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"Latar belakang. Sepsis merupakan suatu disfungsi organ yang dikarenakan ketidakmampuan tubuh dalam merespon infeksi dan kemungkinan disebabkan karena kerusakan dari lapisan glikokaliks endothel. Kerusakan lapisan ini kemungkinan juga dipengaruhi oleh faktor lain yang memperberat kerusakannya, diantaranya adalah balans cairan rerata yang tinggi, dosis norepinefrin yang tinggi, kadar gula darah yang tinggi serta kadar awal syndecan-1 yang tinggi. Penelitian ini bertujuan untuk membuktikan faktor-faktor tersebut merupakan faktor resiko yang memperberat kerusakan lapisan glikokaliks endothel pada pasien sepsis yang dilihat dari kadar syndecan-1 Metodologi. Penelitian ini merupakan uji analitik observasional dengan metode cohort prospektif yang dilakukan terhadap pasien sepsis usia 18-65 tahun yang dirawat di intensive care unit (ICU) RSUD Dr Moewardi sejak bulan Maret sampai dengan Juni 2021. Sebanyak 40 subjek dibagi menjadi dua kelompok kemudian diikuti selama 3 hari. Kadar syndecan-1 di ukur pada hari ke-0 dan hari ke-3. Uji statistik dengan menggunakan uji chi square kemudian dilanjutkan dengan uji regresi logistik untuk menilai secara multivariat jika memenuhi persyaratan.Hasil penelitian. Dari ke empat variabel tidak didapatkan hasil yang bermakna terhadap hubungan balans cairan rerata,dosis rerata norepinefrin, kadar gula darah sewaktu dan kadar awal syndecan-1 terhadap pengingkatan kadar syndecan-1 dengan nilai p secara berturut-turut : p=1, p=0,145, p=1. tetapi pada kadar awal syndecan-1 secara statistik bermakna berpengaruh terhadap kenaikan kadar syndecan-1 >30%, dengan p=0,01. Dari penelitian kami, kami mendapatkan hasil yang bermakna dalam hubungan vasoaktif inotropik skor dengan luaran sekunder kami yaitu angka kematian dengan p=0.018, sedangkan jikalau dengan peningkatan kadar syndecan-1>30% tidak signifikan (p=0,918). peningkatan kadar syndecan-1>30% juga tidak signifikan mempengaruhi angka kematian (p=0,609) Kesimpulan. Tidak terdapat hubungan bermakna antara Balans Cairan Rerata,Dosis Rerata Norepinefrin, Kadar Gula Darah Sewaktu Dan Skor Vasoaktif Inotropik dengan peningkatan kadar syndecan-1 pada pasien sepsis. Serta tidak terdapat hubungan antara peningkatan kadar syndecan-1 >30% dengan angka kematian pada pasien sepsis. Terdapat hubungan bermakna antara kadar awal syndecan-1 dengan pengingkatan >30% kadar syndecan-1 pada pasien sepsis.

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Background. Damage to the endothelium glycocalyx layer can induce sepsis, an organ failure caused by the body's inability to react to infection. High mean fluid balance, high norepinephrine dosages, high blood sugar levels, and high starting levels of syndecan-1 may all increase damage to this layer. The goal of this study is to show that these characteristics are risk factors for endothelial glycocalyx layer destruction in septic patients, as seen by syndecan-1 levels. Methodology. From March to June 2021, this study will conduct an observational analytic test using a prospective cohort approach on sepsis patients aged 18 to 65 who are treated in the Dr Moewardi Hospital's intensive care unit (ICU). A total of 40 people were split into two groups and monitored for three days. On days 0 and 3, the levels of syndecan-1 were tested. Statistical test using the chi square test, followed by a multivariate assessment using the logistic regression test to see if it fits the standards. Outcome. On the link between mean fluid balance, mean norepinephrine dosage, temporary blood sugar levels, and beginning levels of syndecan-1 on rising levels of syndecan-1, no significant findings were observed with p values of 1, p=0,145, and p=1. However, at baseline syndecan-1 levels, there was a statistically significant impact on raising syndecan-1 levels > 30%, with p = 0.01. We found significant findings in the connection of vasoactive inotropic scores with our secondary outcome, death, with p=0.018, but not in the association of rising levels of syndecan-1>30 percent (p=0.918). The mortality rate was not substantially affected by higher levels of syndecan-1 > 30% (p = 0.609). Conclusion. There was no link between elevated levels of syndecan-1 and mean fluid balance, mean norepinephrine dosage, transient blood sugar levels, and vasoactive inotropic scores in septic patients. Furthermore, there is no link between higher levels of syndecan-1 > 30% and septic patient mortality. In septic patients, there is a substantial correlation between initial syndecan-1 levels and a >30% rise in syndecan-1 levels."

