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"[ABSTRAKPendahuluan: Tatalaksana osteomielitis dengan debridement, guttering, pemberian antibiotika sistemik sering tidak mencapai hasil yang memuaskan dikarenakan antibiotik tidak dapat mencapai lokasi infeksi dengan baik. Cara lain dengan pemberian antibiotik lokal untuk mencapai lokasi infeksi dalam bentuk beads dinilai tidak efektif karena memerlukan 2 kali operasi. Kombinasi antibiotik lokal dengan scaffolding berupa hidroxyapatite (HA) porous yang dapat diserap dan pembawa antibiotik belum pernah diteliti.Metode penelitian: Dilakukan uji pre test post test kelompok kontrol pada model kelinci osteomielitis. Sepuluh ekor kelinci New Zealand digunakan dengan berat 2.500-3500 gr yang dibagi kedalam 2 kelompok yaitu kelompok kontrol dan kelompok perlakuan (n=5). Dilakukan penyuntikan bakteripada tulang tibia kelinci, setelah terbentuk model osteomielitis kemudian dilakukan perlakuan. Untuk kelompok kontrol dilakukan debridement dan diberikan injeksi antibiotik ceftriaxon selama 4 minggu dan kelompok perlakuan dilakukan debridement, diberikan kombinasi HA dan Gentamisin serta injeksi antibiotik ceftriaxon selama 4 minggu. Setelahnya dilakukan penilaian klinis, x- ray, kultur dan histopatologis.Temuan dan Diskusi: Secara radiologis ditemukan perbaikan skor penebalan kortek tibia pada kelompok perlakuan dibanding kelompok kontrol (p=0.48), begitu juga pada Histopatological osteomyelitis evaluation score (p=0,009). Secara klinis terdapat perbaikan skor pembengkakan pada semua (n=5) kelompok perlakuan dibanding dengan kelompok kontrol, namun secara statistik tidak bermakna (p=0,053). Sementara pada penilaian kultur tidak ditemukan perbedaan bermakna antar kedua kelompok (p=1,00)Kesimpulan: Kombinasi Hydroxyapaptite porous dan gentamisin sebagai antibiotik lokal pada pengobatan model osteomielitis tibia kelinci memberikan perbaikan skor radiologis, histopatologis dan perbaikan klinis dibanding dengan prosedur standar pengobatan oseomielitis kronis yang sudah ada.

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ABSTRACTIntroduction. Treatment of osteomyelitis with debridement, guttering, systemic antibiotics often do not achieve satisfactory results due to the antibiotic can not reach the infection site. Another way of local antibiotic delivery to reach the site of infection in the form of beads is considered ineffective because it requires two separate surgeries. Local antibiotic combined with scaffold in the form of porous hidroxyapatite that can be absorbed and antibiotics cariere have not been studied.Methods. We conducted pretest and posttest control group in a rabbit model of osteomyelitis. Ten rabbits divided in control group and the treatment group (n=5). We injected Staphylococcus aureus in the rabbit tibia, forming the osteomyelitis model, and then performed treatment for osteomyelitis. In the control group, we performed debridement and gave ceftriaxone injection for 4 weeks. Whereas in the treatment group, we add the combination of porous hidroxyapatite and Gentamicin. Afterwards, we did clinical assessment, x-ray, culture, and histopathology.Results and discussion. Radiologically, tibia cortical thickening scores improved in the treatment group compared to the control group (p=0.48) as well as histopatological osteomyelitis evaluation score (p=0,009). Clinically, there were improvements in the swelling scores (n=5) of the treatment group compared to control group, but no significant statistically (p=0.053). In culture, there were no significant difference between the two groups (p=1.00).Conclusion. Combination of porous hydroxyapaptite and gentamycin as a local treatment of osteomyelitis of the rabbit tibial osteomyelitis models improved radiological and histopathological scores and also clinically compared to existing standard treatment procedures for chronic osteomyelitis., Introduction. Treatment of osteomyelitis with debridement, guttering, systemic antibiotics often do not achieve satisfactory results due to the antibiotic can not reach the infection site. Another way of local antibiotic delivery to reach the site of infection in the form of beads is considered ineffective because it requires two separate surgeries. Local antibiotic combined with scaffold in the form of porous hidroxyapatite that can be absorbed and antibiotics cariere have not been studied.Methods. We conducted pretest and posttest control group in a rabbit model of osteomyelitis. Ten rabbits divided in control group and the treatment group (n=5). We injected Staphylococcus aureus in the rabbit tibia, forming the osteomyelitis model, and then performed treatment for osteomyelitis. In the control group, we performed debridement and gave ceftriaxone injection for 4 weeks. Whereas in the treatment group, we add the combination of porous hidroxyapatite and Gentamicin. Afterwards, we did clinical assessment, x-ray, culture, and histopathology.Results and discussion. Radiologically, tibia cortical thickening scores improved in the treatment group compared to the control group (p=0.48) as well as histopatological osteomyelitis evaluation score (p=0,009). Clinically, there were improvements in the swelling scores (n=5) of the treatment group compared to control group, but no significant statistically (p=0.053). In culture, there were no significant difference between the two groups (p=1.00).Conclusion. Combination of porous hydroxyapaptite and gentamycin as a local treatment of osteomyelitis of the rabbit tibial osteomyelitis models improved radiological and histopathological scores and also clinically compared to existing standard treatment procedures for chronic osteomyelitis.]"

