RESPONSES OF BRAIN TISSUES AGAINST HYPOXIC CONDITION IN HEMORRHAGIC STROKE PATIENTS: NEUROGLOBIN EXPRESSION IN BRAIN TISSUE AND PLASMA

Objective: Strokes remain a significant health concern and are the highest cause of mortality and physical or mental disability in productive and the elderly hospitalized patients in Indonesia. Neuroglobin (Ngb) mostly located in the central and peripheral nervous system, predicted enhanced neuronal survival under hypoxic condition, such as in a stroke. The aim of this study is to observe the response of the brain tissue of hemorrhagic stroke patients against hypoxic/ischemic conditions. The objectives are to recognize the pattern of Ngb expression in the brain tissue and plasma of hemorrhagic stroke patients, and furthermore, to compare the level of Ngb in the brain tissue and plasma of hemorrhagic stroke patients.Methods: This is an observational study with consecutive sampling methods using cerebral cortex and the blood of hemorrhagic stroke patients, who underwent craniotomies to evacuate hematomas at Cipto Mangunkusumo Hospital (RSCM) and other hospitals in Jakarta. Ngb expression was measured in brain tissue and blood using real time reverse transcription polymerase chain reaction, while the ELISA method was adopted to measure Ngb protein in plasma.Results: Hypoxia/ischemia in the brain tissue of hemorrhagic stroke patients increased the expression of Ngb in brain tissue compared to the blood. The level of Ngb protein in plasma of hemorrhagic stroke patients increased significantly compared to normal subjects; however, there is no significant difference between the plasma and brain tissue of hemorrhagic stroke patients.Conclusion: Hypoxia/ischemia in hemorrhagic stroke patients increases the expression of Ngb mRNA and protein level.Keywords: Neuroglobin, Hypoxia, Hemorrhagic stroke

Tigecycline reduced tumor necrosis factor alpha level and inhospital mortality in spontaneous supratentorial intracerebral hemorrhage

Background: The outcome of patients with spontaneous supratentorial intracerebral hemorrhage (SSICH) is unsatisfactory. Inflammatory response secondary to brain injury as well as those resulted from surgical procedure were considered responsible of this outcome. This study was intended to elucidate the anti-inflammatory activity of tigecycline by measuring TNF-α level and its neuroprotective effect as represented by inhospital mortality rate. Methods: Patients with SSICH who were prepared for hematoma evacuation were randomized to receive either tigecycline (n=35) or fosfomycine (n=37) as prophylactic antibiotic. TNF-α level was measured in all subjects before surgery and postoperatively on day-1 and day-7. A repeated brain CT Scan was performed on postoperative day-7. The Glasgow outcome scale (GOS) and length of stay (LOS) were recorded at the time of hospital discharge. Data were analyzed using Mann-Whitney and Chi square test. Relative clinical effectiveness was measured by calculating the number needed to treat (NNT). Results: There was a significant difference regarding the proportion of subject who had  reduced TNF-α level on postoperative day-7 between the groups receiving tigecycline and fosfomycine (62% vs 29%, p=0.022). Decrease brain edema on CT control (86% vs 80%, p=0.580). Tigecycline administration showed a tendency of better clinical effectiveness in lowering inhospital mortality (17% vs 35%; p=0.083; OR=0.49; NNT=5) and worse clinical outcome / GOS ≤ 2 (20% vs 38% ; p=0.096; OR=0.41; NNT=6). LOS ≥ 15 hari ( 40% vs 27%; p=0.243; OR=1.81; NNT=8). Conclusion: Tigecycline showed anti-inflammatory and neuroprotective activities. These activities were associated with improved clinical outcome in patients with SSICH after hematoma evacuation

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

Background. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

Background. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries

MMP-9, brain edema, and length of hospital stay of patients with spontaneous supratentorial intracerebral hemorrhage after hematoma evacuation along with the administration of tigecycline

Background: The high plasma level of matrix metalloproteinses–9 (MMP-9) is believed to disrupt the blood-brain barrier (BBB) and cause brain edema, as well as increase patient’s length of hospital stay (LOS). Tigecycline showed ability to reduce the MMP-9 level on study in animals. This study aimed to evaluate whether tigecycline can reduce the plasma levels of MMP-9; brain edema; and LOS of patients with supratentorial spontaneous intracerebral hemorrhage (SSICH). Methods: A randomized clinical trial (RCT) was conducted on 72 SSICH patients who underwent hematoma evacuation in eleven hospitals in Jakarta; 100 mg tigecycline (n=35) or 2 g fosfomycine (n=37) administered intravenously before skin incision as an prophylactic antibiotics to avoid post-operative infections. Plasma levels of MMP-9 were measured in all subjects before and on the first and seventh day after the surgery. Reduction of brain edema was assessed by comparing the extent of brain edema on computed tomography scan (CT scan) before and CT scan after surgery. The length of stay (LOS) was recorded at the time of hospital discharge either survive or death. Data were analyzed using Mann-Whitney and Chi-Square test. Results: There were non-significant statistical differences between two groups in the proportion of subjects with reduced MMP-9 levels on the first day (48% vs 50%; p=0.902; OR=1.1) and seventh day after the surgery (33% vs 48%; p=0.296; OR=1.9); proportion of the subjects with brain edema reduction (86% vs 80%, p=0.58); LOS (median 12 days vs 13 days, p=0.256; LOS ≥15 days 40% vs 27%; p=0.243; OR=1.81; NNT=8). Conclusion: On SSICH patients who underwent hematoma evacuation, tigecycline did not either reduce MMP-9 levels and brain edema or shorthen LOS

