The Lactate/Pyruvate Ratio of Metabolic Modulation Using Glucose Insulin Kalium and Lactate Solution and Their Effect on Functional Mechanical Recovery of the Isolated Perfused Heart

Metabolic modulation with Glucose Insulin Kalium (GIK) solution has beenreally well known in their capacity to improve post ischemic heart function. In this regardGIK intervention on post operative Coronary Artery Bypass Graft (CABG) can improveheart function recovery on reperfusion period (Goldhaber dan Weiss, 1992; Atwell et al.,1997). Post operative CABG intervention with GIK will produce a beneficial effect onthe elevation of heart energy to prevent ionic homeostasis disturbance and reactiveoxygen species (ROS) production that become the basis of reperfusion injury (Silvermandan Stern, 1994; Cross et al., 1995; Taegtmeyer et al., 1997; Opie, 1999; Lazar, 2002;Doenst et al., 2003; Trence et al., 2003).Many efforts have been made to clarify how exactly GIK works to improve postischemic heart function as in CABG. This is crucially done in order to be able to modifythe solution concerned. Although this solution has been clearly proved to improve postischemic heart function, it is not totally free from its adverse effect. Its main side effect isthat it can provoke hyperglycemic state, which contrasts with the tight glucose control incontinuously normal range for the patients who are critically ill.In this study lactate and pyruvate level in the coronary effluent were measuredfrom the isolated heart directly perfused with GIK and lactate. It was shown that thepreischemic lactate level was low and then clearly elevated as soon as the reperfusiontook place due to anaerobic metabolism. In accordance with reperfusion time lactate leveldecreased gradually. In relation with pyruvate level, this substrate evolution looked likethe appearance of lactate but its value was lower if compared with lactate.The recovery in functional mechanical activity of the post ischemic heart seems tobe much more related to the pattern of the evolution of logarithmic lactate/pyruvate ratio(L/P ratio). Logarithmic value of L/P ratio in GIK group increased since the earlyreperfusion period (+40%, p < 0.05), followed by improvement in recovery ofmechanical activity in this group which was significantly higher if compared with thecontrol group. Similar fashion was found in lactate group in regard to the evolution of thelogarithmic value of L/P ratio in this group, where its value was significantly highercompared with the control group. The logarithmic evolution pattern on L/P ratio for thisgroup increased along the reperfusion time (+34% p < 0.05).From the present study, it can be concluded that the recovery of functionalmechanical activity of the post ischemic heart perfused with GIK is through modificationon cellular lactate metabolism

PENDAMPINGAN ALUMNI JURUSAN GIZI POLTEKKES KEMENKES MATARAM DALAM PROGRAM PENGEMBANGAN KEWIRAUSAHAAN

Alumni Jurusan Gizi Politeknik kesehatan Mataram sudah mampu membuat produk  yang inovasi dan bernilai gizi tinggi, masih kurang dalam kemampuan mengembangkan menjadi produk komersial karena  pengetahuan berwirausaha dan ketrampilan manajemen masih perlu dikembangkan. Sehingga upaya agar alumni bisa mengembangkan jiwa wirausahanya melalui program pengembangan kewirausahan pada kegiatan pengabdian masyarakat. Sasaran dalam kegiatan ini adalah alumni yang sedang merintis usaha dibidang makanan sebanyak 10 orang.  Pendekatan yang dilakukan menggunakan modifikasi metode PALS (participatory action learning system)

PENGARUH EDUKASI PERSONAL HYGIENE DAN SANITASI MAKANAN TERHADAP PERILAKU PEDAGANG SATE BULAYAK

Salah satu cara menjaga kesehatan tubuh ialah mengonsumsi makanan yang aman dan memastikan makanan dalam keadaan baik atau aman. Makanan yang telah terkontaminasi dapat menjadi wadah berkembangnya pathogen yang biasa dikenal dengan food borne diseases. Upaya keamanan makanan diantaranya dengan menerapkan hiegene dan sanitasi makanan. Hal tersebut dapat didukung apabila pedagang memiliki pengetahuan yang baik dalam menerapkan perilaku positif dalam melakukan pengolahan hingga penyajian makanan. Tujuan penelitian untuk mengetahui pengaruh edukasi personal hiegene dan sanitasi terhadap perilaku pedagang sate bulayak. Penelitian ini menggunakan 30 orang pedagang Sate Bulayak yang akan diberikan edukasi untuk melihat perubahan perilaku tentang personal hygiene dan sanitasi makanan. Sampel dalam penelitian menggunakan metode sampel jenuh, yaitu seluruh populasi dijadikan sampel. Jenis penelitian ini adalah pra-eksperimen dengan metode one group pre-test post-test. Hasil penelitian menunjukkan terdapat pengaruh edukasi personal hiegene dan sanitasi makanan yang ditunjukkan dengan perubahan perilaku pedagang dengan menerapkan kegiatan personal hiegene dengan baik mulai dari persiapan hingga penyajian. Hasil uji statistik perilaku menggunakan paired t test menunjukkan nilai signifikansi sebesar 0.015 (p<0,05)

