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"Purpose: This multicenter, randomized controlled study evaluates the safety of early oral feeding following gastrectomy, and its effect on the length of postoperative hospital stay.Methods: The subjects of this study were patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for gastric cancer between January 2014 and December 2015. Patients were randomly assigned to the early oral feeding group (intervention group) or the conventional postoperative management group (control group) for each procedure. We evaluated the length of postoperative hospital stay and the incidence of postoperative complications in each group.Results: No significant differences in length of postoperative stay were found between the intervention and control groups of the patients who underwent DG. The incidence of postoperative complications was significantly greater in the DG intervention group. In contrast, the length of postoperative stay was significantly shorter in the TG intervention group, although the TG group did not attain the established target sample size.Conclusion: Early oral feeding did not shorten the postoperative hospital stay after DG. The higher incidence of postoperative complications precluded the unselected adoption of early oral feeding for DG patients. Further confirmative studies are required to definitively establish the potential benefits of early oral feeding for TG patients."

"Anak di bawah dua tahun berisiko tinggi untuk defisiensi zat gizi mikro khususnya defisiensi zat besi, sebagian dikarenakan praktek pemberian makanan tambahan yang salah. Untuk meningkatkan kualitas pemberian makanan tambahan, rekomendasi makanan tambahan (Complementary Feeding Recommendation - CFR) berbasis pangan lokal dibutuhkan. Suplementasi zat besi digunakan secara luas untuk menanggulangi defisiensi zat besi di negara berkembang; namun, efek dari suplementasi tersebut pada mikronutrien lain dan pertumbuhan menjadi perhatian tersendiri. Fortifikasi zat besi telah menunjukkan dampak negatif pada mikrobiota usus melalui peningkatan pertumbuhan bakteri patogen pada usus dikarenakan peningkatan besi yang diserap dan suplementasi zat besi mungkin memiliki dampak yang serupa pada mikrobiota usus tetapi masih belum pernah diteliti. Sebaliknya, jika suplementasi zat besi diberikan dengan optimalisasi diet menggunakan CFR, status gizi anak-anak akan meningkat dengan efek samping yang lebih kecil pada mikronutrien lain dan pertumbuhan. Studi ini meneliti efek dari suplementasi zat besi; dengan atau tanpa diet optimal; pada status mikronutrien, mikrobiota usus dan pertumbuhan anak-anak Myanmar yang berusia di bawah 2 tahun. Sebuah percobaan acak terkontrol (NCT01758159) dilaksanakan selama 24 minggu pada anak usia 12-23 bulan di Ayeyarwady, Myanmar. Optimalisasi CFR berbasis pangan lokal dikembangkan dengan pendekatan Linear Programming. Pengacakan berdasarkan Desa untuk CFR dan non-CFR dan berdasarkan anak (n=433) untuk suplemen besi atau placebo, menghasilkan: 1. kelompok CFR+Fe (n=112); 2. kelompok CFR (n=112); 3. kelompok Fe (n=105); or 4. kelompok pembanding (plasebo) (n=104). Ibu dari kelompok CFR menerima pendidikan CFR dan anak-anak dari kelompok Fe menerima 15 mg Ferric NaEDTA setiap hari. Serum Feritin, Transferin receptor (sTfR), Zinc, retinol-binding-protein (RBP), C-reactive protein dan α-1 acid glycoprotein; feces untuk melihat mikrobiota usus (Bifidobacteria, Lactobacilli, Enterobacteriaceae, E.coli, EPEC, EAEC dan ETEC) diukur pada awal dan akhir penelitian. Di awal penelitian, 88.4% anak mengalami anemia (Hb<110g/L); setelah dikontrol dengan infeksi, 74.4% mengalami defisiensi zat besi (SF<12μg/L dan/ atau sTfR>8.3mg/L) dan 68.9% mengalami anemia gizi besi (AGB) (Hb<110g/L and ID), 41.3% mempunyai kadar serum Send rendah (serum send <10.7µmol/L). Suplementasi besi menurunkan anemia, defisiensi zat besi dan AGB dengan atau tanpa pemberian diet optimal. Namun, suplementasi besi meningkatkan risiko serum Send rendah dan pendek (stunting) bila diberikan tanpa penambahan diet optimal. Efek samping ini tidak terlihat saat suplementasi tablet besi diberikan bersama dengan diet yang optimal. Tidak ada perbedaan yang nyata pada komposisi mikrobiota usus diantara semua kelompok. Suplementasi zat besi harus diberikan bersama dengan diet optimal untuk mengurangi efek samping baik pada kadar zat gizi mikro lainnya di dalam tubuh maupun pertumbuhan anak.