"Resusitasi cairan yang berlebihan selama pengobatan awal syok septik pediatri berhubungan dengan komplikasi seperti edema paru dan disfungsi organ. Pada pasien dewasa, penggunaan vasopresor dini dianjurkan untuk mengembalikan perfusi tanpa menyebabkan kelebihan cairan. Namun, penelitian mengenai penggunaan awal norepinefrin (NE) pada anak dengan syok sepsis masih terbatas. Penelitian ini bertujuan untuk menilai pengaruh pemberian NE dini terhadap jumlah cairan resusitasi, kadar laktat, dan kejadian edema paru pada anak dengan syok sepsis. Penelitian ini merupakan uji klinis acak dengan label terbuka yang dilakukan di satu pusat yaitu RS Cipto Mangunkusumo Jakarta pada bulan Maret hingga Mei 2024. Penelitian ini melibatkan 42 pasien anak dengan sepsis. Peserta dibagi secara acak menjadi dua kelompok: kelompok intervensi yang menerima loading cairan dengan tambahan NE dini 0,1 mcg/kg/menit (n=21) dan kelompok kontrol yang mendapat loading cairan sesuai protokol standar (n=21). Parameter jumlah cairan yang diberikan, kadar laktat, edema paru, dan hemodinamik dievaluasi dengan melakukan pemeriksaan klinis serta pemeriksaan USCOM, dan ultrasonografi paru. Hasil penelitian didapatkan bahwa pemberian NE sejak awal resusitasi tidak terbukti mengurangi jumlah cairan resusitasi pada anak dengan syok sepsis yang bermakna, namun tren jumlah cairan resusitasi lebih sedikit pada kelompok perlakuan dibanding kelompok kontrol (p=0,060), Selain itu, juga tidak terbukti adanya perbedaan kadar laktat pasca-pemberian NE dini dibandingkan kontrol [8/21(38%) vs 4/21 (28,6%), p=0,306], serta tidak terbukti adanya perbedaan kejadian edema paru pasca-pemberian NE dini dibandingkan kontrol [7/21 (33%) vs 5/21 (24%); p=0,734]. Sedangkan untuk pengukuran stroke volume index, cardiac index, dan systemic vascular resistancy index, tidak terbukti terdapat perbedaan antara kelompok loading cairan ditambah NE dini dengan kelompok loading cairan saja. Simpulan dari penelitian ini adalah pemberian NE dini tidak terbukti mengurangi jumlah cairan resusitasi pada anak dengan syok sepsis, namun tren jumlah cairan resusitasi lebih sedikit.

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Excessive fluid resuscitation during initial treatment of pediatric septic shock is associated with complications such as pulmonary edema and organ dysfunction. In adult patients, early use of vasopressors is recommended to restore perfusion without causing fluid overload. However, research on the early use of norepinephrine (NE) in children with septic shock is limited. This study aims to assess the effect of early NE administration on the amount of resuscitation fluid, lactate, and pulmonary edema in children with septic shock. This study was a single-site, randomized, open-label clinical trial conducted at Cipto Mangunkusumo Hospital, Jakarta from March to May 2024. This study involved 42 pediatric patients with sepsis. Participants were divided randomly into two groups: the intervention group received fluid loading with additional early NE 0.1 mcg/kg/minute (n=21), the control group received fluid loading according to standard protocol (n=21) Parameters such as the amount of fluid administered , lactate levels, pulmonary edema, and hemodynamics were evaluated using clinical examination, USCOM, and lung ultrasonography. The research results showed that it was not proven to reduce the amount of resuscitation fluid in children with septic shock, but the trend was that the amount of resuscitation fluid was less in the treatment group than the control group (p=0.060), it was not proven that there was no increase in lactate levels after early NE administration compared to controls [8/21 (38%) vs 4/21 (28.6%), p=0.306], and there was no proven difference in the incidence of pulmonary edema after early NE administration compared to controls [7/21 (33%) vs 5/21 (24%) ; p=0.734]. Meanwhile, measurements of stroke volume index, cardiac index, and systemic vascular resistance index did not prove to be a difference between the fluid loading plus early NE group and the fluid loading only group. The conclusion of this study is that early NE administration is not proven to reduce the amount of resuscitation fluid in children with septic shock, but the trend for the amount of fluid to be less."