"Penelitian ini bertujuan untuk mengamati efek implantasi scaffold Injeksi Hidroksiapatit Kitosan IHAK pada regenerasi defek tulang femur kelinci melalui gambaran histologis. Penelitian ini menggunakan kelinci New Zealand dewasa yang dibagi menjadi dua kelompok yaitu kelompok perlakuan dan kontrol, kemudian dibuat defek pada area kondil tulang femur. Defek pada kelompok perlakuan menerima implantasi scaffold IHAK dan kelompok kontrol tidak menerima apapun. Kelinci dikorbankan pada minggu ke-4 lalu dilakukan pengamatan histologis menggunakan skoring Salkeld yang telah dimodifikasi. Didapatkan hasil berupa skor histologis kelompok perlakuan adalah 4 yang menandakan tulang sudah termineralisasi dan penyatuan tulang yang sempurna. Sementara itu, skor kelompok kontrol adalah 2 yang menandakan tulang masih berbentuk kalus dengan gambaran sel kondrosit dan fibroblas. Oleh karena itu, Scaffold IHAK efektif dalam mempercepat regenerasi defek tulang femur kelinci.

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This study aimed to evaluate the effect of Injectable Hydroxyapatite Chitosan IHAC Scaffold on rabbit femoral defect regeneration by assessing its histological view. In this study, we used two adult New Zealand rabbit that divided into two groups, treated group and control group. Defect was made in femoral bone of each rabbit. The defect of treated rabbit received implantation of IHAC scaffold, while the defect of control group was left empty. Rabbit was sacrificed in the after four weeks and evaluated histologically using Modified Salkeld Histological Scoring. The results showed score for treated group was 4 which indicated mineralization and complete union of bone defect. While score for control group was 2 which indicated bone defect was still in callus stage with presence of chondrocyte and fibroblast. Therefore, Injectable Hydroxyapatite Chitosan IHAC scaffold was effective for regeneration of rabbit femoral bone defect."

"ABSTRAKKarbonat hidroksiapatit merupakan suatu jenis biomaterial yang memiliki kompatibilitas tinggi dengan tulang manusia. Tujuan penelitian ini adalah untuk mempelajari pengaruh suhu dan waktu sintering untuk mendapatkan karbonat hidroksiapatit yang disintesis dengan metode hidrotermal menggunakan CaCO3 sebagai salah satu komponen. Sampel hasil sintesis dikarakterisasi dengan Fourier-transform infrared spectroscopy, x-ray diffraction, dan scanning electron microscope. Hasil FTIR menunjukkan bahwa kandungan gugus CO3 pada sampel yang dihasilkan sebanding dengan kuantitas CaCO3 yang digunakan dalam sintesis. Hasil XRD menunjukkan bahwa kandungan karbonat apatit meningkat dan kandungan kalsit menurun dengan meningkatnya suhu dan waktu sintering. Kalsit tidak terlihat pada suhu sintering 900 ̊C dan waktu sintering 2 jam.

