terbanyak adalah kardiovaskuler  (41%) , dan penyebab kematian pasien tidak diketahui (30%). Tujuan penelitian ini untuk mengetahui faktor penyebab kematian satu tahun pertama pasien gagal ginjal kronik yang menjalani hemodialisis.Penelitian ini merupakan studi deskriptif dan analitik dengan pendekatan cross sectional. Pengambilan data dengan melihat rekam medik pasien. Total sampel sebanyak 46 orang, sampel menggunakan metode total sampling. Analisis data secara univariat untuk melihat distribusi profil pasien, analisis bivariat dengan uji Chi square dan analisis multivariat dengan menggunakan regresi logistik untuk melihat hubungan antar variabel. Hasil analisis menunjukan faktor-faktor yang berhubungan dengan kematian satu tahun pertama pasien gagal ginjal kronik yang menjalani hemodialisis adalah, umur (p=0,03) dan akses vaskular (p=0,000).Dari penelitian ini dapat disimpulkan faktor-faktor yang berhubungan dengan kematian satu tahun pertama pasien gagal ginjal kronik yang menjalani hemodialisis adalah umur dan akses vaskula

Pengaruh Ekstrak Undur-undur (Myrmeleon sp) terhadap Glukosa Darah dan Hematokrit pada Tikus Diabetes

Diabetes Mellitus (DM) is one of the major health problems in the world and Indonesia. The prevalence is more increasing and also shows the trend of events is shifting to young age. Diabetes mellitus treatment requires high costs and also a lifetime. Most of the people of Indonesia still use traditional methods of treatment, especially herbs from various biological substances that are available in the environment. Undur-undur (myrmeleon sp.) is believed to have the effect of anti-hyperglycemia, and also anti-viscosity. The aim of this study was to determine anti-hyperglycemia and anti-viscosity of myrmeleon sp. extract in diabetic rats. The design of study is randomized experiment. Diabetic rats were induced by streptozocin 100mg/ kg BW intraperitoneal. Fifty rats were divided into 2 groups administered by Myrmeleon sp. extract dose 0,01ml/ 200 gram BW (100%) and 0,005ml/ 200 gram BW (50%). Myrmeleon sp. shows the effect of anti-hyperglycemic and anti-viscosity in diabetic rats. There was a difference between 50% and 100% doses. The effect of anti-hyperglycemia and anti-viscosity occurs after the second day. Conclusion: the extract of myrmeleon sp. could be considered as one of the traditional treatments of diabetic patients

ARTIFICIAL INTELEGENCE TECHNOLOGY IS SHAPING THE WOUND CARE

Chronic wounds cause significant morbidity and mortality in the health care system.1 Patients with chronic wounds require frequent visits for evaluation by health professionals. The main indicator of healing is wound reduction surface area that helps doctors determine the progress of healing and choose the right therapy. conventional wound care using photo planimetry is the safest and most effective way to provide wound care and to ensure continuous monitoring; this. Telemedicine approaches that involve remote monitoring are more suitable from both an economic and patient experience point of view. However, prompt intervention is proving difficult, and healthcare professionals must be able to ensure a high standard of care. Several technological support tools for wound care professionals that have provided ulcer morphology measurements are able to provide automatic diagnostic information through a standard wound classification scale using the Artificial Intelligence (AI) method

FACTORS ASSOCIATED WITH THE PREVALENCE OF SARCOPENIA IN ELDERLY UNIVERSITY WORKERS

The most common cause of sarcopenia is a lack of physical activity throughout the day. In addition, there are also other possibilities that could be the cause of this loss of muscle mass, namely: Decreased levels of certain hormones related to muscle. University workers who experience retirement often experience sarcopenia, because when they are still active, university workers are less active and have less protein intake. For this reason, it is necessary to pay attention to the activities of university workers while they are still active and productive at wor

