277 low. According to Widyastuti et al.
, the concentration of ethanolic extract of super red dragon fruit peel ylocereus costaricensis FAC Weber Britton Rose
demonstrated effectiveness either as a sunscreen at a concentration of ppm
with SPF value of . 8, while at a concentration of ppm of ethanolic extract of
super red dragon fruit peel does not show its effectiveness as sunscreen since the SPF value of less than or equal .
.
Table 5. The scanning of Maximum Wavelength of RDFP‐AcOEt Fraction
Concentration µgmL
The maximum
Wavelength nm
Absorbance Ultraviolet
Area 5
. B
25
. 8 B
50
. B
100
. C
Conclusion
Ethylacetate fraction of an ethanolic extract of red dragon fruit peel RDFP‐AcOEt containing flavonoids at . ± . ww EQ is measured by the AlCl
chelation method and total phenolic content of
. ± . mg GAE g which measured
by the Folin‐Ciocalteu method. Antioxidant potential of RDFP‐AcOEt fractions is weak by the C value that is equal to
. µgmL measured by DPP method. SPF value KBNM‐AcOEt fraction was .
± . . This indicates KBNM‐AcOEt fraction
concentration of , ,
and mgL were tested using in vitro methods
spectrophotometry does not have significant photoprotective potential.
Acknowledgements We thank nstitute of Research, Publications and Community Service of
Universitas Muhammadiyah Yogyakarta for financial support through the Tridharma enhancement grant
‐ .
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Joint Scientific Symposium
IJJSS 2016
Chiba, 20‐24 November 2016
280
Effectiveness of Wound Cleansing Using Guava Leaves 20
Infusion with Showering Technique 15 Psi Pressure toward the
number of bacteria on Diabetic Foot Ulcer at Kitamura Clinic,
Pontianak
Jaka Pradika
a
, Yoni Astuti
b
, Novita Kurnia Sari
a
Student of Master of Nursing Postgraduate Programme , Universitas Muhammadiyah
Yogyakarta, jalan Lingkar Selatan,Tamantirto, Kasihan, Bantul, DIY, Indonesia. 55183
b
Master of Nursing Postgraduate Programme , Universitas Muhammadiyah Yogyakarta, jalan
Lingkar Selatan,Tamantirto, Kasihan, Bantul, DIY, Indonesia. 55183
Abstract
Wound cleansing is required to reduce the prevalence of Diabetic Foot Ulcer DFU . Guava leaves infusion has a lot of subtances that able to reduce the bacteria. This study to
determine the effect of wound cleansing using guava leaves infusion with showering techniques Psi toward the number of bacteria on wound of DFU. This study used quasi
experimental. Sixty six respondents were divided into the infusion of guava leaves group
, NaCl . group and ozone water group
. Each group was performed cleansing wounds using the showering technique with Psi. The sampling technique
used was consecutive sampling to count the number of bacteria on DFU. Bacteria collecting used swab method on areas. To count the number of bacteria used bacteria
counter machine. Data was analysed by one way anova. The average of responden age years old were
. ± . 8 , . ± . 8 , and . ± .
. The average of bacteria number were . ± .
. , . ± . 8 .
, and . ± . 8 .
. There were significant difference of reducing the number of bacteria using NaCl p= .
, guava leaf infusion p= .
and ozone p = , 8 .The most effective was guava leaf infusion.
The guava leaves infusion showed the most significant results in lowering number of bacteria on DFU .
Keywords: Diabetic foot ulcers, Wound cleansing, Showering Technique, nfusion of
guava leaves , number of bacteria
1.Introduction
Diabetic Foot Ulcer DFU was an effect of complication on cronic diabetic mellitus and as the main cause of morbidity, mortality and defect of the patient with diabetic.The
main cause of DFU was neurophaty sensoric, motoric and deficit of otonom , and ischemic or both neuro‐ischemic arwani, at al,
; Benbow and Steven, The insidenci and mortality of DFU is always increase, due to the serious health
problems that need well management. The good wound management consists of cleansing, debridement and dressing were some ways to reduce mortality cause of DFU.
