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Pengaruh pemberian plasma kaya trombosit dan karbonat hidroksiapatit pada proses penutupan defek tulang kepala hewan coba tikus Nirmalasari, Lucia; Oley, Maximillian Ch.; Prasetyo, Eko; Hatibie, Mendy; Loho, Lily L.
Jurnal Biomedik : JBM Vol 8, No 3 (2016): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.8.3.2016.14152

Abstract: Recently, platelet rich plasma has been popular and its use has begin on human in developed countries. Platelet rich plasma is defined as autologus blood with concentration of platelets three to five times above baseline level, which contains at least seven growth factors like Platelet Derived Growth Factor (PDGF), Platelet Derived Angiogenesis Factor (PDAF), Platelet Derived Endothelial Growth Factor (PDEGF), Transforming Growth Factor Beta (TGF- Î²), Insulin like Growth Factor (IGF), Fibroblast Growth Factor (FGF), and Vascular Endothelial Growth Factor (VEGF). The golden standard for reconstruction of cranial bone defects demonstrates osteoconduction scaffold, osteoinduction like growth factors, and osteogenesis. Alloplastic biomaterials have revolutionalized craniofacial reconstruction. Carbonated hydroxyapatite (CHA) has been studied for years as implant material due to its similarity with the mineral component of bone. In this study we investigated and compare the effects of PRP and CHA on bone regeneration in rat cranial defects. This was an experimental study with a true experimental design on white male rats (Rattus norvegicus). Cranial deffects of 3 mm diameter were created in rat cranium and grafted with CHA and PRP combination, CHA alone, and control. The relationships among them were analyzed by using Mann Whitney and SPSS Statistics Program Package Version 22.0. The results showed that the experimental group of 2 weeks had no different between inflammatory reaction (P = 0.119), woven bone (P = 0.094) and lamellar bone (P = 0.130). At 4 weeks,a combination of PRP and CHA showed a superior growth of lamellar bone compared to CHA (P = 0.009). Conclusion: A combination of PRP and CHA in bone regeneration showed a histological tendency toward increased bone formation. However, future investigations should be conducted in different period times.Keywords: platelet rich plasma, carbonated hydroxyapatite, cranial defectAbstrak: Plasma kaya trombosit makin banyak digunakan dalam dunia kedokteran. Di negara maju pengunaannya sudah mulai diteliti pada manusia. Plasma kaya trombosit adalah fraksi plasma darah dengan konsentrasi platelet 3-5 kali diatas nilai normal yang mengandung sekurang-kurangnya 7 faktor pertumbuhan, diantaranya Platelet Derived Growth Factor (PDGF), Platelet Derived Angiogenesis Factor (PDAF), Platelet Derived Endothelial Growth Factor (PDEGF), Transforming Growth Factor Beta (TGF- Î²), Insulin like Growth Factor (IGF), Fibroblast Growth Factor (FGF), dan Vascular Endothelial Growth Factor (VEGF) yang dapat meningkatkan proses osteogenesis. Karbonat hidroksiapatit adalah material pengganti tulang yang dapat mempercepat regenerasi jaringan tulang serta memiliki kandungan kalsium,fosfat dan karbonat yang mirip dengan tulang manusia. Tulang yang tumbuh pada awal berupa tulang muda yang memiliki serat kolagen yang tidak teratur dan banyak osteosit disebut tulang imatur. Tulang imatur kemudian akan diganti oleh tulang matur yang memiliki serabut kolagen yang teratur. Jenis penelitian ini ialah eksperimental pada 36 hewan coba tikus putih wistar (Rattus norvegicus). Defek kalvaria pada tikus dengan diameter 3 mm diisi sesuai perlakuan: plasma kaya trombosit dengan karbonat hidroksiapatit, karbonat apatit tunggal, dan kontrol. Plasma kaya trombosit dibuat dari autologus darah tikus yang diberi perlakuan plasma kaya trombosit serta karbonat hidroksiapatit dan karbonat apatit tunggal. Data dianalisis dengan uji Mann Whitney dan diolah dengan SPSS. Hasil penelitian memperlihatkan pada minggu ke-2, tidak terdapat perbedaan bermakna reaksi inflamasi (P = 0,119), tulang imatur (P = 0,094), dan tulang matur (P = 0,130) diantara ketiga perlakuan. Pada minggu ke-4, tulang matur yang terbentuk lebih banyak pada perlakuan plasma kaya trombosit dan karbonat hidroksiapatit (P = 0,009). Simpulan: Pemberian plasma kaya trombosit dan karbonat hidroksiapatit dapat meningkatkan proses penutupan defek tulang kepala hewan percobaan tikus.Kata kunci : plasma kaya trombosit, karbonat hidroksiapatit, defek tulang kepala.

