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"Tujuan Menguji secara in vitro kemampuan kasa steril hidrofobik Cutimed® Sorbact® untuk mengikat mikroorganisme multiresisten penyebab luka, methicillin-resistant Staphylococcus aureus (MRSA) dan Pseudomonas aeruginosa. Metode Desain penelitian ini adalah potong lintang. Penelitian dilakukan di Departemen Mikrobiologi, Fakultas Kedokteran, Universitas Indonesia pada bulan Januari 2009. Pengujian kasa steril hidrofobik untuk mengikat mikroorganisme secara in-vitro dilakukan dengan cara menghitung jumlah MRSA dan Pseudomonas aeruginosa yang terikat pada 1 cm persegi selapis kasa steril hidrofobik Cutimed® Sorbact®. Setiap pengujian dilakukan secara triplo pada waktu paparan 0,5, 1, 5, 10, dan 30 menit serta 1, 2, 3, dan 4 jam. Untuk melihat kemampuan daya ikat kasa steril hidrofobik terhadap mikroorganisme uji, sebagai pembanding dilakukan juga uji daya ikat secara in vitro dari kasa steril konvensional terhadap mikroorganisme uji, pada waktu paparan 0,5 menit dan 2 jam. Hasil Kasa steril hidrofobik Cutimed® Sorbact® mempunyai kemampuan untuk mengikat MRSA dan Pseudomonas aeruginosa mulai dari waktu paparan 0,5 menit dan mencapai maksimal pengikatan pada paparan selama 2 jam. Dibandingkan dengan kasa steril konvensional, kasa steril hidrofobik Cutimed® Sorbact® mempunyai kemampuan yang lebih kuat untuk mengikat MRSA dan Pseudomonas aeruginosa. Kesimpulan Kasa steril hidrofobik Cutimed® Sorbact® mempunyai kemampuan mengikat MRSA dan Pseudomonas aeruginosa yang lebih baik daripada kasa steril konvensional.

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AbstractAim To do in vitro test to assess the efficacy of hydrophobic dressing Cutimed® Sorbact® to bind multiresistant bacteria that caused wound infection, the methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Method This was a cross sectional study that was conducted in the Department of Microbiology, Faculty of Medicine, University of Indonesia, on January 2009. In-vitro testing of sterile hydrophobic dressing to bind microorganisms was conducted by counting MRSA and Pseudomonas aeruginosa that were bound to 1 square centimetre of single layer sterile hydrophobic dressing (Cutimed® Sorbact®). Every test was done in triplicate at 0.5, 1, 5, 10, 30 minutes, 1, 2, 3, and 4 hours. To compare the hydrophobic dressing capability to bind microorganisms, in vitro testing of sterile conventional dressing to bind microorganisms on 0.5 minutes and 2 hours was done. Result The binding capacity of sterile hydrophobic dressing began at 0.5 minutes and teached a maximum at 2 hours. Compared with conventional dressing, sterile hydrophobic dressing had more binding capability to MRSA and Pseudomonas aeruginosa. Conclusion Hydrophobic dressing (Cutimed® Sorbact®) had a higher capability to bind MRSA and Pseudomonas aeruginosa compared to conventional dressing. "

"Pseudomonas aeruginosa infection on wounds, especially burn wounds can cause prolonged healing and may lead to sepsis. Framycetin, an aminoglycoside, can be impregnated into paraffin based-dressing used in wound management to prevent wound infection. Inhibitory potential of framycetin dressing against Pseudomonas aeruginosa needs to be evaluated in order to find out whether this dressing can prevent pseudomonas wound infection or not. This research aims to determine inhibitory potential of framycetin dressing against Pseudomonas aeruginosa compared to paraffin dressing. In vitro test was conducted by exposing suspension of Pseudomonas aeruginosa to framycetin dressing and paraffin dressing. The suspension was diluted in ten time serial dilution. Plating on agar plates was done in duplo at exposure time of 0, 30 minutes, 2, 4, 6, and 24 hours. Growth of colonies on medium was evaluated and colonies on plates that are 10-150 in number were counted. The test was done in triplicate. Inhibitory potential of dressing is defined as its ability to inhibit bacterial growth, indicated by lower colony number in dressing exposed groups compared to positive control. The result of this experiment showed that framycetin dressing exhibited inhibitory potential at exposure time of 4, 6, and 24 hours. Optimal inhibitory potential of framycetin dressing was exhibited after 4 hours of exposure, when the only decrease in colony number throughout the incubation occured. Paraffin dressing exhibited its potential at 4 and 24 hours. The colony number of framycetin dressing exposed suspension was signifficantly lower than that of paraffin dressing after exposure time of 4 and 6 hours. In conclusion, framycetin dressing has better inhibitory potential compared to paraffin dressing especially within 4 to 6 hours of exposure. This result implicates that framycetin dressing may have the ability to prevent Pseudomonas aeruginosa infection. "