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ABSTRACTCarbonated hydroxyapatite is a biomaterial with high biocompatibility with human bone, moreso than regular hydroxyapatite, making it an acceptable synthetic bone graft material. The purpose of this research is to study the effect of sintering temperature and time on carbonated hydroxyapatite samples synthesized using the hydrothermal method with CaCO3 as one of its components. The samples are then characterized using Fourier-transform infrared spectroscopy, x-ray diffraction, and a scanning electron microscope. IR spectra show that the CO3 content in each sample is proportional to the amount of CaCO3 used in the synthesis of said samples. Diffraction patterns from XRD show an increase in apatite content and a decrease in calcite content as sintering temperature and time increases, with temperature increases having a stronger effect on the samples than time increases. Calcite disappears completely after sintering at 900 ̊C for 2 hours."

"ABSTRAKLatar Belakang:. Scaffold komposit kitosan-hidroksiapatit-kolagen yang berasal dari cangkang kepiting serta tulang dan tendon sapi berpotensi sebagai material rekonstruksi maksilofasial yang perlu di uji Tujuan: Mengevaluasi potensi scaffold komposit kitosan-hidroksiapatit-kolagen yang ditinjau dari perubahan morfologi permukaan dan komposisinya. Metode: Spesimen scaffold direndam di dalam simulated body fluid SBF dengan suhu 37 C dalam periode 2, 4, 6, dan 8 hari. Morfologi permukaan dan komposisi scaffold dievaluasi dengan menggunakan Scanning Electron Microscope SEM dan Energy Dispersive Spectroscopy EDS . Hasil: Setelah 8 hari perendaman, terlihat partikel globular dengan diameter berkisar antara 947,6 nm 20 ?m yang membentuk lapisan pada scaffold. Porus yang terbentuk oleh partikel tersebut berdiameter 100 ?m. Persentase kalsium dan fosfor meningkat dan rasio Ca/P yang tinggi 3,82 pada scaffold yang telah direndam mengindikasikan terbentuknya lapisan hidroksiapatit. Kesimpulan: Scaffold komposit kitosan-hidroksiapatit-kolagen berpotensi sebagai material rekonstruksi maksilofasial.

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"[ABSTRAKPendahuluan: Sel punca mesenkimal (SPM) sebagai salah satu alternatif terapi kasus sulit dapat diperoleh dari jaringan adiposa. Kemampuan SPM dalam rekayasa jaringan membutuhkan prosedur implantasi SPM yang aman dan bebas kontaminasi. Tindakan minimal invasive pada kasus cedera medulla spinalis dengan terapi implantasi SPM dapat menyebabkan sel tersebut terpajan radiasi sinar-x c-arm. Viabilitas dan waktu penggandaan populasi (WPP) merupakan salah satu komponen utama keberhasilan prosedur implantasi tersebut. Penelitian ini bertujuan mengetahui efek pajanan sinar-x c-arm terhadap viabilitas dan WPP SPM.Metode: Penelitian ini adalah penelitian eksperimental SPM jaringan adiposa pasca cryopreservation. Sel punca pasca thaw dan propagasi kemudian dilakukan pajanan radiasi sinar-x dengan c-arm. Sel punca kemudian di kultur untuk menilai viabilitas dan waktu penggandaan populasi. Uji Generalized Linear Model untuk menilai perbedaan viabilitas antara besar dosis radiasi. Uji Spearman menilai korelasi perbedaan viabilitas kelompok pasca-radiasi, dan pasca radiasi dan kultur. Uji Kruskall-Wallis menilai WPP kelompok pasca-radiasi antara masing-masing besar dosis. Uji Wilcoxon menilai WPP antara kelompok pre-radiasi dengan kelompok pasca-radiasi.Hasil: Waktu konfluensi kultur sel pasca radiasi rata-rata 4.33 hari. Rerata perbedaan viabilitas antara besar dosis radiasi tidak terdapat perbedaan yang bermakna secara statistik (p>0.05). Didapatkan korelasi positif viabilitas pasca radiasi dengan besar dosis radiasi namun tidak bermakna secara statistik (p>0.05) namun didapatkan korelasi negatif viabilitas pasca radiasi dan kultur dengan besar dosis radiasi dan bermakna secara statistik. Tidak didapatkan perbedaan bermakna median WPP antara kelompok pre-radiasi dan pasca-radiasi (p>0.05) dan perbedaan WPP diantara kelompok pasca radiasi (p>0.05).Kesimpulan: Tidak terdapat perbedaan secara statistic viabilitas dan WPP SPM jaringan adiposa pasca pajanan radiasi sinar-x c-arm sampai sampai dosis radiasi 32.34 mSv.

