EFEKTIVITAS DEXMEDETOMIDINE TERHADAP KADAR KORTISOL PADA PASIEN YANG MENJALANI OPERASI GINEKOLOGI DALAM ANESTESI UMUM

Respons stres adalah perubahan hormon dan metabolik yang terjadi setelah trauma seperti pembedahan, salah satunya terjadi peningkatan kadar kortisol. Dexmedetomidine dapat menurunkan respons stres dengan menghambat sintesis kortisol. Tujuan penelitian ini adalah mengetahui efek dexmedetomidine terhadap kadar kortisol pada pasien yang menjalani operasi ginekologi dalam anestesi umum yang dilakukan di RSUP dr. Mohammad Hoesin Palembang dari Januari–Maret 2018. Jumlah sampel 30 orang yang dibagi menjadi 2 kelompok, kelompok dexmedetomidine dan kelompok plasebo. Kelompok dexmedetomidine mendapatkan dosis dexmedetomidine awal 1 µg/kgBB selama 10 menit dilanjutkan 0,5 µg/kgBB/jam, 20 menit sebelum induksi. Pada kelompok plasebo menggunakan NaCl 0,9%. Induksi menggunakan propofol, fentanil 2 µg/kgBB, dan atrakurium 0,5 µg/kgBB serta pemeliharaan menggunakan sevofluran 3% dalam O2 dan N2O 50%:50%. Kemudian 1 jam pascaekstubasi diambil sampel darah kembali untuk pemeriksaan kadar kortisol. Hasil penelitian pada kedua kelompok terjadi peningkatan kadar kortisol saat 1 jam pascaekstubasi dibanding dengan awal (9,638±7,082 µg/dL menjadi 14,503±7,082 µg/dL pada kelompok dexmedetomidine dan 10,276±3,166 µg/dL menjadi 19,99±6,273 µg/dL pada kelompok placebo). Namun, kadar kortisol signifikan lebih tinggi pada kelompok plasebo. Simpulan, pada kedua kelompok terjadi peningkatan kadar kortisol dibanding dengan nilai awal, tetapi kadar lebih rendah pada kelompok dexmedetomidine. Effectiveness of Dexmedetomidine on Cortisol Level in Patients Undergoing Gynecologic Surgery under General AnesthesiaStress response is a term used to define the metabolic and hormonal changes following an injury or trauma, including as surgery. One of the responses is an increase in cortisol release. Dexmedetomidine may attenuate stress response by inhibiting cortisol synthesis. The aim of this study was to determine the effects of dexmedetomidine on cortisol level, compared to placebo, in patients undergoing major gynecological surgery under general anesthesia. A double-blind randomized clinical trial was performed at Mohammad Hoesin General Hospital from January to March 2018. There were thirty samples that were divided into two groups, dexmedetomidine group and placebo group. The dexmedetomidine group received an initial dexmedetomidine loading dose of 1 µg kg -1 over 10 min, followed by 0.5 µg kg-1h-1 20 minutes before induction. In the placebo group, 0.9% sodium chloride was administered. Anesthesia was induced with propofol, 2 µg/kgBW fentanyl, and 0.5 mg/kgBW atracurium and was maintained with 3% sevoflurane in O2 and N2O 50%:50%. After standard monitoring was established, blood samples were collected for cortisol plasma testing at baseline and 1 hour post-extubation. Hemodynamic data were recorded intraoperatively and postoperatively. Results in both groups presented a significant increase in cortisol level relative to the baseline at 1 hour post-extubation (9.638±7.082 µg/dL to 14.503±7.082 µg/dL in dexmedetomidine group and 10.276±3.166 µg/dL to 19.99±6.273 µg/dL in placebo group [P value<0.05]) with a significantly higher corticsol level in the placebo group when compared to the dexmedetomidine group (P value<0.05). In conclusion, the plasma cortisol level was found to increase significantly relative to baseline level in both groups. However, the increase was significantly lower in the dexmedetomidine group.Pendahuluan: Respons stres adalah perubahan hormon dan metabolik yang terjadi setelah trauma seperti pembedahan, salah satunya terjadi peningkatan kadar kortisol. Dexmedetomidine dapat menurunkan respons stress dengan menghambat sintesis kortisol Tujuan dari penelitian ini adalah untuk mengetahui efek dexmedetomidine terhadap kadar kortisol pada pasien yang menjalani operasi ginekologi dalam anestesi umum.Metode: Penelitian dilakukan di RSUP dr Mohammad Hoesin Palembang dari Januari-Maret 2018. Jumlah sampel 30 orang yang dibagi menjadi 2 kelompok. Kelompok dexmedetomidine dan kelompok plasebo. Sampel darah diambil untuk pemeriksaan kadar kortisol awal. Kelompok dexmedetomidine mendapatkan dosis dexmedetomidine awal 1 µg kg -1 selama 10 menit dilanjutkan 0.5 µg kg-1jam-1, 20 menit sebelum induksi. Pada kelompok plasebo, menggunakan NaCl 0,9%. Induksi menggunakan propofol, fentanyl 2 µg kg-1, dan atracurium 0.5 mg kg-1 dan pemeliharaan menggunakan sevofluran 3% dalam O2 dan N2O 50 %:50 %. Kemudian 1 jam post ekstubasi diambil sampel darah kembali untuk pemeriksaan kadar kortisol.Hasil: Pada kedua kelompok terjadi peningkatan kadar kortisol saat 1 jam post ekstubasi dibandingkan awal (9,638±7,082µg/dL menjadi 14,503±7,082µg/dL pada kelompok dexmedetomidine dan 10,276±3,166µg/dL menjadi 19,99±6,273µg/dL pada kelompok plasebo. Namun kadar kortisol signifikan lebih tinggi pada kelompok plasebo.Kesimpulan: Pada kedua kelompok terjadi peningkatan kadar kortisol dibandingkan nilai awal tetapi kadar lebih rendah secara signifikan pada kelompok dexmedetomidin

Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study

Background Childsmile School adopts a directed-population approach to target fluoride varnish applications to 20% of the primary one (P1) population in priority schools selected on the basis of the proportion of enrolled children considered to be at increased-risk of developing dental caries. The study sought to compare the effectiveness of four different methods for identifying individuals most in need when a directed-population approach is taken. &lt;p&gt;&lt;/p&gt; Methods The 2008 Basic National Dental Inspection Programme (BNDIP) cross-sectional P1 Scottish epidemiological survey dataset was used to model four methods and test three definitions of increased-risk. Effectiveness was determined by the positive predictive value (PPV) and explored in relation to 1-sensitivity and 1-specificity. &lt;p&gt;&lt;/p&gt; Results Complete data was available on 43470 children (87% of the survey). At the Scotland level, at least half (50%) of the children targeted were at increased-risk irrespective of the method used to target or the definition of increased-risk. There was no one method across all definitions of &lt;i&gt;increased-risk&lt;/i&gt; that maximised PPV. Instead, PPV was highest when the targeting method complimented the definition of &lt;i&gt;increased-risk&lt;/i&gt;. There was a higher percentage of children at &lt;i&gt;increased-risk&lt;/i&gt; who were not targeted (1-sensitivity) when caries experience (rather than deprivation) was used to define &lt;i&gt;increased-risk&lt;/i&gt;, irrespective of the method used for targeting. Over all three definitions of &lt;i&gt;increased-risk&lt;/i&gt;, there was no one method that minimised (1-sensitivity) although this was lowest when the method and definition of &lt;i&gt;increased-risk&lt;/i&gt; were complimentary. The false positive rate (1-specificity) for all methods and all definitions of &lt;i&gt;increased-risk&lt;/i&gt; was consistently low (&#60;20%), again being lowest when the method and definition of &lt;i&gt;increased-risk&lt;/i&gt; were complimentary. &lt;p&gt;&lt;/p&gt; Conclusion Developing a method to reach all (or even the vast majority) of individuals at &lt;i&gt;increased-risk&lt;/i&gt; defined by either caries experience or deprivation is difficult using a directed-population approach at a group level. There is a need for a wider debate between politicians and public health experts to decide how best to reach those most at need of intervention to improve health and reduce inequalities. &lt;p&gt;&lt;/p&gt

Role of PII proteins in nitrogen fixation control of Herbaspirillum seropedicae strain SmR1

<p>Abstract</p> <p>Background</p> <p>The PII protein family comprises homotrimeric proteins which act as transducers of the cellular nitrogen and carbon status in prokaryotes and plants. In <it>Herbaspirillum seropedicae</it>, two PII-like proteins (GlnB and GlnK), encoded by the genes <it>glnB </it>and <it>glnK</it>, were identified. The <it>glnB </it>gene is monocistronic and its expression is constitutive, while <it>glnK </it>is located in the <it>nlmAglnKamtB </it>operon and is expressed under nitrogen-limiting conditions.</p> <p>Results</p> <p>In order to determine the involvement of the <it>H. seropedicae glnB </it>and <it>glnK </it>gene products in nitrogen fixation, a series of mutant strains were constructed and characterized. The <it>glnK^-</it>mutants were deficient in nitrogen fixation and they were complemented by plasmids expressing the GlnK protein or an N-truncated form of NifA. The nitrogenase post-translational control by ammonium was studied and the results showed that the <it>glnK </it>mutant is partially defective in nitrogenase inactivation upon addition of ammonium while the <it>glnB </it>mutant has a wild-type phenotype.</p> <p>Conclusions</p> <p>Our results indicate that GlnK is mainly responsible for NifA activity regulation and ammonium-dependent post-translational regulation of nitrogenase in <it>H. seropedicae</it>.</p

Challenges of Loss to Follow-up in Tuberculosis Research.