"Penyembuhan luka merupakan sebuah proses transisi yang merupakan salah satu proses paling kompleks dalam fisiologi manusia yang melibatkan serangkaian reaksi dan interaksi kompleks antara sel dan mediator. Fase peradangan bertujuan untuk membuang jaringan mati dan mencegah infeksi. Fase proliferasi bercirikan terbentuknya jaringan granulasi yang disertai kekayaan jaringan pembuluh darah baru, fibroblast, dan makrofag dalam jaringan penyangga yang longgar. Fase kedua yang berlangsung sejak hari ke-8 hingga ke-21 pascaluka merupakan fase terjadinya epitelisasi dan sekaligus memberikan refleksi dalam perawatan luka untuk dapat mencapai kondisi luka yang telah tertutup dengan epitel.Fase terakhir adalah fase maturasi yang bercirikan keseimbangan antara proses pembentukan dan degradasi kolagen. Setidaknya terdapat 3 prasyarat kondisi lokal agar proses penyembuhan luka dapat berlangsung dengan normal, yaitu: 1) semua jaringan di area luka dan sekitarnya harus vital, 2) tidak terdapat benda asing, 3) tidak disertai kontaminasi eksesif atau infeksi. Penulis mengusulkan formulasi pola hirarkis dalam intensi penyembuhan luka yang mengikuti urutan intensi primer sebagai intensi ideal, diikuti intensi tersier, dan yang Vsekunder. Key words: inflammatory mediator, epithelialisation, growth factor, wound healing.

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Wound healing is a transition of processes which is also recognized as one of the most complex processes in human physiology. Complex series of reactions and interactions among cells and mediators take place in the healing process of wound involving cellular and molecular events. The inflammatory phase is naturally intended to remove devitalized tissue and prevent invasive infection. The proliferative phase is characterized by the formation of granulation tissue within the wound bed, composed of new capillary network, fibroblast, and macrophages in a loose arrangement of supporting structure. This second phase lasts from day 8 to 21 after the injury is also the phase for epithelialisation. The natural period of proliferative phase is a reflection for us in treating wound to reach the goal which ultimately defines as closed wound.

The final maturation phase is also characterized by the balancing between deposition of collagen and its degradation. There are at least three prerequisites which are ideal local conditions for the nature of wound to go on a normal process of healing i.e. 1) all tissue involved in the wound and surrounding should be vital, 2) no foreign bodies in the wound, and 3) free from excessive contamination/infection. The author formulated a step ladder of thinking in regards of healing intentions covering all acute and chronic wounds. Regarding the ?hierarchy? of healing intention, the first and ideal choice to heal wounds is by primary intention followed by tertiary intention and lastly the secondary intention."

"Pseudomonas aeruginosa adalah bakteri Gram negatif penyebab berbagai infeksi oportunistik dan nosokomial. Bakteri ini tidak peka terhadap berbagai golongan antibiotik sehingga menjadi kendala utama dalam penanganan infeksi. Penelitian ini bertujuan untuk mengevaluasi pola kepekaan Pseudomonas aeruginosa terhadap beberapa golongan antibiotik. Desain penelitian bersifat cross-sectional dengan analisis data sekunder dari isolat Pseudomonas aeruginosa yang terdapat di Laboratorium Mikrobiologi Klinik FKUI dari tahun pertengahan 2013-2019. Dari 396 sampel yang didapat, Pseudomonas aeruginosa mengalami perubahan tingkat kepekaan terhadap 37 antibiotik yang diiuji dari tahun ke tahun. Berdasarkan hasil evaluasi diatas, dapat disimpulkan bahwa tingkat kepekaan tertinggi terdapat pada antibiotik golongan polimiksin. Adapun tingkat kepekaan yang rendah terdapat pada antibiotik ampicillin, ampicillin/sulbactam, amoxicillin, amoxicillin/a.clavulanat, cefazolin, cefoxitin, cefuroxime, cefotiam, cefotaxime, cotrimoxazole, chloramphenicol, dan nitrofurantoin. Kedepannya, penelitian mengenai evaluasi pola kepekaan antibiotik perlu dilakukan secara kontinyu agar mendapatkan pola terapi yang sesuai.

