Andi Asadul Islam

Cortisol dynamics are associated with electrocardiographic abnormalities following the aneurysmal subarachnoid hemorrhage

Context: Electrocardiographic (ECG) abnormalities are common following subarachnoid hemorrhage (SAH). It probably represents cardiovascular stress after SAH. Aims: The purpose of this study was to assess cortisol dynamics in relation to the ECG abnormality and disease course of SAH. Settings and Design: The study follows a consecutive cohort of aneurysmal SAH patients, who underwent surgery within 72 hours of onset, and they were followed up for 10 days. Materials and Methods: Serum cortisols, cortisol-binding globulin (CGB), adenocorticotropic hormone were measured (between 08.00-09.00 hours) preoperatively and then on postoperative days (PODs) 2, 4, 7, and 10. Electrocardiographs (ECG) were recorded on initial assessment and after surgery on daily basis in ICU. ECG abnormalities will be followed up by measurement of cardiac troponin T to quantify the myocyte necrosis. Statistical Analysis Used: Logistic regression analysis using commercial available software STATA 9. Results: A total of 44 patients (20 M and 24 F) were eligible for the cohort analysis. Average patient age is 52.02 years (52.02 ± 11.23), and 86% (6/44) arrived with World Federation of Neurosurgical Society Scale grade 3 or better. The ECG abnormality was found in 10 cases (22.7%), but the abnormal TnT (>1 μg/l) were found in eight cases, and two cases contribute to the mortality. The ECG abnormalities are significantly associated with total cortisol on day 4 (P < 0.05) and free cortisol on day 2 (P = 0.0065). Conclusions: Elevated levels of morning cortisol within the first four days after surgery are associated with the ECG abnormality.

Impact of interleukin-6 and interleukin-10 serum level and its mRNA expression level on polytrauma patients

Purpose Host response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patients outcome. This study evaluated the interaction of two main cytokines in immune response after major trauma, specifically interleukin-6 (IL-6) and interleukin-10 (IL-10). Plasma level of these cytokines is determined by mRNA expression of these cytokines genes which may decide the outcome of polytrauma patients. Methods This prospective multicenter trial held at four trauma centers enrolled 54 polytrauma patients [Injury Severity Score (ISS) ≥ 16]. Plasma levels and mRNA expression of IL-6 and IL-10 were measured for 5 days after trauma. Clinical evaluation was conducted to observe whether patients endured multiple organ dysfunction syndrome (MODS) and death. MODS evaluation was performed using sequential organ failure assessment (SOFA). Trauma load which in this study is represented with ISS, plasma level, expression of cytokine genes and patients outcome were examined with correlation test and statistical analysis. Results The elevated IL-6/IL-10 ratio indicated increased activity of systemic inflammation response, especially pro-inflammation response which bears higher probability of progressing to MODS and death. The decline of IL-6/IL-10 ratio with heavy trauma load (ISS > 30) showed that compensatory anti-inflammation response syndrome (CARS) state was more dominant than systemic inflammatory response syndrome (SIRS), indicating that malfunction and failure of immune system eventually lead to MODS and deaths. The statistical significance in plasma level of cytokines was found in the outcome group which was defined as bearing a low trauma load but mortality. Conclusion The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patients outcome.

The association between cortisol dynamics and the course of aneurysmal subarachnoid hemorrhage

Context: One of aneurysmal subarachnoid hemorrhage complication is delayed ischemic neurological deficits (DIND). It is postulated that cortisol dynamics might be associated with the severity of this complication. Aims: The goal of the study is to investigate whether the peak of morning serum cortisol levels are associated with the severity of its complication during the course of the disease. Settings and Design: This is a prospective cohort study conducted from January 2009 to June 2011, at our institution. Materials and Methods: The study follows a consecutive cohort of patients for 14 days after the aneurysmal subarachnoid hemorrhage. Serum cortisols, cortisol binding globulin, adenocorticotrophic hormone (ACTH) were measured pre operatively and then on post operative days (POD) 2, 4, 7, and 10. Blood was drawn to coincide with peak cortisol levels between 08.00-09.00 hours. Neurological examinations were conducted at least twice daily and patient outcome were graded according to modified Ranklin Scale. DIND was defined by a decrease in the Glasgow Coma Scale of two or more points compared to the status on POD 1. Statistical Analysis: All the results were analyzed using statistical software, Statistical Package for Social Sciences (SPSS v61; SPSS, Inc., Chicago, IL). Logistic regression analysis was used to compare the relationship between the variables. Results: Thirty six consecutive patients are collected, but only 28 patients (12 M and 16 F) were eligible for the cohort analysis. Average patient age is 50.75 years old (50.75±12.27), and more than 50% (15/28) arrived with World Federation of Neurologic Surgeons grade 3 or better. Elevated total cortisol levels of more than 24 mg/dl on day 2, 4, and 10 were associated with DIND, and the most significant being on day 4 (P=0.011). These patients also had a higher grade on the modified Ranklin scale of disability. Conclusions: This study shows that the elevated levels of morning total cortisol in the serum are associated with the onset of DIND during the disease course, and its also associated with bad outcomes.