Wound Cleansing is the first step to cure the wound that maintain the wound cleanliness, release the debris, to minimize of bacterial number and to facilitate wound
281 recovery Yusuf, et al,
. Wound Cleansing consist of the methods how to spread solution and the kind of solusion for cleansing. The esiest and the effective cleansing
technic is showering meanwhile for the solusion used to NaCl . .The solusion NaCl , was physiologic solution, it wasnot irritate and untoxic to tissue but NaCl . . did
not has antibacterial effect. NaCl . . were not the best solusion for DFU with infection Atiyah, et al,
. Kitamura Pontianak is the clinic to cure the DFU, using showering technic to clean the
DFU but there was not measurable standart pressure and used NaCl . as cleaning solution. This study conducted to addresses the showering technic with psi as an
optimum pressure on DFU and to explore an alternative solution contain antibacterial to the bacterial number on DFU. This study use guava leaves infusion . Guava leaves
contains anti microbial, anti inflammation, and analgesic Baronski and Ayello, .
Research Methods
This research was an experimental research. There were patients with DFU at Kitamura clinic. This research consists of groups, groups treated with guava leaves
infusion patient , group treated with ozone as positive groups. patients
and groups treated with the NaCl . as negative groups, patient . Wound
cleansing is conducted one times per days. The bacteria was swabbed areas on the wound. And the bacteria number measured with bacteria counter machine.
The Data were analysed using one way annova.
Result and Discussion
1.
The characteristic of subject
Group : Guava infusion treatment Group ; ozone treatment
Group : NaCl treatment The characteristic of subject was listed in table . Female was bigger number than
male. Women has estrogen much more than man and monthly has hormone cyclus . The unstable hormon could induce high risk of wound. The incidence of DFU higher on the
menopause women . Degeneration of estrogen induce neurophaty ardman and ashcrft,
8 . Eestrogen fasilitate respond of inflamation, maintain lipid and cholesterol, manage insulin and regulate apoptoiss stem cell that determine cell life and tissue growth
during wounded . Most of subject were not smoking
. Smoking was one of the risks that inhibited recovery process but the exact mechanisme of smoking patophisiology was not
determine yet. Thought the free radical from the tobacco or smoke was contribute to the worse wounded.
Characteristic of subject Group
N Group
N Group
N Total
Sex Male
Female Smoking history
Yes
8 8
No 8
282 . Age and Blood glucose
. .Age The average of age and blood glucose on each groups was listed on table . The
average of age on groups was . ± . 8 years, groups was
. ± . 8 years and groups
. ± . years. All subject were elderly. There were not significant
different between the groups p . . People in age more than y.o entrance to the
DM risk Anonim, . The Age is one of the factors influenced the health progressing.
During the degerative process cell and organ has decreasing functional. On this age, the apetite was decrease, result on low nutrision, rest time was decrease, and stress effect of
wound increase, and the capability to wound self curing was decrease. Blood sirculation, oxygen distribution to the wound, blood clotting, inflammation
respond, and fagocytosis were demaged at the aging process due to high risk for infection during the wound curing Mogford,et al,
8 a; anonym, .
Table . The average of age and blood glucose on the groups
Variabel Group
1 Group
2 Group
3 P
value Mean±SD
Mean±SD Mean±SD
Age years . ± . 8
. ± . 8 . ± .
P . Blood
glucose grdl . ± .
. ± . 88. ± .
P0.05
Group : Guava infusion treatment Group : ozone treatment
Group : NaCl treatment . . Blood Glucose
The average of blood glucose at all the groups were around ‐
mgdl. The increasing of blood glucose along time and unwell treated will increase the blood viscosity
and cause the decreasing of oxygen and some important nutrients that needed by the wound tissue LeMone and Burke,
8 . The decreasing of blood flow and oxygen supply
to the neuron was a acause the neuropathy Sukarni, .
The high blood glucose on the subject were influenced by some factor that we did not control well, such as, diet, medicine, stress. The diet was depend on the family menu.
There werenot certain menu for the patient.The expense for wound managemen and check blood glusose were expensive for them induce some stresses.
.The bacteria number Table . The average of bacterial number on the groups
Variabel Group
1 Group
2 Group
3 P
value Mean±SD
Mean±SD Mean±SD
Bacteria number per
cm . ± .