Terapi Hipotermia Ringan Menurunkan Kadar Protein MMP-9 dan Memperbaiki FOUR Score pada Cedera Otak Traumatik Risiko Tinggi ., Hendra; Wijaya, Halim; Prasetyo, Eko; Oley, Maximillian Ch.
Jurnal Biomedik : JBM Vol 9, No 3 (2017): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.9.3.2017.17343

Abstract: In this study, patients with high risk traumatic brain injury (TBI) were treated with mild therapeutic hypothermia and their serum MMP-9 levels as well as neurological outcome were evaluated. This was an experimental analytical study conducted at Intensive Care Unit Prof. Dr. R. D. Kandou Hospital, Manado. The results showed that there were 20 patients with high risk TBI (the FOUR score <7) prospective randomly assigned to mild therapeutic hypothermia and control groups. Patients were evaluated at the time of admission and after 72 hours. The serum MMP-9 level was examined by using enzyme-linked immunosorbent assay (ELISA) and the clinical outcome was evaluated by using the FOUR score. Levels of the variables were compared between the two groups. In the hypothermia group, level of serum MMP-9 was decreased (P > 0.05) after 72 hours and there was a significant improvement of the FOUR score (P < 0.05). Conclusion: Mild therapeutic hypothermia could reduce serum MMP-9 level and significantly improve the neurological outcome after 72 hours.Keyword: mild hypothermia, MMP-9, FOUR scoreAbstrak: Penelitian ini dilakukan terhadap penderita cedera otak akibat trauma (COT) risiko tinggi yang diberi perlakuan hipotermia ringan (HPTr) dengan mengevaluasi kadar MMP-9 serum dan hasil klinis yang dinilai melalui skor FOUR. Jenis penelitian ini ialah eksperimental analitik. Penelitian ini dilakukan di Intensive Care Unit (ICU) RSUP Prof. Dr. R. D. Kandou Manado. Terdapat total 20 pasien dengan COT risiko tinggi (skor FOUR <7) yang secara random dibagi dalam kelompok kontrol dan kelompok HPTr. Pasien dinilai saat masuk dan setelah 72 jam kemudian. Kadar MMP-9 serum dinilai menggunakan enzyme-linked immunosorbent assay (ELISA). Perbedaan level dari kedua variabel ini dibandingkan pada kedua kelompok. Hasil penelitian memperlihatkan bahwa pada kelompok perlakuan HPTr, kadar MMP-9 serum berkurang setelah 72 jam walaupun tidak bermakna (P > 0,05) dan terdapat peningkatan skor FOUR secara bermakna (P < 0,05). Simpulan: Perlakuan hipotermi ringan dapat menurunkan kadar MMP-9 serum dan memberikan peningkatan hasil klinis melalui penilaian skor FOUR setelah 72 jam kemudian.Kata kunci: hipotermi ringan, MMP-9, FOUR score

Hubungan Kadar Interleukin 6 Serum dan Klasifikasi CT Marshal pada Penderita Cedera Otak Berat Akibat Trauma Manginte, Mervin; Prasetyo, Eko; Oley, Maximillian Ch.
Jurnal Biomedik : JBM Vol 11, No 1 (2019): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.11.1.2019.23210