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Pseudomonas aeruginosa is a Gram-negative bacterium that causes a variety of opportunistic and nosocomial infections. These bacteria are not sensitive to various classes of antibiotics so they become a major problem in infection management. This study aims to establish a pattern of Pseudomonas aeruginosa sensitivity to several antibiotic classes. The research design was cross-sectional with secondary data analysis of Pseudomonas aeruginosa isolates in the Clinical Microbiology Laboratory of the Faculty of Medicine UI from mid-2013-2019. Of the 396 samples obtained, Pseudomonas aeruginosa experienced changes in the level of sensitivity to 37 antibiotics tested from year to year. Based on the results of the evaluation above, it can be said that the highest level of sensitivity is in the polymyxin group antibiotics. The low level of sensitivity is found in the antibiotics ampicillin, ampicillin/sulbactam, amoxicillin, amoxicillin/clavulanic acid, cefazolin, cefoxitin, cefuroxime, cefotiam, cefotaxime, cotrimoxazole, chloramphenicol, and nitrofurantoin. In the future, research to evaluate the pattern of antibiotic sensitivity needs to be carried out continuously in order to obtain the appropriate therapy pattern."

"Pseudomonas aeruginosa merupakan salah satu jenis bakteri Gram negatif yang sering ditemukan pada peralatan medis yang terkontaminasi. P. aeruginosa menjadi penyebab beberapa infeksi nosokomial seperti penyakit otitis eksterna, dermatitis, folikulitis, selain itu dapat menyebabkan infeksi pada mata, luka bakar, saluran napas bagian bawah, saluran kemih, dan organ lainnya.  Pencegahan terhadap penyebaran P.  aeruginosa di lingkungan fasilitas kesehatan sangat dibutuhkan, salah satunya dengan memanfaatkan paparan ozon dan radiasi UV-C untuk mensterilkan alat kesehatan untuk mencegah penyebaran bakteri P. aeruginosa. Tujuan dari penelitian ini ialah untuk melihat efektivitas paparan ozon dan radiasi UV-C dengan variasi waktu 0, 15, 30, dan 45 menit terhadap bakteri P. aeruginosa. Penelitian lanjutan diberikan perlakuan terhadap alat medis yaitu thermo-gun dengan variasi waktu 0, 10, 15, dan 30 menit untuk melihat efektivitas dari metode sterilisasi yang digunakan. Selanjutnya dilakukan persentase pengurangan jumlah koloni dan uji statistik menggunakan ANOVA, Mann-Whitney, dan Kruskall-Wallis. Hasil penelitian menunjukan persentase pengurang koloni bakteri 100% setelah diberikan paparan UV-C dengan durasi 15 menit pada media padat. 96% koloni bakteri berkurang setelah diberikan paparan ozon dengan kapasitas 2000 mg/h selama 45 menit. Sedangkan pada uji lanjutan didapatkan pengurangan bakteri sebanyak 75% dan 74% pada paparan UV-C dan Ozon oleh karena itu kedua perlakuan tidak menunjukan perbedaan signifikan untuk mensterilisasi thermo-gun

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Pseudomonas aeruginosa is a type of Gram-negative bacteria that is often found in contaminated medical equipment and is not cleaned properly. P. aeruginosa is the cause of several infections such as externa otitis disease, dermatitis, folliculitis, in addition it can cause infections of the eyes, burns, urinary tract, and other organs. Prevention against the spread of P. aeruginosa in the hospital environment is needed, the study using plasma and radiated UV to sterilize medical devices is considered to prevent the spread of P. aeruginosa bacteria. The purpose of this study was to determine the effectiveness of exposure to ozone and UV-C radiation with time variations of 0, 15, 30, and 45 minutes against P. aeruginosa bacteria. Further research was given treatment of medical devices, namely thermo-guns with time variations of 0, 10, 15, and 30 minutes to see the effectiveness of the sterilization method used. Furthermore, the percentage reduction in the number of colonies and statistical tests using ANOVA, Mann-Whitney, and Kruskall-Wallis were carried out. The results showed that the percentage of bacterial colony reduction was 100% after being exposed to UV-C with a duration of 15 minutes on solid media. 96% of bacterial colonies were reduced after being exposed to ozone with a capacity of 2000 mg/h for 45 minutes. Meanwhile, in the follow-up test, it was found that there was a 75% and 74% reduction in bacteria on exposure to UV-C and Ozone. Therefore, the two treatments did not show a significant difference to sterilize the thermo-gun."