Association between asthma control and Interleukin-17F expression levels in adult patients with atopic asthma

Objectives: To investigate the correlation between Interleukin 17 (IL-17F) and the level of asthma control. Methods: This is a cross-sectional study of 40 subjects who were diagnosed with atopic asthma. All participants were recruited from the Allergy and Immunology Clinic, Prof. R.D. Kandou General Hospital, Manado, Indonesia, between April 2015 and April 2016. Total serum IL-17F measured by using Enzyme-Linked Immunosorbent Assay methods; and mRNA IL-17F was obtained by using real-time reverse transcriptase polymerase chain reaction. Level of asthma control was quantified by using asthma control test (ACT) scoring system. The correlation between IL-17F, mRNA, and level of asthma control was analyzed by using Pearson’s correlation coefficient (r). Results: There is a strong positive correlation between IL-17F serum level and Nathan’s ACT-score (r=0.969) which is statistically significant (p<0.001). Analysis of the correlation between mRNA IL-17F serum level and Nathan’s ACT-score revealed a strong positive correlation (r=0.963), which is statistically significant (p<0.001). Conclusion: These findings suggest that IL-17F plays an important role in asthma control. However, the role played by IL-17F in asthma pathogenesis are still questions to be answered.

The Relationship between Total Ige and Neutrophils Count with Degrees of Asthma Control in Adult Atopic Patients

Introduction: Asthma is a chronic reversible inflammation which is caused by bronchial hypereactivity due to exposure to allergen and hyperproduction of certain specific IgE. Neutrophil in respiratory tract and high level of IgE in the blood serum is known to play in complex mechanism in asthma development. The role of total IgE serum and neutrophil serum in asthma development is still not well known. Aim: This study aim is to assess the correlation between level of total IgE and neutrophil serum with degree of asthma control. Methods: This is a cross sectional study with 35 adult subjects with atophy asthma (age 22-61), all of participant reside in Manado and its surrounding area. Degree of asthma control is categorized as intermittent, mild persistent, moderate persistent and severe persistent based on criteria by GINA. Patient with malignancy, sepsis, lung tuberculosis, diabetes mellitus, pregnant, and late stage chronic kidney disease are excluded from this study. Result: In this study there is no significant correlation between total IgE serum level and degree of asthma control (p>0.05.) also there is no significant correlation between each total IgE level and each degree of asthma control. There is significant positive correlation between neutrophil count and degree of asthma control (r = 0.309; pConclusion: The neutrophil count in serum is related to degree of asthma control. Especially neutrophil count in mild persistent is higher than intermittent asthma. There is no correlation between total IgE level with degree of asthma control in adult subject with atopic asthma.

The Profile of MMP-9, MMP-9 mRNA Expression, -1562 C/T Polymorphism and Outcome in High-risk Traumatic Brain Injury: The Effect of Therapeutic Mild Hypothermia

The aim of this study was to investigate the effect of mild hypothermia therapy (34–36°C) and the alterations of matrix metalloproteinase-9 (MMP-9) in 20 patients with high-risk traumatic brain injury (TBI). The neurologic status and outcome were assessed using Full Outline of UnResponsiveness (FOUR) score and Glasgow Coma Scale (GCS). A prospective randomized control study involved patients with high-risk TBI (FOUR score ≤ 7). Patients were randomized into two groups, with and without mild hypothermia therapy which were investigated within 24 and 72 h. The MMP-9 level, MMP-9 mRNA expression and -1562 C/T polymorphism were estimated using enzyme-linked immune sorbent assay (ELISA), reversing transcription polymerase chain reaction (RT-PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP). Different levels of these variables were compared in the two groups. In the hypothermia group, the expression of MMP-9 mRNA and the level of serum MMP-9 were significantly decreased (P < 0.05) within 72 h. There was a highly significant correlation between the expression of MMP-9 mRNA and the level of MMP-9 protein (R2 = 0.741, r = 0.861, P < 0.05). The study did not find in -1562 C/T polymorphism. The patients’ outcome was improved significantly after mild hypothermia therapy (P < 0.05). The data obtained from this study show that mild hypothermia therapy down regulated the expression of MMP-9 mRNA, the MMP-9 protein level and increased the FOUR score and GCS in high-risk TBI patients within 72 h.

