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"Latar Belakang: Hipertensi berkontribusi secara bermakna terhadap morbiditas dan mortalitas kardiovaskular (KV) di dunia. Dua penyebab terpentingnya adalah asupan garam dan disfungsi endotel yang dapat dinilai menggunakan flow-mediated dilatation (FMD). Modifikasi keduanya dapat menurunkan morbiditas dan mortalitas hipertensi. Diet rendah natrium DRN belum diterapkan secara optimal di dunia karena keterbatasan produk garam rendah natrium. Belum ada studi tentang perbandingan efek diet rendah natrium yang bervariasi terhadap perbaikan fungsi endotel yang dinilai melalui FMD pada subjek hipertensi derajat I, khususnya di Indonesia. Metode: Uji klinis ini dilaksanakan di RSJPD Harapan Kita terhadap 52 subjek hipertensi derajat I (26 laki-laki dan 26 perempuan), berusia 25 - 59 tahun, dan berindeks massa tubuh 18,5 - 29,99 kg/m2. Subjek dieksklusi jika berpenyakit atau berfaktor risiko KV, memiliki penyakit liver, kanker, alergi rumput laut, infeksi berat, atau dalam terapi KV, hormonal, steroid, atau terapi herbal rutin. Data primer didapat dari anamnesis dan pemeriksaan fisik. Subjek-subjek dirandomisasi menjadi dua kelompok, yaitu kelompok DRN dengan kadar natrium 21 - 23% dan kelompok DRN dengan kadar natrium 38 - 40%, kedua diet diberikan dalam bentuk kuah. Nilai FMD diukur sebelum intervensi dan 60 menit setelahnya. Hasil: Karakteristik dasar, termasuk diameter arteri brakialis prakompresi dan pascakompresi serta FMD, tidak berbeda bermakna di antara kedua grup. Pada kelompok DRN 38 - 40%, nilai FMD pada menit ke-60 pasca-intervensi menurun dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut tidak bermakna median [kisaran]: 7,92 [0,00 - 17,50]; p>0,05). Pada kelompok DRN 21 - 23%, nilai FMD pada menit ke-60 pasca-intervensi meningkat dibandingkan nilainya pra-intervensi, tetapi perbedaan tersebut juga tidak bermakna 7,65 [1,36 - 19,51]; p>0,05). Simpulan: Nilai FMD pasca-intervensi tidak berbeda bermakna antarkelompok. Ketidakbermaknaan perbedaan nilai-nilai FMD dalam penelitian ini mungkin disebabkan oleh aspek-aspek internal subjek yang memengaruhi fungsi endotel dan prosedur evaluasi FMD.

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Background: Hypertension contributes significantly to cardiovascular (CV) morbidity and mortality in the world. Two of its most important causes are salt intake and endothelial dysfunction which can be assessed using flow-mediated dilatation (FMD) test. Modification of both may decrease its morbidity and mortality. Low-sodium diet (LSD) has not been optimally implemented in the world due to the limited low-sodiumsalt products. There has been no study regarding the effects of low-sodium salt with various sodium concentrations on FMD of grade-I-hypertension subjects, especially in Indonesia. Methods: This clinical trial was conducted at the NCC Harapan Kita on 52 grade-Ihypertension subjects 26 men, 26 women , aged 25 - 59 years old, with body mass index of 18.5 - 29.99 kg/m2. Subjects were excluded if they had CVD, CV risk factors, liver disease, cancer, seaweed allergy, severe infection, or on routine CV-, hormonal-, steroid, or herbal-therapy. Primary data were collected from anamnesis and physical examinations. We randomly assigned the subjects into two groups, i.e. the group LSD with natrium concentration of 21 - 23% and the group of LSD with natrium concentration of 38-40% . Both diets were given in a soup form. The FMD values were measured before the intervention and 60 minutes after it. Results: Baseline characteristics, including pre-compression and post-compression brachial artery diameter and baseline FMD, were not significantly different between both groups. At group LSD 38 - 40%, FMD value at 60 minutes post-intervention was decreased compared to its baseline value, but the difference was not significant median [range]: 7.92 [0.00 mdash;17.50]; p>0.05). At group LSD 21 - 23%, FMD value at 60 minutes post-intervention was increased compared to its baseline value, but the difference was also not significant 7.65 [1.36 mdash;19.51]; p>0.05). Conclusion: The post-intervention FMD values were not significantly different between both groups. The non-significant differences between FMD values in this study may be due to the subjects' internal aspects influencing endothelial function and FMD evaluation procedure."

