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"ABSTRAKLatar belakang dan tujuan: Modalitas radiografi toraks merupakan pemeriksaanrutin dan tersedia di hampir setiap rumah sakit. Pengukuran secara kuantitatifberupa vascular pedicle width (VPW), cardiothoracic ratio (CTR) maupunvascular pedicle-thoracic ratio (VPTR) melalui radiografi toraks dapat membantudalam membedakan jenis edema paru dengan mengetahui titik potong rerataVPTR berdasarkan kombinasi VPW dan CTR. Metode: Penelitian dilakukan retrospektif dengan descriptive cross sectional pada100 pasien dengan klinis edema paru yang telah melakukan radiografi toraks diICU Rumah Sakit CiptoMangunkusumo (RSCM) dalam rentang waktu Januari2013 ? Desember 2015. Subjek dibagi menjadi edema kardiogenik dan nonkardiogenik berdasarkan kombinasi pengukuran VPW dan CTR. Kemudiandilakukan pengukuran VPTR dan ditentukan titik potong rerata VPTR, sensitivitasdan spesifisitas berdasarkan kombinasi VPW dan CTR dalam membedakan edemaparu.Hasil: Dari total 100 subjek penelitian di ICU RSCM dengan metode ReceiverOperating Curve (ROC) didapatkan titik potong VPTR sebesar 25,1% dengansentivitas 90,5% dan spesifisitas 86,1% dalam membedakan edema parukardiogenik dan non kardiogenik. Selain itu diperoleh juga proporsi edema parukardiogenik sebesar 21%, sedangkan edema paru non kardiogenik sebesar 79%.Kesimpulan: Titik potong VPTR berdasarkan kombinasi VPW dan CTR memilikisensitivitas dan spesifisitas yang cukup tinggi dalam membedakan edema parukardiogenik dan non kardiogenik.

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ABSTRACTBackground and purpose: Pulmonary edema in critically ill patient werechallenging in intensive care unit (ICU). Radiography of thorax is routineexamination and widely available in almost every hospital. Measurementquantitatively of vascular pedicle width (VPW), cardiothoracic ratio (CTR) andvascular pedicle-thoracic ratio in thorax radiography can help in differentiatingthe type of pulmonary edema through the cut off of VPTR based on combinationVPW and CTR. Methods: Descriptive cross sectional restrospective in 100 patients with clinicallypulmonary edema which have examined by thorax radiography at ICU RSCM inJanuary 2013 to Desember 2015. Subject divided to cardiogenic and noncardiogenic pulmonary edema based on combination VPW and CTR. Then,VPTR were measured and the cut off of VPTR determined based on combinationVPW and CTR in differentiaiting pulmonary edema.Results: From total 100 subject study at ICU RSCM using Receiver OperatingCurve (ROC) metode, the cut off of VPTR is 25,1% with sensitivity 90,5% andspecificity 86,1% in differentiating cardiogenic and non cardiogenic pulmonaryedema. Beside that, the prevalence of cardiogenik pulmonary edema is 21% andnon cardiogenic pulmonary edema is 79%.Conclusion : The cut off of VPTR based on combination VPW and CTR havesignificant sensitivity and specificity in differentiating cardiogenic and noncardiogenic pulmonary edema."