"Latar Belakang: Pembentukan jaringan parut terkait dengan fibroblast yang dihasilkan selama fase proliferasi dan salah satu strategi untuk menekan pembentukannya yang berlebihan adalah dengan menggunakan bahan perawatan luka. Penggunaan obat herbal saat ini diminati karena menghindari efek samping obat sintetik dan Hydnophytum formicarum berpotensi sebagai antioksidan dan anti inflamasi. Tujuan Penelitian: Menganalisis pengaruhekstrak Hydnophytum formicarum terhadap kerapatan kolagen, angiogenesis, panjang luka, dan reepitelisasi penyembuhan luka. Metode Penelitian: 24 ekor tikus Sprague Dawley dibagi dalam kelompok kontrol dan kelompok perlakuan. Luka dibuat menggunakan biopsy punch. Empat ekor tikus dari tiap kelompok di nekropsi pada hari ke 4, 7 dan 14. Analisa kerapatan kolagen, angiogenesis, panjang luka, dan reepitelisasi dilakukan menggunakan pemeriksaan hematoksilin eosin dan masson’s trichrome. Hasil: Terdapat perbedaan bermakna pada angiogenesis, panjang luka, reepiteliasasi antar kelompok. Angiogenesis pada kelompok perlakuan memiliki jumlah yang lebih sedikit namun lebih matur. Selain itu terdapat interaksi antara pengaplikasian ekstrak Hydnophytum formicarum dan hari nekropsi terhadap kerapatan kolagen dan tingkat reepitelisasi. Kesimpulan: Penggunaan ekstrak Hydnophytum formicarum mempengaruhi pembentukkan jaringan parut yang ditunjukkan kerapatan kolagen, angiogenesis, reepitelisasi, dan panjang luka pada fase granulasi. Tidak terdapat kelainan spesifik pada luka pada kelompok perlakuan. Inhibisi angiogenesis pada aplikasiHydnophytum formicarum berhubungan dengan pembentukan jaringan parut pada luka.

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Background: Formation of scar tissue associated with fibroblast and wound care material is used to suppress the formation of excessive scar tissue. Herbal medicine is currently popular because it avoids the side effects of synthetic drugs and Hydnophytum formicarum has antioxidant and anti-inflammation potential. Purpose: Analyzing the effects of Hydnophytum formicarum extract on collagen density, angiogenesis, wound length, reepithelialization in wound healing. Material and Method: 24 mice are divided in the control and treated group. Wounds were made using biopsy punch. Four rats from each group were necropsed on day 4, 7 and 14. Collagen density, angiogenesis, wound length, reepithelialization were then analyzed using hematoxylin eosin and masson’s trichrome staining. Results: There were significant differences in the results of the angiogenesis analysis, wound length, reepitheliasation between the groups. Angiogenesis in the treatment group had smaller number but more mature. There was interaction between the application of Hydnophytum formicarum extract and necropsy day on collagen density and reepithelialization rate. Conclusion: Hydnophytum formicarum extracts affected the formation of scar tissue as indicated by collagen density, angiogenesis, reepithelialization, wound length in granulation phases. Inhibition of angiogenesis in the application of Hydnophytum formicarum is related to the formation of scar tissue in the wound."

"Depresi pasien ulkus diabetikum dapat menurunkan respon imun dan inflamasi yang dibutuhkan pada proses penyembuhan luja. Penelitian kuasi eksperimen ini bertujuan untuk mengidentifikasi pengaruh pengelolaan depresi dengan pranayama terhadap perkembangan proses penyembuhan ulkus diabetikum di RS pemerintah Aceh. Hasil penelitian menunjukkan latihan pranayama dapat mempengaruhi perkembangan proses penyembuhan ulkus dan penurunan skor depresi, namun tidak ditemukan pengaruh pengelolaan depresi dengan pranayama terhadap perkembangan proses penyembuhan ulkus diabetikum.

