The relationship of Soluble Suppression of Tumorigenicity 2 (sST2) and Troponin T (TnT) levels in Acute Myocardial Infarction (AMI) patients at Sanglah General Hospital, Bali, Indonesia

Background: Acute Myocardial Infarction (AMI) as cardiovascular disease is a significant cause of death worldwide and requires examining cardiac biomarkers such as Troponin T (TnT) for diagnosis. However, increased troponin levels are often found in non-AMI patients. Soluble Suppression of Tumorigenicity 2 (sST2) as a novel biomarker has known will increase after the occurrence of AMI. This study aims to evaluate the relationship of sST2 and TnT levels in AMI patients at Sanglah General Hospital, Bali, Indonesia

Methods: The study was conducted among 61 participants during August-December 2020 by consecutive sampling. The samples were examined for TnT levels using a Roche Cobass h232 and sST2 with the Human sST2 Elabscience© Enzyme-linked Immunosorbent Assay (ELISA) Kit. Normality and correlation tests were performed between the two parameters. Data were analyzed using SPSS version 17 for Windows.

Results: The average age of participants was 59.5±10.0 years old. Most of the participants were male and had hypertension history in STEMI (71.0% and 67.7%) and NSTEMI (70.0% and 79.0%) groups. There is no significant difference in BMI between STEMI (23.5±3.1 kg/m²) and NSTEMI (24.6±3.8 kg/m²) (p=0.319). However, there was a significant moderate positive correlation between TnT and sST2 levels (r=0.394, p=0.002).

Conclusion: There was an increase in troponin T and sST2 levels in AMI patients at Sanglah Hospital. There is a significant positive correlation between sST2 levels and troponin T levels in AMI patients at Sanglah Hospital.  

The effectiveness of Triamcinolone Acetonide (TA) and Interleukin-6 (IL-6) levels in preventing intraperitoneal adhesion

Background: Intraperitoneal adhesions are formed due to the inflammatory response in releasing proinflammatory cytokines such as IL-6. Triamcinolone Acetonide (TA) acts as an anti-inflammatory by inhibiting the production and release of IL-6 cytokines. This study aims to determine the effectiveness of triamcinolone acetonide in preventing intraperitoneal adhesions and its effect on assessing IL-6 levels in post-exploratory laparotomy in rats.

Methods: An experimental study was conducted among 40 male Wistar rats from January and March 2021 in the Animal Laboratory of Universitas Padjadjaran, Bandung, Indonesia. Blood samples were taken before treatment and on the 14th day after treatment. In rats, laparotomy and cecum abrasion were performed with a needle. Rats in the treatment group were given triamcinolone acetonide at a dose of 0.1 mg, 0.3 mg, or 0.5 mg. On the 14th day, a microscopic examination of the degree of adhesion was performed. Data were analyzed using SPSS version 20 for Windows.

Results: The results of the Kruskal-Wallis test analysis on the formation of intraperitoneal adhesions microscopically showed a significant difference between the control group and the treatment group (p < 0.001) with the lowest mean rank in the TA group of 0.3 mg (11.4), which stated that this dose was more effective in preventing intraperitoneal adhesions. The One-Way ANOVA test on IL-6 examination had a significant difference in postoperative IL-6 reduction between the control and treatment groups (p < 0.001).

Conclusion: Triamcinolone acetonide was effective in preventing intraperitoneal adhesions and reducing IL-6 levels in post-exploratory laparotomy rats.

A discrepancy of blood group A with missing antigen in anorectal malformation patient at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: Blood group discrepancy is a discrepancy in the results of the cell grouping with serum grouping examination. The source of discrepancy is from technical errors or a patient's medical status such as age, disease, history of blood transfusion and medication, pregnancy. This case study aims to evaluate a discrepancy of blood group A with missing antigen in anorectal malformation patient at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Case Presentation: A male baby, 6 months 19 days old, was unable to defecate since birth post-colostomy. Physical examination reveals anemia. A routine blood test showed a hemoglobin level of 8.8 g/dL. The diagnosis was high position anorectal malformation post colostomy suspect Hirschsprung Disease, with 110 cc Packed Red Cell (PRC) transfusion plan. A routine pre-transfusion procedure was performed. It was found a discrepancy of blood group A with missing antigen.  Crossmatching with blood groups O and A both gave compatible results. Examination of peripheral blood smear after PRC blood group A transfusion found no signs of hemolytic.

Conclusion: Blood group discrepancy, in this case, was due to missing antigen, which was caused by the possibility of gastrointestinal bacterial infection.

General surgery practice in Aceh rural hospital during the COVID-19 pandemic: a descriptive cross-sectional study

Background: COVID-19 pandemic is one of the biggest issues that we have faced and has had a significant impact on healthcare practice worldwide. Increasing COVID-19 cases requires the surgical department to reorganize all the patient treatment to prevent infection. This study aims to find out the pattern of general surgery care during the COVID-19 pandemic compared to the non COVID-19 period and to know better to prepare for surgical patients' treatment in the future.

Method: This is a descriptive cross-sectional study. We studied the important points of a complete range of the patient at the department of surgery outpatient, inpatient, and operation theatre of Datu Beru Hospital from 1 March 2020 to 31 December 2020 for the COVID period and 1 March 2019 to 31 December 2019 for the non-COVID period.

Result: There were 2822 outpatient visits during the non-COVID period and 1949 patients during the COVID period. The total decrease in outpatient visits was 30.93% during the pandemic. Female outpatient visits are 51.25% during COVID period. There is 36.49 % reduction in total operation during pandemic. Total elective cases were 78,68% decrease over the pandemic period from 591 to 126 cases. There were 45% reduction inpatient admissions during pandemic.

Conclusion: There is a reduction in number of general surgery cases during COVID-19. Some elective surgeries can still be performed with triage according to the guideline. All actions are following protocol and Personal Protection Equipment so that the safety of surgeons, staff, and patients is maintained. 

A case of Nevus of Ota treated with laser picosecond Alexandrite 755 nm: A case-report

Background: Nevus of Ota is a well-defined dermal melanocytosis characterized by bilateral multiple small, bluish-brown macules in the area innervated by the first and second branches of the trigeminal nerve. Currently, the therapeutic modalities for this condition are still limited and complete resolution is difficult to achieve.

Case Description: A 23-year-old woman complained a brown spot on the right cheek since the patient was born. It looked like the skin but slightly darker than its surroundings. Four years ago the patient had received 6 sessions of QS: Nd-YAG laser therapy, but the spot is still clearly visible. Dermatological status of the orbital, infraorbital, zygomatic, and right buccal regions showed multiple hyperpigmented patches, gray-brown, well-defined, geographically in shape with size 0.2 x 0.3cm – 5 x 7cm. The lesion was unilateral and distributed within the innervation area of the second and third trigeminal nerve. Miravex® skin analysis showed that the average level of melanin was 0.464 with a melanin variation of 45%. Therefore, patient was diagnosed with Nevus of Ota. The proposed treatment was  picosecond alexandrite 755nm laser, with a frequency of 2.5 Hz, pulse duration 550-750 ps, spot size 4 mm, and fluence 1.59 J/cm². A marked improvement was observed after the treatment and after 21 days, a good grade of improvement was reported.

Conclusion: Nevus of Ota can effectively treated with 755nm picosecond alexandrite laser therapy and results in a good grade of improvement.