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" ABSTRAKLatar belakang. Sepsis masih menjadi masalah di bidang neonatalogi sampai saat ini karenadapat meningkatkan mortalitas dan morbiditas. Kolestasis merupakan salah satu morbiditasyang terjadi selama sepsis. Angka kematian dan lama perawatan di rumah sakit akanmeningkat pada sepsis neonatorum yang disertai kolestasis. Asam ursodeoksikolat (AUDK)dilaporkan dapat memperbaiki luaran kolestasis pada dewasa dan anak. Penelitian mengenaimanfaat AUDK pada neonatus masih terbatas, sampai saat ini belum ada penelitian tentangmanfaat AUDK pada kolestasis terkait sepsis (KTS).Tujuan. Mengetahui pengaruh AUDK terhadap penurunan parameter fungsi hati (bilirubintotal/direk/indirek, AST, ALT, GGT), angka kematian, dan lama rawat neonatus denganKTS.Metode. Penelitian ini merupakan uji klinis acak tersamar ganda yang dilakukan di DivisiNeonatologi Departemen IKA FKUI-RSCM dari Januari - Oktober 2012. Neonatus yangmemenuhi kriteria inklusi dibagi secara random menjadi 2 kelompok (AUDK atau plasebo).Asam ursodeoksikolat diberikan 30 mg/kgBB/hari dibagi 3 dosis selama 7 hari. Parameterfungsi hati di evaluasi setelah 7 hari pengobatan. Luaran utama adalah penurunan nilaibilirubin total/direk/indirek, AST, ALT, dan GGT. Luaran tambahan adalah angka kematiandan lama rawat. Analisis statistik untuk luaran utama dan lama rawat dilakukan dengan ujit/uji Mann-Whitney. Perbedaan kematian di analisis dengan uji x2 dan perbedaan survivaldengan metode Kaplan Meier.Hasil : Penelitian dilakukan pada 37 subjek, 19 subjek pada kelompok AUDK dan 18 subjekpada kelompok plasebo. Perbedaan perubahan parameter fungsi hati antara kelompok AUDKdan kelompok plasebo tidak bermakna [bilirubin total (2,2 ± 2,9 vs 1,7 ± 4,6; p= 0,080),bilirubin direk (1,1 ± 2,3 vs 0,6 ± 3,6; p= 0,080), bilirubin indirek [0,4 (0,1-5,6) vs 0,9 (0,1-4,1); p= 0,358], ALT (0,5 [(-80,0) – (21,0)] vs -2,0 [(-167,0) – (85,0)]; p= 0,730), AST (43,0(14,0-297,0) vs 150,0 (24,0-840,0); p= 0,081), and GGT (125,0 (48,0-481,0) vs 235,0 (56,0-456,0); p= 0,108)], tetapi perubahan nilai bilirubin total, bilirubin direk, dan AST cenderunglebih baik pada kelompok AUDK. Penurunan nilai bilirubin total terjadi pada 85,7% subjekkelompok AUDK dan 64,3% pada kelompok plasebo. Nilai bilirubin direk menurun pada78,6% subjek kelompok AUDK dan 64,3% subjek kelompok plasebo. Penurunan nilai ASTterdapat pada 57% subjek kelompok AUDK dengan penurunan terbesar 72 U/L, sedangkanpada kelompok plasebo 57% subjek mengalami peningkatan nilai AST dengan peningkatantertinggi 473 U/L. Kematian terjadi pada 10,5% subjek di kelompok AUDK dan 27,7% dikelompok plasebo (p=0,232). Dari analisis kesintasan tidak terdapat perbedaan survivalantara kedua kelompok. Tidak terdapat perbedaan rentang waktu lama rawat antarakelompok AUDK (15-70) hari dan kelompok plasebo (10-88) hari (p=0,148).Simpulan : Pemberian AUDK 30 mg/kg/hari selama 7 hari cenderung menurunkan nilaibilirubin total, bilirubin direk, AST, serta angka kematian meskipun secara statistik tidakterbukti bermakna. Hal ini masih mungkin disebabkan oleh power yang kurang padapenelitian ini. Penelitian ulang perlu dilakukan dengan jumlah sampel yang lebih besar dandurasi pemberian AUDK yang lebih panjang.