Abstract: Increase of interleukin 6 (IL-6) level occurs in the brain after traumatic brain injury (TBI), however, studies about IL-6 as a prodictor based on CT-scan is still limited. This study was aimed to evaluate the relationship between serum IL-6 level and CT Marshall classification in patients with severe TBI. This was an observational study with a cross sectional design. There were 20 patients with severe TBI admitted at the Emergency Surgery Installation of Prof. Dr. R. D. Kandou Hospital Manado in this study. CT-scan was performed on them to determine the CT Marshall classification and to categorize the hemorrhage location (extra-axial, intra-axial, both), hemisphere (midline/diffuse, dextral, sinistral), and area (frontal, parietal, temporal, occipital, multiple). Venous blood sample used for IL-6 examination was drawn less than 24 hours after trauma. The results showed that mean IL-6 level was 22.0060 pg/mL (SD 4.64494 pg/mL). Patients were distributed relatively uniform in 4 detected categories (diffuse injury II, III, V, and VI) of CT Marshall classification. Final regression model consisted of IL-6, age, and temporal injury as predictors. The Spearman coefficient correlation showed rs = -0.005 (P=0.491). Conclusion: There was no significant relationship between serum Il-6 level and CT Marshall classification, albeit, both of them increased consistantly following the severity of TBI and could be potential predictors to determine the prognosis of severe TBI patients.Keywords: IL-6, CT Marshall, severe TBIAbstrak: Pada cedera otak berat akibat trauma (COBT) terjadi peningkatan ekspresi IL-6 di otak namun penelitian mengenai kemampuannya untuk memrediksi hasil berdasarkan klasifikasi CT scan masih terbatas. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar IL-6 serum dan klasifikasi CT Marshall pada pasien dengan COBT. Jenis penelitian ialah observasional dengan desain potong lintang. Hasil penelitian mendapatkan 20 pasien yang dirawat dengan COBT di IRDB RSUP Prof. Dr. R. D. Kandou Manado. CT-scan segera digunakan untuk menentukan klasifikasi CT Marshall dan untuk mengategorikan lokasi (ekstra-aksial, intra-aksial, keduanya), belahan (garis tengah/difus, dekstra, sisnitra), dan area otak yang terlibat dalam cedera. Sampel darah vena untuk IL-6 diambil kurang dari 24 jam setelah trauma. Hasil penelitian mendapatkan rerata kadar IL-6 22,0060 pg/mL (SD 4,64494 pg/mL). Pasien didistribusikan relatif seragam dalam empat kategori yang terdeteksi (difus cedera II, III, V, dan VI) dari klasifikasi CT Marshall. Model regresi akhir terdiri dari IL-6, usia, dan cedera pada area temporal sebagai prediktor. Korelasi antara kadar IL-6 serum dan klasifikasi CT Marshall dianalisis dengan koefisien korelasi Spearman dan mendapatkan rs = -0,005 (P=0,491). Simpulan: Walaupun secara statistik tidak terdapat hubungan bermakna antara kadar Il-6 serum dan CT Marshall namun keduanya secara konsisten meningkat mengikuti COBT dan dapat menjadi prediktor potensial untuk menentukan prognosis pada pasien dengan COBT.Kata kunci: IL-6, CT Marshall, COBT

Penetrating Facial Injury by a Tree Branch: a Case Report Tombeng, Marthinson A.; Prasetyo, Eko; Lumintang, Nico A.; Oley, Maximillian Ch.
Jurnal Biomedik : JBM Vol 11, No 2 (2019): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.11.2.2019.23319

Abstrak: Cedera tembus wajah dapat berbahaya karena adanya struktur-struktur penting pada wajah yang membutuhkan penanganan dengan cepat dan tepat. Benda asing organik dapat menyebabkan risiko tinggi infeksi luka. Kami memresentasikan suatu kasus yang jarang ditemukan yaitu seorang laki-laki berusia 19 tahun dengan luka tembus wajah oleh patahan cabang pohon akibat kecelakaan sepeda motor. Panjang cabang pohon 25 cm dengan diameter sekitar 4 cm, menembus melalui sisi depan kanan wajah, tepat di samping hidung, dan menjorok keluar melalui sudut kanan mandibula. Evaluasi dan penatalaksanaan cedera tembus wajah dilakukan mengikuti protokol ATLS. Tujuan penatalaksanaan cedera tembus wajah ialah mengeluarkan benda asing dengan trauma minimal pada struktur berdekatan dan mempertahankan fungsi dan penampilan yang normal. Pasien ini menjalani operasi darurat untuk pengangkatan benda asing dan eksplorasi luka dengan anestesi umum. Evaluasi pasca operasi tidak mendapatkan adanya perdarahan maupun tanda-tanda infeksi. Defisit neurologik pada wajah kanan diterapi secara konservatif dengan terapi fisik dan pulih sepenuhnya satu tahun pasca kecelakaan.Kata kunci: luka tembus, trauma wajah, cabang pohonAbstract: Penetrating facial injury can be dangerous because of the presence of important structures in the face which requires immediate and proper management. Organic foreign bodies may cause a high risk of wound infection. We present a case of a 19-year-old male with an unusual penetrating facial injury by a broken tree branch due to a motorcycle accident. The length of the tree branch was 25 cm with a diameter of approximately 4 cm, penetrating through the right anterior side of his face, just lateral to the nose, and protruding through the right angle of the mandible. The evaluation and management of the penetrating facial injury were performed in accordance with the ATLS protocol. The aim of the penetrating facial injuries management is to remove foreign body with minimal trauma to adjacent structures and to maintain the normal function and appearance. The patient underwent emergency surgery for removal of the foreign body and wound exploration under general anesthesia. In postoperative evaluation, there was not any bleeding or signs of infection. The neurological deficit in the right face was managed conservatively with physical therapy and was fully recovered in 1 year after the accident.Keywords: penetrating wound, facial trauma, tree branch

