Peran Skor Kandida Sebagai Metode Diagnostik Kandidiasis Invasif Terhadap Neutropenia Berat pada Anak dengan Keganasan

Latar belakang. Infeksi kandidiasis invasif meliputi infeksi aliran darah dan infeksi invasif dalam lainnya yang disebabkan oleh spesies Kandida dan merupakan penyebab morbiditas dan mortalitas yang signifikan, khususnya pada pasien dengan status immunocompromised, seperti pada kondisi keganasan hematologis, kelainan limfoproliferatif, dan gangguan myeloproliferative.Tujuan. Menginvestigasi peran skor Kandida, dibandingkan dengan kultur darah dan PCR, sebagai alat diagnostik kandidiasis invasif pada pasien dengan neutropenia berat, khususnya pada kasus keganasan.Metode. Penelitian ini menggunakan desain penelitian cross sectional. Data yang diperoleh diolah dan dianalisis menggunakan metode Receiver operating characteristic (ROC) untuk mendapatkan nilai area under curve (AUC). Berdasarkan kurva AUC kemudian dilakukan pencarian titik potong yang paling optimal untuk mendapatkan nilai sensitivitas dan spesifisitasHasil. Hasil penelitian menunjukkan bahwa pada kedua kelompok dengan kultur positif dan negatif tidak didapatkan perbedaan bermakna berdasarkan karakteristik jenis kelamin, usia, berat badan, status gizi, dan diagnosis klinis (uji Mann-Whitney, p>0,05).Kesimpulan. Berdasarkan hasil tersebut, dapat disimpulkan bahwa tidak didapatkan perbedaan pada sensitivitas dan spesifisitas skor Kandida dibandingkan dengan hasil kultur pada pada pasien anak dengan neutropenia berat.

Combining Mesenchymal Stem Cell from Stromal Vascular Fraction with Scaffold (in silico, Biocompatibility, and Attachment Study)

AIM: The aim of this study is to evaluate the in silico, biocompatibility, and attachment of mesenchymal stem cell (MSC) from stromal vascular fraction (SVF) combined with scaffolds. METHODS: This research is true experimental study. In silico study using HEX version 8.0. Attachment of MSC from SVF to scaffolds was evaluated using electron microscope and measured. Biocompatibility was evaluated using viability and apoptosis of MSC from SVF after combined with MSC with scaffold. RESULTS: From in silico study, the strongest bound to scaffold is between MSC from SVF to hydroxyapatite (HA) in both receptor which was integrin alpha V to HA which need a total energy of −89.24 (J/Mol) and integrin beta 2 to HA which need a total energy of −177.8 (J/Mol). MSC from SVF cells is capable to combine with three types of bone substitution material. At HA-calcium sulfate administration, SVF cells had apoptosis of 30.27%, and viable cells were 69.73%. At the administration of bovine bone cancellous, SVF cells had apoptosis of 22.20% and viable cells of 77.80%. From microscope electron study, the best result of attachment was obtained from MSC to HA-calcium phosphate with an average value of 12.66 cluster cells counting per 100 μm2 scaffold material. CONCLUSION: From in silico study showed that MSC from SVF could attach to scaffold with stronger binding between integrin alpha V and integrin beta 2 to HA scaffold. Bovine bone cancellous has the best biocompatibility and attachment among other scaffold with the highest viability and lowest cell apoptosis. From microscope electron study, we can prove that MSC can make a cluster cell in those scaffolds with HA-calcium sulfate having the biggest cluster cell counting.

The Role of Collagen Scaffold and Stromal Vascular Fraction on Healing Process in Growth Plate Injury (SOX9 and Histological Examination)

BACKGROUND: Pediatric skeletal trauma presents a distinct approach to its treatment because of its unique auses and possibility of its troublesome complications. One of its major complications is growth plate injury which may disturb the longitudinal growth of child’s bone. AIM: In this study, the author combined stromal vascular fraction (SVF) and collagen scaffold as biomaterial for future treatment of physeal injury in skeletally immature patients using SOX9 and histological examination as a marker. METHODS: The study was conducted experimentally on Rattus norvegicus growth plate based on Erickson study, and the SVF was from R. norvegicus fat tissue with ZUK method. Histological examination was evaluated with 8 times magnification and SOX9 from the growth plate was measured with enzyme-linked immunosorbent assay. RESULTS: Histological examination showed that the best result was obtained in SVF + collagen group judging by the bony bridge diameter. The result was differed significantly from the positive control group with p < 0.05 in Tukey test. The result from SOX9 level measurement shows that all of the treatment groups SOX9 level almost the same as normal value (negative control group) and it is significantly differ from the positive control group with p < 0.05 in Mann–Whitney U-test. CONCLUSIONS: This study showed that the combination of collagen and SVF had a great effect on healing process in growth plate injury.

