Budi Mulyono

Hyperglycemia as a Prognosis Predictor of Length of Stay and Functional Outcomes in Patients with Acute Ischemic Stroke.

ABSTRACT Background: Hyperglycemia has been shown to influence prognosis outcome of stroke. The objective of this study was to determine the correlation between hyperglycemia with length of stay (LOS) and functional outcomes in ischemic stroke patients. This is the first study to correlate hyperglycemia in ischemic stroke patients with their functional outcome as assessed by using Barthel index. Methods: This is a prospective cohort study of patients admitted to the Stroke Unit of Dr. Sardjito General Hospital for ischemic stroke from January 2012 to June 2014. Subjects were selected in a consecutive manner until the required number of subjects was obtained. Data collected from medical records included the baseline social demographic variables and clinical variables. Bivariate and multivariate analyses with multiple linear regression analysis were used to identify correlation between hyperglycemia with LOS and functional outcomes. Results: In total, 208 patients were included, of which 126 (60.6%) were men. The mean age was 61.18 (SD = 10.45), and the mean LOS in our study was 4.52 (SD = 5.89) d. For the univariate analysis, factors associated with LOS were history of diabetes (p = 0.003), urinary tract infection (p = 0.025), hyperglycemia (p < 0.001) and moderate to severe Barthel index on admission (p < 0.001), and the independent factor was hyperglycemia (β: 6.212, p < 0.001) based on multivariate analysis. Furthermore, hyperglycemia was an independent factor of functional outcomes as measured with Barthel index (β: 9.185, p < 0.001). Conclusions: Hyperglycemia is a prognosis predictor of LOS and functional outcomes of patients with acute ischemic stroke measured by discharge Barthel index.

STATUS PENGGUMPALAN (AGREGASI) TROMBOSIT SEBAGAI FAKTOR PROGNOSTIK TEJADINYA KELUARAN KLINIS STROK INFARK MENDADAK (STROK INFARK AKUT)

The propriate management of acute infarction stroke will be able to reduce the morbidity and mortality of the disease. In diagnosing and managing the diseases, for the detection of the risk or prognostic factors information’s such as the history physical findings, confirmation and other supporting tests are needed. One of the supporting test is the laboratory examination i.e. platelet aggregation test. Platelet aggregation is suggested having an important role in haemostasis especially to prevent excessive bleeding by forming platelet plug. Finally, further hyperactivity of platelet in terms of platelet hyper aggregation can create a thrombus and moreover lead to obstruct the vessels. The occlusion will give a negative outcome of an acute infarction stroke. The aim of this study is to know whether platelet hyper aggregation has a contribution in the outcome of the disease or not by certain testing. A prospective cohort study was carried out, to compare between two groups of exposed and non-exposed group in Sardjito hospital Yogyakarta during the period of March up to early July 2007. Eighty four subjects who met the inclusion and exclusion criteria were involved in this study. The exposed group was a group of acute infarction stroke patient who were exposed to platelet hyper aggregation 48 (57%), on the other hand, patients who did not have platelet hyper aggregation was separated as non-exposed group is 36 (43%). Inception of cohort was applied when the patient was admitted to the emergency unit during 72 hours of the onset, before receiving antithrombotic drugs and had no previous history of stroke. The patients were followed after 7 days hospitalization in the stroke unit and neurology unit and the outcome was measured by evaluating the score using Gadjah Mada stroke scale. The characteristics of the subjects were grouped by baseline data X2 test. Unvaried analysis and multivariate analysis were taken to get the relative risk of having acute infarction stroke. In this case logistic regression analysis was used to know the relative risk (RR) measurement. Prognostic factors had influenced the outcome of acute infarction stroke in patients who had a history of cardiovascular disease and aggregation status. The outcome of the platelet hyper aggregation group had a RR=2.15 (95% CI: 2.01–4.07) and the history of cardiovascular disease had a RR=1.78 (95% CI: 1.18–13.28).

DARAH AMAN DAN PENDONOR DARAH SUKARELA

Safe blood was collected from safe, low risk donors with a related absence of infectious disease screening as well. WHO has stated that to guarantee its safety, blood should only be collected from voluntary non-remunerated blood donors (VNBD) coming from a lowrisk population. The aim of this study was to know the blood donors’ profile in Fatmawati Hospital (FH), Jakarta and Dr. Sardjito Hospital (SH), Yogyakarta by comparison The research was carried out by cross sectional study and data were obtained from the donor’s information records 2011-2013. The data were further descriptively analyzed and presented in tables and graphs. The Student’s t-test was used to analyze the difference of percentage mean for VNBD per-month between two hospitals with p<0.05. Based on the blood donor types, it was shown that most of the blood donors consisted of replacement persons. The mean of monthly VNBD percentage was significantly higher in FH than in SH. There was an increased VNBD percentage i.e. 32, 35, 54 (FH) and 12, 18, 22 (SH) respectively, within the year 2011, 2012 and 2013.

METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS COLONIZATION AND SCREENING METHOD EFFECTIVENESS FOR PATIENTS ADMITTED TO THE INTENSIVE CARE

Methicillin-resistant S.aureus (MRSA) menyebabkan banyak infeksi nosokomial (inos) dan penyebarannya menunjukkan mutu clean care. Kejadian inos MRSA meningkatkan angka kesakitan, kematian, lama rawat inap, kebutuhan antibiotika dan meluasnya resistensi, readmisi serta biaya kesehatan. Penapisan kolonisasi MRSA di pasien yang akan dirawat intensif diperlukan untuk mencegah penyebaran dan mengendalikan peresepan antibiotika. Pemeriksaannya diharapkan tepat guna untuk mendukung Sistem Jaminan Kesehatan Nasional. Penelitian dilaksanakan di Ruang Rawat Intensif RSUP Dr Sardjito Yogyakarta di seluruh pasien pada tahun 2015 saat masuk sesuai patokan kesertaan dan non-kesertaan. Spesimen dari nares anterior dan kulit (aksila-inguinal), diambil dalam 1x24 jam, dinilai kepositifan MRSA menggunakan beberapa media identifikasi di Instalasi Laboratorium Klinik. Perbandingan analitik dan praktikabilitas metode identifikasi dianalisis efektivitasnya. Kejadian kolonisasi S.aureus dan MRSA di pasien saat masuk perawatan Ruang Intensif 23,4% dan 9,7%. Faktor kebahayaan dominan kolonisasi MRSA adalah riwayat perawatan RS. Nares anterior dominan sebagai tempat kolonisasi S.aureus (74,2%) dan MRSA (33,7%). Terdapat 7,7% kolonisasi lolos deteksi bila sampling hanya dilakukan di nares. Kesepakatan hasil pemeriksaan antar metode baik (indeks Kappa >0,8) dengan metode yang disarankan adalah penggunaan media selektif MRSA langsung atau urutan metode deteksi menggunakan Blood Agar, pengecatan Gram, uji aglutinasi, media khromogenik selektif MRSA. Metode penapisan dengan tingkat deteksi dan praktikabilitas yang baik bermanfaat mendukung pengendalian infeksi di ruang berkebahayaan tinggi.

PHYLOGENETIC PROFILE OF ESCHERICHIA COLI CAUSING BLOODSTREAM INFECTION AND ITS CLINICAL ASPECT

Escherchia coli merupakan satu dari bakteri yang paling sering ditemukan dalam infeksi aliran darah. Tujuan penelitian ini adalah untuk mengeksplorasi profil filogenetik E. coli yang menyebabkan infeksi aliran darah dan aspek klinisnya. Ini merupakan penelitian observasional yang melibatkan 12 subjek yang menderita infeksi aliran darah yang disebabkan oleh E.coli. Isolat klinis E.coli serta hasil uji kepekaan antimikroba diperoleh dari metode kaldu microdilution otomatis. Data klinis diperoleh dari rekam medis dan analisis filogenetik yang dilakukan dengan polymerase chain reaction menggunakan gena chuA dan YjaA. Data dianalisis dengan menggunakan statistik deskriptif. Sumber infeksi ini berasal dari saluran kemih, paru-paru, saluran pencernaan dan kulit yang ditemukan dalam 7 kasus. Namun, sumber infeksi tidak diketahui dalam 5 kasus. Sebagian besar subjek adalah pria dewasa dengan keganasan sebagai penyakit yang mendasarinya. Escherichia coli sebagai etiologi infeksi aliran darah sebagian besar (75%) menghasilkan enzim ESBL dan resistensinya terhadap antimikroba seperti ampicilin, ampicilin/sulbactam, ceftazidime, ceftriaxon, cefepime, aztreonam, ciprofloxacin dan trimetropim-sulfamethoxazol yang cukup tinggi. Kelompok filogenetik dari isolat klinis ini sebagian besar (75%) adalah grup B2 dan grup D yang dikenal sebagai strain virulen ekstraintestinal. Isolat klinis yang tersisa (25%) dapat digolongkan sebagai kelompok filogenetik A atau B1 dimana kelompok A dikenal sebagai strain komensal.

KESAHIHAN DIAGNOSTIK HEMOGLOBIN RETIKULOSIT UNTUK DETEKSI DEFISIENSI ZAT BESI DI KEHAMILAN (Diagnostic Validity of Reticulocyte Hemoglobin for Iron Deficiency Detection in Pregnancy)

Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume and the development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stage parameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-He examination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those in term pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered from PKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from the cubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while the Ret-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serum of the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzer C501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two (2) groups based on the Hb levels, namely: anemia (Hb<11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were also classified into two (2) groups based on transferrin saturation values: iron deficient (Tsat <9%) and normal (Tsat ≥9%). From 291 subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency in pregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for iron deficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively. The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.

Safe Blood and Voluntary Non-Remunerated Blood Donors

Safe blood was collected from safe, low risk donors with a related absence of infectious disease screening as well. WHO has stated that to guarantee its safety, blood should only be collected from voluntary non-remunerated blood donors (VNBD) coming from a lowrisk population. The aim of this study was to know the blood donors’ profile in Fatmawati Hospital (FH), Jakarta and Dr. Sardjito Hospital (SH), Yogyakarta by comparison The research was carried out by cross sectional study and data were obtained from the donor’s information records 2011-2013. The data were further descriptively analyzed and presented in tables and graphs. The Student’s t-test was used to analyze the difference of percentage mean for VNBD per-month between two hospitals with p<0.05. Based on the blood donor types, it was shown that most of the blood donors consisted of replacement persons. The mean of monthly VNBD percentage was significantly higher in FH than in SH. There was an increased VNBD percentage i.e. 32, 35, 54 (FH) and 12, 18, 22 (SH) respectively, within the year 2011, 2012 and 2013.