Pengaruh Proses Fermentasi pada Daun Centella asiatica oleh Acetobacter tropicalis Terhadap Aktivitas Trombolitik

Agen trombolitik merupakan plasminogen activator yang dapat memecah fibrin menjadi fibrin degradation product (FDP) dan dapat digunakan pada terapi penyakit kardiovaskular. Agen trombolitik dapat diperoleh dari mikroorganisme seperti Acetobacter tropicalis InaCC B374 dan dari tanaman seperti Centella asiatica. Kedua sumber agen trombolitik tersebut dapat dilakukan kombinasi melalui proses fermentasi untuk meningkatkan efek terapetiknya. Proses fermentasi sendiri dipengaruhi oleh beberapa faktor termasuk media fermentasi dan waktu fermentasi. Penelitian ini bertujuan untuk mengetahui pengaruh proses fermentasi terhadap peningkatan aktivitas trombolitik dari hasil fermentasi Centella asiatica oleh Acetobacter tropicalis InaCC B374 pada berbagai variasi waktu fermentasi. Preparasi dilakukan dengan memfermentasi Centella asiatica selama 24, 48, dan 72 jam pada suhu 30°±1°C dengan kecepatan pengocokan 100 rpm kemudian ditentukan aktivitas trombolitiknya dengan metode clot lysis yang dilakukan inkubasi pada suhu 37°±1°C selama 60 menit. Hasil pengujian aktivitas trombolitik menunjukkan bahwa terjadi peningkatan aktivitas trombolitik setelah dilakukan proses fermentasi selama 24, 48 dan 72 jam dan aktivitas trombolitik maksimum tercapai pada hasil fermentasi 72 jam. Centella asiatica yang difermentasi selama 72 jam menunjukkan nilai indeks trombolitik yang paling besar (82,03) jika dibandingkan dengan infusa Centella asiatica tanpa fermentasi (37,39) dan Acetobacter tropicalis InaCC B374 (37,68). Disimpulkan bahwa proses fermentasi Centella asiatica oleh Acetobacter tropicalis InaCC B374 secara signifikan dapat meningkatkan aktivitas trombolitik keduanya

Plasma levels of D-dimer and fibrin degradation product are unreliable for diagnosing periprosthetic joint infection in patients undergoing re-revision arthroplasty

Background The preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing re-revision arthroplasty is crucial, so we evaluated whether plasma levels of D-dimer and fibrin degradation product (FDP) could aid such diagnosis. Methods We retrospectively analyzed data on patients who underwent re-revision hip or knee arthroplasty at our institute during 2008–2020. Patients were stratified into those who experienced PJI or not, based on 2013 International Consensus Meeting Criteria. Plasma levels of D-dimer and FDP as well as levels of the traditional inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and interleukin-6 were compared between the groups. The ability of these biomarkers to diagnose PJI was assessed based on the area under the receiver operating characteristic (AUC) curve, for which predictive cut-offs were optimized based on the Youden index. Results Based on a cut-off of 0.80 mg/L, D-dimer gave an AUC of 0.595, high sensitivity of 85.7% but poor specificity of 47.8%. Based on a cut-off of 2.80 mg/L, FDP gave an AUC of 0.550, poor sensitivity of 56.5% and poor specificity of 52.9%. CRP, ESR and interleukin-6 showed much better diagnostic ability, with AUCs > 0.82. The combination of CRP and interleukin-6 gave an AUC of 0.877, high sensitivity of 91.7% and acceptable specificity of 78.3%. Conclusions Plasma levels of D-dimer and FDP may be inappropriate for diagnosing PJI in patients undergoing re-revision arthroplasty, whereas the combination of serum CRP and interleukin-6 may be effective.

Plasma fibrinogen, d-dimer, and fibrin degradation product as biomarkers of rheumatoid arthritis

This study aimed to assess the association of coagulation-related indicators such as plasma fibrinogen (FIB), d-dimer, and fibrin degradation product (FDP) in rheumatoid arthritis (RA) with the disease activity. Data from 105 RA patients and 102 age- and gender-matched healthy controls were collected in the retrospective study. Disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) was used to divide RA patients into low activity group (DAS28-CRP ≤ 2.7) and active group (DAS28-CRP > 2.7). Receiver operating characteristic (ROC) curve was applied to determine area under the curve (AUC). The association between plasma FIB, d-dimer, and FDP and DAS28-CRP was evaluated by spearman correlation. Logistical regression analysis was used to identify the independent variables associated with RA disease activity. RA patients showed higher levels of plasma FIB, d-dimer, and FDP than the controls (P < 0.01). Plasma FIB, d-dimer, and FDP were also increased in active groups of RA patients than those in inactive groups (P < 0.001). ROC curve analyses revealed that the AUC of d-dimer was higher than erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF), and that of FDP was higher than RF in RA patients. In addition, the optimal cut-off value of plasma FIB, d-dimer, and FDP for RA diagnosis was 286 mg/dL, 470 μg/L, and 1.45 mg/L, respectively. Spearman analysis showed that plasma FIB, d-dimer, and FDP were positively related with DAS28-CRP (P < 0.001) in RA patients. Logistical regression analysis showed that d-dimer (odds ratio 2.862, 95% confidence interval 1.851–5.426, P < 0.001) was an independent variable associated with RA disease activity. FIB, d-dimer, and FDP were increased in RA patients and positively correlated with the disease activity of RA. d-dimer may act as a novel inflammatory indice for indicating disease activity in RA patients.