"Pengaruh Prekondisi dan Hipotermia pada Cedera Iskemia-Reperfusi Terhadap Endotel Pembuluh Darah Perifer pada Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih3 1Program Studi Ilmu Bedah, Fakultas Kedokteran Universitas Indonesia2Departemen Medik Ilmu Bedah, RSUPN Cipto Mangunkusumo Pendahuluan. Cedera iskemia -reperfusi CI/R merupakan masalah serius yang dihadapi pascahipoksia; menyebabkan kerusakan sel yang letaknya remote organ injury. Intervensi prekondisi iskemia-reperfusi PI/R merupakan fenomena jaringan yang diberikan stimulasi hipoksia berulang sebelum mendapatkan keadaan iskemia lama. Keadaan hipotermia iskemia reperfusi HI/R menyebabkan metabolisme sel menurun termasuk respon sel terhadap iskemia. Penelitian ini bertujuan untuk mengetahui efek intervensi PI/R dan HI/R terhadap perubahan morfologi endotel pembuluh darah dan peningkatan kadar malondialdehyde MDA sebagai respon stress oksidatif pada jaringan endotel a/v femoralis komunis distal obstruksi iskemia dan kontralateral CI/R. Metode: Studi eksperimental yang bersifat deskriptif analitik pada Oryctolagus cuniculus, Pada kelompok CI/R dilakukan ligasi arteri femoralis komunis dalam pembiusan selama empat jam untuk menginduksi iskemia. Pada kelompok PI/R dilakukan dengan ligasi berulang arteri femoralis komunis kanan selama dua menit, dilepaskan tiga menit sebanyak dua siklus, kemudian diligasi selama empat jam. Pada kelompok hipotermia, dilakukan ligasi arteri femoralis komunis selama empat jam yang disertai dengan membungkus ekstremitas bawah kanan dengan es dengan target suhu antara 31-33 C, kemudian pada ketiga intervensi ligasi dibuka dan kelinci dibiarkan beraktivitas selama delapan jam. Setelah itu, dilakukan pengambilan sampel a.v yang berasal dari distal dari ligasi ipsilateral dan kontralateral untuk pemeriksaan histopatologi dan biokimia. Pemeriksaan biokimia dilakukan menggunakan malondialdehid MDA. Hasil: Pada pemeriksaan histomorfologi menunjukan perbedaan bermakna antara skoring kerusakan endotel jaringan a.v. ipsilateral pada ketiga sampel intervensi dibanding kontrol dan nilai sampel intervensi preventif lebih baik daripada sampel CI/R p< 0,05 . Pada sampel a.v kontralateral kelompok PI/R dan HIR tidak memiliki perbedaan bermakna dengan kontrol p> 0,05 . Pada evaluasi kadar MDA ditemukan kadar MDA meningkat pada semua intervensi baik pada CIR, PI/R, dan HI/R yang tidak berbeda bermakna dengan kontrol p> 0,05. Konklusi: Keadaan CI/R menyebabkan disfungsi endotel bukan hanya pada daerah iskemik, namun pada organ yang letaknya berjauhan. Kerusakan endhotelial lining dapat dicegah dengan tindakan PI/R dan HI/R dan peningkatan kadar MDA merupakan respon fisiologis jaringan terhadap iskemia dan cedera reperfusi yang terjadi baik pada CI/R, PI/R, dan HI/R.

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The Effect of Preconditioning and Hypothermia in Ischemia Reperfusion Injury to the Endothelial Cells from Peripheral Blood Vessels in Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih31General Surgery Science Study Program, Faculty of Medicine Universitas Indonesia2Department of Surgery, Dr. Cipto Mangunkusumo National General HospitalIntroduction. Ischemia reperfusion injury IRI is a serious problem in the post hypoxia period, which causes remote organ injury. Ischemic preconditioning IPC is a phenomenon where tissues are subjected to repeated hypoxic stimulations to protect against subsequent prolonged period of ischemia. Hypothermia during ischemia reperfusion injury HI decreases metabolism of cells including their response to ischemia. The goal of this study is to investigate the effects of interventions such as IPC and HI on the morphology of endothelial cells in blood vessels and the increased level of malondialdehyde MDA as an oxidative stress response in endothelial tissues of distal common femoral artery and vein obstruction ischemia and its contralateral IRI.

