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The Effect of Snakehead Fish (Channa striata) Extract Capsule to the

Albumin Serum Level of Post-operative Neurosurgery Patients

Article  in  Biomedical and Pharmacology Journal · June 2019

DOI: 10.13005/bpj/1714

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Biomedical & Pharmacology Journal, June 2019. Vol. 12(2), p. 893-899

The Effect of Snakehead Fish (Channa striata) Extract

Capsule to the Albumin Serum Level of Post-operative
Neurosurgery Patients
Rohadi M Rosyidi1, Januarman2 , Bambang Priyanto3,
Andi Asadul Islam4, Mochammad Hatta5 and Agussalim Bukhari6

Post Graduate, Medical Faculty of Hasanuddin University, Makassar, Indonesia.

1,3,4,5,6

1,2,3
Departement of Neurosurgery Medical Faculty of Mataram University,
West Nusa Tenggara General Hospital, Mataram Indonesia.
*Corresponding author E-mail : rha.ns2010@gmail.com

http://dx.doi.org/10.13005/bpj/1714

(Received: 06 February 2019; accepted: 22 May 2019)

To evaluate the Effect of Snakehead Fish (Channa striata) Extract Capsule to the
Albumin Serum Level of Post-operative Neurosurgery Patients. This research is a clinical
research with Quasi-Experimental method. The experimental design used was one group
pre-post test. The research design of one group pretest-posttest was measured using a pre-test
which carried out before being given treatment and post-test carried out after being treated.
The population of this study was all post-neurosurgical patients that treated at the West Nusa
Tenggara General Hospital. Each patient who underwent surgery and included within research
criteria was given Snakehead Fish (Channa striata) up to 3 weeks after surgery and the wound
has healed. The sample consisted of 37 patients with criteria of over 18 years of age and no
kidney disorders (proteinuria). The results of the data distribution of 37 patients stated that
there were 12 males (32.4%) and 25 females (67.6%). The most number of diagnosis were
abnormalities of meningioma and skull defect (17; 46% and 13; 35,1%). Mostly patients spent
8 – 14 days to control post-operatively (22; 59,4%). It was found that the pre-operative and
post-operative albumin serum level had no significant difference (the significance value 0.115).
The pre-operative and post-treatment albumin levels had a significant difference (a significance
value of 0.003). However, albumin levels in post-operative and post-treatment had significant
differences (significance value (0.001). This research is important for several reasons, including
therapy in patients with pre-operative or recovery period after surgery. Snakehead fish can
increase serum albumin levels in patients after surgery.

Keywords: Albumin, snakehead fish (Channa striata), extract capsule,

Post-operative Neurosurgery Patients.

Snakehead fish (C. striata) is a carnivorous other fish. The quality of essential and non-essential
fish. Snakehead fish has albumin fraction (64.61%) amino acids in snakehead is also better than of an
of protein.1 This number is very high compared to egg.1
other animal protein sources. Albumin is the most The generally used assessment for
abundant type of protein in blood plasma. The nutritional status to determine the prevalence
albumin in snakehead fish is generally higher than of malnutrition on hospitals is done through

This is an Open Access article licensed under a Creative Commons license: Attribution 4.0 International (CC-BY).
Published by Oriental Scientific Publishing Company © 2019
894 Rosyidi et al., Biomed. & Pharmacol. J, Vol. 12(2), 893-899 (2019)