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Children under 2-years of age are at high risk of micronutrient deficiencies especially iron deficiency (ID), partly due to poor complementary feeding practices. To improve feeding practices, local food-based complementary feeding recommendations (CFR) are needed. Iron supplementation is widely used to treat ID in developing countries; however, its potential effects on other micronutrients and growth are of concern. Iron fortification had shown negative impact on gut microbiota with increased growth of gut pathogens due to increased unabsorbed iron. It was assumed that iron supplementation may have similar impact on gut microbiota but has not yet been explored. On the other hand, if iron supplementation is given with optimized diet using CFRs, nutritional status of children would be improved with less adverse effects on other micronutrients status and growth.

The study investigated the effect of iron supplementation; given with or without optimized diet; on micronutrient status, gut microbiota and growth of under 2-year Myanmar children. A randomizedcontrolled trial (NCT01758159) was conducted for 24 weeks among 12-23 month old children from Ayeyarwady, Myanmar. Optimized CFRs based on locally available foods were developed by Linear Programming approach. Randomization by village for CFRs or non-CFRs and by child (n=433) for iron supplements or placebo, created: 1.CFR+Fe (n=112); 2.CFR-alone (n=112); 3.Fe-alone (n=105); or 4.Placebo (n=104) groups. Mothers from CFR-groups received education on CFRs and children from Fe groups received 15mg Ferric NaEDTA daily.

Serum for ferritin (SF), transferrinreceptor (sTfR), zinc, retinol-binding-protein (RBP), C-reactive protein and α-1 acid glycoprotein; stool for gut microbiota (Bifidobacteria, Lactobacilli, Enterobacteriaceae, E.coli, EPEC, EAEC and ETEC) were measured at baseline and endline. At baseline, 88.4% of children were anemic (Hb<110g/L); after adjusting for infection, 74.4% had ID (SF<12μg/L and/or sTfR>8.3mg/L) 68.9% had irondeficiency- anemia (IDA) (Hb<110g/L and ID), and 41.3% had low serum zinc status (serum zinc <10.7μmol/L).

Iron supplementation reduced anemia, ID and IDA whether or not it was given with optimized diet. However, iron supplementation increased the risk of low serum zinc and stunting when it is given without optimized diet. These adverse effects were not seen when iron supplementation was given with optimized diet. No significant difference was found in gut microbiota composition among groups. In conclusion, iron supplementation should be given together with optimized diet to reduce its adverse effect on other micronutrients status and growth to best improve nutritional status of these children."

"Background: low-grade chronic inflammation in obese individuals contributes to the development of lipid abnormality and insulin resistance. Vitamin E has antioxidant and insulin-sensitizing properties, mediated by adiponectin. In this study, we aimed to evaluate the effect of vitamin E supplementation on lipid profiles and adiponectin levels in obese adolescents.Methods: this was a randomized, double-blind, controlled study. Obese adolescents aged 14-18 years, with no history of taking anti-obesity or antioxidant drugs, were recruited and randomized into two groups: vitamin E and placebo. The dose of vitamin E was 400 IU/day. Intervention was administered for two months. Lipid profiles and adiponectin levels were measured at baseline and after intervention. Primary outcomes were analyzed using the per-protocol analysis principle. Statistical analysis was performed using the independent t-test or the Mann-Whitney U test.Results: a total of 66 subjects completed the intervention study, 34 in the vitamin E group and 32 in the placebo group. Lipid profiles and adiponectin levels at 2 months after intervention did not differ significantly between the two groups. Changes from the baseline level were also not significantly different between the two groups and were inconsistent from one subject to another.Conclusion: in obese adolescents, vitamin E supplementation of 400 IU/day for 2 months does not significantly affect lipid profiles and adiponectin levels."

