Effect of Canopy Gaps on Growth and Water Use Efficiency of Seedling of Vulnerable Species, Hopea sangal Korth

Aims: Hopea sangal Korth. is listed as vulnerable species and recently its remnant habitat was rediscovered in the degraded forest near the springs area in East Java. In the forest, the regeneration of the seedling and saplings understory is affected by the heterogeneity in environmental factors especially various light levels due to the canopy gaps. H. sangal is considered a shade-tolerant species, hence the establishment of the seedling in its natural habitat occurs under the closed canopy. This study aimed to understand the Water Use Efficiency (WUE) and Relative Growth Rate (RGR) of Hopea sangal Korth seedling grown in two different levels of tree canopy shades. Study Design: This research was using a completely randomized design, with 9 replications. Place and Duration of Study: This study was conducted in the Purwodadi Botanic Garden, East Java, between March � July. Methodology: We used seedling of H. sangal collected from the field in Pasuruan which were planted in plastic pots and acclimatized to obtain seedling of a similar size. The microclimate was measured weekly using solarimetri and sling psychrometer at 08.00; 10:00; 12:00; 14:00 and 16:00. RGR was measured by harvesting the seedling and whole plant WUE was measured using the gravimetric method. Results: We observed the light level during the periodic opening of the canopy gap was significantly different at a specific time (8-12 am), with the highest light intensity at 10.00 of 333.57 祄ol photon m-2s-1. The canopy shades differences did not affect the WUE of seedling (P = 0.333), meanwhile, there was a significant difference in the seedling RGR (P = 0.025). The seedling that were grown under a higher gap and received higher light intensity periodically during a day had higher RGR than those under a closed canopy. The WUE has a positive relationship with the RGR of seedling (R2 = 0.5; P < 0.05). Conclusions: This study suggested that the H. sangal is one of the shade-tolerant species capable of responding to gap-opening sunlight. The study also showed RGR of the seedling positively correlated with the WUE of plants, indicating that the seedling could use the water supply efficiently to grow rapidly.

Clinical Picture, Insulin Resistance, and Adipocytokines Profiles of Nonalcoholic Steatohepatitis (NASH) Patients in Indonesia.

Aim: to know the clinical picture of subjects with NASH in Jakarta, Indonesia and the prevalence of insulin resistance, TNF-a, and adiponectin levels among them. Methods: this was a comparative cross-sectional study between patients with histopathologically confirmed NASH and normal subjects. The population of study was patients with fatty liver without history or significant consumption of ethanol. Patients were consecutively enrolled in the study if the ultrasonography showed fatty liver appearance with or without increased liver transaminases. Results: thirty patients and thirty normal subjects were recruited between February 2005 and January 2006. Median age of the patients was 45 years while the median age of the control group was 32 years. More than 80% of the patients were overweight (BMI 23-25 kg/m2) and obese (BMI > 25 kg/m2). Increased alanine aminotransaminase levels were found in almost two thirds of the patients. Other comorbidities included hypertension, hypertriglyceridemia, and type-2 diabetes mellitus. In patients with NASH, fasting insulin level, insulin resistance, and TNF-a level were significantly higher, whereas adiponectin level was significantly lower than the control group. Conclusion: most of the metabolic syndrome determinants were found in patients with NASH. HOMA-IR and TNF-alpha levels in subjects with NASH are higher than those in controls. Adiponectin levels in subjects with NASH are lower than those in controls. Further epidemiological studies are still needed to elaborate the causal relationship of insulin resistance and cytokine profiles to the development of NASH in Indonesia.

Management of immobilization and its complication for elderly.

Increased life expectancy have an effect on the rising percentage of elderly population in Indonesia and health problem associated with the elderly, particularly immobilization. Immobilization may cause various complications, especially when it has been overlooked without any appropriate and proper medical care in keeping with the procedures. High incidence of immobilization in elderly and the life-threatening complication call for an agreement on management of immobilization and its complication. Management of immobilization needs interdisciplinary team-work cooperation, the patients and their family. The management may be commenced through a complete geriatric review, formulating functional goals and constructing therapeutic plan. Various medical conditions and external factors that may act as risk factors of immobilization as well as drugs intake that may exaggerate the immobilization should be evaluated and optimally managed. Any complication due to immobilization and other concomitant disease/condition should be recognized and managed comprehensively in order to reduce morbidity and mortality. Management of immobilization and its complications include pharmacological and non-pharmacological treatment, i.e. various mobility exercises, utilization of ambulatory device and supporting appliance for assisting patients in stand-up position, as well as the management of urinary voiding and defecation.

