Perbandingan antara Rasio Neutrofil Limfosit dan Trombosit pada Kebocoran Plasma Anak

Background: Dengue virus infection is a global health problem. Dengue Hemorrhagic Fever (DHF) has become a global attention because of children death due to plasma leakage. Plasma leakage is a symptom of critical phase in children that occurs on the 3rd to 5th day. Neutrophil lymphocyte (NL) ratio and platelet count change can be seen in critical phase of plasma leakage which can help process of patient’s therapy. Objective: This study aimed to compare the NL ratio and platelets count on plasma leakage in children with DHF. Methods: This study was an analytical study with cross-sectional design. The sample was children with DHF at RSUD Dr.Pirngadi Medan. The data of this study were analyzed by computer software, used an unpaired t test with p <0.05. Results: This study found that the most age of DHF was 6-10 years old, most gender are male and DHF grade 1. Unpaired t test found the average difference between NL ratio and platelet with value of p = 0.043 (p<0.05). Conclusion: Plasma leakage average on NL ratio is higher than plasma leakage average on platelets that occurs in children with DHF at RSUD Dr.Pirngadi Medan.

Assessment of Casual Relations, Direct and Indirect Effects of Latent Covariates On CD4 Cell Count Change Among HIV Positive Adults

Background: The use of structural equation modelling and latent variables remains unusual in epidemiology despite its potential usefulness and assessment of casual relations. Measuring direct and indirect effect of latent variables helps for proper intervention and for the ART program to be effective. The main objective of current investigation was to assess casual relations, direct and indirect effect of latent covariates on CD4 cell count change for HIV positive adults under HAART. Methods: Based on the repeated measures of CD4 cell count change data obtained in ART section at Felege Hiwot Teaching and Specialized hospital, AMOS software was employed parameter estimation. The data was conducted on 792 randomly selected HIV positive adults. The data was collected by the health staff for sake of delivering medication adherence. Results: CD4 cell count change was directly and indirectly affected by the latent variables. The powers of effects of observed variables with and without latent variables were a little bit different from each other. Hence, the power effect of observed variables with latent variables was lower as compared to without latent variables. The direct effect of latent variables on the response variable was a little bit greater than indirect effect. Conclusion: The power of effects of observed variables were stronger than their effects with latent variables. Hence, the latent variables had significant contributions for progress of CD4 cell count change. Health related education about the direct and indirect effect of latent variables should be given for patients under HAART.

Web-Based Physical Activity Intervention for COPD: Differences Between Rural and Urban Veterans

Physical activity is recommended for all patients with chronic obstructive pulmonary disease (COPD), a disease prevalent among older adults. Rural Veterans often lack access to in-person services to support behavior change. Technology can be used to overcome these barriers. This secondary analysis of a randomized controlled trial compared engagement (weekly website-logons) and efficacy (step-count change) measures of a 4-month technology-based physical activity intervention between rural and urban Veterans with COPD. Rural-urban commuting codes (RUCA) were used to classify participants (N=239; mean age=66.7±8.84 years) as ‘rural’ or ‘urban’. Participants were randomized 2:1 to a pedometer and website with iterative, individualized step-count feedback and goals, motivational and informational messages, and an online community (intervention group, n=155, 45.8% rural) or to receive a pedometer-alone (waitlist-control group, n=84, 44% rural). General linear modeling estimated the adjusted effect of rurality on intervention response. There was no significant rural-urban difference in weekly website-logons (3.33 vs. 3.17; p=.364). There was a significant interaction between rurality and group on step-count change (p=.045). Among rural participants, both intervention and controls increased their step counts (567.32 vs. 732.30; p=.769). Among urban participants, the intervention group demonstrated a significantly higher change in step-counts compared to controls (1052.67 vs. -313.57; p=.008). Results suggest that rural participants increased their step-counts similarly whether they received a pedometer alone or used the intervention, whereas only urban participants who used the intervention increased their step counts. It is possible that simply receiving the pedometer alone was sufficient for behavior change in the rural participants.

Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

Dynamic curve analysis of indicators related to lumbar cistern drainage for postoperative meningitis

Background Lumbar cisterna drainage (LCD) is widely used in neurosurgery as an effective treatment for postoperative meningitis, vasospasm of subarachnoid hemorrhage and ventricular system hemorrhage, and for reducing intracranial pressure in patients with severe craniocerebral trauma. The purpose of this work was two-fold: to analyze the dynamic curve of cerebrospinal fluid (CSF) related indices in cases of postoperative meningitis after selective craniotomy and to provide reference data for the clinical treatment with LCD. Methods We conducted a retrospective study of LCD placement in patients who underwent either supratentorial craniotomy (n=23) or subtentorial craniotomy (m=28). Primary outcomes measured included pre-intervention and post-intervention dynamic changes of body temperature, and CSF biochemical parameters (white blood cell (WBC) count, polykaryocyte percentage, protein, glucose and chloride) over the course of 13 days of catheter placement. We also assessed the bivariate correlation between WBC count changes, polykaryocyte percentage, body temperature and daily CSF drainage volume. Finally, we analyzed the effect of average daily drainage volume, antibiotic choice, and surgical site on the WBC count change curves. Results After LCD, a trend of increased WBC count was observed on the first day of drainage, followed by an overall decrease in WBC count. There was a statistically significant ( P<0.05 ) difference between the WBC count before drainage and the WBC count on the fourth day of drainage. Polykaryocyte percentage decreased initially and then increased progressively each day after drainage. There was a negative correlation between the change curve of the WBC count and the curve of daily drainage volume (r = -0.56). When the daily drainage volume was 250-300 ml/d, the change curve pattern of the WBC count was consistent with the overall trend of the WBC count, and there was no significant difference in the curve of the WBC count between different surgical sites ( P > 0.05 ). Conclusions LCD is an effective method for the treatment of postoperative meningitis. The WBC count can decrease significantly by the fourth day after drainage, and placement of the LCD for six to seven days is ideal. An average drainage volume of 250-300 ml/d is safe and effective.

Structural Equation Modeling to Detect Predictors of CD4 Cell Count Change due to Long Term Antiretroviral Therapy Administered to HIV-Positive Adults at Felege Hiwot Teaching and Specialized Hospital, Bahir Dar, Ethiopia

Background The relationship between predictors and the variable of interest was estimated using a structural equation model which is used to predict latent variables. The main advantage of the SEM is the ability to estimate the direct and indirect pathways of the effect of the primary independent variable on the outcome, given sufficient sample sizes. Despite not directly modeling the mediated pathways, GLMMs excluding mediating variables performed well with respect to power, bias and coverage probability in modeling the total effect of the primary independent variables on the outcome. In longitudinal studies, data are collected from subjects at several time points. The main purpose of longitudinal analysis is to detecting the trends or trajectories of the variables of interest. Methods A longitudinal study was conducted on 792 adults living with HIV/AIDS who commenced HAART. Structural equation modeling was used to construct a model to detecting predictors of CD4 cell count change. The procedure was illustrated by applying it to longitudinal health-related quality-of-life data on HIV/AIDS patients, collected from September 2008 to August 2012 monthly for the first six months and quarterly for remaining study period. Results The result of current investigation indicates that CD4 cell count change was highly influenced by certain socio-demographic and clinical variables. Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. Conclusions The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.

Socio-Demographic and Clinical Predictor Variables on CD4 Cell Count Change among HIV Positive adults; a Structural Equations Modelling