Pengaruh pemberian plasma kaya trombosit terhadap ekspresi VEGF pada proses penutupan defek kalvaria menggunakan karbonat apatit Pranoto, Agung S.; Oley, Maximillian Ch.; Prasetyo, Eko
Jurnal Biomedik : JBM Vol 9, No 1 (2017): JURNAL BIOMEDIK : JBM Suplemen
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.9.1.2017.15379

Abstract: To date, there are increasing brain injuries and calvaria defect due to traffic accidents. Angiogenesis plays a pivotal role in bone healing. This study was aimed to obtain the immunohistochemistry analysis of vascular endothelial growth factor (VEGF) expression in osteogenesis process with platelet rich plasma (PRP) and carbonate apatite scaffold in rat model. This was an experimental study with 24 male Wistar rats (Rattus norvegicus) as subjects. A 3-mm burrhole of calvaria was performed on each rat. The control group was applied with 0.1 ml normal saline and the experimental group with 0.1 ml PRP and carbonate apatite scaffold. The rats were sacrificed at 3 weeks later and the osteogenesis process were examined histologically focused on immunohistochemistry pattern of VEGF. The results showed that the defects applied with PRP and carbonate appatite scaffold showed earler osteoid tissue deposition with higher cell count for osteoblasts, osteocytes, and osteoclasts. Immunohistochemistry evaluation showed more VEGF expression in the PRP and carbonate apatite group compared with the normal saline group. The Mann-Whitney test showed significant difference between the two groups (P < 0.0001). Conclusion: Combination of PRP and carbonate appatite scaffold resulted in good closure of calvaria defect.Keywords: VEGF, carbonate apatite scaffold, PRPAbstrak: Kecelakaan lalu-lintas meningkatkan kejadian cedera otak dan defek kalvaria. Angiogenesis berperan penting dalam proses penyembuhan tulang. Penelitian ini bertujuan untuk menganalisis ekspresi VEGF secara imunohistokimia dalam proses osteogenesis terhadap pemberian plasma kaya trombosit dan perancah karbonat apatit pada hewan coba tikus. Jenis penelitian ini ialah eksperimental menggunakan 24 tikus jantan strain Wistar (Rattus norvegicus) yang diberi perlakuan pembuatan defek kalvaria ukuran 3 mm. Pada kelompok kontrol diberikan 0,1ml NaCl0,9% dan pada kelompok perlakuan diberikan 0,1 ml plasma kaya trombosit dan perancah karbonat apatit. Semua tikus diterminasi tiga minggu setelah perlakuan dan dilakukan pemeriksaan imunohistokimia ekspresi VEGF untuk mengevaluasi proses osteogenesis. Hasil penelitian mendapatkan pada kelompok defek yang diberikan plasma kaya trombosit dan perancah karbonat apatit menunjukkan pembentukan jaringan osteoid yang lebih cepat dengan jumlah osteoblas, osteosit, dan osteoklas yang lebih banyak. Pemeriksaan imunohistokimia untuk mengetahui ekspresi VEGF menunjukkan hasil yang lebih tinggi pada kelompok perlakuan dibandingkan pada kelompok kontrol. Uji Mann-Whitney menunjukkan perbedaan bermakna antara kedua kelompok (P < 0,0001). Simpulan: Pemberian plasma kaya trombosit dan perancah karbonat apatit memberikan hasil yang baik pada proses penutupan defek kalvaria.Kata kunci: VEGF, perancah karbonat apatit, plasma kaya trombosit

Kadar Protein MMP-9 dan Skor CT Marshall pada Cedera Otak Akibat Trauma (COT) Risiko Tinggi: Efek Terapi Hipotermia Ringan (HPTr) Wijaya, Halim; ., Hendra; Prasetyo, Eko; Oley, Maximillian Ch.
JURNAL BIOMEDIK : JBM Vol 10, No 1 (2018): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.10.1.2018.18998

