THE DEGREE OF SECRETORY IMMUNOGLOBULIN A IN BURN PATIENTS WITH PROBIOTIC THERAPY

Background: One of the problems with burn patients is the impairment of host immunity, which makes difficult to treat. In burns, immunoglobulinA has demonstrated to decrease. Immunoglobulin A is the main product of mucous immune system, which increases viral clearance and decreasesbacterial adhesion in the intestine. Probiotics consist of living microflora, which control the balance of lactobacilli and bifidobacteria in the intestine.Instead of producing organic component, increasing the acidity of intestine, mucin and bacteriocin, they also activate the intestinal immune systemand secretory immunoglobulin A (sIgA). The goal of this study was to propose that regular intake of probiotic might help to improve the mucousimmune system, especially sIgA in intestines in burn patients.Methods: An experimental, double-blind, controlled clinical trial was carried out in 33 burn patients. Those patients were divided into two groups.The first group was given daily probiotic and the second group was given only placebo for 10 days. The treatment began on the 4th day admission, andthen, the degree of sIgA was evaluated before treatment and day 14 from fecal specimen.Results: Significant differences between probiotic and control group were observed (p<0.0001). The degree of sIgA in the probiotic group increased61.25%, and in the control group, it decreased to 36.80%.Conclusion: The mucous immune system, especially sIgA, increases by probiotic intake

The Role of the Bovine Amniotic Membrane in Accelerating of Wound Epithelization: A Systematic Review and Meta-analysis

ABSTRACT Modern dressings promise a smoother and less visible scar than typical wound management. The bovine amniotic membrane, one of the amniotic membranes that is often to be used in wound management known to be safe and effective in accelerating wound healing. However, no robust data of its effect in accelerating wound healing is available. The aim of this systematic-review and metaanalysis was to provide robust data on the role of bovine amniotic membrane on wound epithelization process. The searches of the eligible studies were conducted in two databases (Medline and PubMed). Data on authors, year of publication, location, type of wound dressing, and the outcomes were collected from each eligible study based on PRISMA guideline. Five studies from the systematic review, included human and non-human wounds, were included in the meta-analysis and all of them used freeze-dried bovine amniotic membrane. Individual study found indicated that freeze-dried bovine amniotic membrane could accelerate epithelialization in wound healing. However, metaanalysis suggested that there was no difference between administration of freeze-dried bovine amniotic membrane and the use of other dressing in term of epithelialization process on wound healing (summary of effect was 69.52and 95% confidence interval (95%CI) from -61 to 200). In conclusion, there areno adequate data and therefore there is no strong evidence from human and nonhuman wounds to suggest that bovine amniotic membrane accelerates the wound epithelization faster than other types of dressing. Keywords: Wound healing, bovine amniotic membrane, epithelializatio

THE EFFICACY OF COMBINED CREAM BROMELAIN -LIPOSOME AS ENZYMATIC DEBRIDING AGENT FOR DEEP BURN PATIENTS

ABSTRAC

Penanganan Luka Bakar

Luka bakar terutama yang luas (lebih dari 20%) menyebabkan terganggunya keseirrbangan dalam tubuh, di antaranya adalah terjadinya berbagai macam perubahan metabolisme. Semakin luas luka bakar yang dialami, maka semakin besar gangguan metabolisme yang ditimbulkan, sehingga memerlukan perhatian tersendiri salah satunya adalah tunjangan nutrisi yang adekuat nutrisi. Tunjangan nutrisi pada penanganan luka bakar memegang Peranan yang sangat penting dalam menurunkan angka mortalitas mauPun morbiditas. Terutama pada luka bakar lebih dari 30% karena ketidakmampuan hrbuh untuk mengkompensasi perubahan perubahan yang terjadi, yaitu perubahan metabolisme protein, karbohidrat, lemak dan kebutuhan energi. Sudah banyak penelitian yang telah dilakukan dalam manajemen luka bakar yang bertujuan menurunkan angka kematian mauPun morbiditas pada luka bakar. Di antaranya adalah early excision dan early skin grafting yaitu membuang dengan segera jaringan yang terbakar sebelum onset inleksi dan dilanjutkan dengan penutupan dengan skin graft alatt pengganti kulit. Kemajuan dalam manajemen critical care ituga memegang Peranan penting dalam menurunkan angka morbiditas dan mgka kematian yang diakiba&m oleh luka bakar Penanganan terhadap perubahan metabotk juga merupakan hal yang penting pada penderita luka bakar dapat kehilangan berat badan sampai 30% bila tunjangm nutrisi yang diberikan tidak adekuat. Pada bab ini akan dibahas tentang nutrisi pada luka bakar, perubahan metabolisme akibat luka bakar, terutama perubahan metabolisme karbohidra! lemak dan protein, Penentuan kebutuhan nukisi pada penderita luka bakar serta teknik pemberian nutrisi pada penderita luka bakar

