Neurologico Spinale Medico Chirurgico

Centella asiatica extract cream inhibited microphthalmia-associated transcription factor (MITF) expression and prevented melanin amount increase in Guinea pig skin exposed to ultraviolet-B

Fatri Idana — 2022-03-27

Background: Centella asiatica has been popularly used in cosmetic products, especially due to its antioxidant benefits in soothing and healing wounds. However, the inhibition of melanogenesis in the content of Centella asiatica has not been widely studied. This study aimed to prove the effectiveness of 10% Centella asiatica cream on male Guinea pig (Cavia porcellus) skin exposed to UVB.

Methods: The randomized posttest-only control group study was conducted on 36 Guinea pigs aged 3-months, body weight 300-350 grams with a healthy skin condition. They were randomly divided into two groups; each consists of 18 Guinea pigs. The first group was a control group given base cream 20-minutes before and 4-hours after UVB exposure, 3-times-a-week for two weeks. The second group was the treatment group given 10% Centella asiatica cream and expose to UVB with the same procedure. The histopathological preparations were made using a punch biopsy after intervention was completed. Immunohistochemical staining was performed to measure the expression of microphthalmia-associated-transcription-factor (MITF) and Masson-Fontana to measure the amount of melanin. Data analysis was conducted to compare the results in both groups.

Results: The treatment group had a significantly lower mean MITF expression (13.61 ± 5.36 vs. 27.24 ± 6.50%) and melanin amount (5.95 ± 3.81 vs. 16.59 ± 5.77%) (p < 0.001) compared to the control group.

Conclusion: The administration of cream consists of Centella asiatica extract 10% effectively inhibits the expression of MITF and prevented the increase of melanin amount in male guinea pigs (Cavia porcellus) exposed to UVB.

Characteristics and outcome of traumatic brain injury in Nabire General Hospital, Papua, Indonesia

I Nyoman Surya Negara — 2022-03-27

Background: Traumatic brain injury (TBI) is a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. TBI is a major public health problem that can lead to long-term disability. This study was performed to cognize the clinical characteristic and parameters that could predict the outcome of TBI patients and become the foundations for public health interventions to help prevent and lower the mortality rates of TBI in other rural and remote areas.

Methods: This research is a retrospective study. Our patient data were collected from Nabire General Hospital medical records from 1 January 2020 to 31 December 2020. This study included all patients who were diagnosed with TBI and excluded the incomplete data. The study was analyzed using chi-square.

Results: This study shows TBI mostly occurs in men and the peak incidence in aged 17-65 years old and mainly caused by road traffic accidents. Some factors significantly shows correlation to predict worse outcomes in TBI patients are impaired oxygen distribution, low GCS score, history of consuming anticoagulant and antiplatelet, and the different types of brain hemorrhage.

Conclusion: TBI in Papua mostly occurs in men aged between 17-65 years old and road traffic accidents are the main cause. The impaired oxygen distribution, low GCS score, history of consuming anticoagulant and antiplatelet, and the different types of brain hemorrhage were associated with unfavorable outcomes.

Correlation between knowledge, attitude, practice toward anxiety, and perception of the need for mental health services in Bali communities during the COVID-19 pandemic

Putu Satyakumara Upadhana — 2022-03-27

Background: The level of knowledge, attitudes, and practices of a person in dealing with the COVID-19 pandemic can be a factor that influences the emergence of anxiety disorders. The study aims to determine the correlation between knowledge, attitude, practice toward anxiety, and perception of the need for mental health services in Bali communities during the COVID-19 pandemic.

Methods: This study was a cross-sectional observational analytical study with a consecutive sampling method. An online questionnaire was distributed in all provinces by the enumerator from 1 November to 30 November 2020. The inclusion criteria are respondents that lived in Bali and were aged between 18 to 65 years old.

Results: There were 356 respondents included in this study. Most of them were female (n = 227, 63.8%), and not married (n = 251, 70.5%), with a median age of 25 years old (18-64 years old). There was a significant correlation between attitude and perception of the need for mental health service (p = 0.028, R = 0.177) and anxiety of the respondent (p = 0.004, R = 0.151). Also, the correlation between practice and perception of the need for mental health (p = 0.039, R = 0.109) and anxiety with the perception of the need for mental health (p = 0.039, R = 0.109) were found to be statistically significant.

Conclusion: There is a correlation between knowledge, attitude, practice toward anxiety, and perception of the need for mental health services in Bali communities during the COVID-19 pandemic.

Comparison of Alvarado scores, Tzanakis scores, and RIPASA scores in the diagnosis of acute appendicitis in Sanglah Hospital

I Made Maha Satya Dwi Palguna — 2022-03-31

Background: Acute appendicitis (AA) is the most common cause of gastrointestinal emergency surgery worldwide. However, to confirm the diagnosis of acute appendicitis, it is largely dependent on clinical judgment, causing the rate of negative appendectomy or misdiagnosis reach 20 – 40%. Several scoring systems have been developed to identify patients who did not require surgery, thereby reducing the burden of negative appendectomy.

