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"Latar Belakang: Tetralogy of Fallot (ToF) merupakan kombinasi khas dari VSD, overriding aorta, pulmonary stenosis, dan hipertrofi ventrikel kanan. Operasi total koreksi adalah cara untuk memperbaiki kelainan dengan membuka jantung, tujuan utama total koreksi untuk menutup VSD dan mengoreksi aliran keluar ventrikel kanan dari obstruksi. Kompleksnya permasalahan yang timbul postoperasi bedah jantung khususnya post total koreksi dengan kejadian komplikasi efusi pleura, dengan anak yang harus dipasang atau sudah terpasang chest tube maka peran perawat dalam memberikan asuhan keperawatan diharapkan memperhatikan status pernapasan. Jenis penelitian: yang digunakan adalah observasional analitik dengan rancangan case control dengan tujuan untuk mengidentifikasi faktor-faktor yang berkontribusi terhadap kejadian efusi pleura pada pasien anak dengan ToF post operasi total koreksi. Cara pengumpulan data dilakukan secara retrospektif yang diambil dari data sekunder berupa rekam medis, lembar observasi pasien selama perawatan, dan data penunjang (Echo dan Xray). Subyek penelitian ini adalah 134 pasien anak dengan ToF di Rumah Sakit Jantung Jakarta periode Januari 2019 sampai Juli 2022. Hasil: Tidak ada hubungan yang signifikan antara faktor-faktor preoperasi (usia saat operasi, saturasi preoperasi, dan berat badan saat operasi), faktor-faktor intraopersi (durasi CPB dan varian) dan faktor postoperasi (Kejadian infeksi), terdapat hubungan yang signifikan antara faktor postoperasi (lama ventilasi mekanik) dengan kejadian efusi pleura pada pasien anak dengan ToF post operasi total koreksi. Simpulan: dari penelitian ini uji statistik menunjukkan kejadian infeksi tidak signifikan terhadap kejadian efusi pleura, sebaiknya dapat juga dilakukan pengkajian mengenai faktor infeksi preoperasi untuk melihat hubungannya dengan kejadian efusi pleura.

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Background: Tetralogy of Fallot (ToF) is a typical combination of VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Total correction surgery is a way to correct the abnormality by opening the heart, the main goal of total correction is to close the VSD and correct the right ventricular outflow obstruction. The complexity of the problems that arise after cardiac surgery, especially post total correction with the incidence of complications of pleural effusion, with children who must be installed or have chest tubes installed, the role of nurses in providing nursing care is expected to pay attention to respiratory status. Type of study: the analytic observational used with a case control design with the aim of identifying the factors that contribute to the occurrence of pleural effusion in pediatric patients with ToF post total surgery correction. The method of data collection was carried out retrospectively taken from secondary data in the form of medical records, patient observation sheets during treatment, and supporting data (Echo and Xray). The subjects of this study were 134 pediatric patients with ToF at the Jakarta Heart Hospital for the period January 2019 to July 2022.

Results: There was no significant relationship between preoperative factors (age at surgery, preoperative saturation, and weight at surgery), factors Intraoperative factors (CPB duration and variants) and postoperative factors (incidence of infection), there is a significant relationship between postoperative factors (time of mechanical ventilation) and the incidence of pleural effusion in pediatric patients with total postoperative ToF correction.

Conclusion: from this study statistical tests showed that the incidence of infection was not significant for the incidence of pleural effusion, it is advisable to assess preoperative infection factors to see the relationship with the incidence of pleural effusion."