Ki-67 Expression by Immunohistochemistry and Quantitative Real-Time Polymerase Chain Reaction as Predictor of Clinical Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer

Background Chemotherapy has become a standard of treatment in managing breast cancer. To achieve proper treatment for the right patients, the predictive marker is needed. Ki-67 is a biomarker of proliferation for solid tumor. Studies mentioned association of Ki-67 expression with chemotherapy response. The study aims are to evaluate whether Ki-67 expression detected by immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (qRT-PCR) may predict clinical response to neoadjuvant chemotherapy in breast cancer. Methods This study utilized a longitudinal study. IHC and qRT-PCR methods were used for detection of Ki-67 expression. Chemotherapy response was calculated using RECIST. Data were analyzed with Chi-square and Wilcoxons test. Results There were 48 subjects in this study. Analysis of Ki-67 expression with chemotherapy response has a significant correlation with p = 0.025 (<0.05), OR: 1.69, confidence interval (95% CI) 1.022–2.810. Analysis of Ki-67 mRNA expression with chemotherapy response has a significant correlation p = 0.002 (<0.05), OR: 6.85, confidence interval (95% CI) 1.064–44.193. Detection of Ki-67 expression using IHC and qRT-PCR has similar results, p = 0.012 (<0.05). Conclusion These results suggest that Ki-67 expression detected by both IHC and qRT-PCR is considered to be a predictor of clinical response to neoadjuvant chemotherapy in locally advanced breast cancer.

Downregulation of MMP-9 Level and GCS Score Improvement in Severe Traumatic Brain Injury Due to the Mild Hypothermia Therapy

We recently investigated the effect of the mild hypothermia therapy towards alteration of matrix metalloproteinase-9 (MMP-9) and outcome of severe traumatic brain injury (TBI). The neurologic outcome was assessed by applying with GCS (Glasgow Coma Scale) score. Twenty patients with severe TBI whose the GCS score ≤ 8 between June 2015 and June 2016 were enrolled in RD Kandou Hospital, Manado, Indonesia. Patients were randomized into two groups, with and without the mild hypothermia therapy (34-36°C) which was investigated within 24 and 72 h. The MMP-9 level was estimated using enzyme-linked immunosorbent assay (ELISA). The assessments of outcomes were determined using the GCS score within 24 and 72 h during the mild hypothermia therapy. Our results showed that the level of serum MMP-9 was decreased significantly within 72 h in the mild hypothermia therapy group. The effects of the mild hypothermia therapy toward to the GCS score alteration were noticeable increased and differences were significant in the two groups within 72 h. We concluded that the mild hypothermia therapy diminished MMP-9 protein level and improvement of the GCS score in severe TBI patients within 72 h.

The Effect of Intervention Recombinant IL-10 on Level of TNF-α and GFAP Serum in the Wistar Rats with Traumatic Brain Injury Treatment

Traumatic brain injury (TBI) can trigger an inflammation and activation the mediator substances. TNF-α is a major cytokine that has adverse effects in high level. Glial Fibrillary Acidic Protein (GFAP) in brain cells increases in TBI thus can be an accurate biomarker for brain damage. The purposes of this study are to know the intervention effect of IL-10 as an anti-inflammatory to inflammatory processes (pro anti-inflammatory balance) in TBI. This is an experimental laboratory study with a post-test control group design consisting of four treatment groups and one control group. Measurement of Tumor Necrosis Factor α (TNF-α) and GFAP using Enzyme-Linked Immunoabsorbent Assay (ELISA) methods. The result of this study shows Groups with provoked brain injury had significantly higher levels of serum TNF-α (p <0.05) than the control group. Group provoked a brain injury and given recombinant IL-10 did not have increased levels of TNF-α in serum after 1 hour, differ significantly with no intervention of IL-10. The levels of GFAP have no significant difference 1 hour after TBI, and these levels increase at 24 hours. The conclusion is Intervention by IL-10 could decrease the levels of TNF-α serum immediately after TBI in the Wistar rats and the levels of GFAP 24 hours after TBI are increasing persistently although given by intervention of IL-10 or not.