Methods This study is a cross-sectional observational study with diagnostic tests. The study was conducted at the Surgical Department of Sanglah Hospital, Denpasar from January 1^st, 2020 to December 31^st, 2020. All patients enrolled in this study were calculated with Alvarado, Tzanakis, and RIPASA scores to determine the need for appendectomy. In patients undergoing surgery, the diagnosis of AA was confirmed by histopathological examination. Descriptive analysis, receiver operating characteristics (ROC) analysis, and diagnostic tests were used to assess the effectiveness of the three scoring systems.

Results: The total respondents in this study who met the inclusion and exclusion criteria were 103 people. This study found that acute appendicitis was more common in male patients with a mean age of 28.26 years. The RIPASA scoring system has better sensitivity and accuracy than the Alvarado and Tzanakis scores, so it is recommended to use the RIPASA score as a diagnosis of acute appendicitis. However, if an ultrasound facility is available, the Tzanakis score can be used.

Conclusion: RIPASA score is the best score to diagnose acute appendicitis.

Validity of predictive score of mortality in peptic ulcer perforation (POMPP) in predicting perforated peptic ulcer mortality operated in Sanglah General Hospital, Denpasar, Bali

I Gusti Putu Agung Pratama Putra — 2022-04-01

Introduction: Peptic ulcer perforation is a non-traumatic emergency that is often encountered and gives a mortality rate of up to 70%. The need for a system that is easy and simple in predicting and screening patients in the initial triage to predict the incidence of mortality after surgery is important. This study aim to test the validity of predictive score of mortality in peptic ulcer perforation (POMPP) in predicting mortality in patients with perforated peptic ulcer surgery.

Methods: This study was a diagnostic study with 50 peptic ulcer perforation patients operated between February 2019 to February 2020, and collected with consecutive sampling method. All patients who were operated was calculated for the preoperative POMPP scores, with parameters of age, blood urea nitrogen, and albumin. Patients who were deceased or refused to participate were excluded. The best cut-off point was calculated, then sensitivity, specificity, positive and negative predictive value (PPV/NPV), accuracy of score and POMPP score validity were calculated in predicting post-operative patient mortality.

Results: The best cut-off value obtained from receiver operating characteristic (ROC) curve was ≥1.5, where patients with POMPP ≥1 were exposed to a high risk of postoperative mortality (80.8%), and POMPP <1.5 had a low risk of postoperative mortality (19.2%). Other scores were calculated as follow: sensitivity 80.7%, specificity 91.6%, PPV 91.3%, NPV 81.4%, accuracy 86% and the validity test score of 50 patients reached 100%.

Conclusion: POMPP has good validity and can be used as a screening tool for patients with perforated peptic ulcer surgery.

Occipito-cervical fusion approach to Hangman’s fracture on osteoporosis patient

Glen Sandi Saapang — 2022-03-27

An unstable Hangman fracture in an elderly patient is a condition that requires special consideration in selecting a surgical approach. In a healthy sixty-year-old man with a good Karnofsky score, a cervical X-ray and non-contrast CT-scan (NCCT) were performed to confirm the diagnosis. Installation of cervical traction with light weights first followed by occipito-cervical fusion has shown improvement in fracture alignment without complications, even with limited resources. Postoperative radiological examination showed good realignment with lateral mass screw fixation. From this case, it can be seen that the selection of the right surgical procedure in elderly patients is important, especially for those who do not have significant comorbidities.

Surgery on displaced depressed skull fracture overlying sigmoid sinus: Rationale, techniques, and risk management

Kadek Biondi — 2022-03-27

Skull fracture may occur at all parts of the skull after direct trauma. Skull fragment overlying dural venous structure, may inherit the risk of infection, thrombosis, and massive bleeding. Controversy arises among institutions whether the surgical measure is superior to the conservative option. The occurrence of depressed skull fracture overlying sigmoid sinus is seldom discussed in trauma literature, but some authors reported that the risk of infection and sepsis might occur in a delayed fashion in this group of patients. Several reports on the radiological study in depressed skull fracture overlying venous sinus found that fracture may predispose to venous sinus thrombosis. However, the risk of profuse bleeding when attempting to elevate bone fragments could place the patient into serious and devastating conditions, which need aggressive and effective bleeding control. We report a case of a middle-aged man who had a displaced depressed skull fracture overlying the right sigmoid sinus after falling from height. Surgery was performed in order to decompress the right sigmoid sinus structure and repair the cerebrospinal fluid leak at the overlying duramater. The patient was discharged from the hospital with minimal conductive hearing disturbance, with no sign of infection and neurologic deficits.

