Suryani As'ad

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.

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.

The Effect of Giving Barusa Kacang Gude on the Body Weight, the Upper Arm Circumference, and the Total Protein Concentration of Elementary School Students With Malnutrition in Bonto Ramba Sub District, Jeneponto Regency

The aim of study to observe influence of the baruasa kacang gude (gude bean) consumption on the body weight, upper arm circumferences and serum protein level in the elementary school student with malnutrition. The study was conducted by using quasi experimental research with non-randomized pre-post design for 2 months period. The sampling method was purposive sampling technique. The study involved 56 students is divided to 2 groups: intervention and control group. The intervention group is consisted samples who had gude bean and deworming agent only. Meanwhile, control group is included samples who had deworming agent. The intervention group had given 10 ml of deworming agent (pryantel pamoate) and gude bean (78 g/day) for 60 days. In additions, 10 ml of deworming agent (pryantel pamoate) was given to control group. The measurement of the body weight, upper arm circumference, and serum protein was taken before and after the intervention. The result showed changed of mean value of body weight, upper arm circumference and total serum protein in the intervention group was higher than control group. Statistically, there was significant difference in increment of upper arm circumference in the intervention group compared to control group. The gude beans had increased body weight, upper arm circumference and serum protein level in the elementary school students with malnutrition.