FACTORS AFFECTING POST-OPERATIVE PAIN AFTER DOPPLER GUIDED HEMORRHOID ARTERY LIGATION AND RECTO-ANAL REPAIR (DGHAL-RAR) OF INTERNAL HEMORRHOID

Background: DGHAL-RAR is new modality for grade II-IV internal hemorrhoid treatment. It is developed to reduce post-operative pain that mostly found in traditional hemorrhoidectomy even in Stappler hemorrhoidopexy. However, in clinical practice some patients are complaint of moderate until severe pain. This study is intended to know factors affecting the post-operative pain after DGHAL-RAR of internal hemorrhoid.Methods: A series of 61 grade II-IV internal hemorrhoid patients, underwent DGHAL-RAR in St Elizabeth Hospital, Semarang Indonesia, period of August 2012 – March 2014 were analyzed prospectively. Age, sex, grade, removing of thrombus  either internal or external, anal fissure, removing of hypertrophic anal papilla, removing skin tag, anal laceration due to procedure, were analyzed to know it relation with post operative pain in 24 hours, 48 hours and 7 days post-operatively. VAS for pain (0–10) were used to assess the degree of pain. Mann-Whitney method was used for univariate analysis, while Kruskal-Wallis and Median method were used for multivariate analysis.Results: After multivariate analysis variables that significantly influence post operative pain on 24 hours were removing of internal thrombosis, removing of anal papilla hypertrophy and anal laceration, on 48 hours were removing of external thrombosis, removing of anal papilla hypertrophy and anal laceration and  on 7 days were the same with on 24 hours.Conclusion: Factors that affecting post-operative pain after DGHAL-RAR  for grade II-IV internal hemorrhoid were removing of both internal and external thrombosis, removing of anal papilla hypertrophy and anal laceration due to DGHAL-RAR procedure. Keywords: Internal hemorrhoid, Hemorrhoid artery ligation and recto-anal repair, thrombosis, anal papilla hypertrophy, anal laceration

Effects of ursodeoxycholic acid and glutathione combination in spleen TNF-α and apoptotic index in rats with cholestasis

Background: Cholestasis is a disorder of the formation or flow of bile. Among its contributors, tumour necrosis factor (TNF)-α stands out as the most influential inducer of apoptosis. Meanwhile, ursodeoxycholic acid (UDCA) is a valuable agent with choleretic properties, protecting the hepatobiliary system. Glutathione (GSH) enhances endothelial response and prevents liver fibrosis Objectives: This study evaluates the effect of a combination of GSH-UDCA on splenic TNF-α expression and apoptosis index in Sprague Dawley (SD) rats with cholestasis Methods: This experiment with a post-tests-only control group design involving 28 male SD rats. They were randomly into four groups: group (K) with 20 mg UDCA, group 1 (P1) with 10 mg UDCA + 10 mg GSH, group 2 (P2) was given UDCA 20 mg + GSH 15 mg, and group 3 (P3) was given UDCA 30 mg + GSH 20 mg. Cholestasis was obtained by ligation of the common bile duct through a laparotomy. During three weeks of trial, rats were administered daily with UDCA orally and GSH intramuscularly. On day 22, rats were sacrificed and spleen samples were taken for anatomical pathology examination. Results: There were significant differences in TNF-α expression between groups K vs P3; P1 vs P3, and P2 vs P3 (p=0.002). There was a significant difference in the apoptotic index between groups K vs P1 (p<0.001); K vs P2 (p=0.004), and K vs P3 (p=0.005). Conclusions: The UDCA-GSH combination demonstrated a prophylactic effect in SD rats with cholestasis and might be an effective supplemental therapy with UDCA for cholestatic diseases. The difference in TNF-α expression and apoptotic index was lower in SD rats UDCA-glutathione combination group than single dose UDCA. Between TNF-α and the apoptotic index, there is a moderate positive relation

Phlebotrophic Effect of Graptophyllum Pictum (L.) Griff on Experimental Wistar Hemorrhoids

Background : The 1st and 2nd degree hemorrhoids is managed non-operatively with the anti-inflammatory and plebothropic drugs. Graptophyllum pictum extract (GPE) has already been used widely in Indonesia to treat hemorrhoid with good result, however, the mechanism is not supported by the molecular research.Objective : This study is intended to study the phlebothropic effects of GPE by measuring the degree of edema and extravassal leucocytes of experimental wistar hemorrhoid.Methods : Experimental study with Randomized Controlled Trial Post-test only design in male wistar rats, weight around 200 gr, induced for the development of a disease-like condition of hemorrhoids by 6% croton oil on the anus for 3 days. Random allocation was performed to divide the 14 wistar rats in 2 groups. Group I as control got normal saline solution, while group II was treated with GPE 100mg/kgbw, started on day 4th for 5 consecutive days. On 9th day blood was extracted from retroorbital fossa and anus was resected up to 2 cm from anal verge and weighted. The degree of anal edema was measured by rectoanal coefficient, that is rasio between anal weight (miligrams) and body weight (grams).Results : Until the end of study, all wistar rat were still alive. The mean (±SD) of body weight   of control group was 173.84 ­(±13.37) and the treatment group was 171.70  (±13.10), and there was no significant differences (p = 0.833). The mean (±SD) of rectoanal coefficient in the treatment group was 2.46 (±0.41) and it was significantly lower than control group  (3.13 ± 0.85) (p = 0.029). The mean (±SD) of extravassal leukocytes in the treatment group was 900.14(±48.09) and it was significantly lower than the control (1003.28 ± 99.30) (p = 0.042).Conclusions : Graptophyllum pictum extract at doses of 100 mg/Kgbw have phlebotonic effect  in decreased edema and extravassal leukocytes