"Latar belakang: Disfungsi ventrikel kanan merupakan salah satu komplikasi penyakit paru obstruktif kronik (PPOK). Penilaian fungsi ventrikel kanan penting, karena berkaitan dengan keterbatasan kemampuan kerja pasien serta prognosis yang buruk. Tujuan: Untuk mengetahui proporsi disfungsi sistolik dan diastolik ventrikel kanan pada PPOK stabil, serta untuk mengetahui korelasi forced expiratory volume in one second (FEV1) % prediksi dengan nilai Tricuspid annular plane systolic excursion (TAPSE) dan nilai titik potong kedua variabel tersebut. Metode: Dilakukan pemeriksaan spirometri terhadap 30 pasien PPOK stabil (rerata usia: 65 ± 6 tahun). Kemudian semua pasien menjalani pemeriksaan ekokardiografi standar, TAPSE, mengukuran dimensi ruang jantung kanan dan inflow trikuspid. Hasil: Rerata nilai rerata FEV1 28 ± 8% prediksi. Tidak terdapat pasien dengan derajat obstruksi yang ringan, 57% subjek mengalami derajat obstruksi yang sangat berat. Semua pasien menunjukan pola spirometri campuran obstruktif dan restriktif. Rerata dimensi ruang jantung kanan pasien dalam batas normal. Terdapat 40% pasien yang mengalami disfungsi diastolik. Rerata nilai TAPSE 16, 96 ± 96 mm. Terdapat 60% pasien yang mengalami penurunan nilai TAPSE. Tidak terdapat beda rerata nilai TAPSE antara kelompok dengan derajat obstruksi sedang-berat dengan derajat obstruksi sangat berat. Tidak terdapat korelasi yang signifikan antara FEV1 % prediksi dengan TAPSE, sehingga titik potong kedua variabel tidak dapat ditentukan. Simpulan: Proporsi disfungsi sistolik ventrikel kanan 60% dan disfungsi diastolik 40%. Tidak terdapat korelasi nilai FEV1 % prediksi dengan nilai TAPSE, sehingga nilai titik potong kedua variabel tidak dapat ditentukan pada PPOK stabil.

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Background: Right ventricular dysfunction is one of the common complication of chronic obstructive pulmonary disease (COPD). Right ventricular assessment is importance, since it related with exercise intolerance and poor prognosis.

Objective: To determine the proportion of systolic and diastolic dysfunction of right ventricle in stable COPD patients and to determine the correlation between forced expiratory volume in one second (FEV1) % prediction and Tricuspid annular plane systolic excursion (TAPSE) and also to determine the cut-off value between the two variables.

Methods: Thirty stable COPD men (mean age: 65 ± 6 yr) underwent spirometry. In addition to conventional echocardiographic parameters, TAPSE, right heart chambers, and trans tricuspid inflow were determined.

Results: The mean value of FEV1 was 28 ± 8% of the predicted value. There was no subject with mild airflow limitation, 57% subjects were with very severe airflow obstruction. All of pulmonary function test showed mixed restrictive-obstructive pattern. Mean of right chamber was in normal limit. Forty percent of the patients suffered right ventricular diastolic dysfunction. Means of TAPSE was 16.96 ± 96 mm. Sixty percent of the patients suffered right ventricular systolic dysfunction. There was no significant difference in TAPSE between groups with moderate-severe flow obstruction and very severe airflow obstruction. There was no significant correlation between FEV1 % prediction and TAPSE, so the cut-off value between the two variables cannot be determined.

Conclusions: The proportion of right ventricular systolic dysfunction was 60% and diastolic dysfunction was 40%. There was no correlation between FEV1 % prediction and TAPSE. The cut-off value between the two variable in stable COPD patients cannot be determined."

"[ABSTRAK Latar Belakang : pengukuran VPW dari modalitas foto toraks merupakanpemeriksaan yang non invasif, cepat dan mudah untuk memprediksi kondisihipervolemia. Namun belum terdapat konsensus nilai rerata VPW yang dipakaisecara global, sehingga penggunaan nilai rerata VPW dari penelitian sebelumnyaterhadap populasi diluar populasi penelitian tersebut mungkin tidak relavan. DiIndonesia khususnya di Rumah Sakit Cipto Mangunkusumo belum terdapat datadasar nilai rerata VPW.Tujuan Penelitian: Mengetahui rerata nilai VPW dewasa normal IndonesiaDesain Penelitian: Retrospektif potong lintangMetode: Pengukuran jarak antara tepi terluar arteri subklavia kiri dengan tepiterluar vena kava superior yang melewati bronkus utama kanan (VPW),pengukuran rasio VPW terhadap diameter jantung terluas dan rasio VPW terhadapdiameter terluas rongga toraks. Pengukuran dilakukan pada radiografi toraks PAdari 104 subyek normal yang terdiri dari 52 laki-laki dan 52 perempuan, dihitungrerata dan standar deviasi. Pengukuran serupa juga dilakukan pada topogram CTscan toraks (radiografi toraks AP supine) dan CT scan toraks dari 103 subyekyang terdiri dari 51 laki-laki dan 52 perempuan.Hasil: Pada pemeriksaan toraks PA didapatkan rerata VPW 48,0 mm ± 5,5 mm,rerata VPCR 40,3% ± 4,6 %, dan rerata VPTR 17,2% ± 1,7%. Pada pemeriksaantopogram CT scan didapatkan rerata VPW 50,3 mm ± 6,2 mm, rerata VPTR 45%± 5,1%, dan rerata VPTR 19,8% ± 2,5%. Rerata VPW pada CT scan toraks 50,4 ±6,1 mm. Pengukuran pada foto toraks AP sekitar 10 % lebih besar dibandingkanpada foto toraks PA, dan pengukuranVPW pada foto toraks terbukti memilikiakurasi yang tinggi.Kesimpulan: Rerata VPW pada pemeriksaan foto toraks PA tegak dewasa normalIndonesia adalah 48 ± 5,5 mm, ternyata tidak berbeda bermakna dengan rerataVPW pada populasi barat ( 48 ± 5mm). Rerata VPCR pada foto toraks PAadalah 40,3 % ± 4,6 % dan VPTR adalah 17,2 % ± 1,7 %.