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ABSTRACTIntroduction. The use of adipose tissue derived mesenchymal stem cells (MSCs)in tissue engineering require implantation procedure that is safe and free of contamination. Minimally invasive procedure in the case of spinal cord injury using a c-arm device for MSC implantation causes x-ray exposure to the implanted cells. Viability and population doubling time (PDT) is a major component of the success of the implantation procedure. This study aims to determine the effect of c-arm x-ray exposure on MSC viability and PDT.Methods. This was an experimental study that used cryopreserved adipose tissue derived MSCs. Cells were thawed, propagated, and exposed to varying doses of c-arm x-ray radiation. Stem cell viability was measured, and then the cells were cultured to assess their PDT. Generalized linear models test was used to compare cell viability between post-thaw, post-propagation, post-radiation, post-culture post-radiation, and control and between radiation dose groups. Kruskal-Wallis test assessed PDT between various radiation doses in post-radiation groups. Wilcoxon test assessed PDT between pre-radiation and post-radiation groups.Results. Mean confluence period of adipose MSCs post radiation was 4.33 days. There was no statistically significant difference in MSC mean viability after exposure to x-ray radiation between each group and control (p>0.05). There was no significant positive correlation between post radiation viability and radiation dose (p > 0.05), however, there was significant negative correlation between post radiation post culture viability and radiation dose. There were no significant differences in PDT between pre- and post-culture post radiation groups and between various radiation doses in post-radiation groups (p>0.05).Conclusion. No statistical differences in MSC viability and PDT after x-ray radiation exposure of c-arm up to 32.34 mSv;Introduction. The use of adipose tissue derived mesenchymal stem cells (MSCs)in tissue engineering require implantation procedure that is safe and free of contamination. Minimally invasive procedure in the case of spinal cord injury using a c-arm device for MSC implantation causes x-ray exposure to the implanted cells. Viability and population doubling time (PDT) is a major component of the success of the implantation procedure. This study aims to determine the effect of c-arm x-ray exposure on MSC viability and PDT.Methods. This was an experimental study that used cryopreserved adipose tissue derived MSCs. Cells were thawed, propagated, and exposed to varying doses of c-arm x-ray radiation. Stem cell viability was measured, and then the cells were cultured to assess their PDT. Generalized linear models test was used to compare cell viability between post-thaw, post-propagation, post-radiation, post-culture post-radiation, and control and between radiation dose groups. Kruskal-Wallis test assessed PDT between various radiation doses in post-radiation groups. Wilcoxon test assessed PDT between pre-radiation and post-radiation groups.Results. Mean confluence period of adipose MSCs post radiation was 4.33 days. There was no statistically significant difference in MSC mean viability after exposure to x-ray radiation between each group and control (p>0.05). There was no significant positive correlation between post radiation viability and radiation dose (p > 0.05), however, there was significant negative correlation between post radiation post culture viability and radiation dose. There were no significant differences in PDT between pre- and post-culture post radiation groups and between various radiation doses in post-radiation groups (p>0.05).Conclusion. No statistical differences in MSC viability and PDT after x-ray radiation exposure of c-arm up to 32.34 mSv, Introduction. The use of adipose tissue derived mesenchymal stem cells (MSCs)in tissue engineering require implantation procedure that is safe and free of contamination. Minimally invasive procedure in the case of spinal cord injury using a c-arm device for MSC implantation causes x-ray exposure to the implanted cells. Viability and population doubling time (PDT) is a major component of the success of the implantation procedure. This study aims to determine the effect of c-arm x-ray exposure on MSC viability and PDT.Methods. This was an experimental study that used cryopreserved adipose tissue derived MSCs. Cells were thawed, propagated, and exposed to varying doses of c-arm x-ray radiation. Stem cell viability was measured, and then the cells were cultured to assess their PDT. Generalized linear models test was used to compare cell viability between post-thaw, post-propagation, post-radiation, post-culture post-radiation, and control and between radiation dose groups. Kruskal-Wallis test assessed PDT between various radiation doses in post-radiation groups. Wilcoxon test assessed PDT between pre-radiation and post-radiation groups.Results. Mean confluence period of adipose MSCs post radiation was 4.33 days. There was no statistically significant difference in MSC mean viability after exposure to x-ray radiation between each group and control (p>0.05). There was no significant positive correlation between post radiation viability and radiation dose (p > 0.05), however, there was significant negative correlation between post radiation post culture viability and radiation dose. There were no significant differences in PDT between pre- and post-culture post radiation groups and between various radiation doses in post-radiation groups (p>0.05).Conclusion. No statistical differences in MSC viability and PDT after x-ray radiation exposure of c-arm up to 32.34 mSv]"

