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"Therapeutic hypothermia has emerged as a very important treatment option for patients with cardiac arrest as it provides significant protection from developing neurologic injury once the patient has been successfully resuscitated. Studies have demonstrated over 15% absolute risk reduction in death and neurologic injury using this therapy. Although hospitals and medical centers have become familiar with this important intervention it still remains greatly under utilized due to an experience and lack of resources to safely and effectively deploy such a program. The objective of this book is to educate and familiarize both providers and institutions as to how to develop and deploy and provide therapeutic hypothermia to their patients. The current knowledge for this is provided by speakers and national experts and also by literature review. There are several courses being provided on this as well throughout the US. These are good venues for people to come and see and get hands on experience, but there still needs to be a concrete book with references on how to go about getting this program started."

"Hipospadia adalah salah satu penyakit kelainan kongenital yang sering terjadi pada laki- laki khususnya pada usia anak-anak. Hipospadia dapat disembuhkan dengan penatalaksanaan medis seperti pembedahan. Kondisi suhu kamar operasi yang dingin, peralatan medis yang bersuhu dingin, terbatasnya linen dan blanket warmer dapat berkontribusi terhadap kejadian hipotermia pada anak intraoperasi. Tujuan karya ilmiah akhir ini adalah menggambarkan analisis tindakan manajemen hipotermia dengan aktif dan pasif warming touch pada anak dengan hipospadia. Berdasarkan hasil evaluasi, teknik Manajemen hipotermia dengan active dan pasif warming touch mampu mengatasi hipotermia pada anak. Pernyataan tersebut dibuktikan dengan perbaikan suhu tubuh pasien kedalam rentang normal (36,5OC-37,5OC). Keberhasilan teknik ini juga didukung dengan tindakan caring perawat dalam memantau suhu tubuh pasien selama perioperative. Agar teknik manajemen hipotermia dengan active dan pasif warming touch ini lebih efektif untuk mengatasi hipotermia pada anak, pihak institusi pelayanan kesehatan perlu membuat kebijakan dalam bentuk Standar Prosedur Operasional atau instruksi kerja mengenai persiapan perioperative pada pasien anak dengan memprioritaskan waktu jadwal operasi, lama operasi, dan pemasangan blanket warmer yang mendorong adanya intervensi perioperative sesuai tumbuh kembang anak.

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Hypospadias is one of the most common congenital abnormalities in boys, especially at the age of children. Hypospadias can be cured with media management such as surgery. Cold operating room temperature conditions, cold medical equipment, limited linen and warmer blankets can contribute to the incidence of hypothermia in intraoperative children. The purpose of this final scientific paper is to describe the analysis of hypothermia management actions with active and passive warming touch in children with

hypospadias. Based on the evaluation results, hypothermia management techniques with active and passive warming touch are able to overcome hypothermia in children. This statement is evidenced by the improvement of the patient's body temperature into the normal range (36.5OC-37.5OC). The success of this technique is also supported by the caring actions of nurses in monitoring the patient's body temperature during perioperative. In order for the hypothermia management technique with active and passive warming touch to be more effective in dealing with hypothermia in children, the health care institution needs to make policies in the form of Standart Operational Procedure or work instructions regarding perioperative preparation in pediatric patients by prioritizing the operating schedule, duration of surgery, and the installation of appropriate blanket warmers. Encourage perioperative intervention according to the child's growth and development."