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<ABSTRACTBackground. Sepsis is still an important issue in Neonatology field since it is related withhigh mortality and morbidity. Cholestasis is one of the morbidities that related with sepsis.Mortality and length of hospital stay will be increased in neonatal sepsis that associated withcholestasis. Efficacy of ursodeoxycholic acid (UDCA) in cholestasis has been reported fromadult and pediatric population, however there is no publication regarding the efficacy of thisdrug in neonates with sepsis associated cholestasis.Objectives. To investigate the role of UDCA in liver function parameter (total, direct,indirect bilirubin, AST, ALT, GGT), mortality, and length of hospital stay in neonates withsepsis associated cholestasis.Methods. A randomized controlled trial were done in Neonatology Division, PediatricDepartment, Cipto Mangunkusumo Hospital from January to October 2012. Neonates thatfulfilled the inclusion criteria, randomized into UDCA group and placebo group. We gaveursodeoxycholic acid 30 mg/kg BW/day which divided into 3 doses for 7 days. Liverfunction test were done after 7 days treatment. Primary outcome are an improvement of liverfunction parameter and the secondary outcome are mortality rate and length of hospital stay.Statistical analysis with t test/ Mann-Whitney test was done for primary outcome and lengthof hospital stay, x2 test for differences of mortality, and Kaplan Meier method for survivalanalysis.Result. There were 37 subject, 19 subject in UDCA group and 18 in placebo group. Therewere no significant differences of liver function parameter between UDCA group andplacebo [total bilirubin (2.2 ± 2.9 vs 1.7 ± 4.6; p= 0.080), direct bilirubin (1.1 ± 2.3 vs 0.6 ±.6; p= 0.080), indirect bilirubin [0.4 (0.1-5.6) vs 0.9 (0.1-4.1); p= 0.358], ALT (0.5 [(-80.0) –(21.0)] vs -2.0 [(-167.0) – (85.0)]; p= 0.730), AST (43.0 (14.0-297.0) vs 150.0 (24.0-840.0);p= 0.081), and GGT (125.0 (48.0-481.0) vs 235,0 (56.0-456.0); p= 0.108)]. Although that,there were a better improvement of total bilirubin, direct bilirubin, and AST in UDCA group.Decrease of total bilirubin and direct bilirubin level occurred in 85.7% and 78.6% in UDCAgroup vs 64.3% and 64.3% in placebo group. For the AST level, there was an improvementin 57% subject UDCA with the profound declining 72 U/L; conversely, deteriorationoccurred in 57% subject placebo, with the maximal increment 473 U/L. Mortality occurredin 10.5% subject in UDCA group and 27.7% placebo group (p=0.232). There were nodifferences of survival from both groups. Length of hospital stay in UDCA and placebogroup were 15-70 days and 10-88 days (p=0.148).Conclusion: UDCA treatment 30 mg/kgBW/day for 7 days tends to decrease the totalbilirubin, direct bilirubin, AST level, and mortality, although not statistically significant.This could be happened due to the limitation of power in this study. Future studies withlarger subject and longer duration of UDCA treatment will be needed."

"Latar Belakang: Neonatus kurang bulan berisiko mengalami hiperbilirubinemia 12,5 kali lipat lebih besar dibandingkan neonatus cukup bulan, 54% membutuhkan fototerapi. Hiperbilirubinemia dapat menyebabkan neurotoksisitas hingga kematian, sedangkan fototerapi dapat menyebabkan beberapa komplikasi. Terapi ajuvan seperti asam ursodeoksikolat diperlukan untuk meningkatkan klirens bilirubin sehingga mengurangi durasi fototerapi. Saat ini belum ada data yang tersedia mengenai pengaruh penambahan asam ursodeoksikolat terhadap durasi fototerapi pada neonatus kurang bulan dengan hiperbilirubinemia.Tujuan: Penelitian ini bertujuan untuk menentukan durasi fototerapi dan penurunan kadar bilirubin pada neonatus kurang bulan yang mendapat fototerapi dan tambahan asam ursodeoksikolat.Metode: Penelitian ini merupakan uji klinis, terandomisasi, tersamar ganda, dengan kontrol plasebo, mencakup neonatus usia gestasi <37 minggu, mengalami hiperbilirubinemia yang terindikasi fototerapi, dirawat di unit perinatologi Rumah Sakit Dr. Cipto Mangunkusumo sejak bulan Februari-Mei 2024, sudah mendapat minum per oral sebanyak ≥10 mL/kgBB/hari. Grafik American Academy of Pediatrics (AAP) tahun 2022 dan The Royal Women’s Hospital (RWH) tahun 2020 digunakan untuk menentukan batas fototerapi. Total 40 subjek yang dibagi menjadi 2 kelompok. Kelompok intervensi (n=20) mendapat asam ursodeoksikolat 10 mg/kgBB/hari (puyer) dibagi 2 dosis sebagai terapi tambahan fototerapi, sedangkan kelompok kontrol (n=20) hanya mendapat fototerapi. Kadar bilirubin total diukur setiap 24 jam dengan serum dan/atau Bilistick. Hasil: Rerata durasi fototerapi adalah 24 jam pada kelompok intervensi, 36 jam pada kelompok kontrol (p=0,289). Di kelompok intervensi, penurunan kadar bilirubin setelah 24 jam fototerapi 4,15 ± 5,50 mg/dL (p=0,758), setelah 48 jam fototerapi 4,99 ± 7,66 mg/dL (p=0,664). Kadar bilirubin setelah 48 jam fototerapi lebih rendah bermakna pada neonatus yang mendapat asam ursodeoksikolat (p=0,020).Kesimpulan: Penambahan asam ursodeoksikolat tidak mengurangi durasi fototerapi maupun mempercepat penurunan kadar bilirubin pada neonatus kurang bulan dengan hiperbilirubinemia yang mendapat fototerapi setelah 24 jam dan 48 jam. Penelitian lanjutan perlu dilakukan sampai jumlah sampel terpenuhi.