"Osteomielitis merupakan infeksi pada tulang, sumsum tulang dan jaringan sekitar yang terjadi karena masuknya mikroorganisme dengan tanda yang khas yaitu nyeri. Pembedahan merupakan salah satu pilihan penatalaksanaan pada osteomielitis dengan nyeri sebagai keluhan utama yang sering dilaporkan. Nyeri yang dialami pada klien dengan osteomielitis setelah pembedahan menjadi semakin berat ketika dilakukan perawatan luka. Asuhan keperawatan manajemen nyeri diterapkan pada Tn. MI berusia 25 tahun dengan latar belakang etnis Betawi yang menjalani debridement dan remove implant dengan riwayat operasi open reduction internal fixation ORIF femur dan tibia dekstra tujuh tahun lalu. Manajemen nyeri yang diterapkan yaitu dengan mendengarkan musik selama perawatan luka. Evaluasi dilakukan dengan menggunakan visual analogue scale VAS dan monitor tanda nonverbal nyeri. Evaluasi hasil pada hari pertama setelah debridement pada saat dilakukan perawatan luka yaitu VAS 8 dengan wajah ekspresi merintih disertai menggerakkan kaki kiri. Nyeri yang dirasakan TN. MI berkurang secara progresif selama perawatan luka dengan nilai VAS 3 dan ekspresi wajah tenang pada hari keenam setelah operasi. Penulis merekomendasikan terapi musik sebagai pilihan manajemen nyeri nonfarmakologi dengan kolaborasi pemberian analgetik sebelum perawatan luka sehingga tujuan manajemen nyeri dapat tercapai optimal.

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Osteomyelitis is an infection of bone, bone marrow and surrounding tissues that occur due to the entry of microorganisms with pain as spesific sign. Surgery is one of the management options in osteomyelitis with pain as the main complaint that often reported. Pain experienced by clients with osteomyelitis after surgery becomes more severe during wound care. Nursing care of pain management applied to Mr. MI , 25 years old with Betawi ethnic background undergoing debridement and remove implants with a history of open reduction internal internal fixation ORIF surgery of the femur and tibia dekstra seven years ago.

Pain management is applied by listening music during wound care. The evaluation was performed using visual analogue scale VAS and nonverbal pain monitor. Evaluation of the results on the first day after debridement during wound care that showed VAS value 8 with a face moaning expression and wiggle his left foot. Music therapy was effective on reducing pain especially during wound care. The pain felt by TN. MI progressively decreased during wound care with VAS value 3 and calm facial expression on the sixth day after surgery. Recommendation music therapy as nonpharmacological pain management option with collaboratve analgesic treatment before wound care will provide optimal results for pain management goal. "