"ABSTRAKSaat ini jumlah kasus positif Covid-19 baik nasional maupun global terus meningkat. Covid-19 tidak hanya menyerang usia dewasa namun juga anak-anak. Anak-anak di bawah usia 3 tahun dan anak-anak dengan penyakit jantung adalah kelompok yang paling banyak ditemui terinfeksi Covid-19. Covid-19 dapat menyebabkan gangguan oksigenasi yang serius pada pasien anak hingga menyebabkan gagal nafas. Pemberian ventilasi invasive melalui tindakan intubasi merupakan bagian dari airway management dalam upaya optimalisasi patensi jalan nafas. Efek samping dari tindakan ini adalah timbulnya masalah kebersihan jalan nafas pada pasien akibat menurunnya fungsi pembersihan jalan nafas secara spontan. Studi kasus ini bertujuan untuk memaparkan hasil analisis asuhan keperawatan pada pasien post operasi total koreksi & PDP terpasang ventilator dengan penerapan suctioning. Hasil studi kasus ini mendapatkan empat diagnosa keperawatan. Ketiga diagnosa keperawatan tersebut diantaranya: 1) Gangguan ventilasi spontan b.d ketidakseimbangan ventilasi perfusi; 2) Ketidakefektifan bersihan jalan nafas b.d kondisi mukus berlebihan; 3) Kelebihan volume cairan b.d edema paru; 4) Resiko keterlambatan perkembangan b.d penyakit kronis: kelainan jantung bawaan.

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ABSTRACT

At present, the number of positive cases of Covid-19 both nationally and globally continues to increase. Covid-19 is not only attacks adults but also children. Children under the age of 3 years and children with heart diseases are the most vulnerable groups that frequently infected by Covid-19. Covid-19 resulting in severe oxygenation disorders in pediatric patients and causing respiratory failure. Invasive ventilation procedure through intubation is one of airway management as the effort to optimize airway patency. The side effect of this procedure prompting ineffective airway clearance due to the decrease of spontaneous airway cleansing function. This case study aims to describe the results of the nursing care analysis in post-total repair surgery patient and COVID-19 suspect with ventilator with the application of suctioning method. The result of this case study unveil four nursing diagnoses: 1) Impaired spontaneous ventilation related to ventilation-perfusion mismatch; 2) Ineffective airway clearance related to the excessive mucous condition; 3) Excess fluid volume related to pulmonary congestion or edema; 4) Risk for delayed development related to chronic disease: congenital heart disease."

"Penyakit Jantung Bawaaan (PJB) Tetralogy of Fallot (TOF) merupakan PJB sianotik (biru) terbanyak. Tatalaksana definitif operasi sedini mungkin. Hampir semua pembiayaan menggunakan BPJS Kesehatan berdasarkan tarif INA-CBG. Adanya selisih negatif tarif INA-CBG tahun 2016 dengan tagihan perawatan operasi TOF menyebabkan banyak rumah sakit tidak mengoperasi dan merujuk ke RSJPD Harapan Kita. Dengan adanya tarif INA-CBG terbaru tahun 2023 yang mengalami kenaikan, diperlukan penelitian apakah terdapat selisih negatif. Perlu dianalisa faktor yang berhubungan dengan tagihan perawatan serta kepatuhan Clinical Pathway (CP) TOF. Penelitian observasional deskriptif cross sectional mengambil sampel pasien perawatan operasi total koreksi TOF tahun 2022 sejumlah 82 pasien. Hasil penelitian didapatkan sebagian besar usia ≥1 tahun, perempuan, status gizi normal, ada diagnosa sekunder, severitas PPK I (ringan) dan INA-CBG II (sedang), tidak ada komplikasi, kelas III, median lama CPB 103,5 menit dan AoX 55 menit, lama rawat post operasi 6 hari dan total 8 hari. Faktor yang berhubungan dengan tagihan perawatan adalah komplikasi, kelas rawat dan lama rawat CP. Hal yang belum sesuai dengan CP TOF yaitu lama rawat, pemeriksaan laboratorium, radiologi, pemakaian obat, alkes dan BMHP. Masih terdapat selisih negatif antara total tagihan perawatan pasien operasi total koreksi TOF tahun 2022 dengan total tarif INA-CBG terbaru tahun 2023.