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Background: Preterm neonates have a 12.5 times higher risk of developing hyperbilirubinemia compared to full-term neonates, with 54% requiring phototherapy. Hyperbilirubinemia can lead to neurotoxicity and even death, while phototherapy can cause several complications. Adjuvant therapy, such as ursodeoxycholic acid, is needed to increase bilirubin clearance and reduce the duration of phototherapy. Currently, there is no available data on the effect of adding ursodeoxycholic acid on the duration of phototherapy in preterm neonates with hyperbilirubinemia.

Objective: This study aims to determine the duration of phototherapy and the reduction of bilirubin levels in preterm neonates who receive phototherapy and additional ursodeoxycholic acid.

Method: This study is a randomized, double-blind, placebo-controlled clinical trial, involving neonates with a gestational age of less than 37 weeks who have hyperbilirubinemia requiring phototherapy, treated in the perinatology unit of Dr. Cipto Mangunkusumo Hospital from February to May 2024, and who have been fed orally at least 10 mL/kgBW/day. The 2022 American Academy of Pediatrics (AAP) and 2020 The Royal Women’s Hospital (RWH) charts were used to determine the phototherapy threshold. A total of 40 subjects were divided into 2 groups. The intervention group (n=20) received 10 mg/kgBW/day of ursodeoxycholic acid (powder) divided into 2 doses as an additional phototherapy treatment, while the control group (n=20) received only phototherapy. Total bilirubin levels were measured every 24 hours using serum and/or Bilistick.

Results: The average duration of phototherapy was 24 hours in the intervention group and 36 hours in the control group (p=0.289). In the intervention group, the reduction in bilirubin levels after 24 hours of phototherapy was 4.15 ± 5.50 mg/dL (p=0.758), and after 48 hours of phototherapy was 4.99 ± 7.66 mg/dL (p=0.664). Bilirubin levels were significantly lower after 48 hours of phototherapy in neonates who received ursodeoxycholic acid (p=0.020).

Conclusion: The addition of ursodeoxycholic acid did not reduce the duration of phototherapy nor accelerate the decrease of bilirubin levels in preterm neonates with hyperbilirubinemia who received phototherapy after 24 and 48 hours. Further research needs to be conducted until the sample size is sufficient."

"Latar belakang. Kolestasis terkait sepsis (KTS) masih merupakan permasalahan medis di negara berkembang disebabkan tingginya morbiditas, mortalitas dan lama rawat. Inflamasi usus akibat disfungsi sawar usus diduga berperan dalam KTS sehingga perlu dibuktikan perannya terhadap terjadinya KTS. Inflamasi dan permeabilitas mukosa usus dapat dinilai melalui kadar kalprotektin dan alfa-1 antitripsin (AAT) pada tinja.Tujuan. Untuk mengetahui hubungan antara terjadinya KTS pada sepsis neonatorum dengan inflamasi dan gangguan permeabilitas usus yang dinilai dengan peningkatan kadar kalprotektin dan α-1-antitripsin dalam tinja. Metode. Studi kohort prospektif di ruang rawat inap Perinatologi dan Neonatal Intensive Care Unit Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo periode Juni 2012- Oktober 2013. Delapan puluh neonatus diambil secara consecutive sampling dari 271 subjek proven sepsis yang dirawat pada periode studi ini, terbagi menjadi 2 kelompok (KTS dan sepsis tidak kolestasis) masing-masing 40 subjek. Dilakukan pemeriksaan kadar kalprotektin dan AAT tinja.Hasil penelitian. Tidak ditemukan perbedaan antara KTS dan sepsis tidak kolestasis dalam ekskresi kalprotektin tinja [KTS vs. sepsis tidak kolestasis, median (rentang) 104,4 (25 sampai 358,5) vs. 103,5 (5,4 sampai 351) μg/g; p = 0,637] dan alfa-1 antitripsin tinja [median (rentang) 28 (2 sampai 96) vs. 28 (2 sampai 120) mg/dL; p = 0,476). Tidak ditemukan peningkatan bermakna kadar kalprotektin tinja dengan nilai p = 0,63 (IK 95% 0,4 sampai 3,6) dan kadar AAT tinja dengan nilai p=0,152 (IK 95% 0,4 sampai 3,3).Simpulan. Kadar kalprotektin dan alfa-1 antitripsin tinja tidak terbukti dapat memprediksi kejadian KTS pada sepsis neonatorum. Tidak ada bukti proses inflamasi usus yang terjadi pada KTS melalui peningkatan permeabilitas paraselular usus. Perlu dilakukan penelitian lebih lanjut mengenai patogenesis inflamasi usus yang terjadi melalui peningkatan permeabilitas trans-selular dan kerusakan enterosit usus pada KTS.