"Latar Belakang: Pasien sakit kritis dengan sepsis biasanya menerima volume cairan yang sangat besar menyebabkan balans cairan positif yang sangat signifikan dalam upaya untuk memenuhi kebutuhan kardiak output, tekanan darah sistemik, dan perfusi ke ginjal. Kondisi ini juga ternyata berkaitan dengan angka survival yang buruk. Tujuan dari penelitian ini adalah untuk mengetahui apakah rumatan dini norepinefrin dapat mengurangi pemberian cairan dan mencegah overload pada resusitasi pasien syok septik. Metode: Penelitian ini merupakan penelitian uji klinis acak tidak tersamar dengan subjek penelitian adalah pasien dewasa yang masuk di unit perawatan intensif dan instalasi rawat darurat dari Januari- November 2020 yang didiagnosa dengan syok septik. Terdapat dua kelompok perlakuan, kelompok norepinefrin dini dan kelompok resusitasi cairan 30 ml/kgBB. Dilakukan penilaian terhadap rasio albumin kreatinin urin, peningkatan nilai serum kreatinin, rasio PaO2/FiO2, dan tekanan intraabdominal pada saat diagnosa syok septik ditegakkan, 3 jam dan 24 jam setelah perlakuan diberikan. Data diolah dalam menggunakan perangkat SPSS. Hasil: Berdasarkan analisis didapatkan perbedaan yang bermakna untuk semua variabel penelitian pada kelompok perlakuan resusitasi cairan dibandingkan dengan kelompok norepinefrin. Jumlah pemberian cairan pada kelompok norepinefrin dini rata-rata adalah 2198,63 ml, lebih sedikit dibandingkan pada kelompok resusitasi cairan 30 ml/kgBB dengan rata-rata 3999,30 ml, uji Chi Square p = 0,000. Dengan membandingkan hasil pengukuran terhadap nilai pengukuran awal pada kedua kelompok, overload cairan sangat berisiko terjadi pada kelompok resusitasi cairan 30 ml/kgBB. Didapatkan hubungan yang bermakna pada rasio albumin kreatinin urin, peningkatan nilai serum kreatinin, rendahnya rasio PaO2/FiO2 dan peningkatan tekanan intraabdominal dengan pemberian resusitasi cairan 30 ml/kgBB yang menunjukkan risiko terjadi overload cairan (OR 48,273 ; CI 95% = 16,708-139,472, OR = 73,381 ; CI 95% = 19,955-269,849, OR = 12,225 ; CI 95% = 5,290-28,252, dan OR = 32,667 ; CI 95% = 10,490-101,724).Kesimpulan: Pemberian norepinefrin dini dapat mengurangi pemberian cairan dan mencegah overload pada resusitasi pasien syok septik

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Background: Critically ill patients with sepsis usually receive a very large volume of fluids causing a very significant positive fluid balance in an effort to meet the needs of cardiac output, systemic blood pressure, and perfusion to the kidneys. This condition also turns out to be associated with poor survival rates. The aim of this study was to determine whether early maintenance of norepinephrine can reduce fluid administration and prevent overload in the resuscitation of patients with septic shock.

Methods: This study is a randomized, non-blind clinical trial with the subject of the study being an adult patient diagnosed with septic shock who were admitted to the intensive care unit and emergency care unit from January to November 2020 who were diagnosed with septic shock. There were two treatment groups, the early norepinephrine group and the 30 ml/kgBW fluid resuscitation group. An assessment of the urinary albumin to creatinine ratio, increased serum creatinine value, PaO2/FiO2 ratio, and intraabdominal pressure at the time of diagnosis of septic shock was established, 3 hours and 24 hours after the treatment was given. The data is processed using the SPSS device.

Results: Based on the analysis, it was found that there were significant differences for all study variables in the fluid resuscitation group compared to the norepinephrine group. The amount of fluid administration in the early norepinephrine group averaged 2198.63 ml, less than that in the 30 ml / kgBW fluid resuscitation group with an average of 3999.30 ml, Chi Square test p = 0.000. By comparing the measurement results against the initial measurement values in the two groups, fluid overload was very risky in the 30 ml / kgBW fluid resuscitation group. There is a significant relationship between the urinary albumin to creatinine ratio, the increase in the serum creatinine value, the low PaO2/FiO2 ratio and the increase in intraabdominal pressure with the provision of 30 ml/kgBW fluid resuscitation which indicated the risk of fluid overload (OR 48.273; 95% CI = 16.708-139.472, OR = 73,381; 95% CI = 19,955-269,849, OR = 12,225; 95% CI = 5,290-28,252, and OR = 32,667; 95% CI = 10,490-101,724).