"Latar Belakang: Osteomielitis merupakan proses inflamasi yang disebabkan oleh organisme piogenik, salah satunya bakteri. Bakteri yang paling umum ditemukan sebagai penyebab osteomielitis adalah bakteri Staphylococcus aureus. Tatalaksana osteomielitis dilakukan dengan penggabungan antara tindakan bedah dan penggunaan antibiotik. Saat ini, mulai dikembangkan penggunaan antibiotik secara lokal karena adanya keterbatasan apabila diberikan secara sistemik. Bone graft digunakan sebagai material pembawa antibiotik dan menjadi alternatif dari penggunaan PMMA (Polymethylmethacrylate). Pembuatan biphasic kalsium sulfat dan kalsium fosfat bertujuan untuk mengatasi kekurangan masing-masing fasa. Tujuan: Mengetahui daya hambat antibakteri material gipsum-monetite pembawa gentamisin terhadap bakteri Staphylococcus aureus (ATCC 25923). Metode: Kemampuan daya hambat antibakteri diuji menggunakan metode Kirby-Bauer yaitu dengan menghitung zona inhibisi yang terbentuk di sekitar pelet. Terdapat 4 kelompok komposisi pelet biphasic gipsum-monetite yang digunakan, yaitu 100:0, 90:10, 80:20, dan 60:40. Pelet direndam dalam larutan gentamisin dan dilakukan pengujian pada media agar Mueller-Hinton. Zona inhibisi diukur setelah waktu inkubasi selama 24 dan 48 jam, serta penurunan zona antara kedua waktu tersebut. Selanjutnya, hasil tersebut akan diuji menggunakan uji statistik One-Way ANOVA dan T-Test Dependen. Hasil: Terbentuk zona inhibisi di sekitar pelet biphasic gipsum-monetite untuk seluruh kelompok. Berdasarkan hasil uji One Way ANOVA didapatkan adanya perbedaan yang tidak bermakna antar setiap kelompok komposisi terhadap zona inhibisi yang terbentuk setelah inkubasi 24 dan 48 jam. Sedangkan, berdasarkan hasil uji T-Test Dependen didapatkan adanya perbedaan yang bermakna antara zona inhibisi 24 dan 48 jam pada setiap kelompok. Kesimpulan: Pelet biphasic gipsum-monetite dapat digunakan sebagai material pembawa antibiotik dan tidak terdapat pengaruh antara komposisi gipsum dan monetite terhadap daya hambat antibakteri. Zona inhibisi yang terbentuk mengalami penurunan seiring bertambahnya waktu inkubasi

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Background: Osteomyelitis is an inflammatory process caused by pyogenic organism, such as bacteria. The most common bacteria found as a cause of osteomyelitis is Staphylococcus aureus. The management of osteomyelitis is carried out by combining surgery and the use of antibiotics. Antibiotic is currently being developed for localised uses due to limitations when administered systemically. Bone graft is used as a carrier for antibiotics and as an alternative to PMMA (Polymethylmethacrylate). Preparation of biphasic calcium sulfate and calcium phosphate is used to overcome the deficiency of each phase. Objectives: Determine the antibacterial inhibition of gentamicin-carrying gypsum-monetite material against Staphylococcus aureus (ATCC 25923). Methods: The capability of antibacterial inhibition was tested using the Kirby-Bauer method by calculating the inhibition zones formed around the pellets. There were 4 groups of biphasic gypsum-monetite pellet used, 100:0, 90:10, 80:20 and 60:40 respectively. The pellets were soaked in gentamicin solution and tested on Mueller-Hinton agar media. The zone of inhibition was measured after 24 and 48 hours of incubation, including the decrease in the zone. Furthermore, these results will be tested using One-Way ANOVA statistical tests and Dependent T-Test. Results: Zone of inhibition were formed around the biphasic gypsum-monetite pellets for the entire group. Based on the results of the One Way ANOVA test, it was found that there was no significant difference between each composition group in the inhibition zone formed after 24 and 48 hours of incubation. Meanwhile, based on the results of the Dependent T-Test test, it was found that there was a significant difference between the 24 and 48 hour inhibition zones in each group. Conclusion: Biphasic gypsum-monetite pellets can be used as material for carrying antibiotics and there is no effect between the composition of gypsum and monetite on antibacterial inhibition. The inhibition zone formed decreased with increasing incubation time."