Method: This is a descriptive and analytic experimental study using Oryctolagus cuniculus. In the IRI group, the common femoral artery was ligated during anesthesia for four hours to induce ischemia. In the IPC group, the right common femoral artery was continually ligated for two minutes, which was then released for three minutes for two cycles, and then ligated for four hours. In the hypothermia group, the common femoral artery was ligated for four hours and the right lower extremity was wrapped in ice with the target temperature range between 31 33o C. Then the arteries from the three interventions were unligated and the rabbit was released to observe its activity for eight hours. Next, samples of artery and vein distal from the ligation ipsilateral and its contralateral were obtained for histopathological and biochemical examinations. The biochemical analysis was performed using malondialdehyde MDA.

Results: The histomorphological examination showed significant difference in the injury scores between the endothelial tissues from ipsilateral artery and vein in the three interventional samples compared with control, and the scores for the preventive intervention groups were better than the IRI sample p0.05.

Conclusion: Ischemic reperfusion injury can cause not only endothelial dysfunction in the ischemic area, but also remote organ injury. Endothelial lining injury can be prevented by IPC and HI. The elevated level of MDA is a physiological response of tissue after ischemia reperfusion injury which could be found on IRI, IPC, and HI."

"Panduan resusitasi anak umumnya menganjurkan pemberian cairan dalam jumlah besar. Beberapa penelitian memperlihatkan bahwa penggunaan cairan yang agresif meningkatkan mortalitas. Penelitian pada hewan menunjukkan tekanan vena sentral yang tinggi memicu pelepasan atrial natriuretic peptide ANP , sementara penelitian invitro memperlihatkan ANP meluruhkan glycocalyx endotel vaskular dan meningkatkan permeabilitas endotel. ANP juga memicu vasodilatasi. Hemodilusi berpotensi menurunkan pasokan oksigen tubuh DO2 . Penelitian bertujuan untuk melihat pengaruh resusitasi cairan terhadap kadar ANP serum, peluruhan glycocalyx endotel vaskular, extravascular lung water index ELWI , mean arterial pressure MAP , kadar hemoglobin dan pasokan oksigen. Hewan model renjatan adalah 11 ekor Sus scrofa jantan, usia 6-10 minggu. Renjatan dilakukan dengan metode fixed pressure hemorrhage. Resusitasi pertama dilakukan dengan jumlah cairan sesuai darah yang dikeluarkan resusitasi normovolemik , dilanjutkan dengan 40 mL/kg resusitasi hipervolemik . Pengukuran hemodinamik dilakukan dengan PICCO. Serum ANP dan Syndecan-1, petanda peluruhan glycocalyx, dilakukan dengan teknik ELISA. Hasil penelitian menunjukkan terjadinya peningkatan ANP pasca resusitasi normovolemik p = 0,043 , yang kemudian menurun kembali dalam 30 menit. Peluruhan glycocalyx tidak terjadi. Perbedaan ELWI pada 60 menit pasca resusitasi secara statistik bermakna, dengan perbedaan 0,93 mL/kg 95 IK:0,19 -3,62 . Terdapat korelasi kuat antara SVRI dan CI pasca resusitasi hipervolemik r = -0,587 . Tidak ada perbedaan MAP pasca resusitasi normovolemik dan hipervolemik. Kadar hemoglobin pasca resusitasi hipervolemik lebih rendah daripada pasca resusitasi normovolemik p = 0,009 . Pasokan oksigen tubuh pasca resusitasi hipervolemik lebih tinggi daripada pasca resusitasi normovolemik p = 0,012 . Simpulan: Resusitasi cairan pada renjatan akibat perdarahan tidak mengakibatkan peluruhan glycocalyx endotel vaskular. Peningkatan ELWI amat terbatas. SVRI berkorelasi terbalik dengan CI. Tidak ada perbedaan MAP antara resusitasi normovolemik dan hipervolemik. Resusitasi hipervolemik menyebabkan hemodilusi yang diimbangi dengan peningkatan curah jantung.