Conclusion: Early norepinephrine administration can reduce fluid administration and prevent overload in the resuscitation of patients with septic shock."

"Mortalitas anak dengan sepsis masih tinggi dengan penyebab yang belum banyak diketahui patofisiologinya. Kerusakan lapisan glikokaliks pada permukaan endotel pembuluh darah dapat menyebabkan peningkatan permeabilitas pembuluh darah yang mengakibatkan syok sepsis dan disfungsi organ pada pasien sepsis. Peningkatan kadar syndecan-1 dalam darah merupakan salah satu penanda kerusakan lapisan glikokaliks. Penelitian ini bertujuan untuk mengetahui hubungan kadar syndecan-1 dengan disfungsi organ yang dinilai dengan skor PELOD-2 dan mortalitas 28 hari pada pasien anak dengan sepsis. Hubungan kadar syndecan-1 dengan skor PELOD-2 merupakan studi potong lintang, sementara hubungan syndecan-1 dengan mortalitas merupakan studi prospektif. Penelitian dilakukan pada 55 anak berusia 1 bulan-<18 tahun dengan sepsis yang dirawat di RSCM pada bulan Maret-Agustus 2019 dengan cara consecutive sampling. Evaluasi syndecan-1 dan skor PELOD-2 dilakukan pada hari pertama dan kelima setelah diagnosis sepsis. Pasien diikuti selama 28 hari untuk evaluasi mortalitas. Didapatkan peningkatan syndecan-1 pada seluruh pasien sepsisdengan peningkatan yang lebih tinggi pada pasien dengan syok sepsis (p=0,01). Terdapat korelasi positifantara kadar syndecan-1 dengan skor PELOD-2 pada 24 jam pertama setelah diagnosis sepsis dengan koefisien korelasi 0,32 (p=0,01). Terdapat korelasi positif antara perubahan kadar syndecan-1 dengan perubahan skor PELOD-2 dengan koefisien korelasi 0,469 (p=0,002). Tidak didapatkan hubungan antara kadar syndecan-1 dengan skor PELOD-2 pada hari kelima (p=0,6). Peningkatan kadar syndecan-1 didapatkan tidak berhubungan dengan mortalitas 28 hari (p=0,49).Nilai titik potongsyndecan-1 ≥688 ng/mLpada hari pertama dapat memprediksi skor PELOD-2 ≥8 dengan AUC 73,8%, sensitivitas 67%, spesifisitas 77%, NDP 44,4%, dan NDN 89,2% (p=0,012).

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Sepsis still contributes significantly to morbidity and mortality inpediatric patients. Disruption of glycocalyx layer on vascular endothelium has been described as one of the main pathophysiological events that leads to increased vascular permeability, contributing to organ failure and septic shock. The role of glycocalyx disruption in pediatric sepsis has not been widely studied. Increased syndecan level in blood marks disruption of glycocalyx integrity. This study was aimed to analyze the correlation ofserum syndecan-1 with organ dysfunction assessed by PELOD-2 score, and to evaluate its association with mortality in pediatric sepsis. Correlation of syndecan-1 and PELOD-2 score was a cross sectional study, while association of syndecan-1 with mortality was a prospective study. The study was conducted in pediatric intensive care unit, emergency unit, and pediatric ward of Cipto Mangunkusumo Hospital, Jakarta, on March-August 2019. The subjects were 55 patients aged 1-month to 18-year-old with sepsis that fulfilled the inclusion criteria consecutively. Serum syndecan-1 level and PELOD-2 score were evaluated on day 1 and 5 after diagnosis of sepsis. Survival was assessed after 28 days. There was increased level of syndecan-1 in all subjects, with significantly higher level found in patients with septic shock (p=0,01). There was positive correlation of syndecan-1 with PELOD-2 score in the first 24 hours after diagnosis of sepsis with correlation coefficient of 0.32 (p=0.01). Changes in syndecan-1 level within 5 days positively correlated with changes of PELOD-2 score with correlation coefficient of 0.469 (p=0.002). Syndecan-1 level and PELOD-2 score on day 5 was not significantly correlated (p=0.6). There was no association of increased syndecan-1 level with mortality in 28 days (p=0.49). Cut-off point of syndecan-1 ≥688 ng/mL in the first 24 hours can predictsignificant organ dysfunction (PELOD-2 score of ≥8) with AUC of 73.8%, sensitivity 67%,specificity 77%, positive predictive value 44.4%, and negative predictive value 89.2% (p=0.012)."