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Tetralogy of Fallot (TOF) is the most common cyanotic Congenital Heart Disease (CHD). Definitive management is surgery earliest as possible. Almost all financing uses BPJS Kesehatan based on INA-CBG rate. Negative difference between the 2016 INA-CBG rates and TOF surgery treatment bill make many hospitals not operating and refering to Harapan Kita Hospital. With increasing in the latest 2023 INA-CBG rates, research for negative difference is needed. Analyzing factors related to care bills and adherence to TOF Clinical Pathway (CP) is studied too. This cross-sectional descriptive observational study took a sample of 82 patients undergoing TOF total  correction in 2022. Results showed that most were aged ≥1 year, female, normal nutritional status, had secondary diagnoses, severity of PPK I (mild) and INA-CBG II (moderate), no complications, class III, median duration of CPB 103.5 minutes and AoX 55 minutes, length of postoperative care 6 days and total of 8 days. Factors related to treatment bills are complications, class of care and CP length of care. Things not in accordance with the TOF CP are length of stay, laboratory, radiology, drug, medical equipment and BMHP use. There is still negative difference between the 2022 TOF total correction treatment patient bills and the latest 2023 INA-CBG rate."

"[ABSTRAKHipertrofi ventrikel kanan (HVKa) pada tetralogy fallot (TF) merupakan suatu respon adaptif akibat dari peningkatan tekanan di ventrikel kanan (VKa) dan hipoksia. HVKa yang berat vektor jantung akan mengarah ke kanan-posterior dapat menyebabkan gelombang S yang dalam di sadapan V6. Sementara itu pasien TF yang lama tidak dikoreksi akan mengalami paparan tekanan berlebih dan sianosis yang lebih lama juga, yang dapat menyebabkan perubahan-perubahan di tingkat seluler kardiomiosit yang pada akhirnya menyebabkan disfungsi VKa, dan sindrom curah jantung rendah (SCJR). Walaupun angka kesintasan pasca operasi baik, tapi perburukan SCJR dapat mengakibatkan kematian. Saat ini belum jelas bagaimana hubungan antara gelombang S di V6 dengan luaran total koreksi TF khususnya kejadian SCJR.MetodePenelitian dengan metode potong lintang. Subyek penelitian adalah TF yang menjalani total koreksi selama tahun 2013 sebanyak 150 pasien, 35 diantaranya dikeluarkan dari penelitian karena tidak memenuhi kriteri inklusi. Subyek dibagi menjadi 2 kelompok yaitu kelompok subyek dengan temuan kriteria S di V6 dan subyek yang untuk melihat hubungan temuan kriteria tersebut dengan variabel dasar. Kemudian dilakukan analisis bifariat terhadap kejadian SCJR, variabel dengan nilai p < 0.25 di masukkan dalam analisa multivariat. Nilai p< 0.05 dianggap bermakna.HasilUsia yang lebih muda, saturasi dan hematokrit yang lebih tinggi ditemukan pada kelompok subyek memenuhi kriteria gelombang S di V6. Kemudian, usia yag lebih muda, saturasi yang tinggi, kriteria gelombang R di aVR, kriteria gelombang S di I dan kriteria gelombang S di V6 berhubungan dengan kejadian SCJR. Analisis multivariat kriteria gelombang S di V6 berhubungan dengan kejadian SCJR dengan OR 3.2, interval kepercayaan 95% 1.2 - 8.5 dan nilai p=0.02KesimpulanKriteria EKG gelombang S di sadapan V6 untuk diagnosis HVKa berhubungan dengan kejadian SCJR pasca total koreksi pasien TF.

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ABSTRACTTetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn?t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients? OR was 3.2 to predicts LCOS;Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS;Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS;Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS, Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS]"