In studies evaluating methods for diagnosing tuberculosis (TB), follow-up to verify the presence or absence of active TB is crucial and high dropout rates may significantly affect the validity of the results. In a study assessing the diagnostic performance of the QuantiFERON®-TB Gold In-Tube test in TB suspect children in Tanzania, factors influencing patient adherence to attend follow-up examinations and reasons for not attending were examined. In 160 children who attended and 102 children who did not attend scheduled 2-month follow-up baseline health characteristics, demographic data and risk factors for not attending follow-up were determined. Qualitative interviews were used to understand patient and caretakers reasons for not returning for scheduled follow-up. Being treated for active tb in the dots program (OR: 4.14; 95% CI:1.99-8.62;p-value<0.001) and receiving money for the bus fare (OR:129; 95% CI 16->100;P-value<0.001) were positive predictors for attending follow-up at 2 months, and 21/85(25%) of children not attending scheduled follow-up had died. Interviews revealed that limited financial resources, i.e. lack of money for transportation and poor communication, were related to non-adherence. Patients lost to follow-up is a potential problem for TB research. Receiving money for transportation to the hospital and communication is crucial for adherence to follow-up conducted at a study facility. Strategies to ensure follow-up should be part of any study protocol

Identification and characterization of PhbF: A DNA binding protein with regulatory role in the PHB metabolism of Herbaspirillum seropedicae SmR1

<p>Abstract</p> <p>Background</p> <p><it>Herbaspirillum seropedicae </it>SmR1 is a nitrogen fixing endophyte associated with important agricultural crops. It produces polyhydroxybutyrate (PHB) which is stored intracellularly as granules. However, PHB metabolism and regulatory control is not yet well studied in this organism.</p> <p>Results</p> <p>In this work we describe the characterization of the PhbF protein from <it>H. seropedicae </it>SmR1 which was purified and characterized after expression in <it>E. coli</it>. The purified PhbF protein was able to bind to eleven putative promoters of genes involved in PHB metabolism in <it>H. seropedicae </it>SmR1. <it>In silico </it>analyses indicated a probable DNA-binding sequence which was shown to be protected in DNA footprinting assays using purified PhbF. Analyses using <it>lacZ </it>fusions showed that PhbF can act as a repressor protein controlling the expression of PHB metabolism-related genes.</p> <p>Conclusions</p> <p>Our results indicate that <it>H. seropedicae </it>SmR1 PhbF regulates expression of <it>phb</it>-related genes by acting as a transcriptional repressor. The knowledge of the PHB metabolism of this plant-associated bacterium may contribute to the understanding of the plant-colonizing process and the organism's resistance and survival <it>in planta</it>.</p

O-RADS US risk stratification and management system: A consensus guideline from the ACR ovarian-adnexal reporting and data system committee.

The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system is designed to provide consistent interpretations, to decrease or eliminate ambiguity in US reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. It was developed by an international multidisciplinary committee sponsored by the American College of Radiology and applies the standardized reporting tool for US based on the 2018 published lexicon of the O-RADS US working group. For risk stratification, the O-RADS US system recommends six categories (O-RADS 0-5), incorporating the range of normal to high risk of malignancy. This unique system represents a collaboration between the pattern-based approach commonly used in North America and the widely used, European-based, algorithmic-style International Ovarian Tumor Analysis (IOTA) Assessment of Different Neoplasias in the Adnexa model system, a risk prediction model that has undergone successful prospective and external validation. The pattern approach relies on a subgroup of the most predictive descriptors in the lexicon based on a retrospective review of evidence prospectively obtained in the IOTA phase 1-3 prospective studies and other supporting studies that assist in differentiating management schemes in a variety of almost certainly benign lesions. With O-RADS US working group consensus, guidelines for management in the different risk categories are proposed. Both systems have been stratified to reach the same risk categories and management strategies regardless of which is initially used. At this time, O-RADS US is the only lexicon and classification system that encompasses all risk categories with their associated management schemes