Functional outcomes evaluation after radial head arthoplasty in DR. Syaiful Anwar General Hospital: Case series

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Three case of radial head fracture treated with radial head arthroplasty.

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Evaluation of the functional outcomes after operative treatment of radial head arthroplasty.

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Functional outcomes assessment with active and passive range of motion.

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Satisfying result on pain and a fair result on functional outcome on patient follow-up.

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Good follow up is important to minimize the complications of radial head arthroplasty.

Introduction

Radial head arthroplasty (RHA) has become one of the mainstay surgical treatment for radial head fracture in certain conditions. Many previous studies compared the superiority of either open reduction and internal fixation (ORIF) and RHA with inconclusive result. Our case series aim to evaluate the functional outcome of the patients treated with RHA in our institution.

Presentation of case

We evaluated three patients who had RHA in 2018 and 2019. The function of flexion, extension, supination and pronation of the elbow was evaluated. The range of motion (ROM) was assessed in both active and passive way.

Discussion

An abundant of literatures stated that RHA result is superior than radial head resection and ORIF. Our case series present a satisfying result on pain and a fair result on functional outcome from the range of motion (ROM) evaluation on patient follow-up.

Conclusion

A good follow up for post-operative care plays an important role in management of RHA to minimize the rate of complications. In this case series, the functional outcomes after RHA is good, but a larger number of patient and longer follow up duration is needed for a better analysis.

Emergency Surgery in High Volume Osteosarcoma of Left Proximal Humerus Due to Vascular Compromise: A Case Report

BACKGROUND Osteosarcoma is the most common type of malignant bone tumor arising from mesenchymal stem cell. When occurring on the proximal humerus, it is associated with poor outcomes; there are numerous neurovascular structures around proximal humerus. Unfortunately, the degree of vascular involvement in osteosarcoma is rarely evaluated and reported. Thus, we would like to highlight our case. CASE REPORT We reported a case of left proximal humerus osteosarcoma causing dead limb in a 14-year-old boy. The dead limb progressed in the span of 3 weeks. An emergency forequarter amputation (FQA) was conducted to prevent further complications such as septicemia and mortality. Two months after the surgery, the patient had improved quality of life. One year after, the patient had no local recurrence. However, there was a lung metastasis detected 9 months after the surgery. The patient died 13 months after the surgery. CONCLUSIONS Osteosarcoma of the proximal humerus can potentially compromise vascular structures. Early diagnosis and treatment are mandatory to prevent such complications.

Union of Brodsky type 1/Eichenholtz stage III Charcot neuroarthropathy after forefoot arthrodesis

INTRODUCTION

One of the surgical intervention options for Charcot neuroarthropathy (CN) is arthrodesis. The arthrodesis procedure for the foot and ankle joint have been widely used in previous studies. This study aimed to evaluate the functional and radiological outcomes after arthrodesis procedure for the CN patient with Brodsky type 1/Eichenholtz stage III.

PRESENTATION OF CASE

A 49-years-old diabetic woman presented with alteration of her right foot's shape and a cracking sensation while walking in the last six months. Rocker-bottom deformity and a decreased sensation on the right foot were found, and the initial American Orthopaedic Foot & Ankle Society (AOFAS) score was 45. Subsequently, forefoot arthrodesis of the right foot was performed.

DISCUSSION

Several studies state that arthrodesis procedure is often used for CN management in order to achieve a plantigrade and stable foot. This study presents an improvement of the foot arch, AOFAS score, and union of the talus six months after surgery.

CONCLUSION

The arthrodesis procedure by using screws and Kirschner wire (K-wire) fixation is an effective method in CN management if the patient is compliant. This study showed a good result, anatomically restored the foot arch, and excellent radiological union, but different tools to analyze foot functional status and longer follow up period are needed for a better analysis.