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Depression on patient with diabetic ulcer impair immune and inflammation response that are needed in wound healing process. The urpose of this quasi experiment research was to identified the effect of pranayama on patient diabetic ulcer in Aceh government hospital. The result showed that pranayama has positive effect to wound healing progress and to decrease the depression score. But there was no effect of controlling depression by pranayama to wound healing progress."

"Tujuan penelitian ini adalah untuk menilai proses penyembuhan luka dengan menggunakan ekstrak metanol daun Jatropha multifida L. berdasarkan mekanisme penurunan jumlah leukosit PMN dan peningkatan jumlah sel fibroblas.Metode: bahan yang digunakan dalam penelitian ini adalah ekstrak metanol dari daun Jatropha multifida Subyek penelitian terdiri dari 36 ekor tikus putih jantan galur Spraque Dawlay umur 2 bulan dengan berat badan sekitar 150-200 g. Hewan coba dibagi menjadi 4 kelompok. Kelompok I (negatif kontrol merupakan kelompok hewan coba yang dilukai tanpa diobati; kelompok II (kontrol positif) merupakan kelompok hewan coba yang diobati dengan Bethasone-N; Kelompok III (kontrol pelarut) merupakan kelompok yang diobati dengan alkohol 70% sedangkan kelompok IV (kelompok perlakuan) merupakan kelompok yang diobati dengan meneteskan 10 mg ekstrak metanol daun Jatropha multifida. Setiap kelompok terdiri dari 3 ekor tikus yang masing-masing dibagi lagi menjadi kelompok waktu dekapitasi pada hari ke 3, 6, dan 13. Pada jaringan luka dibuat sediaan histologi dengan pewarnaan HE dan dilanjutkan dengan menghitung jumlah leukosit PMN dan fibroblas.Pada penelitian ini memperlihatkan bahwa penurunan jumlah leukosit PMN pada kelompok perlakuan dengan ekstrak metanol daun Jatropha multifida relatif lebih baik dibandingkan dengan kontrol negatif, kontrol positif dan kontrol pelarut. Peningkatan jumlah fibroblas terjadi pada hari ke 6 dan 13 setelah perlakuan. Simpulan: ekstrak metanol daun Jatropha multifida dapat mengobati luka sayat lebih baik dibandingkan dengan kontrol negatif, kontrol positif dan kontrol pelarut.

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Objective: The aim of this study was to evaluate the effects of methanol extract of Jatropha multifida leaves on the wound healing process and to investigate the wound healing activity based on reduced numbers of PMN (polymorpho nuclear) leukocytes and increased numbers of fibroblasts.Method: methanol extract of dried leaves of Jatropha multifida was used in the wound healing activity studies. The study subjects were 36 white male Sprague Dawlay rats aged 2 months with 150-200 gram body weight. The subjects were divided into 4 groups and experimentally injured: Group I (negative control) underwent injury without subsequent treatment; group II (positive control) received topical treatment with Bethasone-N after injury; group III (solvent control) was treated with 70% methanol; group IV (treatment group) was treated with 10 mg methanol extract of Jatropha multifida Each group consisted of 3 rats, which were decapitated on days 3, 6, and 13 after the start of treatment. Histological preparation was stained with hematoxyline-eosin (HE) and was continuously examined by counting the numbers of PMN leukocytes and fibroblasts as indicators of wound healing on days 3, 6, and 13 of treatment.The study showed lower numbers of PMN leukocytes in subjects treated with the extract of Jatropha multifidaas compared to the other groups. The numbers of fibroblasts were significantly higher on days 6 and 13 of treatment. In conclusion, the treatment of injuries with methanol extract of leaves from Jatropha multifida provided better results compared to the other groups in our study."