Transfer Jari Kedua Jari Kaki untuk Rekonstruksi Jari Pertama Jari Tangan Setelah Trauma Listrik (Laporan Kasus)

Latar belakang: jari pertama memiliki peran yang sangat penting pada fungsi tangan. Rekonstruksi jari pertama jari tangan dapat dilakukan menggunakan jari pertama jari. Jari kedua jari kaki dapat digunakan apabila jari pertama jari kaki tidak dapat digunakan sebagai lokasi donor, misalnya, ketika tingkatan amputasi melebihi dari sepertiga proksimal metakarpal pertama dan diperlukan tulang metatarsal dengan panjang yang signifikan untuk menyediakan ukuran yang cukup pada rekonstruksi jari pertama tangan. Kasus: dilaporkan satu kasus, laki-laki, 24 tahun, datang ke Instalasi Gawat Darurat, Rumah Sakit Dr. Soetomo dengan hilangnya jari pertama jari tangan setelah trauma listrik. Pada pasien telah dilakukan debridemen dan flap lokal pada pergelangan tangan kiri dan skin graft pada tengan kanan. Flap viable dan hangat. Setelah hari ke-5 operasi, graft take 100%, dan pasien bisa kembali ke rumah. Tiga bulan setelah pembedahan, pasien datang ke poliklinik rawat jalan untuk evaluasi. Kondisi jari baik namun pergerakannya terbatas. Kemudian, pada pasien direncanakan untuk rekonstruksi jari pertama dengan transfer jari kedua jari kaki. Hasilnya, evaluasi jari pertama yang baru, dengan keadaan yang baik, dapat bergerak tetapi tidak dapat fleksi dan ekstensi penuh. Simpulan: pilihan rekonstruksi untuk mengembalikan fungsi jari pertama jari tangan termasuk transfer jari kedua jari kaki ke jari pertama jari tangan atau pollicization jari telunjuk. Jari kaki ke jari tangan untuk rekonstruksi jari pertama dapat memberikan hasil yang sangat baik dan tingkat kepuasan pasien yang tinggi

Comparison of the effectiveness of savlon antiseptic with povidone-iodine for acinetobacter baumannii infected wounds in white rats (Rattus Norvegicus)

Wound washing with antiseptic liquid is one step in the management of chronic wounds. In infected wounds, washing with antiseptic is expected to reduce bacterial colonies and help eradicate infection. One of the important pathogenic bacteria is Acinetobacter Baumannii. These opportunistic germs can form colonies, especially in patients receiving broad-spectrum antibiotic therapy, treatment in the ICU, and on skin affected by burns. Antiseptic commonly used to wash wound are Savlon and Povidone-iodine 10%. Both antiseptic are broad spectrum antisepctic, kill gram negative and gram positive bacteria. However Savlon could caused skin irritation. Therefore dilution is needed to prevent this effect. This study was intended to determine the difference and comparison of the effectiveness of Savlon and Povidone iodine antiseptic to bacterial growth on wound infected by Acinetobacter Baumannii.  This study is an experimental study with a randomized controlled trial without blinding. The wound research procedure was made on the right and left sides of the rat's back with a size of 1x1 cm each. Wounds that have been contaminated with Acinetobacter Baumannii are left for 4 hours. After 4 hours the wound will be washed and irrigated. The wound that has been made is closed with a transparent dressing