Thursday, October 29, 2009

Are serum S100B proteins on patients with TBI important to be studied?

Traumatic brain injury is a lot of tragedies happened and major contributing cause of death and permanent disability. Each year, an estimated 0.3% to 0.5% of the world population suffered head injuries. Each year, from 1.4 million people affected by head injuries in the United States, 50,000 of them died, 235,000 people had to hospitalization, and 1.1 million should be treated in the emergency room. In fact, the productive age group between 15 to 24 years is the highest risk group.

According to Summers, et al (2009), motor vehicle accidents are the second largest cause of traumatic brain injury incidence in the United States in the year 1995 to 2001. Along with the progress of transportation, the incidence of head injuries also increased. According to the news from the department of health, the number of road accidents in 2003 reached 13,399 events with the number of deaths reached 9865 people, 6142 people suffered severe injuries and 8694 minor injuries. With data on average every day events occurred 40 traffic accidents that resulted in 30 people died. The majority of these accident victims also include the productive age group, i.e. between 15 to 40 years. The number of incidents of traffic accidents also continues to increase. Based on data from depkominfo, the number of accident cases in 2008 reached 18,000 and increased to 19,000 cases in 2009.

Traumatic brain injury is one of the many diseases that cause losses. More than a thousand people had to undergo hospitalization for head injuries. The number of people with head injuries ranked first of all hospitalized patients in RSCM. According to Wijarnaka Y (2005), traumatic brain injury is also the second ranked cause of hospitalization in Hospital Nursing Nugroho in the first quarter of 2005. Traumatic brain injury cases fall into 3 major cases most often handled in RSUP Dr. Sardjito (BNS, vol 4 No. 2 77-93, Feb 2003). During the years 2006, 1924 patients or 4.5% of the 28,609 patients who come in IRD RSUP Dr. Sardjito come because of traffic accidents. In fact, from the mortality data for the year 2006, from 194 patients who died, 44.9% caused by head injuries. Patients who died of head injuries were 81% a severe traumatic brain injury.

The high mortality rate, especially head injuries in severe traumatic brain injury patients, rapid treatment is necessary and appropriate in handling traumatic brain injury cases. The handling traumatic brain injury is determined by the type and degree of severity of head injuries. So far, the degree of severity of traumatic brain injury is determined by clinical examination and investigation. Investigations which have been used to determine the degree of severity of traumatic brain injury is the Computed Tomography scan (CT scan). However, the availability of CT-scan is very limited because the price is relatively expensive. In addition, a CT-scan was also considered less practical because it requires mobilization of the patient. This will be difficult if there are conditions that do not allow for mobilization. Because of the problems above, a CT-scan is not routinely done in the series.

Recently, examination of S100B protein was proposed to assess the degree of severity of head injuries. S100B proteins are protein in the cytoplasm and are involved in the regulation of several processes such as cell differentiation, progression, and cell cycle. This protein is a glial specific protein and is expressed primarily by astrocyte. In adult humans, this protein increased due to nervous system injury. This makes S100B protein can be used as a potential clinical marker.

S100B protein is released after brain injury and increased concentration in cerebrospinal fluid. In addition, the increases in permeability of BBB (Blood Brain Barrier) causes these proteins are released into the bloodstream so that levels are elevated in plasma / serum. (Willoughby et al, 2004 and Stocchetti, 2005).

As a biomarker, these proteins can be measured from serum or plasma both arteries and veins, are not affected by hemolysis, is stable within a few hours before the examination, has a sensitivity and high specificity to brain injury, is not affected gender and age, rapidly detected in the serum, and concentration indicates the extent of damaged tissue. . This protein positively correlated with the degree of head trauma and negatively with clinical output. This makes it a potential clinical marker (Korfias et al, 2006).

In several studies of protein S100B correlated with the degree of brain injury caused by encephalopathy for sepsis, central nervous system depression because respiratory depression by an overdose of benzodiazepines, extensive brain damage due to head injuries in autopsy cases, a long time that cardiac surgery causes hypoxia and depression central nervous system, and hypoxia in neonates.

Compared with CT scan, examination S100B protein is more practical because it does not require mobilization of the patient. S100B examination is also relatively more expensive than CT scan. Besides being invasive, examination of this protein is also very possible to be done in a serial examination.

Kinetics of serum S100B protein is very important to know because it can be used to determine when the right time inspection in monitoring disease progression, and to determine if the severity of the disease has been proven in a study. In addition, examination of serum S100B protein can also be used to monitor therapy and a series can be used to determine the prognosis of patients with head injuries. In cases of severe traumatic brain injury is expected kinetics information can be used optimally because of the need to handle these cases quickly and accurately.

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