"Telah dilakukan uji pemanfaatan getah pisang ambon (Musa paradisiaca var sapientum Lamb) dalam penyembuhan luka bakar pada kulit tikus putih (Rattus novergicus). Penyembuhan luka bakar dievaluasi dengan menghitung jumlah leukosit PMN dan jumlah fibroblas pada hari ke 7, 14, dan 21 setelah perlakuan. Hasil penelitian menunjukkan bahwa penurunan jumlah leukosit PMN pada subjek yang diobati dengan getah pisang ambon relatif lebih signifikan dibandingkan dengan kontrol negatif dan positif (Bioplacenton ®). Sebaliknya, peningkatan jumlah fibroblas secara signifikan ditunjukkan pada hari ke-14 dan ke-21 setelah perawatan. Kesimpulannya, pengobatan dengan getah pisang Ambon pada luka bakar memberikan hasil yang lebih baik dibandingkan dengan kedua kontrol positif dan negatif.

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A study of ambonese plantain banana (Musa paradisiaca var sapientum Lamb) treatment in burn wound healing on the skin of white rats (Rattus novergicus) has been conducted. The wound healing of burn injuries was evaluated by counting the number of PMN leukocytes and fibroblasts at the 7th, 14th, and 21st days following the treatment. The study showed that the decrease in number of PMN leukocytes of subjects treated with ambonese plantain banana was relatively more significant compared to both negative and positive control (Bioplacenton®). In contrast, an increasing number of fibroblasts was significantly demonstrated at the 14th and 21st days after treatment. In conclusion, ambonese plantain banana treatment in burn injuries will provide bett er results compared to both positive and negative controls."

"Kenyamanan merupakan salah satu aspek penting dalam perawatan luka diabetes mellitus (DM). Penelitian ini bertujuan menganalisis ekspresi transforming growth factor beta 1 (TGF â1) dan kadar kortisol pada perawatan luka teknik modern dan konvensional pada luka DM dikaitkan dengan aspek kenyamanan. Penelitian menggunakan true experimental design dengan metode pengumpulan sampel secara stratified random sampling. Pengukuran ekspresi TGF â1 dan kadar kortisol dilakukan pada hari ke 0 (pretest) dan 4 (posttest). Sampel yang diambil berasal dari pasien luka kaki DM di Rumah Sakit Saiful Anwar Malang. Ekspresi TGF â1 diukur dengan metode imunohistokimia, sedangkan pengukuran kadar kortisol dilakukan dengan metode ELISA di laboratorium Fisiologi dan Histologi FK Universitas Brawijaya Malang. Hasil penelitian menunjukkan bahwa pada kelompok modern terjadi peningkatan ekspresi TGF â1, sedangkan pada kelompok konvensional terjadi penurunan ekspresi TGF â1. Kadar kortisol pada kelompok modern menunjukkan penurunan lebih besar dibandingkan kelompok konvensional. Hasil uji t menunjukkan ada perbedaan yang signifikan antara perawatan luka teknik modern dan konvensional terhadap ekspresi TGF â1 dan kadar kortisol pada luka DM (p value < 0,05). Hasil uji korelasi Pearson menunjukkan hubungan yang signifikan antara perubahan ekspresi TGF â 1 dengan perubahan kadar kortisol (p = 0,028). Dapat disimpulkan bahwa teknik perawatan luka secara modern mampu meningkatkan ekspresi TGF â1 dan menurunkan kadar kortisol dibandingkan teknik konvensional.

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Comfort is one among several aspects that should be considered in the treatment of diabetic wounds. This study aimed to analyze the expression of TGF β1 and the level of cortisol in modern and conventional wound care techniques of diabetic wounds. TGF β1 expression and cortisol levels were measured on day 0 (pretest) and 4 (posttest). Samples were taken from patients with diabetic ulcer in the Saiful Anwar District Hospital at Malang. The expression of TGF β1 was measured by immunohistochemical methods in the Department of Physiology, Brawijaya University Faculty of Medicine. Cortisol level was measured with ELISA method. The results obtained from the modern group were increased TGF β1 expression and decreased cortisol level. The conventional group yielded decreased TGF β1 expression and decreased cortisol level. The cortisol level decrease was greater in the modern group. T test results showed no significant differences of modern wound care techniques and conventional on the expression of TGF β1 and cortisol levels in diabetic wounds (p value < 0,05). Pearson correlation test results showed a significant relationship between changes in cortisol levels with changes in expression of TGF β1 (p = 0,028). It can be concluded that the techniques of modern wound care is more able to increase the expression of TGF β1 and to decrease the cortisol levels compared with conventional techniques."