"ABSTRACTBACKGROUND: Alphacalcidol, a vitamin D analog, shows immune regulatory potency as it works on the macrophage and T cell to control inflammation and T cell dysregulation in elderly. None has been known about its effect on elderly with various states of frailty syndrome, which have different level of chronic low grade inflammation. This study aimed to determine the effect of alphacalcidol on inflammatory cytokines (IL-6, IL-10, g-IFN ) and T cell subsets (CD4/CD8 ratio and CD8+ CD28-) of elderly with various stages of frailty syndrome. METHODS: from January to July 2017, a double blind randomized controlled trial (RCT) with allocation concealment, involving 110 elderly subjects from Geriatric Outpatient Clinic Cipto Mangunkusumo Hospital Jakarta, was conducted to measure the effect of 0.5 mcg alphacalcidol administration for 90 days to inflammatory cytokines (IL-6, IL-10, g-IFN) from PBMC culture supernatant, as well as CD4/CD8 and CD8+CD28- percentage using flow cytometry. Statistical analysis using SPSS version 20 was performed with t-test to measure mean difference. RESULTS: of 110 subjects involved in the RCT consisting of 27 fit, 27 pre-frail and 56 frail elderly, 25(OH)D serum level was found to be as low as 25.59 (12.2) ng/ml in alphacalcidol group and 28.27 (10.4) ng/ml in placebo group. Alphacalcidol did not decrease IL-6 (p=0.4) and g- IFN (p=0.001), but it increased IL-10 (p=0,005) and decreased IL6/IL10 ratio (p=0.008). Alphacalcidol increased CD4/CD8 ratio from 2.68 (SD 2.45) to 3.2 (SD 2.9); p=0.001 and decreased CD8+ CD28- percentage from 5.1 (SD 3.96) to 2.5 (1.5); p<0.001. Sub group analysis showed similar patterns in all frailty states. CONCLUSION: Alphacalcidol improves immune senescence by acting as anti-inflammatory agent through increased IL-10 and decreased IL6/IL-10 ratio and also improves cellular immunity through increased CD4/CD8 ratio and decreased CD8+ CD28- subset in elderly. This effect is not influenced by frailty state."

"Manfaat pengaturan posisi lateral kanan pada pasien gagal jantung sudah banyak diteliti, tetapi masih belum jelas efek posisi lateral kanan pada hemodinamik pasien gagal jantung. Penelitian ini bertujuan mengidentifikasi efek posisi istirahat lateral kanan terhadap hemodinamik dan tingkat kenyamanan pasien gagal jantung. Metode yang digunakan yaitu randomized controlled trial (RCT) dengan disain cross - over. Dua puluh orang sabjek gagal jantung derajat II dan III (15 laki - laki dan 5 perempuan) di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) telah berpartisipasi. Tekanan darah, Mean Arterial Pressure (MAP), denyut jantung, frekuensi pernafasan dan saturasi oksigen diukur sebelum dan setelah pengaturan posisi menggunakan bedsite monitor sedangkan tingkat kenyamanan menggunakan Verbal Rating Scale Questionnaire. Pengukuran dilakukan pada pagi hari (09.00 - 11.00 WIB) dan sore hari (16.00 - 18.00 WIB). Hasil penelitian ini menunjukkan terdapat efek yang signifikan pada TDS (Pagi: p value 0.000; Sore: p value 0.017), TDD (Pagi: p value 0.004), MAP (Pagi: p value 0.001), denyut jantung (Sore: p value 0.008) sebelum dan setelah dilakukan pengaturan posisi lateral kanan. Terdapat perbedaan yang signifikan tingkat kenyamanan antara kelompok (Sore: p value 0.041). Pengaturan posisi lateral kanan dapat dijadikan sebagai salah satu intervensi keperawatan yang digunakan untuk mempertahankan hemodinamik dan kenyamanan pasien gagal jantung.

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Benefits of right lateral position on patients with heart failure has been widely studied, but it is still unclear the effects of right lateral position on hemodynamics of patients with heart failure. This study aimed to identify the effect of right lateral resting position on hemodynamic and level of comfort heart failure patients. The method of this research was a randomized controlled trial (RCT) with a cross - over design.

Twenty subject patients with heart failure stage II and III (15 men and 5 women) at Harapan Kita Cardiac Hospital were participated. Blood pressure, Mean Arterial Pressure (MAP), heart rate, respiratory rate and oxygen saturation (SaO2) were measured pre and post setting the position used bedsite monitor where as the level of comfort used the Verbal Rating Scale Questionnaire. Measurements were taken in the morning (09:00 to 11:00 AM) and evening (04:00 to 06:00 PM).

The results of this study showed there are significant effects on the SBP (Morning: p value 0.000; Evening: p value: 0.017), DBP (Morning: p value 0.004), MAP (Morning: p value 0.001), heart rate (Evening: p value 0.008) pre and post setting the right lateral position. There is a significant difference between group on level of comfort (Evening: p value 0.041). Recommendation is directed to include right lateral position as in the nursing intervention in order to maintain hemodynamic and level of comfort on patients with heart failure."

"Ibu hamil yang berusia remaja seringkali mengalami ketidakpercayaan diri dalam merawat bayi. Kepercayaan diri dalam merawat bayi merupakan komponen penting dalam persiapan peran sebagai ibu. Diperlukan edukasi selama trimester III untuk mempersiapkan ibu dalam merawat bayi. Penelitian ini bertujuan untuk menguji pengaruh edukasi secara individu tentang perawatan bayi terhadap peningkatan maternal self-efficacy pada ibu hamil remaja trimester III. Desain penelitian menggunakan randomized controlled trial dengan jumlah responden 60 dibagi menjadi kelompok kontrol dan intervensi yang dilakukan randomisasi dan pelaksanaan penelitian menggunakan double blinding. Instrumen yang digunakan yaitu kuesioner The Self-Efficacy for Self and Health Care, Perceived Social Support from Family PSS-Fa dan Adolescent Prenatal Questionnaire APQ. Hasil penelitin menunjukkan ada pengaruh edukasi secara individu tentang perawatan bayi terhadap peningkatan rerata maternal self-efficacy sebesar 11,733 dengan nilai p= 0,001. Penelitian ini merekomendasikan pemberian edukasi secara individu tentang perawatan bayi pada ibu hamil remaja saat kunjungan ANC.