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ABSTRACTBackground: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm)., Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).]"

"ABSTRAKLatar Belakang: terapi injeksi intravitreal bevacizumab monoterapi pasien edema makula diabetik dengan ketebalan makula sentral lebih dari 400 µm dinilai kurang efektif. Kortikosteroid dinilai dapat membantu mencegah progresifitas edema makula diabetik terkait proses inflamasi.Tujuan: Mengetahui hasil terapi injeksi intravitreal kombinasi bevacizumab dan deksametason dibandingkan dengan injeksi intravitreal bevacizumab monoterapi pada pasien dengan edema makula diabetik derajat sedang hingga beratMetodologi: penelitian eksperimental randomisasi acak terkontrol dua kelompok yaitu: kelompok dengan terapi intravitreal bevacizumab 1,25mg (kelompok A) dan terapi injeksi intravitreal bevacizumab 1,25mg dan deksametason 0,5mg (kelompok B). Luaran sensitifitas retina, ketebalan makula sentral serta tajam penglihatan dievaluasi pada minggu pertama dan keempat.Hasil: sebanyak masing-masing 22 orang diteliti di kelompok A dan kelompok B. Median usia pada kelompok A adalah 53,1 + 8,4 dan kelompok B adalah 55,1 + 8. Terdapat perbaikan sensitifitas retina sebanyak 2,1 dB di kelompok A dan 2,03 dB di kelompok B (p=0,673). Perbaikan ketebalan makula sentral didapatkan sebanyak 217µ m pada kelompok A dan 249 µm pada kelompok B (p=0,992). Perbaikan tajam penglihatan dengan koreksi pada kelompok A sebanyak 8,5 huruf dan 7,5 huruf pada kelompok B (p=0,61). Analisis intragroup menunjukkan perbaikan yang signifikan di masing-masing luaran penelitian pada kedua kelompok.Kesimpulan: Terapi kombinasi bevacizumab dan deksametason menjunjukkan perbaikan secara klinis pada luaran sensitivitas retina, ketebalan makula sentral serta tajam penglihatan dengan koreksi. Perbandingan antara kedua grup tidak signifikan secara statistik. Tren positif tampak kategori adanya kista pada Spectrum Domain Optical Coherence Tomography (SD-OCT) dan pasien dengan Non-Proliferative Diabetic Retinopathy (NPDR).