. . ± . 8 .
. ± . 8 . P .
Group : Guava infusion treatment Group ; ozone treatment
Group : NaCl treatment The average bacterial number on group was . ± .
. , groups was .
± . 8 . and groups was
. ± . 8 . , the p value , . There was significant
283 different between guava infusion treatment and NaCl treatment, also ozon treatment and
NaCl treatment. There was not significant between Guava treatment and Ozone treatment p . .
The average of bacterial number more than , this meant an infection on the wound
of FDU Benbow and Steven, .
The infection was caused by the low immunity, micro and macro angiopathy due to lack wound tissue perfusion. This result on prolong of
inflammation and disturb epitheliazation, contraction and collagen deposit. Beside ischemic result in lower circulation induce the vascular damage result in decreasing to
against the infection agent. Ozone solution able to oxidize many kind of bacteria, fungus, spore, yeast, and other
organic substance. The effect of ozone solution to bacteria, was disturbing the capsule of bacteria by oxidising phospholipid and lipoprotein, then penetrate to inner membrane, to
change the structure of DNA result in closed DNA due to inhibit the proliferation of bacteria, disturbing some bacteria metabolism.
Beside ozone improve oxygen distribution and release growth factor that needed to reduce ischemia and increase the wound recovery Dewiyanti et al,
. The increasing of bacterial number reflected the cleanliness level of the wound. Wound dressings
sometimes was wet and unclean . The high moist dressing was a good media for bacteria to grow. Teatment using guava infusion were decreasing the bacterial number ,
almost the same effect to the positive control group Ozone treatment . Ozone was a strong oxidant after flour, and could kill some bacterias by breaking bacteria protein
chain. Ozon was used to kill virus and bacteria in event air and watering media. Ozone is used as cleaning solution via ozonaizer machine but it was expensive Usada and
Purwadi, .
Picture 1. The average of bacterial nu ber on the groups
Picture showed that Guava infusion almost have the similar effect with ozone solution to clean the wound. Guava infusion have the significant effect caused by
natural antimicrobial in it. The antimicrobial inhibited bacterial gram positive growth by breaking cell membrane. Guava infusion contain some beneficial subtances such as
flavonoid, tanin, alcaloid, glucosida, saponin and steroidterpen. Based on in vitro research guava infusion able to inhibit the growth of so e bacteria that
found on the DFU wound such as Staphylococcus aureus, Streptococcus uta s,
2 4
8 10
12 14
Group 1 Group 2
Group 3
The Bacteria Number on the groups
numb er
o f bacteria
x
Group : Guava Group : Ozone
Group : NaCl
284 Pseudo o as aerugi osa, Sal o ella e teritidis, Bacillus cereus, Proteus spp., Shigella spp.
and Escherichia coli.
Conclution The guava leaves infusion as an potential alternative cleaning solution for curing
the DFU wound.The guava leaves has similar effect to reduce the bacterial number
with ozone solution. References
. Arwani., Siswanto, P., Sugijana, R. . Perbedaan tingkat perfusi perifer ulkus kaki
diabetik sebelum dan sesudah olahraga pernafasan dalam di ruang wijaya kusuma rsud dr. R. Soeprapto cepu. n prosiding seminar nasional vol. , no.
. Atiyeh, B.S., Dibo, S.A. and ayek, S.N. . Wound cleansing, topical antiseptics and wound
healing. nternational wound journal, , pp.
‐ .
. Baranoski, S., Ayello, E., A. . Wound Care Essentials : Practice Principles. United States
of America : Lippincott Williams Wilkins. . Benbow, M. and Stevens, J.
. Exudate, infection and patient quality of life. British Journal of Nursing. 19
, p. . . Departemen Kesehatan R.
. Rises Kesehatan Dasar Riskesdas 2007. Jakarta: Laporan Nasional.
. Dewiyanti, A., Ratnawati, ., dan Puradisastra, S. . Perbandingan Pengaruh Ozon, Getah
Jarak Cina Jatropha Multifida L. dan Povidone odine terhadap Waktu Penyembuhan Luka pada Mencit Betina Galur Swiss Webster . Bandung: Universitas Kristen Maranatha.
