The changing microbiological and antimicrobial susceptibility profile of cerebrospinal fluid organism isolates in a teaching hospital, Tangerang, Indonesia

Central nervous system (CNS) infections have become serious problems that contribute to morbidity and mortality in developing countries. In the recent years, antimicrobial resistance has arisen parallel with the changing trend of infectious pathogens, which resulted in the unavailability of an ideal antimicrobial agent. This study was designed to evaluate the central nervous system pathogens and their susceptibility profile using routine microbiological data. The data of CSF culture and susceptibility testing were collected from January 2010 to August 2015. The majority of eligible sample 68/99 (68.7%) had history of neurosurgical procedures. The most common pathogens isolated were coagulase negative staphylococci (CoNS) 39/99 (39.4%) followed by Acinetobacter baumanii 10/99 (10.1%), Pseudomonas aeruginosa 7/99 (7.1%), Sphingomonas paucimobilis 5/99 (5.0%), and Aeromonas salmonocida 4/99 (4.0%). Almost of all Gram positive cocci were susceptible to tigecycline, linezolide, vancomycin, and trimethoprim/sulfamethoxazole. Most Gram negative bacilli (GNB) in this study were multi-drug resistant with high susceptibility level to amikacin, tigecycline, and trimethoprim/sulfamethoxazole. The overall susceptibility testing to cephalosporins was low, ranging 34.2% to 58.5%. The susceptibility to several antifungal remained high for Candida spp. and Cryptococcus neoformans. The present study notifies the changing pathogens trend of CNS infections along with their antimicrobial susceptibility level in our hospital. There is a need of local antimicrobial recommendation and surveillance system to control the usage of antimicrobial and selection of empirical antimicrobial therapy

Glial Fibrillary Acidic Protein Serum Level as a Predictor of Clinical Outcome in Ischemic Stroke

BACKGROUND: Glial Fibrillary Acidic Protein (GFAP) is a protein produced by astrocytes in response to brain injury, which then penetrates the cerebrospinal fluid and the blood stream. AIM: We sought to determine whether GFAP serum level in acute ischemic stroke could predict clinical outcome. METHODS: As much as 64 patients with first-ever ischemic stroke had their GFAP serum level measured at 72 hours after onset. The National Institute of Health Stroke Scale (NIHSS) was assessed during the 72 hours of onset, the seventh day, and followed up 1 month after. RESULTS: There were 46 men and 18 women included in the study. Mean age was 58.3 years old, and nearly half of them (46.9%) were between 50-59 years old. More than half (58.7%) presented with moderate to a severe stroke and mean GFAP serum level was 0.113 ± 0.029 ng/mL. GFAP serum levels had a significant correlation with NIHSS after 1 month (p = 0.04, r = 0.259). CONCLUSION: There is a significant correlation between GFAP serum levels with stroke severity scale after 1 month of stroke onset

Effectiveness of online interprofessional education-communication course during the COVID-19 pandemic

A developed IPE (Interprofessional Education)-communication course was first implemented at Universitas Pelita Harapan/UPH via online learning due to the COVID-19 pandemic. This study aimed to analyze the effectiveness of a newly developed IPE-online communication course offered to medical (MS) and nursing (NS) students. This study was a quantitative study using a pre-post design without control. The IPAS (Interprofessional Attitude Scale) assessed students' attitudes toward IPE. Satisfaction with the program was also measured following its completion. The questionnaire was administered via Survey Monkey to 535 respondents (MS = 250; NS = 285). Univariate and bivariate statistical analyses were employed. Before and after the IPE program, 161 MS and 146 NS completed the IPAS questionnaire (n = 307). The attitude of MS and NS were not improved significantly (p-value >0.05). Moreover, several subscales of attitudes decreased significantly, including ''Diversity and Ethics'' with a low-size effect for medical students and ''Teamwork, Roles, and Responsibilities'' and ''Patient-Centeredness'' with a low-size effect for nursing students. Both students (n = 307) were also satisfied with the IPE course (Mean MS: 4.28 and NS: 4.34). This study suggests that online IPE communication course may not be effective in fostering student attitudes. The IPE communication course should be accomplished through in-person class instead of online learning. Further IPE course evaluations are required to improve the acceptability, applicability, and effectiveness of IPE in health education

Serum vascular endothelial growth factor as a predictor of clinical outcomes in anterior circulation ischemic stroke

Background: Inflammatory response in the acute phase of ischemic stroke will trigger the process of neuroplasticity and determine the clinical outcomes. Angiogenesis and neurogenesis are induced by expression of vascular endothelial growth factor (VEGF) in the acute phase of stroke. The purpose of this study was to determine the association between VEGF serum level in acute phase of stroke with the clinical outcomes.Methods: This longitudinal cohort study was conducted on 64 patients suffering from first-attack of anterior circulation blockage as evidenced by cephalic diffusion-weighted magnetic resonance imaging (DWI). VEGF serum level was measured at 72 hours and 7 days after stroke and the clinical outcomes were assessed on day 30 post-stroke using the National Institutes of Health Stroke Scale (NIHSS).Results: VEGF level at hour-72 and on day-7 were 5.84 ± 0.736 ng/mL and 5.797 ± 0.96 ng/mL, respectively (p &gt; 0.05). High VEGF levels at hour-72 can be used to predict poor clinical outcome 30 days after stroke (OR = 6.5; 95% CI = 1.15-36.61; p = 0.034). Subjects who have increasing levels of VEGF on day-7 compared to hour-72 tend to have better clinical outcomes on day-30. (NIHSS score = 1.33 ± 1.22 vs 3 ± 3.78; p = 0.232).Conclusion: VEGF levels in the acute phase of ischemic stroke reflect the degree of brain damage, the dynamic of the increase in VEGF levels after a stroke was associated with better clinical outcomes.</p