Abstract: This study was aimed to prove the effect of mild therapeutic hypothermia in patients with high-risk traumatic brain injury (TBI). Evaluation was based on classification of CT-scan result and serum matrix metalloproteinase-9 (MMP-9) concentration. This was an experimental analytical study. Subjects were 20 patients with high-risk TBI, divided into two groups: control group and treatment group. CT Scan Marshall and serum MMP-9 examination were performed on both groups. The treatment group was treated with mild therapeutic hypothermia and showed a tendency of decreased serum MMP-9 concentration and improved CT Marshall score; albeit, they were not significant (P > 0.05). Conclusion: In patients with high-risk traumatic brain injury, mild therapeutic hypothermia could decrease serum MMP-9 concentration, meanwhile its inflluence on anatomical imaging was limited and not significant. Moreover, there was no patient with worsened CT Marshall score found.Keywords: mild therapeutic hypothermia, MMP-9, CT Marshall, TBIAbstrak: Penelitian ini bertujuan untuk membuktikan efek terapi HPTr pada penderita cedera otak akibat trauma (COT) risiko tinggi yang dievaluasi berdasarkan penilaian klasifikasi hasil CT scan dan perubahan kadar matrix metalloproteinase-9 (MMP-9) serum. Jenis penelitian ialah eksperimental analitik. Subyek penelitian ialah 20 orang penderita COT risiko tinggi yang dibagi menjadi dua kelompok, yaitu kelompok kontrol dan perlakuan hipotermia. Masing-masing kelompok dilakukan pemeriksaan CT Scan Marshall dan MMP-9. Hasil penelitian memperlihatkan pada kelompok perlakuan terdapat kecenderungan penurunan kadar MMP-9 serum dan perbaikan skor CT Marshall walaupun keduanya tidak bermakna (P > 0,05). Simpulan: Perlakukan HPTr pada penderita COT risiko tinggi dapat menghambat MMP-9 serum, sedangkan pengaruhnya pada gambaran anatomis dinilai kecil dan tidak bermakna, akan tetapi tidak ditemukan pasien dengan perburukan skor CT Marshall.Kata kunci: hipotermia ringan, MMP-9, CT Marshall, COT

Perbandingan antara penggunaan karbonat apatit dan hidroksi apatit pada proses penutupan defek kalvaria dengan menggunakan plasma kaya trombosit Surbakti, Atmaja; Oley, Maximillian Ch.; Prasetyo, Eko
JURNAL BIOMEDIK : JBM Vol 9, No 2 (2017): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.9.2.2017.16359

Abstract: Carbonate hydroxy apatite (CHA) and hydroxyapatite (HA) are calcium phosphate biomaterials for bone substitute which have the characteristics of biocompatibility, bioactivity, and osteoconductivity. Platelet rich plasma (PRP) has platelet concentration of 3-5 times above normal and contains growth factor. This study was aimed to compare the effectiveness of CHA-PRP and HA-PRP in the occlusion of calvaria deffect. This was a descriptive observational study. Subjects were 18 Wistar rats (Rattus norvegicus), aged 20-22 weeks, weighing 350-400 g. PRP was processed from 3 ml of intracardiac blood. Calvaria defect of 3 mm diameter was performed as a burr hole. Subjects were divided into 2 groups. Group 1 was treated with CHA-PRP meanwhile group 2 was treated with HA-PRP. The rats were terminated at weeks 2, 3, and 4, then the calvaria bone tissue was evaluated histopathologically. The results showed that at week-2, group 1 had inflammatory cells of 80-90% and immature bone formation of 10%, while group 2 had inflammatory cells of 60-70% and immature bone formation of 5%. At week-3, group 1 had inflammatory cells of 80% and immature bone formation of 10-45% while group 2 had inflammatory cells of 60-70% and immature bone formation of 10-20%. At week-4, group 1 had inflammatory cells of 80-90% and immature bone formation of 45-90% while group 2 had inflammatory cells of 20-70% and immature bone formation of 15-55%. Conclusion: In rats (Rattus norvegicus) with calvaria defects, CHA-PRP treatment could accelerate the occlusion process better than HA-PRP.Kata kunci: carbonate hydroxy apatite, hydroxyapatite, platelet rich plasmaAbstrak: Karbonat hidroksi apatit (KHA) dan hidroksi apatit (HA) merupakan biomaterial kalsium fosfat pengganti tulang yang bersifat biokompatibilitas, bioaktivitas, osteokonduktif. Plasma kaya trombosit (PKT) mempunyai konsentrasi trombosit 3-5 kali di atas normal dan mengandung faktor pertumbuhan. Penelitian ini bertujuan untuk membandingkan pengaruh pemberian KHA-PKT dan HA-PKT pada proses penutupan defek kalvaria tikus. Jenis penelitian ialah deskriptif observasional. Subyek penelitian berupa 18 ekor tikus putih (Rattus norvegicus) galur Wistar, umur 20-22 minggu, berat badan 350-400 gr. Pengambilan darah tikus 3 cc intrakardiak diolah menjadi PKT. Defek kalvaria dibuat berbentuk burr hole diameter 3 mm. Subyek dibagi atas dua kelompok. Kelompok 1 diberikan KHA-PKT sedangkan kelompok 2 diberikan HA-PKT. Tikus diterminasi pada minggu ke-2, 3, dan 4 dan jaringan tulang kalvaria dievaluasi secara histopatologik. Hasil penelitian memperlihatkan di minggu ke-2, pada kelompok 1 terdapat infiltrasi sel radang 80-90% dan pembentukan tulang imatur 10% sedangkan kelompok 2 infiltrasi sel radang 60-70% dan pembentukan tulang imatur 5%. Di minggu ke-3, pada kelompok 1 terdapat infiltrasi sel radang 80% dan pembentukan tulang imatur 10-45% sedangkan kelompok 2 infiltrasi sel radang 60-70% dan pembentukan tulang imatur 10-20%. Di minggu ke-4, pada kelompok 1 terdapat infiltrasi sel radang 80-90% dan pembentukan tulang imatur 45-90% sedangkan kelompok 2 infiltrasi sel radang 20-70% dan pembentukan tulang imatur 15-55%. Simpulan: Pada tikus (Rattus norvegicus) dengan defek kalvaria, pemberian KHA-PKT dapat lebih mempercepat proses penutupan defek dibandingkan pemberian HA-PKT.Kata kunci: karbonat hidroksi apatit, hidroksi apatit, plasma kaya trombosit