Trends in Science and Technology for Sustainable Living

Dalam buku ini, dibahas mengenai perkembangan tren kajian dalam sains dan teknologi yang mendukung pembangunan berkelanjutan untuk mewujudkan kehidupan berkelanjutan. Pembangunan berkelanjutan mempunyai prinsip pembangunan yang bertujuan memenuhi kebutuhan generasi saat ini tetapi tidak mengurangi ataupun mengorbankan kemampuan generasi selanjutnya dalam memenuhi kebutuhan mereka; sehingga kehidupan yang baik akan terus berlanjut dalam waktu yang lama. Pembangunan berkelanjutan saat ini berfokus pada tiga hal, yaitu pembangunan keberlanjutan ekonomi dan sosial, serta perlindungan terhadap lingkungan untuk generasi mendatang. Ketiganya saling berhubungan dan mendukung dalam mencapai tujuan pembangunan serta stabilitas lingkungan dan sosial. Oleh karena itu, keseimbangan yang baik dalam aspek lingkungan,ekonomi, dan sosial harus dicapai untuk membentuk kehidupan berkelanjutan

TINJAUAN YURIDIS IMPLEMENTASI PASAL 35 UNDANG-UNDANG NOMOR 13 TAHUN 2003 TENTANG KETENAGAKERJAAN

The use of outsourced labor in support activities or activities that are not directly related to the production process as mentioned in the explanation of Article 66 of the Employment Act that are intended to support activities or activities that are not directly related to the production process-related activities outside the core business of a company. Of these provisions, it appears that the arrangement of the terms of hiring contract workers is very limited. The purpose of this study was to determine and analyze the major job classifications and work supporting a company that is the basis for the implementation of outsourcing and to determine and analyze the legal relationship between the employees of the company outsourcing the outsourcing of service users. Study is a study that focuses on the normative juridical norms and legal materials as the main data. Methods of data collection is done by studying and reviewing legal materials related to research. Data obtained from the literature, and directed, discussed and given an explanation by using the method of qualitative analysis, which is a way of research that produces descriptive data analysis. The method of thinking in the decision is the method of inductive inference, which draw conclusions from the general to the particular case. Classification of main job and the job of supporting companies that are the basis for implementing outsourcing only auxiliary service activities in the employer company. Activities, among others, business cleaning services, the business of supplying food for the workers, safety personnel business, business support services in the mining and petroleum, and businesses providing transportation workers. Legal relationship between the employee with the company's outsourcing outsourcing service users place on the basis of agreement by the company with corporate users of outsourcing services outsourcing provider employee, so there is no employment relationship between employees of the outsourcing agreement with the company's service users

Prolapsing Hemorrhoids

Hemorrhoids are a common anorectal disease and are often found in clinical practice. Patients mostly come with a complaint of anal bleeding or prolapsing mass. Grade III and IV prolapsing hemorrhoids are distinguished from grade II by the fact that grade II prolapse only during defecation and returns simultaneously after defecation and usually does not cause complaint. Prolapsing hemorrhoids should be differentiated from prolapsing rectal polyps, small rectal prolapse, anorectal tumors, hypertrophy of the anal papilla, and condylomas. Nowadays, the management of prolapsing hemorrhoids varies. Medical therapy is rarely used alone, it is used to improve the effect of surgical therapy. The surgical gold standard for prolapsing hemorrhoids is excision surgery (hemorrhoidectomy) with or without suturing. However, since it comes with pain complaints, non-excision surgery is now offered. Non-excision surgery is divided into two types—stapled hemorrhoidopexy and hemorrhoidal artery ligation and rectoanal repair. Each method of surgery has its own advantages and disadvantages. This chapter review discusses the anatomy, pathophysiology, diagnosis, and management of prolapsing hemorrhoids

Combination of Ursodeoxycholic Acid and Glutathione Improves Intestinal Morphology in Cholestasis by Downregulating TNF-α Expression

BACKGROUND: Cholestasis caused by obstruction of the common bile duct and may developed gut-derived sepsis due to reactive oxygen species (ROS) accumulation. Ursodeoxycholic acid (UDCA) and glutathione are widely known for their antioxidant properties, that might be beneficial against ROS. However, the effects of UDCA-glutathione combination against ROS have not been well elucidated in previous studies. Thus, this study was conducted to evaluate tumor necrosis factor (TNF)-α level and height of terminal ileal mucosal villus after UDCA-glutathione administration in cholestasis rat model.METHODS: Twenty-eight male Sprague Dawley rats were randomly grouped into four treatment groups, each group consisted of seven rats that had previously undergone bile duct ligation. Three groups received treatment of UDCA-glutathione combination on stratified dose, while the other one only received UDCA. Each treatment was given for 21 days. Ileal samples were collected from the rats and stained with mouse anti TNF-a antibody and hematoxylin-eosin (HE). Immunohistochemistry and histopathological examination were done using microscope and then calculated with ImageJ.RESULTS: The combination of UDCA and glutathione treatment decreased the TNF-α expression (p<0.05) compared to UDCA only group, particularly in group that received 20 mg UDCA and 15 mg glutathione supplementation (p<0.05) and group that received 30 mg UDCA and 20 mg glutathione supplementation (p<0.05). The height of the mucosa villous was higher in the UDCA-glutathione combination groups for all the three dosage variations given (p<0.05) compared to UDCA only group.CONCLUSION: UDCA-glutathione combination downregulates TNF-α expression and improves ileum mucosal villus height in cholestasis.KEYWORDS: cholestasis, glutathione, intestinal villus height, TNF-α, UDCA