New Predictor of In-Hospital Mortality of The Surgically Treated Haemorrhagic Stroke: Subanalysis

At present there are no specific limits on the level of inflammatory markers which can be used as a boundary between excessive or non-inflammatory responses. We investigate the leukocytes count at hospital admission of spontaneous intracerebral haemorrhage patients to be proposed as a boundary between excessive inflammation and not excessive. This is a subanalysis from the study of the neuroprotective effect of tigecycline on brain injury due to spontaneous intracerebral haemorrhage supratentorial who underwent evacuation of the hematoma. Leukocytosis defined as a leukocyte count ≥ 11.000 cells/mL. The primary outcome was inhospital mortality and the secondary outcome was length of hospital stay (LOS). Statistical analysis conducted by chi-square or Fisher’s exact test and logistic regression. Seventy patients were included. Approximately 79% of the patients had leucocytosis. Leucocytosis was not associated with inhospital mortality or LOS of 15 days or longer. However, a leucocyte count of 20,000 mm3 or higher was associated with in-hospital mortality (odds ratio, 9.09; 95% confidence interval, 1.97 to 42.06; P = 0.005). A leucocyte count of 20,000/mm3 or higher can be proposed as a boundary of the excessive inflammation on spontaneous intracerebral haemorrhage. Prediktor Baru Kematian di Rumah Sakit untuk Pasien Stroke Hemoragik yang Dilakukan Operasi: Hasil Subanalisis Saat ini belum ada penanda khusus untuk menilai suatu respons inflamasi yang berlebihan atau tidak. Penelitian ini bermaksud mengungkap jumlah leukosit tertentu sebagai penanda inflamasi yang berlebihan pada pasien perdarahan otak spontan yang dilakukan operasi evakuasi hematoma intracranial. Penelitian Ini adalah subanalisis dari studi efek neuroprotektif tigecycline pada cedera otak akibat perdarahan intraserebral spontan yang menjalani evakuasi hematoma. Leukositosis didefinisikan sebagai jumlah leukosit ≥ 11.000 sel / mL. Luaran utamanya adalah kematian di rumah sakit dan luaran sekundernya adalah lama perawatan di rumah sakit (LOS= length of stay). Analisis statistik dilakukan dengan chi-square atau uji eksak Fisher dan regresi logistik. Hasil: 70 pasien dilibatkan. Sekitar 79% dari pasien memiliki leukositosis. Leucocytosis tidak berhubungan dengan kematian di rumah sakit atau LOS 15 hari atau lebih. Namun, jumlah leukosit 20.000 mm3 atau lebih tinggi berhubungan dengan kematian di rumah sakit (rasio odds, 9,09; interval kepercayaan 95%, 1,97 hingga 42,06; P = 0,005). Jumlah leukosit 20.000 / mm3 atau lebih tinggi dapat diusulkan sebagai batas peradangan berlebihan pada perdarahan intraserebral spontan.&nbsp

In retrospective, the gentle learning curve of unilateral laminectomy promotes favorable clinical outcomes

Background: The learning curve in implementing a new surgical procedure is often time-consuming and potentially comes with the additional risk of injury associated with an unusual surgical procedure, which may harm the patient. Aim: Evaluate intraoperative burden and neurologic recovery of spinal tumor resection following unilateral laminectomy procedures. Methods: Medical records of patients undergoing surgery for intradural spinal tumors from January 2015 to June 2020 were retrospectively reviewed. Preoperative and postoperative data were collected from medical records and interviews. The intraoperative burden was assessed by duration of surgery, estimated intraoperative blood loss (EIBL), and postoperative leukocyte count. Short-term and long-term outcomes were recorded. Data analysis was performed using descriptive statistics and Fisher's exact test. The neurological recovery rate is calculated by the Hirabayashi method, where a 75–100% score indicates an excellent neurological recovery. Results: Twenty-six records were included in this study. The mean duration of surgery was 180 (120–540) minutes, the mean EIBL was 175 (50 – 1,200) mL, and mean increase in postoperative leukocyte count was 5,670 (2,210 – 13,250) cells/mL, and the mean LOS was 6.5 (4 – 42) days. In 20 of 26 (76.9%) patients, gross total resection was achieved. An excellent neurological recovery rate was achieved in 81% of patients. Conclusion: Unilateral laminectomy procedures are adaptable without additional disadvantages, resulting in satisfactory clinical results