PENGARUH PERLAKUAN HIPOTERMIA RINGAN PADA KASUS CEDERA OTAK AKIBAT TRAUMA RISIKO TINGGI BERDASARKAN GLASGOW COMA SCALE DAN KADAR PROTEIN TNF-Î± Hendratno, Josep; Prasetyo, Eko; Oley, Maximillian Ch.
JURNAL BIOMEDIK : JBM Vol 10, No 2 (2018): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.10.2.2018.20089

Abstract: Mild hypothermia treatment could be a useful method for improving the outcome of neurological treatment in patients with severe traumatic brain injury (TBI). There are several mechanisms underlying this effect inter alia reduction of metabolic rate, attenuation of excitatory amino acid and free radical synthesis, suppression of inflammatory responses, and prevention of blood-brain barrier disruption and brain edema. This study was aimed to obtain the effect of mild hypothermia treatment on Glasgow Coma Scale (GCS) dan TNF-? level among patients with severe TBI. This was an experimental analytical study. Subjects were adults aged 16-45 years, divided randomly into two groups (mild hypothermia and control groups) which were observed within 24 and 72 hours. TNF-? serum level was estimated by using TNF-? in vitro simple step ELISA. The assessments of outcomes were determined by using Glasgow Coma Scale (GCS) during the mild hypothermia therapy. The results showed that there were 20 TBI patients enrolled in this study, divided randomly into two groups. The treatment group, treated with mild therapeutic hypothermia, showed a decrease in TNF-? serum level and improved clinical value of GCS score (P <0.05). Conclusion: Mild hypothermia could significantly improve the GCS score and decrease TNF-? serum level among patients with severe TBI.Keywords: mild hypothermia treatment, TNF-?, GCS score,TBIAbstrak: Terapi hipotermia ringan (HPTr) dapat memperbaiki hasil pengobatan neurologik pada pasien dengan cedera otak traumatik (COT) risiko tinggi. Beberapa mekanisme yang mendasari efek tersebut ialah antara lain pengurangan tingkat metabolisme, atenuasi asam amino rangsang maupun sintesis radikal bebas, penekanan respons inflamasi, dan pencegahan gangguan sawar darah otak serta edema otak. Penelitian ini bertujuan untuk mengetahui pengaruh perlakuan HPTr pada kasus COT risiko tinggi berdasarkan skor Glasgow Coma Scale (GCS) dan kadar TNF-?. Jenis penelitian ialah analisis eksperimental. Subjek ialah orang dewasa berusia 16-45 tahun, diacak menjadi dua kelompok yaitu kelompok perlakuan HPTr dan kelompok kontrol. Pengamatan subjek dilakukan pada 24 jam dan 72 jam. Kadar serum TNF-? diperoleh dengan menggunakan metode TNF-? in vitro simple step ELISA. Penilaian klinis dilakukan dengan mengunakan skor GCS pada 24 dan 72 jam perlakuan HPTr. Hasil penelitian mendapatkan 20 penderita COT, dibagi menjadi dua kelompok secara acak. Kelompok perlakuan HPTr menunjukkan kecenderungan penurunan kadar TNF-? serum dan perbaikan nilai klinis dinilai dengan skor GCS (P <0,05). Simpulan: Pada penderita dengan cedera otak traumatik risiko tinggi, terapi hipotermia ringan dapat meningkatkan nilai klinis skor GCS dan menurunkan kadar TNF-? serum secara bermakna.Kata kunci: hipotermia ringan, TNF-?, skor GCS, COT