"Latar Belakang: Penggunaan mesin pintas jantung paru (PJP) selama operasi koreksi pada pasien tetralogi Fallot (TF) dapat menyebabkan respons inflamasi yang intensif. Kombinasi pemberian kardioplegia dan penglepasan spesies oksigen reaktif selama fase reperfusi juga meyebabkan cedera iskemia reperfusi miokardium. Kurkumin diketahui sebagai scavenger beberapa spesies oksigen reaktif. Selain itu, kurkumin juga meningkatkan aktivitas antioksidan seperti glutation (GSH) dan menekan fosforilasi nuclear factor-kappa B (NFκB) dan c-Jun N-terminal kinase (JNK). Inhibisi NFκB dan regulasi jalur bawah JNK merupakan mekanisme yang penting untuk menekan respons inflamasi. Tujuan: Untuk mengevaluasi efek proteksi kurkumin sebagai antioksidan pada pasien TF yang menjalani operasi koreksi dengan menilai konsentrasi MDA dan GSH dalam serum, protein aktif NFκB, JNK dan kaspase-3 di miokardium, serta luaran klinis pascabedah. Metodologi: Pasien TF usia 1-6 tahun yang direncanakan menjalani operasi koreksi dirandomisasi secara acak ke dalam kelompok kurkumin atau plasebo. Kurkumin (45 mg/hari) diberikan peroral selama 14 hari prabedah. MDA dan GSH dinilai pada fase praiskemia, iskemia, reperfusi, dan 6 jam pasca-klem silang aorta dilepas. Pada saat operasi spesimen darah diambil dari atrium kanan pada fase praiskemia dan 6 jam pasca-klem silang aorta dilepas, sedangkan dari sinus koronarius diambil pada fase iskemia dan reperfusi. Untuk menilai NFκB, JNK, dan kaspase-3, spesimen jaringan otot jantung diambil dari infundibulum pada fase praiskemia, iskemia, dan reperfusi. NFκB dan JNK dianalisis dengan metode enzyme-linked immunosorbent assay (ELISA), sedangkan kaspase-3 dengan teknik imunohistokimia. Parameter hemodinamik dan fungsi ventrikel dicatat saat 6 jam, 24 jam, 36 jam, dan hari ke-5 pascabedah. Hasil: Selama periode Juli 2012 - Juli 2013, terdapat 45 orang pasien yang direkrut (22 kurkumin dan 23 plasebo). Tidak ada perbedaan konsentrasi MDA dan GSH pada tiap fase pengamatan pada kedua kelompok. Tidak ada beda bermakna aktivitas protein aktif NFκB di antara ketiga fase pengamatan praiskemia, iskemia, atau reperfusi. Tetapi pada kelompok kurkumin aktivitas protein aktif JNK menurun dari fase praiskemia ke fase reperfusi. Ekspresi kaspase-3 pada fase praiskemia dan reperfusi pada kedua kelompok tidak berbeda. Namun pada kelompok kurkumin terdapat penurunan ekspresi kaspase-3 yang bermakna pada fase iskemia. Hasil klinis menunjukkan terdapat penurunan suhu lebih rendah dan fungsi ventrikel kanan dan kiri yang lebih baik pada kelompok kurkumin secara bermakna, meskipun tidak ada beda dalam waktu pemakaian ventilasi mekanis dan lama perawatan pada kedua kelompok. Simpulan: Efek kardioproteksi kurkumin pada cedera iskemia reperfusi pascabedah koreksi TF menghambat jalur JNK dan kaspase-3 yang terjadi pada kardiomiosit, terutama pada fase iskemia. Kurkumin juga memperbaiki fungsi ventrikel kanan dan kiri, serta menurunkan suhu perioperatif.

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Background. Cardiopulmonary bypass (CPB) during tetralogy of Fallot (TF) corrective surgery has been associated with an intense inflammatory response. The cardioplegia used during surgery and the extraburst of reactive oxygen species (ROS) generated during reperfusion contributes to myocardial ischemia and reperfusion injury. Curcumin has been known as a potent scavenger of several types of ROS. It also enhances the activity of antioxidant, such as glutathione (GSH), and suppresses phosphorylation of nuclear factor-kappa B (NFκB) and c-Jun N-terminal kinase (JNK). Inhibition of NFκB and down regulation of the JNK pathway could be potential mechanisms for controlling inflammatory responses and apoptosis, respectively.

Objectives. To evaluate the protective effects of curcumin as an antioxidant in patients undergoing TF corrective surgery by evaluating the blood levels of MDA and GSH, activity of NFκB and JNK, the presence of caspase-3 (C-3) in the myocardium, and post-operative clinical outcomes.