"Diabetes Mellitus merupakan penyakit kronis yang memerlukan perawatan berkesinambungan dan membutuhkan waktu cukup lama serta merupakan penyakit tidak menular yang prevalensinya terus meningkat, dan berkontribusi terhadap peningkatan angka kematian. Penelitian bertujuan mengidentifikasi hubungan perilaku pemenuhan nutrisi pada dewasa DM tipe 2 dengan kadar gula darah sewaktu di kota Depok. Desain penelitian kuantitatif dengan pendekatan cross- sectional. Populasi dewasa DM tipe 2, Maret 2014 berjumlah 1042 orang dengan sampel yang diambil 92. Tehnik sampling menggunakan teknik Cluster Sampling (Area Sampling). Hasil analisis menunjukan pengetahuan, keterampilan dan sikap berhubungan dengan kadar gula darah sewaktu dengan variabel perancunya adalah status gizi dan dukungan kelurga. Pengetahuan merupakan variabel yang paling berhubungan dengan kadar gula darah sewaktu (OR 7.018) setelah dikontrol dengan variabel perancu. Bagi pelayanan kesehatan diperlukan sosialisasi upaya pencegahan dan perawatan DM tipe 2 secara rutin di puskesmas dan posbindu.

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Diabetes mellitus is a chronic disease that requires continous care for long time. It is not contagious disease which the prevalence increases and contributes with death rate. This research aimed to identify the relation of adult people with type 2 diabetes' diet behaviour with the blood sugar levels in Depok. Quantitative research designuses the cross sectionalapproach. The data obtained from 28 health centers that located in the Depok,on March 2014, the population of adult with DM is I 042 people with 92 samples taken. The sampling technique is using Cluster Sampling (Sampling Area).

The results shows the main Variables that include knowledge, skill and attitude are all related to blood sugar levels in type 2 DM respondents in Depok and the confoundingvariable is nutrition status and support from family member. The knowledge is the most related with the sugar level. Its recomended to provide the information about diabetes, diet and lifestyle in the prevention of type 2 diabetes from health centers in Depok."

"Tesis ini membahas perubahan kadar serum gamma glutamil transpeptidase GGT pada bayi dengan sepsis neonatorum. Penelitian ini merupakan suatu penelitian prospektif, yang dilakukan di ruang perawatan intensif bayi di Rumah Sakit Cipto Mangunkusumo. Pada hasil penelitian didapatkan bahwa kadar serum GGT tidak mempengaruhi luaran bayi dengan sepsis. Simpulan penelitian ini bahwa kadar GGT yang diambil pada bayi dengan sepsis, baik saat awal terdiagnosis sepsis sampai hari ketujuh, tidak mempengaruhi luaran baik dan buruk bayi. Kadar leukosit, trombosit, CRP dan bilirubin direk mempengaruhi luaran bayi dengan sepsis.

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This study discusses changes in serum levels of Gamma Glutamyl Transpeptidase GGT in infants with neonatal sepsis. This study is a prospective study, conducted in theNeonatal Intensive Care Unit NICU at Cipto Mangunkusumo Hospital. The resultsshowed that serum levels of GGT did not affect the outcome of infants with neonatalsepsis.The conclusion of this study is that the serum levels of GGT taken from infants with sepsisboth initially after the diagnosis of sepsis is established or until the seventh day, did notaffect the outcomes of neonatal sepsis. White blood cells, platelet, CRP and directbilirubin levels affect the outcome of infants with sepsis."