anthropometry and biochemical examination level of 0.05 (p = 0.05) and confidence level of 95%
of serum albumin levels. Serum albumin and (á = 0.95). The steps for hypothetic comparative
cholesterol levels, especially HDL, can be statistical testing are normality test, variance
predictors for hospital mortality, nosocomial homogeneity test and paired T-Test.
infections and length of stay. 2 An accurate
nutritional status assessment will result in an Results and Discussion
accurate nutritional interventions.
The problems of protein-energy The results of the data distribution of 37
malnutrition (PEM) in many hospitals are known patients stated that there were 12 males (32.4%)
as iatrogenic malnutrition. The condition of low and 25 females (67.4%).
serum albumin level is called hypoalbuminemia. The researchers divided the class of
Adequate nutrition is important in the process of age the population into 3 classes. The results of
healing and shortening the period of care.3 distribution by age of the patients were under 18
years old 3 (8,1%), 18-50 years old 24 (64,9%) and
Material and Methods above 50 years old 10 (27 %).
The distribution of the patient based on
This study is a clinical research with Quasi the diagnoses were meningioma 17(46%) and skull
Experimental method. The experimental design defect 13(35,1%) among others.
used was one group pre-post test. The research Based on the length of operating injury
design of one group was measured using a pre-test control the results were 0-3 days 2(5,4%), 4-7
which was carried out before being given treatment days 7(19%), 8-14 days 22(59,4%) and > 14 days
and post-tests carried out after being treated. 6 (16,2%).
To implement this method, this research was Based on data, there are varied values
conducted one class and with pre-test and post-test from pre-operation and post-operation in patients.
can show differences before and after treatment. The table below is the data of level
Given treatments or interventions to the subject of albumin after giving chana. From the data, it can
this study and the effect of mentioned treatments be concluded that the level of albumin has been
are measured and analyzed. The research subjects increased.
are given 2 capsules of snakehead fish extract 3 The data (Table 4) was found that pre
times a day. Pre-test data was taken by measuring op and post op albumin levels had no significant
serum albumin levels. After the treatment period differences (the significance value was 0.115).
was completed (7 days), a post-test was carried out The pre-op and post-treatment albumin levels
with albumin measurement. had a significant difference (a significance value
The population of this study was all of 0.003). However, albumin levels in the op and
post-neurosurgical patients that treated at the West post treatment there were significant differences
Nusa Tenggara General Hospital. Each patient who (significance value (0.001).
underwent surgery and included within research The result of the data (Figure 1.) was 12
criteria was given Snakehead Fish (C. striata) males (32.4%) and 25 females (67.4%) and the age
up to 3 weeks after surgery, the wound has been of distribution were under 18 years old 3 (8, 1%),
healed and all patients showed that there were no 18-50 years old 24 (64, 9%) and above 50 years
surgical wound infections. The sample consisted old 10 (27 %). A cross-sectional study found that
of 37 patients. All samples in this study were there were significant differences between male
post-neurosurgical patients who were treated in and female albumin levels per age group. Only one
the neurosurgical ward and were chosen based age group (76-80 years) did not show a significant
on the age of e” 18 years and no kidney disorders difference in albumin levels between male and
(proteinuria). female.4 However, there are several factors that
The change of albumin levels before and might influence the result. For example, females
after the intervention were analyzed statistically who took oral contraceptives generally had albumin
using SPSS program version 22 with a significance levels lower than 2 g / dL compared to those who
 Rosyidi et al., Biomed. & Pharmacol. J, Vol. 12(2), 893-899 (2019) 895

did not take oral contraceptives. This supports the decade. Female in general has albumin levels of
hypothesis that there is a hormonal role in albumin 2 g/L lower than male, but a decrease in albumin
levels. At the age of 20, there was an increase in levels in female is not big as in male. Therefore,
albumin levels, especially in male.4 Albumin levels in the age of 50s and 60s, albumin levels between
in females tend to decline faster after the age of male and female did not show a significant
20, but it can reach, more or less, the same level difference.6
as male in their 60s.4 In a prospective study, it In 37 patients, the most diagnosed
was found that albumin, SGPT, gamma-glutamyl were abnormalities of meningioma and skull
transferase, bilirubin, and alkaline phosphatase defect. Actually, in certain diagnoses other than
levels were higher in male than female. The study the mentioned above, hypoalbuminemia must
also compared african and american. It is found be observed. Pre-operative hypoalbuminemia
that african had lower albumin level. Patients with is a predictor of acute kidney injury in patients
hypertension are also have a higher albumin level undergoing brain tumor surgery, with a cutoff
of 0.5 g/dL in this study.5 Other research shows point of 3.8 g / dl.7 In another study, pre-operative
that albumin levels in male decrease by 1g / L per hypoalbuminemia was associated with an increased