Perioperative management of a morbidly obese patient with Pickwickian syndrome who underwent herniotomy herniorrhaphy surgery

Reynaldi Reiky Hadiwijaya — 2022-03-27

Administering anesthesia in obese patients has its challenges. Most obese patients have multiple comorbidities with a higher risk for perioperative complications. Obese patients also have several physiological changes, including respiratory changes that could affect anesthesia. With the increasing number of obesity rates worldwide, the possibility of obese patients who need anesthesia increases, thus providing challenges for anesthetists in treating obese patients. This case described a 62-year-old male who underwent herniotomy and herniorrhaphy under general anesthesia. The patient was morbidly obese with a BMI of 54.68 kg/m² and found to have Pickwickian Syndrome. The patient was assessed with physical state ASA III and underwent general anesthesia. The patient recovered with no complications and was discharged from the hospital three days after the surgery. In obese patients, several physiological changes could be a challenge for administering anesthesia. The choice of anesthetic agent for obese patients with Pickwickian Syndrome should be carefully selected, considering it can significantly impact the patient. The perioperative period should be focused on careful monitoring and improvement of comorbid diseases.

Is there any benefit from surgery for giant-dumbbell spinal tumors with prolonged paraplegia and joints contractures? a rare case report

Mohamad Saekhu — 2022-03-27

The lack of clarity about the opportunities for significant neurologic improvement, coupled with the risk of severe postoperative complications, decompression surgery for patients with giant tumors in the cervical spine accompanied by long-lasting advanced neurological deficits places a heavy moral burden on surgeons. Here we report a three-year follow-up after surgery for an immense spinal neurofibroma in which the patient was bedridden for the past fifteen years. Our findings suggest surgery remains beneficial for patients without major postoperative complications.

Endovascular coiling procedure for saccular multilobulated anterior communicating artery aneurysm associated with contralateral A1 segment aplasia

Bilzardy Ferry Zulkifli — 2022-03-27

The anterior communicating artery complex anatomy is very important in treating anterior cerebral circulation aneurysms surgically. About a quarter of all intracranial aneurysms are anterior communicating artery (AcomA) aneurysms. Aneurysm formation may be influenced by anatomic risk factors, with a co-occurring incidence of anterior cerebral artery trunks (A₁) asymmetry. Patients with AcomA aneurysm are often presented with anterior cerebral artery A₁ segment aplasia/hypoplasia. In this study, we will report a case of A₁ hypoplasia in a 42-year-old female with a history of headache 3 days prior to admission which worsened overtime. Traditionally, coiling of A₁ hypoplasia was not needed, however due to the neurological deficit, coiling was performed. This case report addresses the comparison between patient’s pre-operative and post-operative results from angiography and coiling.

Optimizing microsurgery training for plastic surgery resident: A systematic review

Gede Wara Samsarga — 2022-03-27

Background: Microsurgery for plastic surgery residents is complex and requires a long learning curve, psychomotor capabilities, and repeated practices. Microsurgery training for plastic surgical residents must be optimized due to the heavy workload during residency and the limited time available to master microsurgery skills.

Methods: Electronic literature searching of the MEDLINE (PubMed), Cochrane, and Google Scholar databases was conducted. Studies that were eligible and published between January 2015 and September 2019 were chosen.

Results: Surgical simulation platforms have been implemented as a result of new training methods to learn microsurgery. Plastic surgery residents can practice microsurgery in virtual, animal models, non-living models, and indirect patient practice. Resident’s competency scores and surgical performance improve as a result of simulation-based training. The demand for simulation-based training in plastic surgery residency programs is expected to rise as a result of its usefulness. A microsurgical skill evaluation is also a mandatory aspect of enhancing microsurgical skills for plastic surgery residents.

Conclusion: Because there is limited time for formal microsurgery training in the operating room, plastic surgery residents must optimize their microsurgery skills outside of the operating room. Implementation of living and non-living models for microsurgery training and standardized objective assessment tools will further advance microsurgical skills in plastic surgery resident.

Role of Rho-kinase Inhibitor and hrsACE2 in COVID-19 Patients Management

Wilson Halim — 2022-04-17

The Renin-angiotensin system (RAS) plays an important role in the SARS-CoV-2 infection through Angiotensin-converting enzyme 2 (ACE2). Human recombinant soluble ACE2 (hrsACE2) has been shown to act as a competitive interceptor for SARS-CoV-2 by preventing the binding of viral particles to the ACE2. In addition, Rho-kinase inhibitors have been proven to suppress SARS-CoV-2 infection through inhibition of the Rho-associated protein kinase (ROCK) pathway. The combined effect of hrsACE2 and Rho-kinase inhibitor increases the activity and levels of ACE2 in protection through the Ang1-7 MasR, Ang1-9, and other mechanisms of protection. This literature review is done by searching journals with “COVID-19”, “ACE2”, “hrsACE2”, “Rho- kinase inhibitor”, and “ROCK pathway” as well as Boolean logic “AND” and “OR”. Relevant journals are used as references to compile systematic writing. Based on research results, hrsACE2 and Rho-kinase inhibitors have been clinically proven to protect tissue through the elevated level of ACE2 by the mechanism of Rho-kinase inhibitor, which increased Ang1-7 MasR concentration that gives vasodilatation, anti-proliferative, anti-inflammation, and anti-fibrotic effect. Rho-kinase inhibitors significantly reduce the number of infected cells by SARS-CoV-2 in COVID-19 patients. The potential of the combination therapy of Rho-kinase inhibitor and hrsACE2 therapy can be an efficient therapeutic solution for COVID-19 patients so that further research can be carried out in the future.