"Latar Belakang. Pada pasien gagal jantung refrakter yang disertai gangguan konduksi intraventrikular, Terapi Resinkronisasi Jantung (Cardiac resynchroni-zation therapy,CRT) diketahui merupakan cara yang efektif dalam memperbaiki kelas fungsional, fraksi ejeksi ventrikel kiri, uji jalan 6 menit, kualitas hidup, dan mengurangi angka hospitalisasi gagal jantung, serta angka mortalitas karena berkurangnya progresivitas penyakit tersebut. Namun demikian persoalan non-responder pasca-CRT masih merupakan masalah yang belum terselesaikan. Tujuan studi ini adalah untuk mengevaluasi ada atau tidaknya reverse remodeling yang ditunjukkan dengan disinkroni mekanis pasca-CRT dihubungkan dengan kapasitas fungsional pasien. Metodologi. Merupakan studi kroseksional dan retrospektif yang dilakukan di Pusat Jantung Nasional Harapan Kita, Jakarta. Semua pasien yang dilakukan pemasangan dari Januari 2008-Oktober 2012 dimasukkan dalam penelitian ini. Data pasien diambil dari data base rumahsakit, termasuk data klinis, EKG, ekokardiografi pra-pemasangan, dan data prosedur pemasangan. Disinkroni intraventrikular, interventrikular, dan atrioventrikular diukur melalui pemeriksaan ekokardiografi dengan Tissue Doppler Imaging (TDI). Kapasitas fungsional diukur melalui kelas fungsional NYHA serta uji jalan 6 menit. Pemeriksaan TDI, penilaian kelas fungsional NYHA dan uji jalan 6 menit dilakukan sedikitnya 6 bulan setelah pemasangan CRT. Hasil. Selama periode penelitian, sebanyak 32 pasien ikut dalam penelitian ini. Tidak ada komplikasi pemasangan. Rerata umur subjek adalah 60,3 + 13,5 tahun. Proporsi disinkroni yang masih terjadi pada subjek adalah 24 orang (75%) untuk disinkroni intraventrikular, 25 orang (78,1%) untuk disinkroni interventrikular, serta 11 orang (34,4%) pada disinkroni atrioventrikular. Rerata nilai Indeks Yu yang menggambarkan disinkroni intraventrikular berdasarkan kapasitas fungsional baik dan buruk secara berurutan adalah 39,04 + 10,69 vs 59,17 + 8,01 (p=0,001). Sedangkan untuk disinkroni interventrikular dan atrioventrikular sebesar 26,07 + 16,17 mdet vs 32,83 + 45,45 mdet (p=0,631) dan 42,76 + 8,65 vs 44,98 + 12,34 (p=0,485). Grafik korelasi linier menunjukkan bahwa adanya peningkatan disinkroni intraventrikular, berkorelasi kuat dengan penurunan kemampuan kapasitas fungsional yang ditunjukkan dalam uji jalan 6 menit (r=0,56;p=0,001). Kesimpulan. Disinkroni intraventrikular yang menetap pasca-pemasangan CRT berhubungan dengan kapasitas fungsional yang lebih buruk.

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Background. Cardiac resynchronization therapy (CRT) is an effective method in management of refractory heart failure with intra-ventricular conduction delay. It will increase functional class, left ventricular ejection fraction (LVEF), six minute walk test, and quality of life, and also decrease hospitalization and mortality rate due to heart failure, and prevent the progression of the disease. However, non-responder after CRT implantation is still a big problem. Aim of this study is to evaluate reverse remodeling after CRT implantation and the correlation with functional capacity of the patients.

Method. This is a cross-sectional and retrospective study which was held in National Cardiovascular Center Harapan Kita, Jakarta. The subject are patients with diagnosis of refractory heart failure who performed CRT implantation between January 2008-October 2012. The data was recorded from medical record, include clinical data, electrocardiography, echocardiography pre-implantation, and implantation procedure. Intra-ventricular, inter-ventricular, and atrio-ventricular dyssynchrony was assessed by tissue Doppler imaging (TDI) echocardiography. Functional capacity was evaluated with New York Heart Association (NYHA) functional class and six minute walk test which performed at least 6 months after implantation.

Results. A total of 32 patients were included in this study, with mean age of 60,3 + 13,5 years. Intra-ventricular dyssynchrony were persisted on 24 subjects (75%), meanwhile interventricular and atrioventricular dyssyncrony was 25 subjects and 11 subjects (78,1% and 34,4%). We found a significant correlation of intraventricular dyssynchrony, which was showed by Indeks Yu, in group with good and poor functional capacity with mean of 39,04 + 10,69 and 59,17 + 8,01, respectively (p=0,001). Meanwhile, mean inter-ventricular dyssynchrony in good functional capacity group and poor functional capacity were 26,07 + 16,17 mdet vs 32,83 + 45,45 mdet (p=0,631), and atrio-ventricular dyssynchrony were 42,76 + 8,65 vs 44,98 + 12,34 (p=0,485). Linear correlation graph showed increasing of intraventricular dyssynchrony will decrease the functional capacity assessed by six minute walk test.

Conclusion. The presence of intraventricular dyssynchrony after CRT implantation correlates with poor functional capacity."

"A practical guide to the recognition and management of myocardial infarction and its complications, both in the community and in hospital. It is now available in paperback format for medical students, junior doctors, care workers and those working in accident and emergency wards."