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ABSTRACTBackground: Bevacizumab intravitreal injection therapy in patients with diabetic macular edema (DME) especially with a central macular thickness more than 400 μm is considered ineffective. Corticosteroid addition to the standard therapy can help prevent the inflammation that happens in the progression of diabetic macular edemaObjective: to compare the result of combination of bevacizumab and dexamethasone intravitreal injection with bevacizumab monotherapy in patient with moderate to severe diabetic macular edema.Methods: randomized controlled trial in two parallel group. Group A received bevacizumab intravitreal 1.25mg in 0.05cc, group B received bevacizumab 1.25mg and dexamethasone 0.5mg. Retinal sensitivity, central macular thickness (CMT) and visual acuity (VA) are evaluated in first and fourth week after injection.Result: 22 patients from each group were evaluated. Median of age was 53,1+ 8,4 in group A and 55,1 + 8 in group B. Improvement of retinal sensitivity was 2.1dB and 2.03dB in group A and B respectively (p=0,673). There was reduction in CMT about 217µm in group A and 249 µm in group B (p=0,992). Visual acuity (VA) outcomes showed little difference between groups; +8.5 letter and +7.5 letter in group A and group B respectively. Intragroup analysis shows significant differentiation in each outcome in both groups. Conclusion: combination of intravitreal bevacizumab and dexamethasone clinically improved retinal sensitivity, CMT and VA in patient with DME. There was no statistical difference between in retinal sensitivity, CMT and VA after therapy in both groups. Positive trend was showed especially in patient with cyst appearance in Spectrum Domain Optical Coherence Tomography (OCT) and Non-proliferative Diabetic Retinopathy (NPDR) patient. "

"Macular edema is a kind of human sight disease as a result of advanced stage of diabetic retinopathy. It affects the central vision of patients and in severe cases lead to blindness. However, it is still difficult to diagnose the grade of macular edema quickly and accurately even by the medical doctor's skill. This paper proposes a new method to classify fundus images of diabetics by combining Self-Organizing Maps (SOM) and Generalized Vector Quantization (GLVQ) that will produce optimal weight in grading macular edema disease class. The proposed method consists of two learning phases. In the first phase, SOM is used to obtain the optimal weight based on dataset and random weight input. The second phase, GLVQ is used as main method to train data based on optimal weight gained from SOM. Final weights from GLVQ are used in fundus image classification. Experimental result shows that the proposed method is good for classification, with accuracy, sensitivity, and specificity at 80%, 100%, and 60%, respectively."

"Latar Belakang: Tata laksana edema makula terus dievaluasi, dengan terapi anti-VEGF sebagai lini pertama. Subthreshold micropulse laser (SML) diajukan sebagai alternatif adjuvan. Studi retrospektif terdahulu menunjukkan efektivitas SML 577-nm sebagai monoterapi pada edema makula dengan ketebalan di bawah 400 μm. Akan tetapi, data prospektif efektivitas SML sebagai adjuvan masih minim. Tujuan: Menilai pengaruh pemberian kombinasi bevacizumab dan laser SML 577-nm dibanding bevacizumab monoterapi terhadap ketebalan makula sentral dan tajam penglihatan pasien edema makula diabetik ringan-sedang.Metode: Penelitian ini merupakan studi eksperimental lengan ganda. Dilakukan randomisasi acak terhadap pasien edema makula diabetik dengan rentang ketebalan makula 300-600 μm, kelompok kontrol mendapatkan protokol standar. Kelompok studi mendapatkan adjuvan laser SML kuning satu minggu pascainjeksi. Pasien menjalani follow-up penilaian tajam penglihatan dan ketebalan makula sentral pada 28 dan 35 hari pascainjeksi.Hasil: Terdapat 26 subjek yang terbagi rata pada kelompok studi dan kontrol. Ditemukan signifikansi nilai CMT pada kontrol 28 hari dan 35 hari pascainjeksi baik pada kelompok studi (p=0,011 dan 0,014) maupun kontrol (p=0,006 dan p=0,001). Akan tetapi, tidak ditemukan perbedaan signifikansi selisih nilai CMT antara kedua kelompok pada kontrol 28 hari (p=0,317) dan 35 hari (p=0,84). Tidak ditemukan perbedaan selisih TPDK ETDRS antara kelompok studi dan kontrol pada kelompok 28 hari (p=0,568) dan 35 hari (p=0,128) pascainjeksi.Kesimpulan: Kombinasi SML dengan bevacizumab intravitreal dapat mengurangi ketebalan makula sentral dan memperbaiki tajam penglihatan namun tidak ditemui perbedaan yang signifikan dengan monoterapi standar.