Methods. TF patients aged 1-6 years who were scheduled for elective corrective surgery were randomized double blind to receive either curcumin (45 mg/day) or placebo orally for 14 days prior to surgery. MDA and GSH levels were evaluated during the pre-ischemia, ischemia, and reperfusion phases, as well as 6 hours after aortic clamping off. Blood specimens were taken directly from the right atrium for the pre-ischemia data and for the 6 hours after aortic clamping off data; and from the coronary sinus for the ischemia and reperfusion data. To assess NFκB, JNK, and C-3, tissue specimens were taken from the infundibulum during the pre-ischemia, ischemia, and reperfusion phase. NFκB and JNK were measured by an enzyme-linked immunosorbent assay (ELISA) methods, and C-3 was measured by an immunohistochemical technique. Hemodynamic parameters and ventricular functions were monitored at 6-, 24-, and 48-hours post-surgery, and day 5 post-surgery.

Results. During July 2012-July 2013, 45 patients were included, 22 in the curcumin and 23 in the placebo groups. In the 4 observation phases, MDA and GSH concentrations were similar between treatment groups. Also, there was no significant difference in NFκB activity between the groups for 3 observations. However, in the curcumin group, JNK activity significantly decreased from the pre-ischemia to reperfusion phases compared to the control group. C-3 expression in both the pre-ischemia and reperfusion phases was not significantly different between groups. However, C-3 expression in the curcumin group was significantly lower than placebo in the ischemia phase. Patients in the curcumin group had lower temperature and better right and left ventricular functions, but there were no significant differences in mechanical ventilation, or length of hospital or ICU stay in the two groups.

Conclusion. Cardioprotective effects of curcumin on ischemia reperfusion injury after TF corrective surgery may include inhibition of the JNK pathway and C-3 in cardiomyocytes, particularly in an ischemia phase. Curcumin also improves right and left ventricular functions and lower perioperative temperature."

"Latar Belakang: Low cardiac output syndrome (LCOS) pada operasi koreksi Tetralogy Fallot (TF) adalah komplikasi yang dapat meningkatkan angka kematian akibat cedera iskemia reperfusi. Terapi definitif cedera iskemia reperfusi belum ditemukan karena masalah translasi dari penelitian pada sel dan hewan coba ke penelitian pada manusia. Hatter Cardiovascular Institute merekomendasikan multitargeted therapy yang mengatasi obstruksi pembuluh darah (OPM), proteksi kardiomiosit, dan antiinflamasi. Penelitian ini menggunakan kombinasi siklosporin dan remote ischemic preconditioning (RIPC) untuk mencapai tujuan tersebut. Telah dilakukan pemeriksaan MDA dan edema mitokondria untuk membuktikan manfaat dari kombinasi siklosporin dan RIPC. Metodologi: Penelitian ini adalah uji acak tersamar ganda label terbuka yang dilakukan di RSCM dan JHC antara 2021 hingga 2022. Pasien TF usia 1-6 tahun diacak ke dalam kelompok kontrol yang mendapat terapi standar dan perlakuan yang mendapat siklosporin oral 3-5 mg/kgBB 2 jam sebelum operasi, dan RIPC sesaat setelah induksi. Limbah jaringan otot infundibulum dan sampel darah diambil di 3 fase: praiskemia, iskemia dan pascareperfusi. Ketiga jaringan yang diperoleh dilakukan isolasi mitokondria. Pemeriksaan JC-1 dan succinate dehydrogenase (SDH) dilakukan untuk mengukur kualitas isolat mitokondria. Pemeriksaan spektrofotometri terhadap isolat mitokondria dilakukan untuk mengukur edema mitokondria. Pemeriksaan MDA dilakukan untuk menilai stres oksidatif. Hasil: Terdapat 42 subyek yang mengikuti penelitian. Walaupun secara statistik tidak ada perbedaan bermakna kadar MDA, uji membran potensial, uji aktivitas enzim spesifik dan derajat edema mitokondria pada kelompok perlakuan dibandingkan kontrol namun terdapat kecenderungan penurunan MDA dan penurunan derajat edema mitokondria. Simpulan: Kombinasi siklosporin dan RIPC tidak bermakna secara statistik menurunkan kadar MDA dan derajat edema mitokondria pada pasien TF yang menjalani operasi koreksi. Terdapat kecenderungan penurunan MDA dan derajat edema mitokondria pada pasien TF yang mendapatkan siklosporin dan RIPC.