. andayani, T. N. . Pengaruh Penegelolaan Depresi Dengan Latihan Pernafasan Yoga
Pranayama Terhadap Perkembangan Proses Penyembuhan Ulkus Kaki Diabetikum Di Rumah Sakit Pemerintah Aceh. Tesis. Jakarta: Universitas ndonesia.
8. ardman, M.J. and Ashcroft, G.S. 8 . Estrogen, not intrinsic aging, is the major regulator
of delayed human wound healing in the elderly. Genome biology, 9 , p. . . LeMone, P Burke, R.
8 , Medical surgical nursing critical thinking in client care th.ed , Upper Sadle River‐New Jersey, Pearson Prentice all.
. Mogford, J.E., Sisco, M., Bonomo, S.R., Robinson, A.M. and Mustoe, T.A. 8 . mpact of aging
on gene expression in a rat model of ischemic cutaneous wound healing. Journal of Surgical Research
, 118 , pp. ‐
. . PERKEN
. Pedoman Penatalaksanaan Kaki Diabetik. Jakarta: Perkeni. . Sukarni.
. Efektivitas muscle stimulator terhadap penyembuhan luka di Klinik Kitamura Pontianak. Tesis. Bandung: Universitas Padjajaran.
. Usada, W. and Purwadi, A. . Prinsip Dasar Teknologi Oksidasi Maju: Teknologi ibrida
Ozon Dengan Titania. Ganendra PTEK Nuklir, .
28
. Yusuf, S., Okuwa, M., Shigeta, Y., Dai, M., uchi, T., Rahman, S., Sanada, . .
Microclimate and development of pressure ulcers and superficial skin changes. nternational wound journal, 12 , ‐ .
Joint Scientific Symposium
IJJSS 2016
Chiba, 20‐24 November 2016
28
RELATIONSHIP BETWEEN URIC ACID LEVELS AND RISK FACTOR
IN HYPERTENSIVE PATIENT
ka Setyawati
a
, Syarif Maulana
b a
Department of Biochemistry, Faculty of Medicine and Health Science,
Universitas Muhammadiyah Yogyakarta
b
Student of Medical and Health Science Faculty of Universitas Muhammadiyah
Yogyakarta Abstract
Background: ypertension is a major health problem in both the developed and developing countries. The prevalence of hypertension in ndonesia according to the
basic health research in was ,8 while the prevalence in Yogyakarta was , .
ypertension is a risk factor of myocardial infarct and CVA cerebrovascular accidents . Cardiovascular disease is the leading cause of death worldwide.
Method: This research was an analytic observational study with cross sectional approach. t has been conducted at PKU Muhammadiyah ospital of Gamping from
March – March . Subjects were obtained using total sampling method. The
researcher used medical records to determine the uric acid level and blood pressure. There were samples that were analyzed in this study.
Result: This study shows there is no significant impact between uric acid levels
towards systolic blood pressure p= .8 and uric acid levels towards diastolic blood
pressure p= . ,
the systole and diastole blood pressure has a positive correlation with the uric acid levels, the systole has a very weak correlation r= .
and so does the diastole r= . .
Conclusion: There is no relationship between uric acid levels and risk factor in hypertensive patient.
Keywords
Keywords: Uric acid levels; hyperuricemia; blood pressure; hypertension.
Corresponding author. Tel.: + 8 8 ; fax: +
8 E
‐mail address: ikasetyawati.drumy.ac.id
287
1. Introduction
ypertension is a major health problem in both the developed and developing countries. According to the survey that is conducted by World ealth Organization
WO in , approximately of population aged over years old are diagnosed
with hypertension. According to the result of basic health research conducted by Research and
Development Ministry of ealth Republic of ndonesia Riskesdas in ,
approximately ,8 population aged over 8 years old are diagnosed with
hypertension. According to the WO in , of million deaths worldwide, about 8
million 8 are due to four Non‐Communicable Diseases, which are: cardiovascular disease, cancer, diabetes, and chronic pulmonary disease. Cardiovascular disease is the
leading cause of death worldwide of , million .
ypertension is a disease that nowadays is more common to be found in ndonesia, especially in big cities. ypertension has a direct risk factor to myocardial
infarct and CVA cerebrovascular accidents Tambayong, . The hypertension is
hard to be cured but it can be controlled to a normal range Sidabuntar et al, .