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Background: The management of macular edema is constantly evaluated, with anti-VEGF therapy being the first line. Subthreshold micropulse laser (SML) has been proposed as an alternative adjuvant. A previous retrospective study demonstrated the effectiveness of 577-nm SML as monotherapy in macular edema with CMT below 400 μm. However, prospective data on the effectiveness of SML as an adjuvant are lacking.

Objective: To assess the effect of the combination of bevacizumab and 577-nm SML laser compared to bevacizumab monotherapy on central macular thickness and visual acuity in mild-moderate diabetic macular edema patients.

Methods: This research is a double arm experimental study. A randomized trial was performed on diabetic macular edema patients with macular thickness range of 300-600 μm. The control group received a standard protocol and the study group received a yellow SML laser adjuvant one week after injection. Patients underwent follow-up assessment of visual acuity and central macular thickness at 28 and 35 days postinjection.

Results: There were 26 subjects which were equally divided into study and control groups. Significant decrease in CMT were found in study group (p=0.011 and 0.014) and the control group (p=0.006 and p=0.001). However, there was no significant difference in delta CMT values between the two groups in the 28-day (p=0.317) and 35-day controls (p=0.84). There was no difference in ∆TPDK ETDRS between the study and control groups at 28 days (p=0.568) and 35 days (p=0.128) after injection.

Conclusion: The combination of SML and intravitreal bevacizumab can reduce central macular thickness and improve visual acuity but there was no significant difference with standard monotherapy."

"Edema makula diabetik atau Diabetic Macular Edema (DME) merupakan penyebab utama kehilangan penglihatan pada pasien diabetes. Patofisiologi DME bersifat multifaktorial dan kompleks. Rusaknya sawar darah retina mengakibatkan penumpukan carian abnormal dan penebalan makula retina yang diinduksi oleh berbagai faktor seperti iskemia, peningkatan Vascular Endothelial Growth Factor (VEGF), radikal bebas, disfungsi perisit dan endotel, serta inflamasi. Penelitian ini menilai efektivitas injeksi loading dose bevacizumab dengan kombinasi inisial deksametason dibandingkan loading dose bevacizumab. Pada studi ini dilakukan uji klinis acak terkontrol dengan randomisasi pada dua kelompok yaitu: kelompok dengan terapi loading dose bevacizumab 1,25mg dengan kombinasi inisial deksametason 0,5mg (studi) dan injeksi loading dose bevacizumab 1,25mg (kontrol). Luaran sensitifitas retina, tajam penglihatan serta CMT dievaluasi pada minggu pertama, keempat, kedelapan dan keduabelas. Sebanyak 22 orang diteliti di kelompok studi dan 21 orang kelompok kontrol. Median usia kelompok studi 53,3 + 10,9 dan kontrol 54,1 + 7,3. Dilakukan analisa terhadap sensitifitas retina, tajam penglihatan serta CMT pada kelompok studi (10 orang) dan kontrol (13 orang). Terdapat perbaikan ketebalan makula sentral 205,5μm (studi) dan 87 μm (kontrol) dengan p=0,010. Perbaikan tajam penglihatan dengan koreksi pada studi 13,5 huruf dan 3 huruf pada kelompok kontrol (p=0,23). Terdapat perbaikan sensitifitas retina 1.02 dB di kelompok studi dan 0,68 dB pada kontrol (p=0,832). Analisis intragroup menunjukkan perbaikan signifikan pada pemeriksaan CMT kedua kelompok dan pada pemeriksaan tajam penglihatan pada kelompok studi. Berdasarkan analisa pendahuluan ini dapat memberikan bukti adanya potensi untuk dilakukan penyelesaian seluruh jumlah sampel hingga akhir dimana terdapat kecendrungan perbaikan secara klinis pada setiap luaran.