Estimation of D-dimer levels in COVID-19 patients and its correlation with age and gender

Background: COVID-19 patients show some kind of abnormal coagulation parameters, related to thrombotic disorders, which can act as marker of the disease. One such marker is D-dimer, which is a widely used fibrin degradation product test used for initial diagnosis of thrombotic disorders. D-dimer levels from patients coming in OPD of sub-district hospital Bishnah, Jammu were analyzed to estimate the degree of this relation to its severity, age and gender.Methods: A retrospective study was conducted on the D-dimer data, collected from the patients coming in OPD of sub-district hospital Bishnah, Jammu, from March 2019 to March 2020. Randomly selected 134 patients infected with COVID-19, with known age and gender and confirmed by RT-PCR were included in the study.Results: Out of these 134 patients, 76 were males (56.72%) and 58 were females (43.28%). 41.04% patients belonged to the age group 51 to 70 years; 92 patients had elevated levels of D-dimer levels, 52 (38.8%) patients showed D-dimer levels four-folds the safe level, >1000 ng/ml and a significant number of females (70.7%) were found to be with elevated D-dimer levels. Women were found to be at a higher risk of developing thrombotic disorders than men. There was slight relation of thrombotic disorders such as D-dimer with postmenopausal age of women as well.Conclusions: This study has shown a clear guidance that women and older individuals are at a higher risk of developing thrombotic disorders during COVID-19 infection.

Chronic subdural hematomas: challenges and solutions. Part 2. New concept for treatment of chronic subdural hematomas and the results

The observed dramatic 6–60-fold increase in fibrin degradation product levels in the cSDH cavity compared to peripheral blood was the rationale that underpinned the development of new concept for treatment of chronic subdural hematoma. The minimally invasive surgery results are reported, demonstrating decrease in fatality rate from 12–18% to 1.2% compared to craniotomy, as well as disappearance of severe post-operative complications, such as cerebral collapse. According to 1–10-year follow-up data, 91.7% of patients have shown good recovery.

Disseminated Intravascular Coagulation Syndrome as a Complication in Acute Spontaneous Canine Babesiosis

The polyetiological syndrome of disseminated intravascular coagulation (DIC) is characterized by changes in patients’ hemostasis. The aim of the current research was to elucidate the main factors for the development of DIC syndrome during canine babesiosis, and to assess their correlation level. Dogs included in this study were of various breeds and sex, weighing 10-40 kg and aged 2-7 years. They were separated in two groups (n=50) according to their diagnosis to babesiosis. Oscillometry (blood pressure, pulse rate), vascular-platelet hemostasis, coagulogram, hematological, biochemical (fibrinogen, fibrin degradation product, soluble fibrin-monomer complex) and hemodynamic (circulating blood volume) assessment methods were used. The group of dogs positive on Babesia spp., had clear manifestation of DIC with 5-7% of the erythrocyte population being affected. DIC was manifested by a significant increase in soluble fibrin-monomer complex and fibrin degradation product (p<0.001), hypofibrinogenemia (p<0.001), thrombocytopenia (p<0.001), and an increase in indicators of spontaneous aggregation ability of platelets and red blood cells (p<0.001). Significant hemodynamic disorders were observed: a decrease in circulating blood volume, circulating erythrocytes volume (p<0.05), specific circulating blood volume and hematocrit value (p<0.001). The average blood pressure was reduced (p<0.001), and the Allgöwer’s shock index was increased 2 times (p<0.05). A shock of II degree (medium, subcompensated) was confirmed. Therefore, it can be concluded that acute spontaneous dogs’ babesiosis can be characterized by the occurrence of DIC in a consumption coagulopathy form, and shock of II degree. This condition renders the patients for emergency admission.

Plasma Fibrinogen, D-dimer, and Fibrin Degradation Product as Biomarkers of Rheumatoid Arthritis

Objective: This study aimed to assess the role of coagulation-related indicators such as plasma fibrinogen (FIB), D-dimer, and fibrin degradation product (FDP) in rheumatoid arthritis (RA) and their association with disease activity.Methods: Data from 105 RA patients and 102 age- and gender- matched healthy controls were collected in the retrospective study. Disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) was used to divide the RA patients into inactive group (DAS28-CRP ≤ 2.7) and active group (DAS28-CRP > 2.7). The association between plasma FIB, D-dimer, and FDP and DAS28-CRP was evaluated by spearman correlation. Receiver operating characteristic (ROC) curve was applied to determine the area under curve (AUC) value. The prognostic value of plasma FIB, D-dimer, and FDP in the RA disease activity was tested by logistical regression analysis.Results: RA patients showed higher FAR levels of plasma FIB, D-dimer, and FDP than the controls (P < 0.01). Plasma FIB, D-dimer, and FDP were also increased in active group of RA patients than those in inactive group (P < 0.001). Spearman analysis showed that plasma FIB, D-dimer, and FDP were positively related with DAS28-CRP (P < 0.001) in RA patients. ROC curve analyses revealed that the AUC of D-dimer was higher than ESR and RF, and that of FDP was higher than RF in RA patients. In addition, the optimal cut-off value of plasma FIB, D-dimer, and FDP for RA diagnosis was 286 mg/dL, 470 μg/L, and 1.45 mg/L, respectively. Logistical regression analyses showed that D-dimer (odds ratio = 2.862, 95% confidence interval: 1.851-4.426, P < 0.001) was a predictor for RA disease activity.Conclusions: FIB, D-dimer, and FDP were increased in RA patients and positively correlated with the disease activity of RA. D-dimer may act as a novel inflammatory parameter for predicting disease activity in RA patients.