AbstrakPenyakit Ginjal Kronik (PGK) adalah kelainan struktural atau fungsi yang terjadi lebih dari 3 bulan dan mempunyai implikasi terhadap kesehatan serta diklasifikasikan berdasarkan penyebab, laju flitrasi glomerulus (LFG) dan albuminuria. Komplikasi serius yang ditimbulkan PGK dapat berupa malnutrisi, kelebihan cairan, perdarahan, serositis, depresi, gangguan kognitif, neuropati perifer, infertilitas dan Infeksi. Untuk mencegah komplikasi tersebut, diperlukan indikasi dan waktu yang tepat untuk memulai terapi dialisis pada pasien PGK. AbstractChronic Kidney Disease (CKD) is a structural or functional abnormality that occurs more than 3 months and has health implications and is classified based on causes, glomerular filtration rate (GFR) and albuminuria. Serious complications caused by CKD can include malnutrition, excess fluid, bleeding, serositis, depression, cognitive impairment, peripheral neuropathy, infertility and infection. To prevent these complications, it is necessary to indicate and the right time to start dialysis therapy in CKD patients.
Background. Contrast-induced nephropathy (CIN) is defined as an increase in serum creatinine ≥ 25% or ≥0.3 mg/dl in 48 hours after the administration of a contrast agent in the absence of other causative factors (KDIGO 2012). Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a substance produced by the kidneys in acute kidney injury (AKI) caused by various insults from ischemia to toxin-induced nephropathy. NGAL is known to increase earlier than serum creatinine level. NGAL is also a protease-resistant polypetide; it is released from the distal tubule, secreted to the urine or returned to the plasma (back leak), freely filtered in the glomerulus, reabsorbed in the proximal tubule through the megalin receptor endocytosis or secreted to urine. This makes NGAL detectable both in the blood and urine. Aim. To elucidate the effect of contrast administration to serum NGAL and serum creatinine levels with in patients undergoing PCI. Methods. The study was done in the Cardiovascular Care ward in M. Djamil General Hospital, Padang, West Sumatra, Indonesia. Through consecutive random sampling, 21 subjects were selected. The subjects’ serum NGAL and creatinine levels were acquired before PCI and 6 hours after contrast administration. Results. The mean serum NGAL and creatinine levels of the subjects before and after contrast administration were 52.26 ng/ml vs 64.78 ng/ml and 1.1 mg/dl vs 1.09 mg/dl, respectively. The serum NGAL level difference before and after contrast administration was statistically significant (p=0.003) whereas the serum creatinine level was not (p>0.005). Conclusion. There is an increase of serum NGAL levels before and after contrast administration in patient undergoing PCI, whereas serum creatinine level was not. Future studies should elaborate on the use of NGAL as an early diagnostic marker for CIN.
The background of the research will focus on the cases of the Black Death pandemic in 14 th century onwards with particular review on the usage of beaked masks by plague doctors. This peculiar mask can be described as Personal Protective Equipment (PPE) at that time to protect the physicians from being infected when treating patients with Black Death symptoms. This research will evaluate the use of PPE from the medical, history, chemistry, technology and sociology perspectives to reach a detailed understanding of the benefits of wearing this peculiar mask in responding to the challenges presented by the epidemic. Hence, the ingredients and elements of the beaked masks need to be scrutinized in order to underscore the physicians' efforts in inventing such equipment in protecting frontline workers like the plague doctors. Analyzing the evolution of PPE and medical protection will help the public to understand medical history and the roles of community in dealing with cataclysmic epidemics in the past. The research found that beaked masks created as PPE by the physicians were able to support them psychologically in dealing with their patients. Unfortunately, the design and property inside beaked masks do not provide the expected protection unlike PPE in modern time which produced significant result in reducing the possibility of disease transmission.
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