Pengaruh penggunaan helm terhadap cedera kraniofasial berdasarkan skor FISS dan CT Marshall Mengga, Hendrik; Hatibie, Mendy; Prasetyo, Eko; Oley, Maximillian Ch.
Jurnal Biomedik : JBM Vol 9, No 2 (2017): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.9.2.2017.16362

Abstract: Helmet can reduce head trauma as well as maxillofacial trauma due to motorcycle accident. This study was aimed to prove the effect of helmet and its type in reducing craniofacial injury. Any intracranial abnormalities were evaluated with the CT Marshall scoring system and maxillofacial abnormalities were evaluated with FISS. This was an analytical comparative study with a cross sectional design. The results showed that there were 72 patients with craniofacial trauma; 59 patients with intracranial abnormalities and 24 patients with maxillofacial abnormalities. There were 43.1% patients that wore helmet; 31.9% of them wore open-face helmet. Data were analyzed by using the unpaired t-tests. Based on FISS, the effect of helmet on maxillofacial injury obtained a t-value of 0.787 (P = 0.217) which indicated that there was no difference in FISS scores between patients wearing helmet and not. Based on the CT Marshall scoring system, the effect of helmet on the intracranial injury obtained a t-value of 1.822 (P = 0.036) which indicated that there was a difference in scores between patients wearing helmet and not. This meant that wearing helmets had some influence on the occurence of head injuries. Based on FISS, the impacts of full-face helmet and open-face helmet on maxillofacial injuries obtained a t-value of 1.890 (P = 0.034) which indicated that there was a difference in FISS between the two types of helmets. Based on the CT Marshall scoring system, the impacts of full-face helmet and open-face helmet on intracranial injuries obtained a t-value of 1.714 (P = 0.049) which indicated that there was a difference in CT Marshall scores between the two types of helmets. Conclusion: Helmet and its type, full-face and open-face, had some influence on the occurence of either maxillofacial or intracranial injuries.Keywords: craniofacial injury, motorcycle, helmetAbstrak: Penggunaan helm dapat mengurangi kejadian trauma kepala dan trauma maksiofasial akibat kecelakaan sepeda motor. Penelitian ini bertujuan untuk membuktikan bahwa pemakaian helm dan tipe helm berperan dalam menurunkan cedera kraniofasial. Abnormalitas intrakranial dievaluasi dengan skoring CT Marshall dan abnormalitas maksilofasial dievaluasi dengan FISS. Jenis penelitian ialah analitik komparatif dengan desain potong lintang. Hasil penelitian mendapatkan 72 pasien dengan trauma kraniofasial; 59 pasien dengan abnormalitas intrakranial dan 24 pasien dengan abnormalitas maksilofasial. Terdapat 43,1% pasien yang menggunakan helm; 31,9% menggunakan helm open-face. Data dianalisis menggyunakan uji t tidak berpasangan. Berdasarkan FISS, efek helm terhadap cedera maksilofasial mendapatkan t = 0,787 (P = 0,217) yag menunjukkan tidak terdapat perbedaan skor antara pasien yang menggunakan dan tidak menggunakan helm. Berdasarkan skoring CT Marshall, efek helm terhadap cedera intrakranial mendapatkan t = 1,822 (P = 0,036) yang menunjukkan terdapat perbedaan skor antara pasien yang menggunakan dan tidak menggunakan helm. Hal ini memperlihatkan bahwa penggunaan helm berpengaruh terhadap kejadian cedera kepala. Berdasarkan FISS, dampak jenis helm full-face dan open-face terhadap cedera maksilofasial mendapatkan t = 1,890 (P = 0,034) yang menyatakan terdapat perbedaan skor FISS antara pengggunaan kedua jenis helm. Berdasarkan skoring CT Marshall, dampak helm full-face dan open-face terhadap cedera intrakranial mendapatkan t = 1,714 (P = 0,049) yang menunjukkan terdapat perbedaan skor CT Marshall antara penggunaan kedua jenis helm. Simpulan: Penggunaan helm dan jenis helm (full-face dan open-face) memengaruhi terjadinya cedera maksilofasial dan intrakranial.Kata kunci: cedera kraniofasial, sepeda motor, helm