Pre-operative Neutrophil-to-Lymphocyte Ratio is Associated with Post-operative Opioid Requirements and Length of Stay after Thoracotomy

BACKGROUND: Surgical pain and prolonged hospital length of stay (LOS) affect a large proportion of patients after thoracotomy. Inflammation plays a crucial role in the mechanism and progression of pain and the outcomes. AIM: The objective of this study was to investigate the association between the pre-operative neutrophil-to-lymphocyte ratio (NLR) and post-operative pain and LOS in patients undergoing thoracotomy. METHODS: This was a retrospective, observational study on 157 patients who underwent thoracotomy under general anesthesia. We classified the subjects into two study groups: Group with for patients with NLR &lt;2 and Group 2 for NLR ≥2. We measured the post-operative pain by gathering the data of post-operative opioid needs. We used Pearson’s and Spearman’s correlation tests to assess the association of the parameters. RESULTS: The mean of total oral morphine equivalent in the first 48 h following thoracotomy in Group 1 was 140.8 ± 60.4 mg compared to Group 2’s 109.7 ± 55.8 (p &lt; 0.05). The median hospital’s LOS was longer in Group 2 compared to Group 1 (7 vs. 10, p &lt; 0.001). We found a weak positive correlation between pre-operative NLR (R = 0.267, p = 0.002) and post-operative opioid requirements, and a weak positive correlation between pre-operative NLR and the hospital’s LOS (R = 0.345, p &lt; 0.001). CONCLUSION: Pre-operative NLR correlates with post-operative opioid requirements and the time hospital’s LOS in patients who underwent elective thoracotomy

The Lactate/Pyruvate Ratio of Metabolic Modulation using Glucose Insulin Kalium and Lactate Solution and their Effect on Functional Mechanical Recovery of the Isolated Perfused Heart

Metabolic modulation with Glucose Insulin Kalium (GIK) solution has beenreally well known in their capacity to improve post ischemic heart function. In this regardGIK intervention on post operative Coronary Artery Bypass Graft (CABG) can improveheart function recovery on reperfusion period (Goldhaber dan Weiss, 1992; Atwell et al.,1997). Post operative CABG intervention with GIK will produce a beneficial effect onthe elevation of heart energy to prevent ionic homeostasis disturbance and reactiveoxygen species (ROS) production that become the basis of reperfusion injury (Silvermandan Stern, 1994; Cross et al., 1995; Taegtmeyer et al., 1997; Opie, 1999; Lazar, 2002;Doenst et al., 2003; Trence et al., 2003).Many efforts have been made to clarify how exactly GIK works to improve postischemic heart function as in CABG. This is crucially done in order to be able to modifythe solution concerned. Although this solution has been clearly proved to improve postischemic heart function, it is not totally free from its adverse effect. Its main side effect isthat it can provoke hyperglycemic state, which contrasts with the tight glucose control incontinuously normal range for the patients who are critically ill.In this study lactate and pyruvate level in the coronary effluent were measuredfrom the isolated heart directly perfused with GIK and lactate. It was shown that thepreischemic lactate level was low and then clearly elevated as soon as the reperfusiontook place due to anaerobic metabolism. In accordance with reperfusion time lactate leveldecreased gradually. In relation with pyruvate level, this substrate evolution looked likethe appearance of lactate but its value was lower if compared with lactate.The recovery in functional mechanical activity of the post ischemic heart seems tobe much more related to the pattern of the evolution of logarithmic lactate/pyruvate ratio(L/P ratio). Logarithmic value of L/P ratio in GIK group increased since the earlyreperfusion period (+40%, p &lt; 0.05), followed by improvement in recovery ofmechanical activity in this group which was significantly higher if compared with thecontrol group. Similar fashion was found in lactate group in regard to the evolution of thelogarithmic value of L/P ratio in this group, where its value was significantly highercompared with the control group. The logarithmic evolution pattern on L/P ratio for thisgroup increased along the reperfusion time (+34% p &lt; 0.05).From the present study, it can be concluded that the recovery of functionalmechanical activity of the post ischemic heart perfused with GIK is through modificationon cellular lactate metabolism

SPONTANEOUS RUPTURE OF ARTERIOVENOUS MALFORMATION: ICU BASED BRAIN RESUSCITATION

Arteriovenous malformations (AVM) is a relatively rare intracranial abnormality. Generally, it caused by congenital abnormalities that recognized after the bleeding started. Spontaneous intracranial bleeding after AVM rupture is an emergency condition and require immediate treatment to reduce mortality rate. After stabilization of intracranial bleeding due to AVM rupture, secondary injury may occur hours or even days after the inciting traumatic event. The injury may result from impairment or local declines in cerebral blood flow (CBF) after brain injury. The decrease in CBF is the result of local edema, hemorrhage, or increased intracranial pressure (ICP). An adequate brain resuscitation is needed to decrease brain edema and intracranial pressure by achieving several targets and avoid things that can interfere with CBF. A recovery phase should be given to the patient with rupture of AVM before going to definitive therapy

Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center

ABSTRACTPain is a common complaint found in the population. Inadequate knowledge about pain management is the most common reason that triggers the inadequate management of pain. Pharmacological pain management is also not without risk. Various risks from the use of pharmacological agents related to side effects that can arise may also cause new problems. Several medical intervention techniques with invasive procedures for pain have also been carried out, although they are still less popular, due to a lack of public knowledge of this technique. We conducted a cost-free, minimally invasive pain procedure in people with chronic musculoskeletal pain in a public health center in a rural area in Bali Island to alleviate their pain-associated symptoms and to introduce this minimally invasive pain management technique

Anaesthesia Management of Patient at 16 Weeks Pregnancy with Primary Malignant Bone Tumour Underwent Hemipelvectomy Surgery

Chondrosarcoma is a type of sarcoma that affects the bones and joints. It is a rare cancer that accounts for about 20% of bone tumours and is diagnosed in approximately 600 patients each year in the United States. Chondrosarcoma typically affects adults between the age of 20 and 60 years old. The disease usually starts in the bones of the arms, legs or pelvis, but it can be found in any part of the body that contains cartilage. Sometimes chondrosarcoma grows on an otherwise healthy bone or it grows on a benign bone tumour (an enchondroma or osteochondroma). Non-obstetric surgery during pregnancy is not uncommon and can have excellent outcomes with proper planning. Between 0.75% and 2% of pregnant women require non-obstetric surgery. Surgery can be required during any stage of pregnancy depending on the urgency of the indication. When caring for pregnant women undergoing non-obstetric surgery, safe anaesthesia must be provided for both the mother and the child. Thorough understanding of the physiological and pharmacological adaptations to pregnancy is required to ensure maternal safety. Fetal safety requires avoidance of potentially dangerous drugs at critical times during fetal development, assurance of continuation of adequate uteroplacental perfusion, and avoidance and/or treatment of preterm labour and delivery.Pregnant patients beyond 18–20 weeks of gestation should be positioned with a 15° left lateral tilt, to reduce aortocaval compression and supine hypotension syndrome. Regional anaesthesia with combined spinal epidural is an option for this case. Regional anaesthesia does reduce the exposure of foetus to potential teratogens, avoids the potential risk of failed intubation and aspiration, and provides excellent post-operative analgesia. The major concern with neuraxial anaesthesia is maternal hypotension, which may reduce placental perfusion.  During anaesthesia and surgery, foetal well-being is best ensured by careful maintenance of stable maternal haemodynamic parameters and oxygenation. Close monitoring of foetal responses for signs of distress is strongly advocated

The Relationship of Inflammatory Regulation and Pain Intensity in SIRS Patients

Aims of this study were to investigate the changes in inflammatory regulation as shown by proinflammatory cytokines (IL-6) and anti-inflammatory cytokines (IL-10) from patients with systemic inflammatory responses syndrome (SIRS) that affect pain intensity changes with the marked increase of critical-care pain observation tools (CPOT) and decreased of the pain pressure threshold (PPT). A cross-sectional analysis to compare the values of IL-6, IL-10, PPT, and CPOT of SIRS patients and patients without SIRS. Of the 46 patients who were the subjects of the study, there were 21 SIRS patients and 25 patients non-SIRS

The correlation between the depth extent of Tuohy epidural needle with body mass index (BMI) to achieve loss of resistance in patients undergoing epidural anesthesia

ABSTRACTBackground: Anesthesia management in obesity is quite challenging. Epidural anesthesia become one of the choices. The attention should be addressed in order to prevent the misidentification of epidural space. The estimation of the depth extent of epidural space becomes crucial, especially in obese patients due to an accumulation of subcutaneous and epidural adipose tissue, which consequently complicate the epidural catheter insertion. This study aimed to analyze the correlation of the depth extent of Tuohy epidural needle to achieve loss of resistance between normal-weighted and obese patients.Method: This study was conducted with 56 adult patients aged 17 to 65 years who underwent elective surgery by epidural anesthesia inserted at level L2-L3 or L3-L4 interspace. Subjects are divided into normal and obese groups. Shapiro-Wilk and chi-square tests were used in the normality test. For normally distributed data, an independent t-test was used to test the hypothesis, otherwise, we used Mann-Whitney test  Results: The results showed that the loss of resistance in epidural needle insertion procedures was 60 mm in a patient with BMI more than 30 kg/m2 and 50 mm in those with BMI &lt;30 kg/m2 (p&lt;0.001).Conclusion: The loss of resistance depth in epidural Tuohy needle insertion is significantly determined by BMI.