"Latar belakang: Antibiotik gentamisin (GEN), klindamisin (CLI) dan minosiklin (MIN) digunakan dalam penanganan infeksi Staphylococcus aureus kebal metisilin (methicillin-resistant Staphylococcus aureus, MRSA). Teknologi next-generation sequencing (NGS) merupakan metode mutakhir yang digunakan untuk pemetaan pola kekebalan kuman untuk pengendalian infeksi di suatu fasilitas pelayanan kesehatan. Penelitian ini bertujuan untuk mengetahui profil genom isolat MRSA klinis melalui pemeriksaan NGS. Metode: Proses sequencing DNA menggunakan Illumina® MiSeq dilakukan pada 92 isolat MRSA klinis yang diperoleh dari pasien yang dirawat di Hiroshima University Hospital, Hiroshima, Jepang sehingga didapatkan masing-masing susunan genom de novo. Susunan genom de novo tersebut kemudian dianalisis in silico menggunakan ResFinder sehingga didapatkan profil genom kekebalan antibiotik kuman. Data ini kemudian dianalisis bersama data fenotip kadar hambat minimum (KHM) GEN, CLI, dan MIN.Hasil: Penelitian ini menunjukkan MRSA aac(6')aph(2")+,spc+, ermA+,tetM+ merupakan isolat terbanyak (42/92) dan memiliki KHM GEN >16 mg/L (40/42), CLI >4 mg/L (26/42) dan MIN >8 mg/L MIN (30/42). Deteksi gen aac(6')aph(2") berhubungan dengan KHM GEN (p<0,001), deteksi gen ermA berhubungan dengan KHM CLI (p<0,001) dan deteksi gen tetM berhubungan dengan KHM MIN (p<0,001). Deteksi bersamaan aac(6')aph(2")-spc-ermA-tetM berkorelasi dengan KHM GEN (φc= 0,398, p <0,001), CLI (φc= 0,448, p <0,001) dan MIN (φc= 0,515, p <0,001). Kesimpulan: Penelitian ini menunjukkan korelasi fenotip KHM dan genotip kekebalan antibiotik GEN, CLI dan MIN pada MRSA. Teknologi NGS berpotensi sebagai uji cepat deteksi kekebalan antibiotik pada kasus infeksi MRSA yang merupakan bagian dari upaya pengendalian infeksi.

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Background: Gentamicin (GEN), clindamycin (CLI) and minocycline (MIN) are amongst the widely used antibiotic treatments in methicillin-resistant Staphylococcus aureus (MRSA) infection. The emerging next-generation sequencing (NGS) technology provides antibiotic resistance pattern mapping to be inferred as a consideration in healthcare infection control policy. The subjective of this study is to reveal genomic resistome using NGS and to correlate the resistome with the phenotype of antibiotic resistance represented as minimum inhibitory concentration (MIC) between clinically isolated MRSA specimens.Methods: Illumina® MiSeq was used to sequence and to de novo assembly the genomic DNA of 92 MRSA specimens obtained from the patients treated in Hiroshima University Hospital, Hiroshima, Japan. Resistome was determined by feeding the de novo genome assembly to ResFinder annotation tool prior to correlation analysis with MIC data. These procedures were performed during GEN, CLI and MIN susceptibility observation.Results: The aac(6')aph(2")+,spc+, ermA+,tetM+ MRSA strains were revealed to be predominant (42/92) of which were possessing GEN MIC >16 mg/L (40/42), CLI MIC >4 mg/L (26/42) and MIN MIC >8 mg/L MIN (30/42). This study also revealed the correlation of aac(6')aph(2") and GEN MIC (p<0.001), ermA and CLI MIC (p<0.001), and tetM and MIN MIC (p<0.001). Simultaneous detection of aac(6')aph(2")-spc-ermA-tetM was correlated with GEN MIC (φc= 0.398, p <0.001), CLI MIC (φc=0.448, p <0.001), and MIN MIC (φc= 0.515, p <0.001).Conclusions: This study showed correlation between the MIC and resistome of GEN, CLI and MIN in MRSA. The emerging NGS technology provides promising method in rapid detection of antibiotic resistance in MRSA thus feasible for infection control near in the future."

"Garre's osteomyelitis is a type of Osteomyelitis which occur frequently in clinic. This disease can occur at any age, but mosk happen in and young adult, and frequently in mandible. Usually patient complaint about pains/hurt and jaw getting bigger and hard on bone jaw surface. Osteomyelitis is more frequently happen at incisisive which expand medial and lateral. If the perios tissue inflamed, it tend to built a new bonetissue inside, which only can be seen by Rontgen photo if the cause is apikal infection. The infection tissue at the apical of teeth expand through bone surface and reach periosteum which can change periosteum from bone surface.If the expand of the new bone apically, so it will be seen with periapical projection. And if the expand goes laterally, it will be seen with oclusal projection.It will be discuss about the connection of Garre's Osteomyelitis Roentgen view in various type of projection and its diferential diagnosa in Roentgen will ostegenik sarkoma and about the other lesion which shown almost the same with it."