Background: The prevalence of HIV/AIDS among adult individuals has been increasing in Sub-Sahara African countries over the last decade. In Ethiopia , the prevalence of HIV among adults was 1%. Hence, 23, 000 people were newly infected with HIV and 11,000 people were died because of AIDS related illness in 2018. The purpose of this study was to identify the most significant socio-demographic, economic, individual and clinical determinants of CD4 cell count change in HIV positive adults who initiated HAART at Felege Hiwot Teaching and Specialized Hospital, North-West Ethiopia. Methods: A secondary and retrospective study design was conducted on 792 HIV positive adults. A structural equation modeling was employed to identify the socio-demographic and clinical covariates that have a statistically significant effect on the status of CD4 cell count change. Results: Literate patients, patients living with partner, patients living in urban area, patients disclosed the disease to family members, high income , ownership of cell, age and sex (male) were statistically significant variables. Conclusion: There was direct relation between socio-demographic variables with retention of HIV positive individuals in HAART program. There was also a direct and significant effect of clinical variables on adherence competence and adherence on CD4 cell change. Retention of patients in the HAART program had direct and significant effect on CD4 cell count change. This finding will be important for policy makers, health officials and for patients to easier access to healthcare service. Keywords: Socio-demographic, clinical factors, individual characteristics, Structural equation, CD4count change

Postoperative Monocyte Count Change Is a Better Predictor of Survival Than Preoperative Monocyte Count in Esophageal Squamous Cell Carcinoma

In esophageal squamous cell carcinoma, an elevated preoperative absolute monocyte count (Pre-AMC) is reported to be a predictor of survival, but the clinical application of postoperative absolute monocyte count change (AMCc) remains unknown. The present study was designed to investigate the prognostic value of AMCc in ESCC. 686 patients of ESCC after radical surgery without preoperative adjuvant therapy were enrolled. The Pre-AMC and AMCc were recorded within one week before the operation and one week after surgery. We considered the median of Pre-AMC as the optimal cut-off value to evaluate the relationship between Pre-AMC and patient survival. AMCc was defined as AMCc increased (higher than Pre-AMC) and AMCc decreased (lower than Pre-AMC). Demographic and clinical characteristics, disease-free survival (DFS), and overall survival (OS) were statistically analyzed. Multivariate analysis revealed that AMCc was a better independent prognostic factor for both OS (P = 0.002, HR = 0.614, 95% CI 0.450-0.837) and DFS (P = 0.023, HR = 0.656, 95% CI 0.456-0.943) than Pre-AMC which was only an independent prognostic factor for OS (P = 0.033, HR = 2.031, 95% CI 1.058-3.898). AMCc could be a better prognostic factor than Pre-AMC in patients with ESCC. AMCc decrease predicts worse OS and DFS in ESCC undergoing curative resection.

Kerusakan Dan Jumlah Hemosit Udang Windu (Penaeus monodon Fab.) Yang Mengalami Zoothamniosis

Tiger shrimp (Penaeus monodon Fab.) is one of the biggest non-oil and natural gas export fisheries commodity. In the other hand, the culture of this shrimp is highly affected by infectious pathogens and disease control is ciliated protozoa, Zoothamnium penaei that play an important role as ectocommensals on the body surface of tiger shrimp and causes “udang lumutan” disease. The aim of this research are to know the destruction and mean total haemocyte count of the Tiger shrimp between healthy and easy, middle and heavy infected degree of Zoothamnium penaei. The healthy and was identified infected Zoothamnium penaei of Tiger shrimp samples collected from one of the nursery pond in Lamongan that divided of 50 healthy indivisuals and infected Zoothamnium penaei (50 individuals for each infestation degree). Haemolymph (haemocytes) was obtained from the ventral part of the haemocoel of the second abdominal segment using 1 ml syringe filled with EDTA (Ethylene Diamine Tetra Acetic Acid). The variable observed were destruction of haemocyte and mean total haemocyte count during 7 days. ANOVA (Analysis Of Varian) was used for mean total haemocyte count change data analysis followed by Duncan’s Multiple Range Test with 5% significantly. The research results revealed that Tiger shrimp that easy, middle and heavy infected of Zoothamnium penaei no destruction occurs, but Tiger shrimp that heavy infected of Zoothamnium penaei occurs haemocyte sitoplasma destruction. The highest mean total haemocyte count change was 61,64x106 ± 3,56x106 cells ml-1 in Tiger shrimp that middle infected of Zoothamnium penaei, while the lowest mean total haemocyte count change was 41,04x106 ± 3,64x106 cells ml-1 occur in Tiger shrimp that heavy infected of Zoothamnium penaei.