Elbow Fracture in Children at Saiful Anwar General Hospital, Nine Years Experiences

AIM:

The frequency, incidence, and types of fracture of the elbow are different between children and adult. The epidemiology of elbow fracture in children has been the subject of a limited number of studies. This study aims to observe the pattern of elbow fractures in children 18 years of age and younger, during a nine years period.

METHODS:

This is a retrospective study about elbow fracture cases in children 18 years old and younger treated in Saiful Anwar General Hospital Malang in the period of June 2009 until December 2018. The data obtained from the medical record include the age at the time of accidents, fracture site, type of lesion and ipsilateral injuries, time of accidents, and the mechanism of injury.

RESULTS:

There is a total of 99 elbow fracture, and there are 62 male (63%) and 37 female patients (37%). The mean age for the entire group is 7.3 years (8.1 years for male and 7.1 years for female). Most cases are supracondylar fracture (n = 77, 78%). The supracondylar fracture is composed of 17 fracture classified to type II, and 60 fracture to type III as classified by Gartland. The most common etiology of fracture is associated with sports, recreational activities, and fall from height of less than two meters. Nerve injury involving the median, radial, and ulnar nerve is seen in eight patients with type III supracondylar fracture. Associated brachial artery injury is seen in four patients with type III supracondylar fractures. A group of 78 patients (79%) were treated surgically and 21 patients (21%) were treated conservatively.

CONCLUSION:

The incidence of elbow fracture in children treated in Saiful Anwar General Hospital during a nine years period is 99 patients, with supracondylar fracture Gartland type III being the leading type of this group. Male patients are more common than female patients. Nerve injury was seen in 13.33% of cases and brachial artery injury was seen 6.67% with type III supracondylar fracture. Most of the elbow fracture in our institution were treated operatively.

Primary single stage Total Hip Arthroplasty in a patient 40 years post traumatic Hip dysplasia, a case report

Introduction

Hip dysplasia refers to an abnormal development of size, shape, or organization of the femoral head, acetabulum, or both. Managing acetabular dysplasia is very challenging in arthroplasty especially in traumatic hip dysplasia case. Mostly, hip dysplasia cases need a special implant, procedure and techniques.

Case presentation

We performed primary Total Hip Arthroplasty (THA) + partial tenotomy of hamstring, iliotibial band, hip abductor in a 73 year old male. His main complaint was that he was unable to sit due to an increasingly intense pain since 3 months ago and he has been unable to walk properly since 40 years ago when he had a major traffic accident and received inadequate treatment. The procedure had been successfully done using a well press-fit cementless acetabular cup and a cementless narrow stem application 1 cm on leg length discrepancy (LLD).

Conclusion

Preoperative planning, surgical techniques and a post-surgery rehabilitation are the key to a successful management in this case.

β-Glucan of Candida albicans Cell Wall Extract Inhibits Salmonella Typhimurium Colonization by Potentiating Cellular Immunity (CD8 + and CD4 + T Cells)

INTRODUCTION

Antimicrobial resistance has been reported in the drugs used for the treatment of typhoid fever. The immunomodulatory substance β-glucan can be used as an alternative therapy as it potentiates host immunity. The aims of this study are to observe the effect of Candida albicans cell wall (CCW) extract towards host immunity (TCD8+ and TCD4+ cells in spleen, intestinal sIgA) and its capacity to kill Salmonella in the intestine and liver of typhoid fever mice models.

METHODS

Typhoid fever mice models were created by infecting mice with S. Typhimurium orally. Mice were divided into four groups: the Non-Infected, Infected, CCW (infected mice treated with 300 µg CCW extract/mouse once a day), and Ciprofloxacin groups (infected mice treated with 15 mg/kg BW ciprofloxacin twice a day).

RESULTS

Secretory IgA (sIgA) concentrations of mice in the CCW group remained unchanged. However, their TCD4+ and TCD8+ cells increased substantially compared to those in the Non-Infected group. In the Ciprofloxacin group, sIgA concentrations increased markedly compared to those in the Non-Infected and CCW groups; TCD4+ and TCD8+ cells also increased significantly compared to those in the Infected Group, but not significant compared to those in the CCW group. Colonization of S. Typhimurium in the intestine and liver decreased significantly in the CCW and Ciprofloxacin groups compared to that in the Infected group, with the lowest reduction being found in the Ciprofloxacin group.

CONCLUSIONS

The inhibition of S. Typhimurium colonization by CCW is associated with the increase in TCD4+ and TCD8+ cells.