"[ABSTRAKLatar Belakang: Penyakit Demam Berdarah Dengue (DBD) masih endemis dan merupakan masalah yang besar dan serius di Indonesia. Peningkatan kadar laktat dalam darah merupakan petanda hipoksia jaringan pada penyakit DBD, bila hipoksia jaringan tidak terdeteksi lebih awal/dini, dan tidak diberikan cairan lebih agresif dan sesuai, maka akan meningkatkan angka komplikasi dan kematian. Tujuan: Mengetahui perbedaan rerata kadar hematokrit dan albumin serum serta beda proporsi efusi pleura dan atau asites, pasien infeksi dengue dewasa pada berbagai derajat hiperlaktatemia untuk mengetahui secara dini adanya hipoksia jaringan Metode: Penelitian ini adalah Studi uji Potong Lintang. Penelitian dilakukan di RSUPN Cipto Mangunkusumo dan RSUP Persahabatan Jakarta, pada pasien yang dirawat periode waktu April 2014 sampai dengan Mei 2015. Menilai beda rerata kadar hematokrit darah dan albumin serum menggunakan uji statistik Uji T, sedangkan beda proporsi efusi pleura dan atau asites dengan Uji Kai Kuadrat. Hasil: Sebanyak 62 pasien infeksi demam dengue, dibagi kedalam 2 kelompok masing-masing 31 pasien berdasarkan kadar laktat darah. Kelompok I dengan kadar laktat darah > 2 sampai ≤ 2,4 mmol/L dan kelompok II > 2,4 mmol/L. Rerata kadar hematokrit darah pada kelompok I dan II masing-masing 40,06 (SB 4,54) dan 41,03 (SB 4,77). Tidak ada perbedaan rerata kadar hematokrit darah pada kedua kelompok dengan nilai p = 0,42. Rerata kadar albumin serum pada kelompok I dan II masing-masing 3,94 (SB 0,29) dan 3,89 (SB 0,30). Tidak ada perbedaan rerata kadar albumin serum pada kedua kelompok dengan nilai p = 0,49. Proporsi efusi pleura dan atau asites pada kelompok I dan II masing-masing 54,8% dan 58,1%. Tidak ada perbedaan proporsi adanya efusi pleura dan atau asites pada kedua kelompok dengan p = 1. Kesimpulan: Tidak ada perbedaan rerata kadar hematokrit darah dan albumin serum, serta beda proporsi efusi pleura dan atau asites pada kelompok kadar laktat darah > 2 sampai ≤ 2,4 mmol/L dibandingkan > 2,4 mmol/L.

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ABSTRACTBackground: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.;Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.;Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L., Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.]"

"Pendahuluan : Di Indonesia, menurut Biro Pusat Statistik, persentase penggunaan benzena terhadap seluruh bahan kimia yang digunakan oleh sektor Industri diperkirakan sebesar 20-40%. Pada industri minyak dan gas, para pekerja terpajan benzena dalam waktu yang lama, sehingga ada kemungkinan menderita efek toksik benzena berupa gangguan metabolisme lemak, dalam hal ini trigliserida pada pekerja terpajan benzena rendah dengan dan tanpa patahan kromosom limfosit. Penelitian ini bertujuan untuk mengetahui perbedaan rerata kadar trigliserida pada pekerja terpajan benzena rendah dengan dan tanpa patahan kromosom limfosit dalam kurun waktu 1 tahun (2011-2012, serta pengaruhnya terhadap faktor sosiodemografi dan pekerjaan. Metode : Penelitian ini menggunakan disain kohort retrospektif. Tempat penelitian dilakukan di sebuah industri migas X. Jumlah sampel yang memenuhi kriteria inklusi den eksklusi adalah 99 orang. Pengumpulan data dilakukan dengan menggunakan data sekunder, yaitu data kepegawaian dari bagian SDM dan data pemeriksaan kesehatan berkala pekerja tahun 2011 dan 2012. Analisis bivariat dengan uji kemaknaan chi square. Hasil : Rata-rata perubahan kadar trigliserida dengan patahan kromosom limfosit tahun 2011-2012 yaitu 2,52 sedangkan rata-rata perubahan kadar trigliserida tanpa patahan kromosom limfosit tahun 2011-2012 yaitu 7,08. Kesimpulan dan Saran : Hipotesis diterima karena : rerata perubahan perbedaan kadar trigliserida dengan patahan kromosom limfosit lebih rendah dibandingkan rerata perubahan perbedaan kadar trigliserida tanpa patahan kromosom limfosit pada tahun 2011 dan 2012. Pada pekerja dengan patahan kromosom limfosit dengan kadar rata-rata trigliserida tinggi atau normal perusahaan melakukan pemeriksaan kadar trigliserida minimal 6 bulan sekali.

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Introduction: In Indonesia, pursuant to Central Statistics Bureau, percentage of benzene utilization upon all chemical material used by Industrial sector was estimated at 20-40%. In oil and gas industry, workers exposed to benzene for a long time, thereby there is a possibility to suffer benzene toxic effect in form of fat metabolism disorder, in this regard triglycerides in workers exposed to low benzene with and without lymphocyte chromosome breakage. The purpose of this research is to understand the different of average levels of triglycerides in workers exposed to low benzene with and without lymphocyte chromosome breakage in period of 1 year (2011-2012), and its affect to socio demographic and work.

Method: This research is using retrospective cohort design. Place of research is in oil and gas industry of X. The amount of sample that comply with inclusion and exclusion criteria is 99 peoples. Data collection was conducted by using secondary data, that is employment data form the Human Resources division and workers? periodic health examination in year of 2011 and 2012. Bivariate analysis with chi square significant test.

Results: Average level change of triglyceride with lymphocyte chromosome breakage in year of 2011-2012 is 2.52 while average level change of triglyceride without lymphocyte chromosome breakage in year of 2011-2012 is 7.08.