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Background. Sepsis-associated cholestasis (SAC) remain a medical problem in developing countries due to high morbidity, mortality and length of hospital. Intestinal inflammation as the causes of intestinal barrier dysfunction are suspected play a role in SAC, so it is necessary to prove its contribution to SAC. Intestinal inflammation and increased permeability were assessed through faecal calprotectin and alpha-1 antitrypsin (AAT) concentrations.Objective. To determine the association between SAC in sepsis neonatorum with intestinal inflammation and permeability were assessed through increased faecal calprotectin and AAT levels.Methods. This was cohort prospective study at Perinatologi and Neonatal Intensive Care Unit Department of Child Health Cipto Mangunkusumo Hospital during June 2012 to October 2013. Eighty neonates were obtained by consecutive sampling, of which 271 proven sepsis hospitalized in this period, devided 2 groups (SAC and non cholestasis sepsis) respectively 40 subjects. Faecal calprotectin and AAT concentrations was measured.Results. There was no significant association between SAC and faecal calprotectin excretion [SAC vs. non cholestasis sepsis, median (range) 104.4 (25 to 358,5) vs. 103.5 (5.4 to 351) μg/g; p = 0.637] and faecal AAT [median (range) 28 (2 to 96) vs. 28 (2 to 120) mg/dL; p = 0.476). Increased faecal calprotectin (CI 95% 0.4 to 3.6; p = 0,63) and AAT (CI 95% 0.4 to 3.3; p=0.152) did not differ significantly between the two groups.Conclusions. Faecal calprotectin and alpha-1 antitrypsin concentrations is not associated with SAC in sepsis neonatorum. There is no evidence of intestinal inflammation causes increased paracellular intestinal permeability in SAC. Further research is needed on the pathogenesis of intestinal inflammation in SAC which may result in increased intestinal permeability by transcellular and enterocyte damage."

"Latar Belakang. Mortalitas akibat sepsis di ICU masih cukup tinggi meskipun telah semakin cepatnya diagnosis dan perbaikan perawatan suportif dan angkanya semakin meningkat dengan insiden acute kidney injury yang merupakan bagian dari disfungsi organ akibat sepsis. Asam askorbat dikatakan dapat memperbaiki disfungsi organ disebabkan efeknya yang sinergis terhadap patofisiologi sepsis. Peranan asam askorbat dalam menurunkan disfungsi organ masih kontroversial. Penelitian ini ingin menganalisis efek pemberian asam askorbat intravena terhadap perbaikan fungsi ginjal pada pasien sepsis/ syok sepsis yaitu dengan melihat efek terhadap kadar urin neutrophil gelatinase associated lipocalin (uNGAL), produksi urin dan balans kumulatif. Metodologi. Penelitian ini merupakan penelitian uji klinis dengan desain penelitian uji acak terkontrol, dilakukan pada pasien usia > 18 tahun dengan sepsis berdasarkan kriteria sepsis-3 yang masuk ICU dalam 6 sampai 24 jam pascaresusitasi setelah diagnosis sepsis. Kriteria penolakan yaitu pasien dengan gangguan ginjal kronik dengan hemodialisis, kelainan batu ginjal, dengan masalah ginjal dalam 3 bulan terakhir. Pasien akan dikeluarkan apabila diberikan kortikosteroid dan mendapatkan terapi pengganti ginjal dalam < 72 jam observasi. Penelitian dilakukan di ICU Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo pada April 2019-Juli 2019. Sebanyak 33 sampel dirandomisasi secara randomisasi sederhana dan dikelompokan menjadi kelompok perlakuan (18 sampel) dan kontrol (15 sampel). Data demografik dasar dicatat saat masuk ICU. NGAL urin (ng/mL) diperiksa pada jam 0, 24, 48 dan 72 setelah terapi. Produksi urin (ml/kg/jam) dan balan kumulatif (L) dicatat pada jam 24, 48 dan 72 setelah terapi. Analisis statistik dengan uji Mann Whitney untuk data numerik dengan persebaran tidak normal, uji T independen untuk data dengan persebaran normal dan uji Fisher untuk data kategorik perbandingan antara kedua kelompok intervensi. Analisis multivariat untuk pengukuran serial menggunakan generalized estimating equations (GEE) untuk membandingkan antara kedua kelompok dalam waktu pengukuran yang berulang. Nilai signifikansi dengan nilai p < 0,05. Hasil. Tidak terdapat perbedaan pada kadar NGAL urin, produksi urin, balans kumulatif antara dua kelompok di setiap jamnya. Kesimpulan. Pada penelitian ini pemberian asam askorbat intravena tidak mempunyai efek terhadap kadar NGAL urin, produksi urin, balans kumulatif.