The impact of 'comprehensive geriatric assessment (CGA)' implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward.

AIM: to investigate the cost effectiveness of CGA in an acute geriatric ward. METHODS: a non-randomized controlled trial was carried out at Dr. Cipto Mangunkusumo General Hospital from January to December 2005. The inclusion criteria were elderly patients with geriatric syndrome. Exclusion criteria were advanced malignancy, APACHE II score > 34,in-hospital mortality in the first 24 hours, move to another ward before completing CGA management, the presence of dementia. After patients were allocated into CGA and non-CGA group, effectiveness was assessed using ADL/WHO Unescap score, days of hospitalization, proportion of re-hospitalization, survival, quality of life score (EQ5D),patients and nurses satisfaction score. Cost effectiveness analysis was done using TreeAge-Pro 2004 software program. RESULTS: the length of hospitalization was shorter in the CGA group than in non-CGA group (10.99 [0.79] days vs.20.16 [2.62] days; p=0.00). At the end of treatment, mean of ADL score changes was significantly higher in CGA group than non-CGA group. Mean of WHO-Unescap score changes in CGA group was higher than non-CGA group (0.71[0.04]vs 0.61 [0.04]; p=0.09). EQ5D-VAS score was also higher in CGA group (0.79[0,01] vs 0.75[0.01]; p=0,01). Survival proportion in CGA group was lower than non-CGA group(80.37% vs 86.92%; p>0.05). Rehospitalization proportion was higher in non-CGA group than in CGA group (21.5%vs 11.21%; p 0.04). Patient's satisfaction level was higher in CGA group (193.38 [1.25] vs 177.47 [3.04]; p=0.00).Nurse satisfaction level was also higher in CGA group than non-CGA group but not statistically significant (225.06[7.08] vs 220.06[8.26]; p=0.65).Mean of healthcare cost in non-CGA group was higher than in CGA group (Rp. 9,746,426.00 [1,180,331] vs Rp 4,760,965.00 [338,089]). Cost effectiveness analysis indicated that CGA was superior to conventional approach because for each point score of QALD's, total cost was lower in geriatric acute care unit than in conventional ward(Rp 418,199.00 vs Rp 628,695.00). Moreover, QALD's in CGA group was better than in non-CGA group (24.1 vs 22.8; p= 0.03). CONCLUSION: the CGA approach is more cost effective compared to conventional approach. Quality adjusted life days are better in CGA group than in non-CGA group although survival is not statistically different. In CGA group, length of hospitalization was shorter, functional status and patient satisfaction is better in general. Working satisfaction of nurses in CGA group was not lower than in non CGA group.

Iron deposit state and risk factors for anemia in the elderly.

AIM: To determine the type of anemia, iron deposit and risk factors for anemia in the elderly. METHODS: A cross-sectional study was conducted among 84 patients admitted to the geriatric inpatient ward of dr. Cipto Mangunkusumo Hospital. The patients underwent anamnesis, administration of a dietary questionnaire which included SQFF and food recording, physical examination, laboratory investigations (blood, urine and benzidine test), chest x-ray, ECG and spirometry. Anemic elderly patients also underwent iron store measurements, including serum iron (SI), total iron binding capacity (TIBC) and serum ferritin (SF). RESULTS: The proportion of anemia was 54.76%. Increased anemia was inversely correlated with increased body mass index (OR 0.870; 95% CI 0.762-0.994), serum albumin (OR 0.285; 95% CI 0.090-0.907) and calorie intake (OR 0.998; 95% CI 0.996-0.999), and positively correlated with renal impairment (OR 2.647; 95% CI 1.084-6.467). Anemia due to chronic disease (ACD) accounted for 21 subjects, 5 subjects with iron deficiency coexisting with ACD, 1 subject with megaloblastic anemia, and the cause of anemia in 19 patients could not be identified due to diagnostic procedural limitation. Most of the anemic elderly subjects had normal iron deposits. As many as 42.1% of the men and 44.4% of the women had elevated iron deposits. The level of hemoglobin, SI, TIBC in ACD patients were lower than in non-ACD patients (Hb 10.4 vs 10.8 g/dl, SI 58.71 vs. 92.38 ug/dl, TIBC 283.11 vs. 288.95 microg/dl). In contrast, serum ferritin levels in ACD patients were higher than in non-ACD (178.26 vs. 111.35 ng/ml). CONCLUSION: Body mass index, serum albumin, calorie intake and renal impairment are risk factors for anemia in the elderly. Normal iron deposits accounted for 57.9% and 55.6% of anemic elderly men and women with elevated iron deposits.