Fig. 1. Patient Gender Demographic

Fig. 2. Patient Age Demographic

896 Rosyidi et al., Biomed. & Pharmacol. J, Vol. 12(2), 893-899 (2019)

risk of mortality and a longer length of stay that low albumin levels are associated with a poor
in tumor patients undergoing craniotomy. 8 prognosis in various malignant tumors. Although
The same thing can be found in patients with previous studies showed albumin as a significant
glioblastoma multiforme (GBM). GBM patients prognostic factor, which would be influenced by
with hypoalbuminemia have a lower 30-day many factors, body dehydration or fluid retention
survival, with a cutoff point <3 mg / dL. Not only had a large impact on albumin.11
in cases of brain malignancy, albumin levels also Strict perioperative nutritional support
affect the survival of patients with lung, breast, and use of immune-modulated formulas have been
gastric, colon, and metastatic malignancies. 9 shown to reduce both complications (infections)
Based on the results of a study by Pandey et al, after major surgery and hospitalization. Similarly,
(2016) low serum albumin levels were a risk the use of perioperative corticosteroid has been
factor for complications of TBI, and the percentage recommended recently; and the initial results for
of favorable clinical outcomes was reduced by this simple intervention are promising in respect
hypoalbuminemia.10 It would be better to maintain to post-operative results. Approved albumin can be
serum albumin levels in excess of 3.5 gm/dl in one of the predictive markers of clinical outcomes
traumatic brain injury patients especially in severe in surgery due to trauma. Simple and reliable
brain injuries. Serum albumin can be routinely parameters that represent surgical stress will be
measured because tests are cheap and accessible clinically important to identify patients at risk and
even in remote laboratories. Albumin, the main to adjust perioperative care.
protein of human plasma, plays an important Although advances in the science of
role in the transport of material metabolites and surgical and perioperative management have
maintenance of plasma osmotic pressure. This not reduced post-operative mortality over the past few
only reflects the body’s nutritional status, but also decades, post-operative morbidity remains high. In
represents the level of inflammation that occurs.11 addition to the patient’s morbidity, post-operative
Cytokines, such as IL-6 and TNF, are complications pose a significant financial burden,
produced by an inflammatory response, which while important efforts are currently being made
can inhibit albumin synthesis in liver cells. to reduce health care spending. The magnitude of
Long-term chronic inflammation can cause the metabolic stress response reflects the level of
vascular endothelial damage and increase vascular surgery and may contribute to the risk of developing
permeability, which can increase albumin levels postoperative complications. Early identification of
in the interstitial fluid and produce a decrease in patients is at risk of increasing outcomes, because
serum albumin. Previous studies have confirmed

Fig. 3. Patient Diagnoses Demographic

 Rosyidi et al., Biomed. & Pharmacol. J, Vol. 12(2), 893-899 (2019) 897

Table 1. Demographics of of measures to weaken the surgical stress response

long operating injury control and to reduce morbidity exists.
Albumin, a non-blood product, can be
Criteria Amount Percentage(%) used to treat hypovolemia. However, the price of
albumin is very expensive and it is also limited.
Long Operating 0 – 3 days 2 5,4
Albumin has a high capacity to bind water, and
Injury Control 4 -7 days 7 19
8 - 14 days 22 59,4
can survive in intravascular for approximately 4
> 14 days 6 16,2 hours. As much as 50-60% of protein in the blood is
Total 37 100 albumin, but 80% of intravascular oncotic pressure
is the role of albumin. Albumin has a high binding
Table 2. Level of albumin before giving chana Table 3. Level of albumin after giving chana

Patient Pre op albumin Post op albumin Patient Albumin after giving Chana
(dd-mm-yy) Value (dd-mm-yy) Value (dd-mm-yy) Value