"Beberapa penelitian terdahulu menunjukkan kontradiksi hubungan antara dispersi QT dengan kejadian takiaritmia ventrikel dan atau kematian jantung mendadak. Penelitian-penelitian itu tidak mengeluarkan pengguna obat penghambat reseptor beta, bahkan pengguna obat tersebut merupakan mayoritas pada sampel mereka. Karena penggunaan penghambat reseptor beta sebagai pencegahan sekunder yang masih rendah di Pusat Jantung Nasional Harapan Kita, maka penelitian ini dilakukan untuk mengetahui hubungan antara dispersi QT dengan kejadian takiaritmia ventrikel dan atau kematian jantung mendadak pada pasien pascainfark. Interval QT, dispersi QT dan variabel klinis dibandingkan antara 36 orang pasien pascainfark yang mengalami takiaritmia ventrikel dan atau kematian jantung mendadak (kelompok kasus), dengan 75 pasien pascainfark yang tidak mengalami kedua kejadian tersebut (kelompok kelola). Dispersi QT yang lebih panjang (115 + 41 msec vs 81 + 25 msec, p < 0.001). Interval QT maksimal terkoreksi juga lebih panjang pada kelompok kasus (534 + 56 vs 501 + 35 msec, p < 0.001). Analisa regresi logistik menunjukkan adanya hubungan antara pemanjangan dispersi QT dengan kejadian takiaritmia ventrikel dan atau kematian jantung mendadak dengan RO 3,2, 4, dan 5,8 masing-masing untuk nilai potong 80, 90, dan 100 mdet. Dispersi QT dapat memprediksi kejadian takiaritmia ventrikel dan atau kematian jantung mendadak pada pasien infark miokard akut. Hasil ini menunjukkan bahwa dispersi QT tetap bermanfaat pada kondisi bebas pengaruh obat penghambat reseptor beta. (Med J Indones 2005; 14: 230-6)

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Recent studies showed contradictive results of the relation between QT dispersion and the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death. In addition, beta adrenoreceptors blocking agents, which are known to decrease the incidence of lethal arrhythmias after myocardial infarction, administered to the majority of patients in those studies population. Since b-blocker as secondary prevention drug was underutilized at National Cardiovascular Center Harapan Kita, this study was performed to find out the relation between QT dispersion and ventricular tachyarrhythmias and/or sudden cardiac death after previous myocardial infarction. The QT interval duration, QT dispersion and clinical variables of 36 postinfarction patients with history of sustained ventricular tachyarrhythmias and/or sudden cardiac death (event group) were compared with 75 postinfarction patients without such events (control group). QT dispersion differed significantly between study groups and was increased in the event group (115 ± 41 msec vs 81 ± 25 msec, p < 0.001). Corrected maximal QT interval duration was also prolonged in the event group (534±56 vs 501±35 msec, p < 0.001). Regression analysis showed that increasing QT dispersion was related to the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death with OR of 3.2, 4, and 5.8 for cut-off point of 80, 90, and 100 msec respectively. The QT dispersion could predict the occurrence of ventricle tachyarrhythmias and/or sudden cardiac death in patient with AMI. This study confirmed that the QTd remain useful in free of beta blocking agents state. (Med J Indones 2005; 14: 230-6)"

"Perubahan warna email setelah aplikasi Averrhoa bilimbi. Perubahan warna gigi terutama diatasi dengan melakukan perawatan pemutihan gigi. Penggunaan agen pemutih kimia dapat menyebabkan efek samping, sehingga perlu ditemukan agen pemutih gigi alternatif berbahan dasar alam. Averrhoa bilimbi mengandung peroksida dan asam oksalat yang memiliki kemampuan memutihkan gigi. Tujuan: Menganalisis perubahan warna email gigi setelah aplikasi Averrhoa bilimbi dan karbamid peroksida 10%. Metode: Penelitian ini menggunakan 20 gigi premolar pascaekstraksi (masing-masing 10 spesimen untuk aplikasi Averrhoa bilimbi dan karbamid peroksida 10%). Setelah aplikasi, spesimen diletakkan di inkubator 37°C selama 2 jam, kemudian dicuci dan direndam dalam akuades, dan diinkubasi kembali selama 14 hari. Perubahan warna diamati oleh 5 pengamat menggunakan panduan warna. Hasil: Hasil pengamatan dianalisis secara kualitatif dan kuantitatif. Perubahan warna email gigi setelahaplikasi dengan Averrhoa bilimbi dari A3 menjadi C1, A2, D2, B2, dan B1. Perubahan warna gigi secara homogen dari A3 ke B1 terjadi dalam aplikasi karbamid peroksida 10%. Perubahan warna yang lebih jelas terjadi pada kelompok karbamid peroksida 10% (p=0,004) dibandingkan kelompok Averrhoa bilimbi (p=0,005). Perbedaan perubahan warna yang terjadi pada kedua kelompok tersebut berbeda bermakna (p=0,002). Simpulan: Averrhoa bilimbi memiliki prospek yang baik sebagai bahan pemutih gigi karena penggunaannya dapat menimbulkan perubahan warna email, namun efektivitasnya masih di bawah 10% karbamid peroksida.