ypertension is a condition where the systolic blood pressure ≥ mmg and
diastolic blood pressure ≥ mmg Sidabuntar et al, . The measurement scale is
nominal. Results categories are hypertension and normotensive. Blood pressure measurement is done by using spigmomanometer cuff wrapped around correspondents
upper arm, the stethoscope is placed over the brachial artery just bellow the cuffs edge. While listening with the sthetoscope,inflate the cuff until the heart sound is disappear
and then inflate again at about mmg more and then release air from the cuff at a moderate rate. The first knocking sound is the systolic pressure and when the knocking
sound disappears, that is the diastolic pressure Muttaqin,
. The uric acid levels is level of uric acid in a serum. The normal rate of uric acid
levels for male is , and below whereas for female is , mgdL and below. The measurement scale is nominal. Results categories are hyperuricemia and normal
Chernecky, C Berger, B., .
2. Material and Methods
This research was an analytic observational study with cross sectional approach. This research aimed to study the dynamics of relationship or correlation between risk
factor and its impact. The researcher used medical records to determine the uric acid level and blood pressure. There were samples that are analyzed in this study.
nclusion criteria in this study are in patients in RS PKU Muhammadiyah Gamping from the period of January
‐ December , both males and females
aged ‐ years that are suffering from hypertension and had been conducted the uric acid measurement. Whereas the exclusion criteria are pregnant women, diabetes
patients, and renal failure patients. Data collection was obtained from medical records in RS PKU Muhammadiyah
Gamping. Data retrieved from medical records include patients identity, blood pressure measurement, uric acid levels, and patients history.
3. Result and Discussion
1.1 Study Sample Characteristic
This study has been conducted in RS PKU Muhammadiyah Gamping from 8 March – March
. Samples used in this study were obtained as a secondary data from medical records from the period of January
– December . Using total
sampling method, there were subjects that are suffered from hypertension consist of
288 males and females. Out of subjects, subjects were having hyperuricemia and
others were normal. Subject characteristic can be seen further as followed.
Table 1. Sample Distribution Based on Age in ypertensive Patients
Age Number
Percentage y.o
. ‐ y.o
. ≥ y.o
24 58.54
Total
41 100
Table shows the prevalence of hypertensive patients increases with age. This sample study shows that hypertensive patients mostly in the age group ≥ years.
Table shows the distribution of hypertensive patients according to age group. Ages has main role in hypertension prevalence. The risk for hypertension increase with
age Rahajeng E, Tuminah S,
. This result is consistent with the result from basic health research conducted by Research and Development Minsitry of health Republic of
ndonesia in that declared that prevalence of hypertension based on measurement
by paramedics is increased with age. Table
2 Sample Distribution Based on Sex and Uric Acid Levels
Sex Normouricemia
Percentage hyperuricemia
Percentage Male
. .
Female . 8
. Table shows that the percentage of patients with hyperuricemia is higher in male with
the number of , compared to the female which is only . Table shows percentage of hypertensive patients that also has hyperuricemia is
higher in male group compared to the female group. The same results also can be found in a research done by Rahman in Ain Shams University ospital in
. Uric acid levels are higher in men because it tends to increase along with age.
Women have estrogen that helps the excretion of uric acid trough urine so that the uric acid levels in women begin to increase when they have menopause
grisa,V.J, . The relationship between high uric acid levels with age is due to change of renal
function that unable to remove uric acid adequately. 1.2 The
Effect of Uric Acid Levels Towards Hypertension The result of uric acid levels and blood pressure measurement obtained from
correspondents were then processed using SPSS. Simple linear regression test was used in this study to determine the relationship between uric acid levels and hypertension. To
perform the normality test this study used Shphiro‐Wilk statistic test because the samples in this study are less than , which were only samples obtained.
After normality test was conducted, simple linear regression test was used to predict the impact of independent variable towards the dependent variable. The impact
can be seen by comparing significanr value with probability value . and also the
number of coefficient regression b . The independent variable in this study is uric acid levels whereas the dependent value is hypertension systole and diastole blood
pressure .