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Background. Sepsis-related mortality in intensive care unit (ICU) remains despite improved diagnostic technology and supportive treatment. Acute kidney injury, one of frequent organ dysfunctions in sepsis, increases risk of mortality. Ascorbic acid could improve organ dysfunction because its direct effect on sepsis pathophysiology. The role of ascorbic acid on improving organ dysfunction remains controversial. This study wished to analyze the effects of intravenous ascorbic acid on kidney function improvement among septic patients by evaluating urine neutrophil gelatinase associated lipocalin (uNGAL), urine output and cumulative fluid balance.

Method. This study was randomized controlled trial held in Cipto Mangunkusumo Hospital from April to July 2019. The inclusion criteria were adult patients aged > 18 years who met sepsis-3 criteria and were admitted to the ICU within 6-24 h after resuscitation and sepsis recognition. The exclusion criteria were patients with hemodialysis-dependent chronic kidney disease, kidney stones or other kidney problems within last 3 months. The drop out criteria were patients underwent renal replacement therapy in the ICU and given corticosteroid less than 72 h after recruitment. Subjects were randomized using simple randomization and divided into two groups with treatment (18 subjects) and control (15 subjects). Baseline demographic data was recorded on the first day. Daily measurements of urine NGAL (ng/ mL) was started as baseline level and continued at 24, 48 and 72 h after treatment. Urine output (ml/kg/h), cumulative fluid balance (L) was recorded at at 24, 48 and 72 h after treatment. Comparison between both groups was analysed by using Mann Whitney test (not normally distributed data), T independent test (normally distributed data) for numerical data and Fisher test for categorical data. Multivariate analysis using generalized estimating equations was used for serial measurement analysis. Level of significant was determined at p-value <0.05.

Result. There were no significant differences in uNGAL, urine output, cumulative fluid balance between the two groups at each hour respectively.

Conclusion. This study showed that intravenous vitamin CMultin administration had no effect on urine NGAL, urine output, cumulative fluid balance."

"Latar belakang: Sepsis pascabedah jantung terbuka merupakan kondisi yang jarang terjadi tetapi memiliki mortalitas yang cukup tinggi. Gejala sepsis yang muncul pascabedah seringkali sulit dibedakan dengan kondisi inflamasi sistemik sehingga menimbulkan keterlambatan dalam menegakkan diagnosis maupun overtreatment pada pasien. Presepsin merupakan salah satu penanda sepsis yang mulai banyak digunakan terutama pada populasi dewasa. Penelitian ini bertujuan untuk melihat peran presepsin dalam menegakkan diagnosis sepsis pascabedah jantung terbuka pada anak.Tujuan: Untuk menguji performa diagnostik presepsin sebagai penanda sepsis pada anak pascabedahjantung terbuka dibandingkan dengan prokalsitonin (PCT).Metode: Studi potong lintang terhadap 49 pasien anak pascabedah jantung terbuka yang dirawat di RSCM. Penelitian ini mencari nilai batas optimal presepsin untuk mendiagnosis sepsis pascabedah jantung terbuka pada anak yaitu pada hari pertama dan ketiga pascabedah, kemudian membandingkannya dengan prokalsitonin. Analisis kurva ROC dikerjakan untuk menentukan nilai batas optimal presepsin.Hasil: Kadar presepsin hari pertama (T1) dan ketiga (T3) lebih tinggi pada subyek dengan sepsis daripada subyek yang tidak sepsis (median 415 pg/mL vs. 141,5 pg/mL pada hari pertama dan 624 pg/mL vs. 75,9 pg/mL pada hari ke tiga). Titik potong presepsin pada T1 dengan nilai 404 pg/mL memiliki performa untuk mendiagnosis sepsis dengan AUC 0,752 sedangkan presepsin T3 dengan nilai 203,5 pg/mL dengan AUC 0,945 yang lebih baik dibandingkan T1.Simpulan: Presepsin dapat dijadikan suatu modalitas untuk memberikan nilai tambah dan pertimbangan bagi klinisi untuk menegakkan diagnosis sepsis pada pasien anak pascabedah jantung terbuka.

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Background: Postoperative open-heart sepsis is a rare condition but has a fairly high mortality. Symptoms of sepsis that appear postoperatively are often difficult to distinguish from systemic inflammatory conditions, causing delays in establishing diagnosis and overtreatment in patients. Presepsin is one of the markers of sepsis that is starting to be widely used, especially in the adult population. This study is to identify the role of presepsin for diagnosing sepsis in post open-heart surgery in pediatric population.

Aim: To perform diagnostic test of presepsin as sepsis screening markers compares to procalcitonin (PCT) in post open-heart surgery.