Conclusion and Recommendation: Hypothesis is accepted due to: different average change of triglyceride levels with lymphocyte chromosome breakage is lower than the average change of triglyceride levels without lymphocyte chromosome breakage in year of 2011 and 2012. For workers with lymphocyte chromosome breakage with high average levels of triglyceride or normal, a company performs examination of triglyceride levels at least every 6 months."

"Latar Belakang : Sepsis adalah penyebab utama kematian pasien dengan penyakit kritis. Uji fungsi hati memiliki nilai prognostik untuk menentukan terjadinya kolestasis terkait sepsis (KTS). Antioksidan diduga berpengaruh dalam KTS sehingga perlu dibuktikan.Tujuan : Mengetahui gambaran umum penderita KTS neonatorum di Departemen IKA FKUI-RSCM. Mengetahui apakah antioksidan (seng, vitamin A dan vitamin D) dan nilai parameter biokimia hati (bilirubin, AST, ALT dan GGT) memiliki nilai prognostik untuk luaran (baik dan buruk) pada KTS.Metode: Penelitian uji prognostik dengan metode kohort prospektif periode Desember 2011-Desember 2012. Subjek penelitian kali ini adalah neonatus cukup bulan usia 0-28 hari atau kurang bulan sampai 42 minggu usia koreksi. Data dilakukan tabulasi untuk melihat karakteristik dan distribusi data kadar antioksidan dan parameter biokimia hati. Analisis statistik menggunakan analisis bivariat (uji Kai kuardat atau Fisher) dan multivariat (uji regresi logistik).Hasil : Penelitian sejak Desember 2011-Desember 2012 terdapat 1052 neonatus, 332 tersangka sepsis, 225 proven sepsis. Penelitian dilakukan pada 80 subjek (50 KTS dan 30 sepsis tanpa kolestasis). Sebagian besar subjek lelaki (61%), berat lahir <2500 gram (41%), usia gestasi cukup bulan (63%). Manifestasi klinis tersering adalah instabilitas suhu (55%), letargis (51%),dan distres pernapasan (45%). Bakteri utama penyebab sepsis adalah Staphylococcus epidermidis (31%), Acinetobacter sp. (16%), dan Enterobacter cloacae (14%). Faktor yang memiliki nilai prognostik untuk memprediksi luaran pada KTS adalah defisiensi vitamin A (RR 0,2; IK95%=0,06-0,78; p=0,020) dan kadar GGT (RR 10; IK95%=1,72-58,31; p=0,010).Simpulan :. Antioksidan, defisiensi vitamin A terbukti sebagai faktor prognostic unutk luaran baik pada KTS neonatorum. Parameter biokimia hati dalam hal ini GGT terbukti sebagai faktor prognosis untuk luaran buruk pada KTS neonatorum.

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Background: Sepsis is the leading cause of death in critically ill patients. Liver plays a role in multiorgan failure during sepsis. Biochemical liver parameters have prognostic value for determining the occurrence of Neonatal sepsis-associated cholestasis (NSAC). Micronutrients thought to play a role in NSAC so it is necessary to prove its contribution to the NSAC.

Objective: To determine the characteristics of patients in the NSAC Child Health Department Faculty of medicine-RSCM in the period December 2011 - December 2012. Knowing the characteristics of the levels of substances such as zinc, vitamin A, and vitamin D and levels of liver function tests such as bilirubin, AST, ALT and GGT which has prognostic value for the occurrence of NSAC outcomes.

Methods: This is a prognostic study with cohort prospective method during December 2011-December 2012. Subjects were full-term neonates aged 0-28 days or preterm neonates until 42 weeks of age correction, has proven sepsis and clinical sepsis. The data was then tabulated to see the characteristics of the data subject and the distribution of antioxidant and biochemical liver parameters. Statistical analysis was performed to search for prognostic factors associated with NSAC with Chi-Square or Fisher (bivariate analysis) and logistic regression (multivariate analysis).

Results: Patients treated in the period December 2011 - December 2012 as many as 1052 patients, 332 subjects suspected sepsis, with 225 proven sepsis. The study was conducted on 80 subjects, consisting of 50 subjects and 30 subjects NSAC sepsis, neonatal majority of subjects were male (61%), gestational age at term (63%) and birth weight < 2500 gram. The clinical manifestations of sepsis are the most temperature instability (55%), followed by symptoms letargis (51%) and respiratory distress (45%). Based on the data, blood culture results obtained with the major bacterial cause of neonatal sepsis in a row is Staphylococcus epidermidis (31%), Acinetobacter sp (16%), and Enterobacter cloacae (14%). Based on logistic regression, micronutrients: deficiency vitamin A (p = 0.020; RR0,2 (95% CI = 0.06 to 0.78) and liver function tests: GGT (p = 0.010; RR10 (95% CI =1.72 to 58.31) has a prognostic value to predict outcomes in NSAC.