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Teeth discoloration is mainly treated with dental bleaching. Use of chemical bleaching has side effects, so it is important to find an alternative natural dental bleaching agent. Averrhoa bilimbi contains peroxide and oxalate acid that possess tooth whitening properties. Objective: To determine the change in color of dental enamel after the application of Averrhoa bilimbi and 10% carbamide peroxide. Methods: Samples were 20 post-extracted of the two tested materials premolars (10 specimens each for Averrhoa bilimbi and carbamide peroxide application). After the application, the specimens were incubated at 37ºC for 2 hours, washed and soaked in aquadest before further incubated for another 14 days. The colour changed was observed by 5 independent observers using shade guide. Results: Quantitative and qualitative analyzes were performed. Qualitatively, A3 color has changed into C1, A2, D2, B2 and B1 in the Averrhoa bilimbi group. A more significant color change in the 10% carbamide peroxide group (p=0.005) compared to Averrhoa bilimbi group (p=0.005) were observed. The difference of resulted enamel colour change was statistically significant (p=0.002). Conclusion: Averrhoa bilimbi had a good prospect as dental bleaching agent since its application effectively resulted in a slight enamel colour change although its whitening properties was still lower than 10% carbamide peroxide."

"Latar belakang: Warfarin merupakan antikoagulan yang rutin diberikan dalam 90 hari pertama pascabedah katup jantung. Salah satu komplikasi yang dapat timbul selama pemberian warfarin adalah perdarahan saluran cerna. Persentase periode intraterapeutik (PIT) dan periode supraterapeutik (PST) warfarin dikaitkan dengan kejadian perdarahan pada populasi fibrilasi atrium non-valvular, namun pengaruhnya pada perdarahan saluran cerna pascabedah katup masih belum diketahui.Tujuan: Mengidentifikasi pengaruh PIT dan PST warfarin pada kejadian perdarahan saluran cerna pascabedah katup jantung.Metode: Penelitian ini merupakan studi kohort retrospektif pada subjek yang telah menjalani bedah katup jantung di Rumah Sakit Jantung dan Pembuluh darah Harapan Kita. Subjek diikuti dalam 90 hari pertama untuk mengevaluasi insiden perdarahan saluran cerna. Pemeriksaan International Normalized Ratio (INR) yang dilakukan setelah tujuh hari setelah inisiasi warfarin hingga terjadi luaran klinis atau akhir masa pengamatan dicatat untuk perhitungan PIT dan PST.Hasil: Dari 195 subjek penelitian, insiden perdarahan saluran cerna ditemukan pada 18 subjek. Median jumlah pemeriksaan INR adalah lima kali. Dalam periode pengamatan, 84% subjek tidak mencapai PIT >60%. Terdapat perbedaan bermakna untuk PST antara subjek dengan dan tanpa perdarahan p>18% (AUC 0,842; sensitivitas 72 dan spesifisitas 80%) dengan risiko relatif (RR) 14,2 (p<0,0001;IK 95% 4,06-49,71). Gangguan fungsi ginjal preoperatif merupakan faktor lainyang berhubungan dengan luaran klinis (p=0,007; RR 6,69 dengan IK 95% 1,67-2677).Kesimpulan: Tidak terdapat hubungan antara PIT dengan insiden perdarahan saluran cerna, namun PST .18% secara independen berhubungan dengan peningkatan risiko terjadinya perdarahan saluran cerna pascabedah katup jantung pada pasien yang mendapat terapi warfarin.

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Background: Warfarin is routinely given in the first 90 days after valvular surgery. One of the complications that may arise during warfarin administration is gastrointestinal bleeding. Time in Therapeutic Range (TTR) and Time Above Therapeutic Range (TATR) of warfarin is associated with bleeding occurrence in non-valvular atrial fibrillation populations, but its relationship with gastrointestinal GI bleeding on postoperative patients remains unknown.Objective: To identify the role of warfarin's TTR and TATR in the incidence of GI bleeding post valvular surgery.Methods: This is a retrospective cohort study on subjects who have undergone valvular surgery in National Cardiovascular Centre Harapan Kita and received warfarin. Subjects were followed in the first 90 days to evaluate the incidence of GI bleeding. All International Normalized Ratio (INR) examinations after seven days of initiation of warfarin until bleeding occurred or end of follow-up period were collected for TTR and TATR calculations.Results: From 195 study subjects, the incidence of gastrointestinal bleeding were found in 18 subjects. The median amount of INR examination was five times. In the follow-up period, 84 of subjects did not achieve TTR> 60%. There was a significant difference for TATR values between subjects with and without bleeding (p<0.0001), but not for TTR (p=0.44). The incidence of GI bleeding was associated with TATR>18% (AUC 0.842, 72% sensitivity and 80% specificity) with relative risk (RR) 14.2 (p<0.0001; 95% CI 4.06-49.71). Preoperative renal insufficiency was another factor related with clinical outcome (p=0,007; RR 6,69 with 95% CI 1,67-26,77)Conclusions: There were no association between TTR values and incidence of GI bleeding, however TATR>18% was independently associated with an increased risk of gastrointestinal bleeding after valvular surgery in patients receiving warfarin. "