Methods: Cross-sectional study of 49 postoperative open-heart pediatric patients treated at RSCM. This study looked for optimal cut-off values of presepsin for diagnosing open-heart postoperative sepsis in children on the first and third postoperative days, then compared it with procalcitonin. ROC curve analysis is performed to determine the optimal limit value of presepsin.

Result: First (T1) and third day (T3) PSP levels were higher in subjects with sepsis than non- sepsis (median 415 pg/mL vs. 141.5 pg/mL on first day and 624 pg/mL vs. 75.9 pg/mL on third day). ). T1 presepsin cut off 404 pg/ml had AUC of 0.772, while T3 presepsin cut off 203.5 og/ml had better AUC of 0.945. T3 is better for diagnosing sepsis.

Conclusion: Presepsin can be used as a modality to provide added value and consideration for clinicians to establish the diagnosis of sepsis in pediatric patients after open-heart surgery."

"Menentukan penyebab kolestasis merupakan tantangan tersendiri, namun hal itu perlu mendapatkan perhatian khusus karena akan menentukan langkah selanjutnya. Leptospirosis, yang dapat bermanifestasi sebagai kolestasis, mempunyai gambaran klinis yang sangat bervariasi sehingga penegakkan diagnosis seringkali sulit. Pada makalah ini dilaporkan kasus laki-laki, usia 50 tahun dengan nyeri perut kanan atas dan kolestasis disertai gangguan fungsi ginjal, pneumonia dan gambaran EKG abnormal. Pemeriksaan serologi leptospira menunjukkan hasil IgM positif. Perlu dipertimbangkan pemeriksaan screening leptospirosis pada pasien dengan kolestasis terutama pasien dengan risiko tinggi terinfeksi leptospira.

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Discovering the etiology of cholestasis is challenging, but it requires particular rconsideration, because it will determine our next steps. While leptospirosis may cause cholestasis, leptospirosis has diverse clinical spectrum so that it is often difficult to establish the diagnosis. We reported a fifty-year-old man with right upper quadrant abdominal pain and cholestasis. In addition, we also found distorted renal function, pneumonia, and ECG abnormalities. The patient underwent serologic test for leptospiral infection and the IgM was positive. These findings showed the necessity for considering leptospirosis screening in patients with cholestasis especially those in higher risk group."

"Pemantauan Terapi Obat pada Neonatus Kurang Bulan, Bayi Berat Lahir Rendah, dan Sepsis di Ruang Neonatus Intensive Care Unit (NICU) RSUP Fatmawati Bulan September 2020.

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Neonates, especially preterm infants have weak physical defenses and immature immune function, making them susceptible to bacterial invasion. One of the efforts to achieve the Sustainable Development Goals (SDGs), which is to reduce the incidence of neonatal mortality to 12 per 1,000 live births, it is necessary to collaborate between health workers in treating patients. Pharmacists in hospitals need to carry out their roles, one of which is by monitoring the therapy given. Data were collected directly by looking at the cardex and patient's medical records with the following criteria: less-month neonatal patients, receiving polypharmacy, patients with antibiotic therapy, and length of stay in the hospital ≥5 days. The data obtained were analyzed using the SOAP method and identified problems related to drugs. From the Monitoring of Drug Therapy (PTO), it was found that drug-related problems that occurred were dose mismatches and frequency mismatches, and analysis of the evaluation of antibiotic administration (EPA) with the Gyssens method found that the use of antibiotics was found in category IIIa, namely giving meropenem too long and category IIa, which was not the right dosage."

"Ikterus pada kolestasis merupakan refleksi dari keadaan patologis yang serius. Kolestasis-sepsis adalah suatu bentuk kolestasis hepatoselular yang timbul pada saat atau setelah proses sepsis akibat gangguan transpor empedu. Penelitian ini adalah penelitian kohort terhadap pasien sepsis neonatorum yang dirawat di Divisi Neonatologi Departemen IKA FKUI-RSCM antara Februari sampai dengan Juni 2007. Tujuan penelitian ini adalah mengetahui angka kejadian kolestasis intrahepatik, faktor resiko terjadinya kolestasis dan angka kematian pada sepsis neonatorum dengan kolestasis. Dari 138 subyek, didapatkan angka kejadian kolestasis intrahepatik sebesar 65,9%. Faktor-faktor risiko yang diteliti secara statistik tidak ada yang bermakna terhadap terjadinya kolestasis. Angka kematian sepsis neonatorum dengan kolestasis 52,8%.

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Cholestatic jaundice represents serious pathological condition. Septic-cholestasis is a kind of hepato-cellular cholestasis that occured during or after sepsis caused by biliary flow obstruction. This is a cohort study from February to June 2007 on neonatal sepsis patients at Neonatology ward Department of Child Health Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General National Hospital. Aim of this study is to find out the incidence of intrahepatic cholestasis in neonatal sepsis, associated risk factors, and mortality rate in neonatal cholestasis-sepsis. From 138 neonatal sepsis patients, the incidence of intrahepatic cholestasis is 65.9%. None of the risk factors tested in this study showed statistically significant result. Mortality rate of neonatal cholestasis-sepsis is 52.8%."