"Pendahuluan: Osteomyelitis adalah penyakit inflamatorik akibat bakteri patogen yang melibatkan struktur tulang. Prioritas penanganan osteomyelitis adalah dengan menggunakan antibiotik, baik sistemik maupun lokal, serta dilakukannya operasi sebagai penanganan suportif. Salah satu metode penggunaan antibiotik lokal yaitu melalui dilusi intralesi. Penelitian ini bertujuan untuk menilai efektifitas dari pemberian dilusi gentamycin intralesi dalam menangani osteomyelitis. Metode: Desain penelitian ini adalah post-test only control group dan menggunakan 24 tikus putih galur Sprague-Dawley yang dibagi menjadi 4 kelompok perlakuan. Kelompok 1 dilakukan debridement menggunakan normal saline 100 ml (kelompok kontrol), kelompok 2 debridement dengan dilusi gentamycin 10mg/kgBB intramedulla, kelompok 3 dengan dilusi gentamycin 25mg/kgBB, dan kelompok 4 dengan dilusi gentamycin 50mg/kgBB. Setelah 3 minggu pasca perlakuan, dilakukan pemeriksaan mikrobiologi dan patologi anatomi.Hasil: Terdapat penurunan jumlah koloni bakteri setelah perlakuan yang signifikan secara statistik dengan bertambahnya dosis gentamycin (p=0,003). Pada analisis lanjutan, didapatkan perbedaan jumlah koloni kuman antara kelompok kontrol, kelompok gentamycin 10mg/kgBB, dan kelompok gentamycin 25mg/kgBB dengan kelompok gentamycin 50mg/kgBB. Rerata skor Smeltzer menunjukkan perbedaan yang bermakna antar kelompok (p=0,013), yaitu pada kelompok kontrol dengan kelompok gentamycin 25mg/kgBB dan gentamycin 50mg/kgBB. Pada pemeriksaan histomorphometri terdapat perbedaan bermakna antara total area fibrosis (p=0,0065) dan total area kartilago (p=0,031). Pembahasan: Setelah dilakukan pencucian luka menggunakan dilusi gentamycin didapatkan penurunan koloni kuman, perbaikan derajat inflamasi, dan proses penyembuhan tulang yang lebih cepat. Pencucian luka menggunakan dilusi gentamycin 50mg/kgBB sebagai terapi ajuvan dinilai efektif dalam mengatasi osteomyelitis.

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Introduction: Osteomyelitis is an inflammatory disease involving bone structure caused by pathogen. Priority of osteomyelitis treatment is antibiotics (both systemic and local), and the operation as a supportive treatment. The study aimed to examine the effectiveness of intracellular gentamycin dilution administration in dealing with osteomyelitis. Methods: The study used post-test only control group design and used 24 Sprague-Dawley rats as subjects, that divided into 4 treatment groups. Group 1 was performed debridement using normal saline 100 ml (control group), group 2 was performed debridement using gentamycin dilution 10mg/kgBW intramedulla, group 3 using gentamycin dilution 25mg/kgBW and group 4 using gentamycin dilution 50mg/kgBW. After 3 weeks post-treatment, microbiology and anatomical pathology were examined.Result: There was significant decrease in the number of bacterial colonies post treatment with increasing doses of gentamycin (p=0.003). In the further analysis, there was difference between control group, gentamycin group 10mg/kgBW, and gentamycin group 25mg/kgBW compare with gentamycin group 50mg/kgBW. Mean of Smeltzer score showed significant difference between groups (p=0,013), showed in control group compare with gentamycin group 25mg/kgBW and gentamycin 50mg/kgBW. In the histomorphometric examination there was significant difference between total area of fibrosis (p=0.0065) and total cartilage area (p=0.031). Discussion: Wound debridement in osteomyelitis using gentamycin dilution showed decrease in bacterial colonies, an improvement in inflammatory degree, and faster bone healing process. Wound debridement using 50mg/kgBw gentamycin dilution as adjuvant therapy is considered effective in osteomyelitis."