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Teenage pregnancy women often experience self efficacy in caring for the baby. Confidence in caring for the baby is an important component in the preparation of the role of mother. Education is required during third trimester to prepare mother in caring for the baby. The purpose of this study to examine the effect individual education about baby care on improvement maternal self efficacy in adolescent pregnant third trimester.

The research design using randomized controlled trial with 60 respondents divided into control group and intervention, conducted randomization and implementation of research using double blinding. The instruments used Self Efficacy for Self and Health Care questionnaire, Perceived Social Support from Family PSS Fa and Adolescent Prenatal Questionnaire APQ.

The results of the study showed effect of individual education on infant care to increase maternal self efficacy with average of 11,733 with p 0,001. This study recommends providing individualized education on infant care in adolescent pregnant during an antenatal care."

"This study's aims were (a) to investigate the feasibility of a school-based motivational enhancement therapy (MET) intervention in voluntarily attracting adolescents who smoke marijuana regularly but who are not seeking formal treatment and (b) to evaluate the efficacy of the intervention in reducing marijuana use. Ninety-seven adolescents who had used marijuana at least 9 times in the past month were randomly assigned to either an immediate 2-session MET intervention or to a 3-month delay condition. Two thirds of the sample characterized themselves as in the precontemplation or contemplation stages of change regarding marijuana use. Participants' marijuana use and associated negative consequences were assessed at baseline and at a 3-month follow-up. Analyses revealed that both groups significantly reduced marijuana use at the 3-month follow-up ( p = .001); however, no between-group differences were observed. Despite the absence of a clear effect of MET, this study demonstrated that adolescents could be attracted to participate in a voluntary marijuana intervention that holds promise for reducing problematic levels of marijuana use."

"ABSTRACTThe aim of this study was to compare the immediate postoperative period of participants rehabilitated with dental implants placed with a conventional technique or with a minimally invasive technique, without a mucoperiosteal flap elevation (flapless). Participants who needed implant placement were divided into two groups: one group was operated using a mucoperiosteal flap elevation (GA), and the other with a flapless surgical technique (G B). Objective clinical parameters including oral hygiene, mouth opening, inflammation (facial perimeter), surgical time and analgesic consumption, as well as subjective parameters of pain and degree of satisfaction with the procedure, were evaluated. 48 implants were placed in 30 participants (15 participants per group). Oral hygiene index, maximum interincisal opening, pain and analgesic consumption values had a significant difference between groups favoring the flapless technique at 24 h and 7 days but at the 15 days follow-up the differences were only significant for oral hygiene and pain (P < 0.05); there were no statistically significant differences between groups in terms of facial perimeter values and surgical time (P > 0.05). Average on the degree of satisfaction was of 2.6 (SD 0.8) for G A and 3.6 (SD 1.02) for G B (P = 0.06). One implant placed in G A (2.0%) failed before prosthetic loading due to mobility and pain at 3 months follow-up. Participants operated for implant placement with flapless surgical technique go through less postoperative discomfort. Both techniques show high success rates, but to perform a flapless technique patients must be properly selected."

"Pendahuluan: Pengobatan analgesik yang ideal pasca operasi harus dapat membantu untuk menghilangkan rasa nyeri yang cepat dan efektif. Metode Penelitian: 80 pasien yang menjalani tindakan endoskopi urologi di Rumah Sakit Kardinah. Efek analgesik dinilai menggunakan Skala Analog Visual VAS. Hasil Penelitian: Pada kelompok eksperimen, tidak ada perbedaan antara kelompok B phenazopyridine HCl dan C natrium diklofenak p> 0,05. Grup A asam pipemidat menunjukkan efek analgesik yang lebih menguntungkan daripada B dan C p

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Introduction: The ideal postoperative analgesic treat ment should provide rapid and effective pain relief.

Methods: The 80 patients who underwent endoscopic urological surgery at Kardinah Hospital. The analgesic effects were assessed using the Visual Analog Scale VAS.

Results: In the experimental group, there was no difference between groups B phenazopyridine HCl and C sodium diclofenac p 0.05. Group A pipemidic acid demonstrated a more favourable analgesic effect than B and C p"