"Latar Belakang: Proses inflamasi dengan respons maladaptif merupakan mekanisme terjadinya disfungsi multiorgan dan kematian pada sepsis. Heparin merupakan sediaan yang digunakan secara luas untuk terapi gangguan koagulasi, secara in-vitro heparin juga memiliki pengaruh sebagai antiinflamasi melalui penurunan aktivitas nuclear factor kappa B (NFkB) dan tumor necrosis factor alpha (TNF-. Penggunan heparin pada sepsis, khususnya sebagai antiinflamasi, masih merupakan kontroversi dan memerlukan penelitian lebih lanjut.Tujuan Penelitian: Tujuan primer penelitian ini adalah mengetahui pengaruh terapi heparin terhadap konsentrasi NFkB, inhibitor kappa B kinase beta (IKK dan TNF-pada pasien sepsis berat Tujuan sekunder adalah menilai pengaruh terapi heparin terhadap mortalitas dan perbaikan disfungsi organ.Metode: Uji klinis acak tersamar ganda membandingkan terapi heparin tidak terfraksinasi, dosis 10 unit/kg berat badan/24 jam, infus kontinu selama 72 jam, dengan plasebo. Kriteria inklusi adalah: subjek usia 18 tahun atau lebih dengan sepsis berat awitan maksimal 48 jam dan bersedia berpartisipasi dalam penelitian. Seleksi subjek dilakukan secara konsekutif dengan alokasi subjek secara acak. Pemantauan terhadap respons klinis dilakukan dengan menilai mortalitas 14 hari serta perbaikan skor APACHE II. Analisis intention to treat (ITT) dilakukan terhadap subjek yang telah mendapat terapi heparin minimal selama 24 jam, pada subjek yang melengkapi seluruh protokol penelitian dilakukan analisis per-protocol (PP).Hasil: Sebanyak 115 subjek telah diinklusi dan dirandomisasi, 58 subjek mendapat heparin dan 57 subjek plasebo. Rentang usia 21 hingga 82 tahun dengan rerata 51 tahun. Analisis ITT dan PP dilakukan terhadap masing-masing 46 dan 22 subjek kelompok heparin dan 50 dan 28 subjek kelompok kontrol. Tidak didapatkan perbedaan yang bermakna konsentrasi NFkBterfosforilasi dan IKK terfosforilasi kelompok heparin dibandingkan kontrol. Didapatkan penurunan konsentrasi TNF-pada kelompok heparin dibandingkan kontrol walaupun secara statistik belum bermakna. Didapatkan penurunan mortalitas pada analisis PP (RR 0,212 [IK 95% 0,053 - 0,815], p = 0,008), dengan ARR 33,8 % dan NNT 3. Terdapat kecenderungan perbaikan disfungsi organ pada kelompok heparin, walaupan secara statistik belum menunjukkan kemaknaan.Simpulan: Terapi heparin memberikan pengaruh terhadap proses inflamasi pada pasien sepsis berat, terlihat dari penurunan konsentrasi TNF-, walaupun pada pengujian statistik tidak didapatkan perbedaan bermakna. Tidak didapatkan pengaruh terapi heparin terhadap penurunan konsentrasi IKKdanNFkB. Heparin memberikan manfaat terhadap penurunan mortalitas, terutama pada subjek yang mendapat heparin selama 72 jam. Pada pengamatan selama 72 jam, heparin belum telihat memberikan pengaruh terhadap perbaikan disfungsi organ.