Virtual Reality Applications in Rehabilitation

The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-319-39510-4_1One of the most valuable applications of virtual reality (VR) is in the domain of rehabilitation. After brain injuries or diseases, many patients suffer from impaired physical and/or cognitive capabilities, such as difficulties in moving arms or remembering names. Over the past two decades, VR has been tested and examined as a technology to assist patients’ recovery and rehabilitation, both physical and cognitive. The increasing prevalence of low-cost VR devices brings new opportunities, allowing VR to be used in practice. Using VR devices such as head-mounted displays (HMDs), special virtual scenes can be designed to assist patients in the process of re-training their brain and reorganizing their functions and abilities. However, such VR interfaces and applications must be comprehensively tested and examined for their effectiveness and potential side effects. This paper presents a review of related literature and discusses the new opportunities and challenges. Most of existing studies examined VR as an assessment method rather than a training/exercise method. Nevertheless, promising cases and positive preliminary results have been shown. Considering the increasing need for self-administered, home-based, and personalized rehabilitation, VR rehabilitation is potentially an important approach. This area requires more studies and research effort

Negative perceptions of aging and decline in walking speed: A self-fulfilling prophecy

Introduction Walking speed is a meaningful marker of physical function in the aging population. While it is a primarily physical measure, experimental studies have shown that merely priming older adults with negative stereotypes about aging results in immediate declines in objective walking speed. What is not clear is whether this is a temporary experimental effect or whether negative aging stereotypes have detrimental effects on long term objective health. We sought to explore the association between baseline negative perceptions of aging in the general population and objective walking speed 2 years later. Method 4,803 participations were assessed over 2 waves of The Irish Longitudinal Study on Ageing (TILDA), a prospective, population representative study of adults aged 50+ in the Republic of Ireland. Wave 1 measures – which included the Aging Perceptions Questionnaire, walking speed and all covariates - were taken between 2009 and 2011. Wave 2 measures – which included a second measurement of walking speed and covariates - were collected 2 years later between March and December 2012. Walking speed was measured as the number of seconds to complete the Timed Up-And-Go (TUG) task. Participations with a history of stroke, Parkinson’s disease or an MMSE < 18 were excluded. Results After full adjustment for all covariates (age, gender, level of education, disability, chronic conditions, medications, global cognition and baseline TUG) negative perceptions of aging at baseline were associated with slower TUG speed 2 years later (B=.03, 95% CI = .01 to 05, p< .01). Conclusions Walking speed has previously been considered to be a consequence of physical decline but these results highlight the direct role of psychological state in predicting an objective aging outcome. Negative perceptions about aging are a potentially modifiable risk factor of some elements of physical decline in aging

Kinematic analisys of the knee when climbing up/down stairs in patellofemoral instability

OBJECTIVE: To analyze and to identify possible gait adaptations by individuals with objective patellofemoral instability when climbing up/down stairs. METHODS: A control group (group A) composed by nine women with mean age = 25 years (±1.87), height = 1.62 m (±0.05) and weight = 56.20 kg (±7.34), and; nine women with objective patellofemoral instability (group B) with mean age = 24 years (±6.02), height = 1.62 m (±0.06) and weight = 60.33 kg (±10.31) were analyzed. The groups underwent kinematic analysis while climbing up/down stairs, in a previously determined area. Images were obtained by six cameras (Qualysis) and data analysis utilized the Q gait software program. RESULTS: Group B presented, in the support phase, less knee flexion when climbing up (p = 0.0268), and lower speed (p = 0.0076/ p =0.0243) and pace (p = 0.0027/ p = 0.0165) when climbing up and down stairs, respectively. CONCLUSION: It is suggested that group B used functional changes such as reduced knee flexion, speed and pace when climbing up and down stairs.OBJETIVO: Analisar e identificar possíveis adaptações da marcha em indivíduos com diagnóstico de instabilidade patelofemoral objetiva, durante a atividade de subida e descida de escada. MÉTODOS: Foram analisados um grupo controle (grupo A), composto por 9 mulheres com média de idade de 25 anos (±1,87), média de altura de 1,62m (±0,05) e média de peso de 56,20kg (±7,34); e, um grupo de 9 mulheres com instabilidade patelofemoral objetiva (grupo B), média de idade de 24 anos (±6,02), média de altura de 1,62m (±0,06) e média de peso de 60,33kg (±10,31). Os grupos foram submetidos a uma análise cinemática, onde as voluntárias subiram e desceram degraus, em uma área previamente selecionada. As imagens foram obtidas por seis câmeras (Qualysis) e a análise dos dados foi realizada através do programa Q gait. RESULTADOS: O grupo B apresentou, no período de apoio, menor flexão do joelho durante a subida (p=0,0268), além de menores velocidade (p=0,0076/ p=0,0243) e cadência (p=0,0027/ p=0,0165) na subida e na descida, respectivamente. CONCLUSÃO: Sugere-se que o grupo B utilizou adaptações funcionais como redução da flexão do joelho, da velocidade e da cadência, durante a subida e a descida de degraus.UNICAMP FCM Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL