Journal MKKI


Peranan Kadar Nitrit Oksida (NO) Darah Dan Asupan Lemak Pada Pasien Hipertensi Dan Tidak Hipertensi

Pudji Astutik1, Bambang Wirjatmadi2, Merryana Adriani2

ABSTRACT

Background : Hypertension is closely related to impaired endothelial dependent vasodilation due to decreasing availability of blood nitric oxide (NO) and high fat intake.
Objective : To analyze blood NO and fat intake differences in patients with hypertension and non hypertension.
Method : The study was a cross-sectional design and sampling was carried out in Sidoarjo District Hospital. Subjects of the study were 24 patients aged between 40 to 65 years, which consist of 12 cases and 12 controls. Measurement of blood NO and recall of fat intake were performed.
Result : Blood NO in hypertension and non hypertension patients were 72.333 + 40.511?M and 116.083 + 46.962 ?M respectively. Fat consumption in hypertension and non hypertension were 51.52 + 5.99 g and 41.65 + 8.32 g respectively. Two independent samples t-test showed meaningful differences in the levels of blood NO (p=0.023) as well as fat intake (p=0.004) between the hypertension and non hypertension patients.
Conclusion : There is a difference in the levels of blood NO and fat intake in patients with hypertension and non hypertension.
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Benefits Of Teaching Medical Students How To Communicate With Patients Having Serious Illness Comparison Of Two Approaches To Experiential, Skill-Based, And Self-reflective Learning

?Matthew S. Ellman, MD*, and Auguste H. Fortin VI, MD, MpH
Yale School of Medicine, New Haven, Connecticut
Innovative approaches are needed to teach medical students effective and compassionate communication with seriously ill patients. We describe two such educational experiences in the Yale Medical School curriculum for third-year medical students: 1) Communicating Difficult News Workshop and 2) Ward-Based End-of-life Care Assignment.
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Melanoma: Differences Between Asian And Caucasian Patients

Introduction
Cutaneous melanoma is the most common cause of mortality amongst skin cancer in Caucasian populations and incidence rates per 100,000 patient years vary between 21.9 in the United States to 55.9 in Australian males. In contrast, the incidence of melanoma in Asia is significantly lower with incidence rates of 0.2 to 0.5 per 100,000 patient years. In addition, the most common histological subtype in Asians is acral lentiginous melanoma (ALM) which accounts for approximately 50% of all cases, compared to Caucasians populations where it constitutes only 2% to 3% of all cases.

Singapore is a multi-ethnic country, located in equatorial Southeast Asia with a resident population of 3.8 million consisting of Chinese (77%), Malays (14%), Indians(8%) and 1% of other races, as well as a non-resident population of 1.2 million of various ethnicities. There have been few reports on the features of melanoma in Asia, particularly in Southeast Asia. Our current study aims to clarify the clinical presentation of cutaneous melanoma in Singapore and to evaluate if ethnic variations exist.
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Surgical Hand Antisepsis, A Pilot Study Comparing Povidone Iodine Hand Scrub And Alcohol-based Chlorhexidine Gluconate Hand Rub

Introduction
Surgical site infection (SSI) is a globally recognised problem that results in significant morbidity (delayed healing, wound breakdown, sepsis) and negative economic impact (prolonged hospital stays, revision surgery). Hand antisepsis remains a cornerstone of the overall aseptic technique in surgery, to eliminate transient micro-organisms and reduce resident skin flora.

Despite significant advances in glove manufacturing techniques and development in surgical instruments design, glove perforation rates have been reported to be as high as 17%, reiterating the importance of good hand antisepsis.

Traditional surgical hand antisepsis consists of an aqueous scrub with or without brush, using povidone iodine (PVP-I) or chlorhexidine-based detergents. Some institutions in Singapore have recently started using alcohol-based hand rub as an alternative to the traditional aqueous scrub, whilst continental Europe has used such alcohol-based hand rubs for more than 30 years.
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Two Strategies To Intensify Evidence-based Medicine Education Of Undergraduate Students: A Randomised Controlled Trial

Introduction
Knowledge and skills of evidence-based medicine (EBM) can be taught by many methods, such as role modeling evidence-based care, using evidence for clinical medicine instruction, and teaching specific EBM skills. Standalone courses and workshops away from the clinical environment are usually the traditional educational designs for teachers to convey knowledge or skills of evidence-based practice (EBP).

Previous systematic reviews have demonstrated the efficacy of integrated courses in teaching EBM and that these integrated strategies are superior to standalone teaching for postgraduates. Emphasis on incorporating EBM principles in undergraduate medical education has been stressed by many associations.

Most medical students usually have limited knowledge and skills in patient management. For medical students in the commencement of clinical training, principles of EBP can serve as the bridge between learning medical knowledge and clinical decision-making strategies. However, there is insufficient evidence supporting the efficacy of an undergraduate EBM curriculum.
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Antimicrobial Stewardship: The Next Big Thing?

Antimicrobial drug resistance is recognized as a global problem; as such, The World Health Organization dedicated World Health Day on April 7 2011 to highlight this pressing issue.1 It is widely accepted that there is a direct correlation between antibiotic use and the development of antimicrobial resistance.

Sadly, the pace of bacterial antimicrobial resistance development worldwide has surpassed the rate of newer antibiotic discovery to replace those rendered ineffective by resistance. Antimicrobial resistance is relevant to Singapore. In a surveillance study at 4 restructured hospitals in Singapore spanning 2006 to 2008, the prevalence of resistant Gram negative bacteria was high and the prescription volume of broad spectrum antibiotics was correspondingly high.

When studies also report that 25% to 68% of hospital antibiotic prescribing had been suboptimal, we as members of the medical community need to sit up and do better.
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Diagnosis Dan Penatalaksanaan Abses Citelli (Oleh:Linda Kodrat)

Latar belakang: Abses Citelli adalah komplikasi dari infeksi pada mastoid berupa abses subperiosteal yang menyebar melalui aspek medial mastoid ke dalam fosa digastrikus.

Tujuan: Karena komplikasi seperti ini sudah sangat jarang terjadi, kasus ini diajukan agar para ahli THT mengetahui dan dapat mengenali bila menjumpainya.

Kasus: Dilaporkan satu kasus, seorang laki-laki 23 tahun dengan keluhan nyeri di belakang telinga kanan, tepatnya pada bagian tengkuk kanan yang menetap dan tidak responsif terhadap pengobatan medikamentosa yang disertai paresis fasialis. Dari hasil pemeriksaan, kami mendiagnosis sebagai komplikasi ekstratemporal otitis media supuratif yang disebut sebagai abses Citelli.
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Treatment Of A 6-Year-Old Girl With Vesicoureteral Reflux

A 6-year-old girl was recently referred to your clinic for further evaluation and management of vesicoureteral reflux, which had first been discovered after she presented at 1 year of age with a temperature of 39.5°C and irritability. Culture of a urine specimen at that time showed more than 106 colony-forming units of pansensitive
Escherichia coli per milliliter, and she was treated with intravenous ampicillin for several days, followed by oral ampicillin, for a total of 14 days of therapy.

After the patient no longer had a fever and a urine culture was sterile, voiding cystourethrography was performed while the patient was still receiving ampicillin. The voiding cystourethrogram showed bilateral grade III vesicoureteral reflux, and renal ultrasonography revealed normal findings. Radionuclide renal scintiscanning was not performed.

Prophylactic trimethoprim–sulfamethoxazole was administered at bedtime each night, and during the ensuing year, the patient had no urinary tract infections, as judged by sterile surveillance cultures of urine specimens and sterile cultures when she had any febrile episodes. A follow-up radionuclide voiding cystourethrogram when the
patient was 2.5 years of age still showed bilateral grade III vesicoureteral reflux.
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Origins Of The E. Coli Strain Causing An Outbreak Of Hemolytic-Uremic Syndrome In Germany

In early May 2011, an outbreak of diarrhea with associated hemolytic–uremic syndrome began in northern Germany; cases have subsequently been reported in 15 other countries. As of July 22, a total of 3167 cases of non–hemolytic–uremic syndrome Shiga-toxin–producing Escherichia coli (16 deaths) and 908 cases of hemolytic–uremic syndrome (34 deaths) have been reported, according to the German Protection against Infection Act.

Several groups reported that the outbreak was caused by a Shiga-toxin–producing E. coli strain belonging to serotype O104:H4, with virulence features that are common to the enteroaggregative E. coli pathotype.1-3 This unusual E. coli serotype has previously been associated with sporadic cases of human disease4,5 but not with large-scale outbreaks.

E. coli are ordinarily commensal organisms, but six pathotypes of diarrheagenic E. coli are recognized, each with distinct phenotypic and genetic traits. Diarrhea associated with the hemolytic–uremic syndrome and neurologic complications is generally caused by E. coli that produce Shiga toxins. The majority of such strains, often referred to as enterohemorrhagic E. coli, contain the enterocyte effacement pathogenicity island, which facilitates colonization of the large intestine.
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Corporate Social Responsibility And Access To Policy Elites: An Analysis Of Tobacco Industry Documents

Abstract

Background: Recent attempts by large tobacco companies to represent themselves as socially responsible have been widely dismissed as image management. Existing research supports such claims by pointing to the failings and misleading nature of corporate social responsibility (CSR) initiatives. However, few studies have focused in depth on what tobacco companies hoped to achieve through CSR or reflected on the extent to which these ambitions have been realised.

Methods and Findings: Iterative searching relating to CSR strategies was undertaken of internal British American Tobacco (BAT) documents, released through litigation in the US. Relevant documents (764) were indexed and qualitatively analysed. In the past decade, BAT has actively developed a wide-ranging CSR programme. Company documents indicate that one of the key aims of this programme was to help the company secure access to policymakers and, thereby, increase the company’s chances of influencing policy decisions. Taking the UK as a case study, this paper demonstrates the way in which CSR can be used to renew and maintain dialogue with policymakers, even in ostensibly unreceptive political contexts. In practice, the impact of this political use of CSR is likely to be context specific; depending on factors such as policy elites' understanding of the credibility of companies as a reliable source of information.
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