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Background. Multiple organ dysfunction and mortality in sepsis are developed as the consequence of the inflammation with maladaptive host response. Heparin has been widely used as an anticoagulant treatment. Based on in vitro evaluation, heparin has an antiinflammatory property by reducing the activity of nuclear factor kappa B (NFkB) and tumor necrosis factor alpha (TNF-. However, the effect of heparin as the anti-inflammatory agent is still controversial. To ascertain the anti-inflammatory effects of heparin in sepsis, further study is needed.Objectives. The primary aim of this study was to determine the effect of heparin in severe sepsis based on the concentration of NFkB, Inhibitor kappa B kinase beta (IKK), and TNF-. Secondary objective was to determine the effect of heparin on mortality rate and improvement of organ dysfunction.Methods. A randomized, double-blind, clinical trial was conducted to compare the unfractionated heparin (UFH) treatment, in dosage of 10 units/ kg BW for 24 hours, continuous infusion for 72 hours, in comparison to placebo. The inclusion criteria were subject 18 years old or above, with severe sepsis in maximum 48 hours after onset and agreed to participate in this study. Furthermore, subjects were consecutively selected and randomly allocated. Clinical responses were monitored by evaluating the 14-days mortality rate and improvement of APACHE II score. Subjects who had received heparin treatment for at least 24 hours were analyzed by intention to treat (ITT), while others who had completed all the protocol, were analyzed by per protocol (PP).Results. There were 115 subjects included and randomly assigned to heparin (n = 58) and placebo (n = 57) groups. The range of age was 21 to 82 years, mean of age was 51 years. ITT and PP analysis were conducted to 46 and 22 subjects in heparin group; 50 and 28 subjects in control group respectively. There were no significant differences in concentration of Phosphorylated-NFkB and Phosphorylated-IKK in both groups. The concentration of TNF-decreased in heparin groups, although statistically was not significant. The 14 days mortality rate reduced in PP analysis (RR 0.212 [95% CI 0.053 – 0.815], p = 0.008), with ARR 33.8 % and NNT 3. Moreover, there are trend of organ dysfunction improvement in heparin group, yet not statistically significant.Conclusion. Heparin treatment has an impact on inflammatory process in severe septic patients; as shown in the reduction of the TNF- concentration, although was not significant statistically. There was no clear impact of heparin treatment on IKK and NFkB concentration. Moreover, heparin shows benefit in reducing the mortality, especially in subjects who has received heparin for 72 hours. No benefit on improvement of organ dysfunction was shown in 72-hour monitoring of heparin treatment."

"Pada sepsis terjadi inflamasi sistemik yang menyebabkan ketidakseimbangan mekanisme hemostasis, yaitu, peningkatan aktivasi koagulasi, penurunan antikoagulan alamiah, dan penurunan aktivitas fibrinolisis. Ketidakseimbangan ini bermanifestasi pada pembentukan trombus mikrovaskular yang menyebabkan perfusi jaringan menurun, terjadi disfungsi organ dan kematian. Tujuan penelitian ini mengetahui peranan kadar D-dimer, kadar FDP dan rasio FDP/D-dimer dalam memprediksi mortalitas 14 hari pada pasien sepsis. Penilaian skor Acute physiology and Chronic Health Evaluation II (APACHE II) digunakan untuk memprediksi morbiditas dan mortalitas. Desain penelitian potong lintang, penyajian data secara deskriptif. Subjek penelitian berjumlah 55 orang yang terdiri dari 32 laki-laki dan 23 perempuan dengan rerata usia 51,62 tahun. Pada subjek penelitian, dinilai korelasi kadar FDP, kadar D-dimer, dan rasio FDP/D-dimer dengan skor APACHE II. Pada hasil penelitian, didapatkan 20 pasien hidup dan 35 pasien meninggal. Median kadar FDP (12,9μg/mL) dan kadar D-dimer (7μg/mL) subjek meninggal lebih tinggi dibandingkan median kadar FDP (10,9μg/mL) dan kadar D-dimer (5,2 μg/mL) subjek hidup. Median rasio FDP/D-dimer subjek meninggal (1,9) lebih rendah dibandingkan subjek hidup (2,1). Koefisien korelasi Spearman antara kadar FDP, kadar D-dimer, dan rasio FDP/D-dimer dengan skor APACHE II berturut-turut 0,176, 0,187, dan -0,182. Ketiga korelasi itu secara statistik tidak bermakna (p ≥ 0,05). Pada penelitian ini disimpulkan bahwa kadar FDP, kadar D-dimer, dan rasio FDP/D-dimer tidak dapat digunakan sebagai prognosis keluaran sepsis pada mortalitas 14 hari.

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Systemic inflamation in sepsis could leads to an imbalance homeostatic mechanisms including elevated coagulation activity, decreasing level of natural anticoagulant, and decreased fibrinolysis activity. This could leads to formation of microvascular thrombus which eventually will cause tissue hypoperfusion, organ dysfunction and death. The aim of this research is to understand the role of d-dimer and fibrin degradation products (FDP) and FDP/d-dimer ratio in predicting 14-days mortality rate on sepsis patient. The morbidity and mortality rate on this research were based on APACHE II scoring system. This is a cross sectional research and all data are presented in a descriptive report. Participant of this research was 55 people (32 male and 23 female), average age was 51,62 years old. This research evaluate the correlation between FDP level, d-dimer level and FDP/d-dimer ratio with APACHE II scoring system. From all the participant we had 20 subject alive and 35 died during this research. The median level of FDP (12,9μg/mL) and d-dimer (7μg/mL) in those who die were higher than those who live (10,9μg/mL and 5,2 μg/mL). The median FDP/d-dimer ratio in those who die (1,9) was lower comparing to those who live (2,1). Spearman coefficient of correlation between FDP level, d-dimer level and FDP/d-dimer ratio with APACHE II scoring system were 0.176; 0.187; and -0.182 repectively. This was not significant statistically (p ≥ 0,05). This research has come to a conclusion that FDP and d-dimer level, and FDP/d-dimer ratio cant be used as a prognostic outcome in sepsis on 14 days mortality."