Conclusion: Vitamin A deficiency has been demonstrated to have a good prognostic factor for the outcome of NSAC. While low GGT level has been demonstrated to have a poor prognostic factor for the outcome of NSAC."

"Latar Belakang. Pasien yang mengalami sepsis dan syok sepsis akan mengalami disfungsi organ akibat reaksi radikal bebas dengan sel endotel mikrovaskular sehingga menyebabkan tingkat morbiditas dan mortalitas yang cukup tinggi. Kondisi difungsi organ dapat diukur melalui perubahan kadar Interleukin-6 (IL-6), C-Reactive Protein (CRP), dan skor Sequential Organ Failure Assessment (SOFA) yang terjadi pada pasien-pasien tersebut. Pemberian asam askorbat yang memiliki kemampuan sebagai free radical scavenging, diharapkan dapat menurunkan proses peradangan atau inflamasi sehingga terjadi perbaikan fungsi organ. Penelitian ini bertujuan untuk mengetahui peran pemberian asam askorbat 6 gram secara intravena terhadap perubahan kadar IL-6, CRP, dan skor SOFA pada pasien sepsis dan syok sepsis di ruang perawatan intensif.Metodologi. Penelitian ini merupakan uji klinis dengan desain uji acak terkontrol, tersamar tunggal yang dilakukan terhadap pasien usia 18-65 tahun dengan diagnosis sepsis atau syok sepsis dalam perawatan 24 jam pertama masuk intensive care unit (ICU) RSUPN Dr. Cipto Mangunkusumo-Jakarta dan ICU RSUP H. Adam Malik-Medan sejak bulan Juli sampai dengan Desember 2019. Sebanyak 49 subyek dirandomisasi menjadi dua kelompok. Kelompok perlakuan (n=23), yang menerima vitamin C 1,5 gram per 6 jam selama 3 hari, dan kelompok kontrol (n=26), yang tidak menerima vitamin C tersebut. Pemeriksaan kadar IL-6, kadar CRP, dan skor SOFA dilakukan pada jam ke-24, 48, dan 72.Hasil. Tidak terdapat perubahan bermakna pada kadar IL-6 (P=0,423), CRP (P=0,080), dan skor SOFA (P=0,809) antara kelompok kontrol dan kelompok perlakuan.Kesimpulan. Pemberian asam askorbat 6 gram secara intravena tidak memberikan perubahan bermakna terhadap kadar IL-6, CRP, dan skor SOFA pada pasien sepsis dan syok sepsis di ruang perawatan intensif.

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Background. Septic and septic shock patients will have organ dysfunctions due to free radical reaction with microvacular endothelial cells, thus morbidity and mortality rate will increase in these conditions. Those organ dysfunctions can be measured through the changes of Interleukin-6 (IL-6) levels, C-Reactive Protein (CRP) levels, and Sequential Organ Failure Assessment (SOFA) scores. The administration of ascorbic acid has a feature known as free radical scavenging. The feature is expected to reduce the inflammatory rate in the organs and to improve the functions. This study was aimed to analyze the intravenous administration effect of 6 grams of ascorbic acid towards the changes of Interleukin-6 levels, C-Reactive Protein levels, and SOFA scores in septic and septic shock patients in intensive care unit

Methods. This was a single blind randomized controlled clinical trial study on patients aged 18-65 years old with septic and septic shock conditions in the first 24 hour care in intensive care unit (ICU) Dr. Cipto Mangunkusumo Hospital-Jakarta and H. Adam Malik Hospital-Medan from July to December 2019. In total, 49 subjects were included in the study and randomized into two groups. Intervetion group (n=23) received 1.5 gram/6 hours of vitamin C in three days consecutively, whereas the control group (n=26) did not receive the vitamin C. Measurements of IL-6 levels, CRP levels, and SOFA scores were performed in the 24th, 48th, and 72th hour.

Results. There were no significant changes of IL-6 levels (p=0.423), CRP levels (p=0.080), and SOFA scores (p=0.809) between the two groups.

Conclusion. The intravenous administration of 6 grams of ascorbic acid did not significantly affect the changes of Interleukin-6 levels, C-Reactive Protein levels, and SOFA scores in septic and septic shock patients in intensive care unit."