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Diabetic Macular Edema is a major cause of vision loss in diabetic patients. The pathophysiology is multifactorial and complex. The damage of the retinal blood barrier results in a buildup of fluid and thickening of the macula that induced by ischemia, Vascular Endothelial Growth Factor, free radicals, pericyte, endothelial dysfunction, and inflammation. This study assessed the effectiveness of bevacizumab loading dose with initial combination versus a bevacizumab monotherapy. In this study, a randomized controlled trial was carried out in two groups, a 1.25 mg bevacizumab loading dose with a combination of the initial 0.5 mg dexamethasone (study) and a 1.25 mg bevacizumab loading dose (control). Retinal sensitivity, visual acuity and CMT were evaluated at the first, fourth, eighth and twelfth weeks. A total of 22 people (study) and 21 people (control). The median age of was 53.3 + 10.9 (study) and 54.1 + 7.3 (control). Retinal sensitivity, visual acuity and CMT were analyzed in study group (10 people) and (13 people) control group. There was an improvement in CMT 205.5μm (study) and 87μm (control) with p = 0.010. Visual acuity improvement 13.5 letters (study) and 3 letters (control) with p = 0.23 and retinal sensitivity 1.02 dB (study) 0.68 dB (control) with p = 0.832. Intragroup analysis showed significant improvements of the CMT examination in both groups and in the visual acuity examination in study group. Based on this preliminary analysis, it can provide the potential for completion of the entire sample size until the end where there is a tendency for clinical improvement in each outcome."

"Pendahuluan. Kebocoran anastomosis merupakan komplikasi yang berat berhubungan dengan peningkatan morbiditas, dan mempengaruhi lama rawat di rumah sakit. Banyak peneliti yang telah meneliti faktor resiko terjadinya kebocoran usus, diantaranya sepsis, malnutrisi, ketegangan garis anastomosis, gangguan perfusi jaringan, obstruksi distal, dll. Usus adalah organ yang rentan terhadap cedera, cedera pada usus dapat menyebabkan edema, ileus, dan kegagalan mekanisme pertahanan usus. Kondisi ini dapat ditemukan pada gastroshizis, invaginasi, strangulasi, penyakit radang usus dan sirosis. Pemberian cairan berlebih dapat menyebabkan edema, peningkatan tekanan intra abdomen, menurunkan aliran darah mesenterik, berpengaruh terhadap penyembuhan dan meningkatkan kebocoran anastomosis. Studi ini bertujuan untuk mengetahui pengaruh edema terhadap anastomosis usus. Metode. Studi eksperimental pada tikus Sprague–Dawley untuk mengetahui pengaruh edema dan pemberian cairan yang berlebihan terhadap anastomosis usus. Hasil. Tidak terdapat perbedaan antara edema usus dan pemberian cairan berlebihan dengan peningkatan kebocoran anastomosis (p=0,178)  Kesimpulan. Edema usus tidak ada hubungan dengan kebocoran anastomosis.

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Introduction. Anastomotic leak is a severe complication associated with increased morbidity, and affects hospital stay. Many researchers have examined risk factors for intestinal leakage, including sepsis, malnutrition, anastomotic line tension, impaired tissue perfusion, distal obstruction, etc. The intestine is an organ that is prone to injury, injury to the intestine can cause edema, ileus, and failure of the intestinal defense mechanism. This condition can be found in gastroshizis, invagination, strangulation, inflammatory bowel disease and cirrhosis. Excessive fluid can cause edema, increase intra-abdominal pressure, decrease mesenteric blood flow, affect healing and increase anastomotic leakage. This study is to investigate intestinal edema on anastomosis. Method. This is an experimental study using Sprague-Dawley to determine the effect of edema and excessive fluid administration on intestinal anastomosis Results. There was no difference between intestinal edema and excessive fluid administration with increased anastomotic leak (p = 0.178). Conclusion. Intestinal edema is not associated with anastomotic leakage."

"ABSTRAKUntuk mengetahui hubungan antara variabel demografi, geografi, iklim, sosial ekonomi, fasilitas pelayanan kesehatan mikroskopis dan tenaga kesehatan terlatih dengan jumlah kasus TB paru BTA positif, perlu dilakukan penelitian di Jakarta Selatan tahun 2007-2009 dengan studi ekologi melalui pendekatan spasial dan menggunakan data sekunder. Data diolah secara statistik dengan uji korelasi Pearson, dan analisis spasial dengan tehnik Overlay. Hasil penelitian menunjukkan secara statistik tidak ada korelasi antara variabel yang diteliti, sedangkan secara spasial variabel kepadatan penduduk, keluarga miskin dan fasilitas pelayanan kesehatan mikroskopis berpengaruh terhadap jumlah kasus TB paru BTA positif di Kecamatan Tebet, dan di kecamatan lain variabel tidak berpengaruh.