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Many pediatric guidelines recommend liberal fluid resuscitation, but recent studies showed that aggressive fluid resuscitation might increase mortality. Animal studies showed that high central venous pressure induced ANP secretion. Invitro studies showed convincing evidence that ANP induced glycocalyx shedding. ANP also induced vasodilatation through cGMP signal transduction pathways. Hemodilution due to a large amount of resuscitation fluid potentially decreasing oxygen delivery.The objectives of this study were investigating the effect of fluid resuscitation, in the animal model, with special concern on serum ANP, glycocalyx shedding indicate by serum Syndecan-1 , changes in extravascular lung water, systemic vascular resirtance and mean arterial pressure, hemoglobin level and oxygen delivery DO2 . The animal models were 11 male domestic pigs, 6 -10 weeks old. The shock was induced with fixed pressure hemorrhage method. Fluid resuscitation was done in 2 phases. On the first attempt, we replaced total numbers of blood that withdrawn normovolemic resuscitation . On the second attempt, we gave 40 mL/kg resuscitation fluids hypervolemic resuscitation . The hemodynamic measurements were done with PICCO. Serum ANP and Syndecan-1 were measure with ELISA method.We found that serum ANP increased after normovolemic resuscitation p = 0.043 and immediately back to base level in 30 minutes. Glycocalyx shedding did not occur. Extravascular lung water index minimally increased. There was a strong correlation between SVRI and CI at hypervolemic resuscitation r = -0.587 . There was no difference in mean arterial pressure between normovolemic and hypervolemic resuscitation. Hemoglobin level after hypervolemic resuscitation was lower than after normovolemic resuscitation p = 0.009 . Oxygen delivery was higher after hypervolemic resuscitation p = 0.012 .Conclusions: Hypervolemic resuscitation in this hemorrhagic shock model did not induce glycocalyx shedding, extravascular lung water index minimally increased. Systemic vascular resistance index negatively correlated to cardiac index. Fluid resuscitation may induce hemodilution, but oxygen delivery can be compensated by increasing cardiac output. "

"[ABSTRAKTujuan: Untuk mengevaluasi perbandingan ketebalan kornea dan morfologi sel endotel penderita miopia sedang dengan pemakaian harian lensa kontak lunak hidrogel konvensional (nelfilcon A) terhadap silikon hidrogel (lotrafilcon B) selama 1 bulan.Metode: Penelitian ini merupakan uji klinis tersamar tunggal pada 17 pasien (34 mata) dengan miopia sedang yang dibagi secara acak untuk memakai lensa kontak lunak nelfilcon A atau Lotrafilcon B. Ketebalan kornea sentral (CCT), Coefficient of variation (CV), dan persentase sel heksagonal (6A) diukur menggunakan mikroskop spekuler non-con robo Konan sebelum penelitian (pre-fitting), 1 minggu serta 1 bulan setelah pemakaian lensa kontak lunak. Pasien juga dievaluasi mengenai adanya efek samping subyektif dan komplikasi selama memakai lensa kontak.Hasil: Terdapat 64,7% subyek dengan riwayat pemakaian lensa kontak lunak sebelumnya, dimana 52,9% diantaranya adalah pemakai hidrogel konvensional yang tidak teratur. Setelah evaluasi 1 bulan, tidak didapatkan perbedaan yang bermakna antara pemakai Nelfilcon A dengan Lotrafilcon B dalam hal: ketebalan kornea sentral (p=0,285; uji Mann Whitney), CV (p=0,587; uji t tidak berpasangan), dan 6A (p=0,353; uji t tidak berpasangan). Analisis general linear model terhadap waktu pengukuran mendapatkan perbedaan yang bermakna pada seluru subyek meliputi penurunan CCT (p=0,001) dan CV (p=0,001), serta peningkatan 6A (p=0,022) pada test within subject effect.Simpulan: Tidak terdapat perbedaan CCT, CV, dan 6A yang bermakna secara statistik antara pada pemakaian harian lensa kontak lunak Lotrafilcon B dan Nelficon A. Pasien dengan riwayat penggunaan lensa kontak sebelumnya mendapatkan manfaat dengan pemakaian nelfilcon A dan lotrafilcon B dalam hal perbaikan hipoksia jaringan berupa: penurunan ketebalan kornea dan perbaikan morfologi sel endotel.