Wound Healing in Diabetic Foot Ulcer Patients Using Combined Use of Platelet Rich Fibrin and Hyaluronic Acid, Platelet Rich Fibrin and Placebo: An Open Label, Randomized Controlled Trial

Background: Autologous platelet-rich fibrin (A-PRF) is an adjunctive method for diabetic foot ulcer (DFU) in addition to glycaemic control and debridement. This study aimed to evaluate the role of A-PRF + hyaluronic acid (HA), A-PRF and sodium chloride 0.9% (control) in DFU wound healing. Nowaday, the use of  PRF autologous consider as adjuvant therapy in DFU treatment. Methods: This open-label randomized controlled trial was conducted at Koja District Hospital and Gatot Soebroto Hospital from July 2019 to April 2020. DFU patients with wound duration of three months, Wagner-2, and ulcer size < 40 cm2 were recruited and randomly assigned into A-PRF + AH, A-PRF and control group. On day-0, day-3 and day -7, samples and photographs were taken. Samples were analysed with ELISA and photographs were analysed with ImageJ to calculate granulation index (GI). Statistical analysis was performed using SPSS version 20. Results: Topical therapy with A-PRF + AH was associated with a significant increase in VEGF from day 0 (232.8 pg/mg) vs day 7 (544.5 pg/mg) compared to A-PRF on day 0 (185.7 pg/mg) vs day 7 (272.8 pg/mg), and the controls on day 0 (183.7 pg/mg) vs day 7 (167.4 pg/mg). On evaluation  of VEGF swab, there is increasing significantly in A-PRF+HA group compare others group in day -3 ( p=0.022) and day -7 (p= 0.001).In the A-PRF + AH group, there was a significant decrease in IL-6 from day 0 (106.4 pg/mg) vs day 7 (88.7 pg/mg) compared with PRF on day 0 (91.9 pg/mg) vs day 7 (48,8 pg/mg). IL-6 was increased in the control group from day 0 (125.3 pg/mg) vs day 7 (167.9 pg/mg). On evaluation  of IL-6 swab, there is decreasing significantly in A-PRF+HA group compare others group in day -7 (p= 0.041). Conclusion: The PRF + HA combination increased angiogenesis and reduced inflammation in DFUs and may represent a new DFU therapy

Advance-Platelet Rich Fibrin and Hyaluronic Acid Combination Improves Interleukin-6 and Granulation Index in Diabetic Foot Ulcer Patients

BACKGROUND: Diabetic foot ulcer (DFU) is the most common and threatening complication of Diabetes Mellitus (DM). Ideal wound dressing for DFU management should relieve symptoms, provide wound protection, and encourage healing. Advanced-Platelet Rich Fibrin (A-PRF) and Hyaluronic Acid (HA) have been proven to improve wound healing process. This study was aimed to demonstrate the ability of combination of A-PRF and HA in reducing inflammation and improving DFU tissue healing.METHODS: Twenty DFU subjects were involved in this study, and divided into two groups based on the topical fibrin gel treatment: A-PRF + HA group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. A-PRF + HA was prepared by homogening A-PRF and AH with a ratio of 1:0.6. Interleukin-6 (IL-6) level, granulation index (GI), numeric pain score (NPS), and inflammation clinical symptoms (ICS) were assessed on day-0, 3, 7 and 14.RESULTS: Wound swabs’ IL-6 level on day-7 was found to be significantly lower in A-PRF + HA compared to A-PRF alone (p=0.041). The IL-6 level reduction also found to be significant higher either in wound swabs (day 0-7, p=0.015) or fibrin gel (day 0-3, p=0.049; day 0-7, p=0.034). A-PRF + HA treatment significantly increased the GI even since day-3 (p=0.043), with lower NPS (p<0.001), and ICS score.CONCLUSION: The combination of A-PRF and HA increases the GI in DFU healing by reducing the inflammation state which will induce the angiogenesis process, as well as reducing pain in DFU subjects better than A-PRF alone.KEYWORDS: inflammation, interleukin-6, wound healing, angiogenesis, proliferation