1. 18-07-17 4.6 29-07-17 3.2 1. 02-08-17 4.2

2. 30-10-17 5,0 10-11-17 4,6 2. 15-08-17 4,8
3. 26-07-17 4,3 03-08-17 4.0 3. 15-08-17 4.1
4. 08-11-17 4.6 13-11-17 3.7 4. 22-11-17 3.4
5. 27-08-17 4.5 06-09-17 3.4 5. 20-09-17 3.8
6. 07-11-17 4.8 08-11-17 3.6 6. 13-11-17 3.8
7. 21-08-17 3.7 22-08-17 4.0 7. 31-08-17 4.1
8. 27-11-17 4.5 04-12-17 3.4 8. 28-12-17 4.0
9. 02-08-17 4.6 09-08-17 3.9 9. 29-08-17 4.2
10. 29-11-17 4.4 12-12-17 3.5 10. 03-01-18 3.8
11. 07-08-17 4.0 03-08-17 3.4 11. 07-09-17 4.0
12. 05-12-17 4.5 12-12-17 4.0 12. 20-12-17 4.2
13. 21-11-17 3.9 20-12-17 3.7 13. 28-12-17 4.5
14. 11-12-17 4.2 18-12-17 3.9 14. 28-12-17 4.0
15. 07-12-17 4.9 29-12-17 4.6 15. 02-01-18 4.7
16. 07-12-17 4.8 02-01-18 3.8 16. 12-01-18 4.7
17. 20-12-17 4.1 03-01-18 4.0 17. 12-01-18 4.4
18. 14-12-18 4.5 17-01-18 3.6 18. 31-01-18 4.2
19. 05-01-18 4.0 19-01-18 3.8 19. 31-01-18 4.2
20. 17-01-18 4.7 02-02-18 3.5 20. 13-02-18 4.3
21. 05-01-18 4.5 23-01-18 3.4 21. 15-02-18 3.7
22. 29-01-18 4.4 10-02-18 3.3 22. 22-02-18 3.7
23. 30-01-18 4.6 05-02-18 4.0 23. 15-02-18 4.2
24. 31-01-18 2.7 17-02-18 2.8 24. 20-02-18 3.0
25. 23-01-18 4.3 19-02-18 4.0 25. 27-01-18 3.7
26. 31-01-18 4.1 17-02-18 3.4 26. 06-03-18 4.7
27. 10-02-18 4.5 17-02-18 3.7 27. 08-03-18 4.6
28. 31-01-18 4.3 01-03-18 4.0 28. 06-03-18 4.9
29. 01-03-18 4.2 06-02-18 4.3 29. 13-03-18 4.5
30. 27-02-18 4.0 07-03-18 3.5 30. 20-03-18 3,8
31. 27-02-18 4.7 07-03-18 3.8 31. 20-03-18 4.0
32. 19-03-18 4.4 24-03-18 3.6 32. 31-03-18 4.8
33. 06-03-18 5,0 22-03-18 3,6 33. 29-03-18 4,9
34. 15-03-18 4.5 21-03-18 4.0 34. 29-03-18 4.8
35. 22-03-18 4.3 27-03-18 4,7 35. 05-04-18 5.0
36. 03-04-18 4.5 06-04-18 3,2 36. 17-04-18 4.6
37. 05-04-18 4.1 14-04-18 4.1 37. 02-05-18 4.4
898 Rosyidi et al., Biomed. & Pharmacol. J, Vol. 12(2), 893-899 (2019)

Table 4. Analysis Paired T Test

Pre_OP Post_OP Post_Treatment

Pre_OP Pearson Correlation 1 0,264 0,475**

Sig. (2-tailed) 0,115 0,003
Sum of Squares and Cross-products 6,177 1,548 3,241
Covariance 0,172 0,043 0,090
N 37 37 37
Post_OP Pearson Correlation 0,264 1 0,531**

Sig. (2-tailed) 0,115 0,001
Sum of Squares and Cross-products 1,548 5,587 3,444
Covariance 0,043 0,155 0,096
N 37 37 37
PostTreatment Pearson Correlation 0,475** 0,531** 1
Sig. (2-tailed) 0,003 0,001
Sum of Squares and Cross-products 3,241 3,444 7,532
Covariance 0,090 0,096 0,209
N 37 37 37

\**. Significant 0,0

ability, for example in water, calcium and sodium. the use of their Snakehead Fish (Channa striata)
Albumin is a transport protein that is important for Extract Capsule; Medical Faculty of Mataram
fatty acids, bilirubin, hormones, and various kinds University; West Nusa Tenggara Provience General
of drugs.12 Hospital, Mataram Indonesia; The authors whose
Hypotension, increased blood sugar, names are listed immediately below certify that
and hypoalbuminemia are poor predictors of they have NO affiliations with or involvement
brain injury patients.13. Although albumin affects in any organization or entity with any financial
outcomes in brain injury patients, albumin is not interest (such as honoraria; educational grants;
a good choice for the resuscitation phase. A post- participation in speakers’ bureaus; membership,
hoc analysis of the use of albumin for correction of employment, consultancies, stock ownership,
hypovolemia in brain injury patients actually has or other equity interest; and expert testimony
a negative impact. The use of albumin to correct or patent-licensing arrangements), or non-
hypovolemia in critically ill patients is no better financial interest (such as personal or professional
than crystalloid use. Therefore, although albumin relationships, affiliations, knowledge or beliefs)
has an important role in the transportation of drugs, in the subject matter or materials discussed in this
hormones, and various other important substances, manuscript
albumin should not be used for hypovolemia.13
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