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ABSTRACTObjective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.Methods: This is a prospective, single blind, randomized study. Seventeen (34 eyes) myopic patients were randomly assigned to wearing either nelfilcon A or lotrafilcon B. Central corneal thickness (CCT), Coefficient of variation (CV), and percentage of six-sided cell (6A) were examined using specular microscope non-con robo Konan. Changes in CCT, CV, and 6A were evaluated before contact lenses fitting as well as 1 week and 1 month after the treatment. Patients were also evaluated for any subjective side effects and complications during the treatment period.Results: There were 64,7% subjects with history of contact lens weares and 52,9% of them was hydrogel wearers. After 1 month daily wear of nelfilcon A and lotrafilcon B, no statistically differences changes in CCT (p=0,285; Mann Whitney test), CV (p=0,587; unpaired t test) dan 6A (p=0,353; unpaired t test). General linear model analysis in follow up evaluation with test of within subject effect revealed decreased CCT(p=0,001) and CV (p=0,001), also increased 6A (p=0,022) in all subjects.Conclusions: There were no statistically difference CCT, CV, and 6A between daily wear of nelfilcon A and lotrafilcon B. Subjects with history of contact lens weares gained advantages in oxygen availability, which is decrease in corneal thickness and improvement of endothelial cell morphology., Objective: To compare corneal thickness and endothelial cell morphology in myopic patients wearing 1 month hydrogel conventional and silicon hydrogel contact lenses in daily wear.Methods: This is a prospective, single blind, randomized study. Seventeen (34 eyes) myopic patients were randomly assigned to wearing either nelfilcon A or lotrafilcon B. Central corneal thickness (CCT), Coefficient of variation (CV), and percentage of six-sided cell (6A) were examined using specular microscope non-con robo Konan. Changes in CCT, CV, and 6A were evaluated before contact lenses fitting as well as 1 week and 1 month after the treatment. Patients were also evaluated for any subjective side effects and complications during the treatment period.Results: There were 64,7% subjects with history of contact lens weares and 52,9% of them was hydrogel wearers. After 1 month daily wear of nelfilcon A and lotrafilcon B, no statistically differences changes in CCT (p=0,285; Mann Whitney test), CV (p=0,587; unpaired t test) dan 6A (p=0,353; unpaired t test). General linear model analysis in follow up evaluation with test of within subject effect revealed decreased CCT(p=0,001) and CV (p=0,001), also increased 6A (p=0,022) in all subjects.Conclusions: There were no statistically difference CCT, CV, and 6A between daily wear of nelfilcon A and lotrafilcon B. Subjects with history of contact lens weares gained advantages in oxygen availability, which is decrease in corneal thickness and improvement of endothelial cell morphology.]"

"Hipertensi adalah salah satu dari masalah kesehatan yang terjadi di daerah perkotaan pada agregat lansia sebagai populasi yang rentan karena memiliki faktor risiko hipertensi yaitu pola diet yang tidak sehat. Penelitian ini dilakukan dengan tujuan menggambarakn hasil asuhan keperawatan pada lansia dengan hipertensi menggunakan intervensi unggulan yaitu pengaturan menu diet DASH (Dietary Approaches to Stop Hypertension) dengan rendah garam. Metode penelitan yang digunakan yaitu praktik lapangan. Hasil yang didapatkan adalah terjadi penurunan tekanan darah sistolik sebesar 30 mmHg dan diastolik sebesar 5-10 mmHg selama dilakukan proses asuhan keperawatan pada intervensi diet DASH dengan rendah garam. Penelitian ini merekomendasikan pengaturan diet DASH sebagai salah satu cara untuk mengontrol dan menurunkan tekanan darah pada agregat lansia yang mengalami hipertensi.

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Hypertension is one of the health problems that is occur in urban areas in the aggregate of elderly as a population that is vulnerable because they have risk factor of hypertension which is unhealthy diet pattern. This study was conducted in with the aims to depict the results of nursing care on elderly with hypertension which was using superior intervension that is the setting of diet menu DASH (Dietary Approaches to Stop Hypertension) with low salt. Research method that is used is field practice. The result obtained decrease in systolic blood pressure is 30 mmHg and diastolic is 5-10 mmHg  during the nursing care process in DASH dietary intervention with low salt. This study recommends the setting of DASH diet as one of the ways to control and reduce blood pressure in the aggregate  of elderly people with hypertension."