Hubungan Kadar Interleukin 10 Serum dan Klasifikasi CT Marshall pada Pasien Cedera Otak Berat akibat Trauma Kurniawan, Melina O.; Prasetyo, Eko; Oley, Maximillian Ch.
JURNAL BIOMEDIK : JBM Vol 11, No 2 (2019): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.11.2.2019.23321

Abstract: Increased level of interleukin 10 (IL 10) in patients with severe traumatic brain injury (TBI) has been documented, yet studies of its ability to predict the outcome based on the Marshall CT classification are still limited and lacks of clarity. This study was aimed to evaluate the relationship between serum level of IL 10 and the Marshall CT classification among patients with severe TBI. This was an analytical observational single-center study with a cross-sectional design. Immediate CT scans were used to determine the Marshall CT classification and to categorize the location (extra-axial, intra-axial, both), hemisphere (midline/diffuse, dextral, sinistral), and area (frontal, parietal, temporal, occipital, multiple) of the injury. Venous blood sample for IL 10 was taken less than 24 hours of trauma in the Intensive Care Unit. Age and gender were also recorded. Variable selection was run in stepwise forward fashion. Proportional odds models were conducted to assess the changes in the Marshall CT classification related to levels of IL 10. There were 25 patients admitted consecutively to the emergency room (ER) with severe TBI included in this study. The results showed that the mean IL 10 was 107.3 pg/ml (SD 16.2 pg/ml). Patients were distributed almost uniformly within four detected categories (diffuse injury II, III, V, and VI) of the CT Marshall classification. Final regression model consisted of IL 10, age, and injury on temporal area as predictors. Controlling for the others, every 10 pg/ml additional of IL 10 increased the odds to higher (worse) categories in the CT Marshall classification by about 1.95 (95% CI 1.16 â€“ 3.30) times. Conclusion: Interleukin 10 is a potential predictor for the CT Marshall classification in patients with severe TBI.Keywords: IL 10, Marshall CT classification, TBIAbstrak: Peningkatan kadar serum interleukin 10 (IL 10) pada pasien dengan cedera otak traumatik (COT) berat telah didokumentasikan, namun studi tentang kemampuannya untuk memrediksi hasil berdasarkan klasifikasi CT Marshall masih terbatas dan belum jelas. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar serum IL 10 dan klasifikasi CT Marshall pada pasien COT berat. Jenis penelitian ialah observasional analitik dengan desain potong lintang. CT scan digunakan untuk menentukan klasifikasi CT Marshall dan untuk mengategorikan lokasi (ekstra-aksial, intra-aksial, keduanya), hemisfer (garis tengah/ difus, dekstra, sinistra), dan area (frontal, parietal, temporal, oksipital, multipel) otak yang terkena cedera. Sampel darah vena untuk IL 10 diambil kurang dari 24 jam pasca trauma. Usia dan jenis kelamin juga dicatat. Seleksi variabel dilakukan secara bertahap. Digunakan model regresi proporsional odds untuk menilai perubahan klasifikasi CT Marshall terkait dengan kadar IL 10. Hasil penelitian mendapatkan 25 pasien dengan COT berat yang masuk ke Instalasi Rawat Darurat Bedah (IRDB). Rerata IL 10 ialah 107,3 pg/ml (SD 16,2 pg/ml). Pasien didistribusikan hampir seragam dalam empat kategori (cedera difus II, III, V, dan VI) dari klasifikasi CT Marshall. Model regresi akhir terdiri dari IL 10, usia, dan cedera pada area temporal sebagai prediktor. Sebagai kontrol, setiap peningkatan IL 10 sebanyak 10 pg/ml meningkatkan kemungkinan klasifikasi CT Marshall yang lebih tinggi (lebih buruk) sekitar 1,95 (95% CI 1,16-3,30) kali lebih tinggi. Simpulan: IL10 merupakan prediktor potensial untuk klasifikasi CT Marshall pada pasien dengan COT berat. Kata kunci: IL 10, klasifikasi CT Marshall, COT

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