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ABSTRACT

To determine the relationship between demographic variables, geography, climate, socio-economic, microscopic health facilities and health personnel trained with the number of BTA positive pulmonary TB cases, need to do research in South Jakarta in 2007-2009 with a spatial approach to ecological studies and to use secondary data. Data was statistically analyzed by Pearson correlation test, and spatial analysis techniques Overlay. The results showed no statistically significant correlation between the variables studied, whereas the spatially variable population density, poor families and microscopic health facilities effect on the number of BTA positive pulmonary TB cases in the District of Tebet, and in other districts did not influence the variables."

"Latar belakang: Penyakit paru obstruktif kronis (PPOK) merupakan penyakit paru yang menyebabkan 60% kematian di Indonesia. Terjadi peningkatan prevalensi frailty pada pasien PPOK hingga dua kali lipat dibandingkan pada pasien tanpa PPOK. Frailty merupakan sindrom lansia terkait perubahan fisiologis dan morfologis pada berbagai sistem tubuh akibat penuaan. Pada PPOK terjadi inflamasi sistemik yang ditandai dengan penanda inflamatori. Rasio neutrofil-limfosit (RNL) merupakan penanda inflamatori yang cukup stabil, terjangkau, dan banyak digunakan. Penelitian ini bertujuan untuk menentukan hubungan RNL dengan frailty pada pasien lansia dengan PPOK. Metode: Penelitian ini merupakan studi potong lintang. Penilaian frailty dilakukan berdasarkan kuesioner FRAIL dan hitung jenis darah perifer melalui data rekam medis RSCM dari bulan Oktober 2021–Oktober 2022. Hasil: Terdapat 103 subjek dengan prevalensi yang mengalami frail sebanyak 63 orang (61,2%). Pada analisis bivariat, didapatkan hasil bahwa RNL memiliki hubungan yang signifikan dengan frailty (p = 0,017). Median RNL pada kelompok frail sebesar 2,30 (1,27 – 7,03) dan kelompok non-frail sebesar 2,01 (0,72 – 4,56). Pada analisis kelompok kuartil, didapatkan hasil yang signifikan antara RNL dengan frailty (p = 0,009). Sebanyak 33,3% pasien frail berada pada kuartil keempat (> 3,060) dan sebanyak 42,2% pasien non-frail berada pada kuartil kesatu (<1,870). Kesimpulan: Terdapat hubungan yang signifikan antara RNL dengan frailty pada pasien lansia dengan PPOK.

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Introduction: Chronic obstructive pulmonary disease (COPD) is a lung disease that causes 60% of deaths in Indonesia. There was an increase in the prevalence of frailty in COPD patients up to two times compared to patients without COPD. Frailty is an elderly syndrome related to physiological and morphological changes in various body systems due to aging. In COPD, there is systemic inflammation characterized by inflammatory markers. Neutrophil to Lymphocyte ratio (NLR) is an inflammatory marker that is relatively stable, affordable, and widely used. This study aims to determine the relationship between NLR and frailty in elderly patients with COPD. Method: This cross-sectional study was conducted on elderly patients with COPD. Subjects performed frailty assessment based on the FRAIL questionnaire and peripheral blood type count through RSCM’s patient medical record from October 2021 – October 2022. Result: There were 103 subjects with a prevalence of frailty in 63 patients (61.2%). In bivariate analysis, results found that RNL had a significant relationship with frailty (p = 0.017). The median RNL in the frail group was 2.30 (1.27 – 7.03), and the non-frail group was 2.01 (0.72 – 4.56). In the quartile group analysis, RNL and frailty obtained significant results (p = 0.009). A total of 33.3% of frail patients were in the 4th quartile (> 3.060), and 42.2% of non-frail patients were in the 1st quartile (<1.870). Conclusion: There is a significant relationship between NLR and frailty in elderly patients with COPD. "