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Background: Low cardiac output syndrome on Tetrallogy Fallot correction surgery is a complication caused by ischemic reperfusion Injury (IRI), which increases mortality rate. Definitive treatment of IRI has not been found until now. A multitargeted treatment that attenuates microvascular obstruction, cardiomyocyte protection, and antiinflammation in human is proposed by Hatter Cardiovascular Institute. Based on this recommendation, this study used combination of cyclosporine as an antiinflammation and treatment for microvascular obstruction and remote ischemic preconditioning (RIPC) as a cardiomyocyte protection measure. Outcome of this treatment will be analyzed mostly by evaluation of mitochondrial edema. Methods: This is an open label randomized controlled trial on patients with Tetralogy of Fallot (TF) underwent surgery in RSCM and JHC on 2021 until 2022. We recruited 1-6 year-old TF patient planned for surgical correction. Cyclosporine and RIPC were given as treatment. Chopped infundibular muscle prior to aortic cross clamping defined as preischemic sample, after aortic cross clamping defined as postischemic sample, and after aortic cross clamping off defined as postreperfusion sample. We performed isolation of mitochondria of each sample. JC-1 and succinate dehydrogenase (SDH) assays were performed to measure quality of mitochondrial isolation. Results: Forty two subjects were recruited in this research. Although there was no significant difference in MDA level and the severity of mitochondrial edema between control and treatment group, we found lower MDA post- reperfusion and lower trend of mitochondrial edema in treatment group. Conclusion: Treatment of TF patient with Cyclosporine-RIPC combination therapy tends to reduce MDA level and mitochondrial edema significantly."

"ABSTRAKTotal Hip Replacement THR merupakan salah satu tindakan bedah rekonstruktif penggantian sendi panggul akibat gangguan anatomi, fungsi tubuh yang mengganggu dan berpengaruh terhadap status fungsional. Tujuan penelitian teridentifikasinya faktor-faktor yang berhubungan dengan status fungsional pasien paska operasi THR. Penelitian ini menggunakan desain case control. Penetapan jumlah sampel menggunakan nonprobability sampling dengan metoda consecutive sampling. Hasil penelitian didapatkan distribusi frekuensi status fungsional dengan menggunakan Hip Haris Score HHS proporsi responden yang mengalami gangguan status fungsional mencapai 24,4 kelompok kasus dimana diantara variabel yang mempunyai hubungan yaitu usia, program rehabilitasi dan lama rawat dengan status fungsional pasien paska operasi THR. Pada kelompok kasus usia merupakan faktor paling besar mempengaruhi status fungsional setelah dikontrol oleh program rehabilitasi dan lama rawat dengan nilai odd ratio OR usia 31,30 p value =0,031, program rehabilitasi OR 28,21, p value=0,056 dan lama rawat OR 12,99 dengan p value=0,093. Pada kelompok case penelitian ini merekomendasikan melakukan latihan meningkatkan status fungsional terintegrasi dengan memperhatikan kemampuan dan kelompok usia.

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ABSTRACTAbstractTotal Hip Replacement THR is one of the reconstructive surgery of hip joint replacements which is done due to anatomic disorder, disturbing body function and effect on functional status. The purpose of the study is to identify the factors associated with the functional status of patients post THR surgery. This research uses case control design. Nonprobability sampling with consecutive sampling method is used to determine a number of samples. The result of this research shows that the functional status of frequency distribution using Hip Haris Score HHS proportion of respondents who have functional status disorder reached 24,4 case group where among variables possess age relationship, rehabilitation program and length of stay with functional status of patient after THR surgery. In the age group, it was the greatest factor affected functional status after controlled by rehabilitation program and length of stay with the value of odd ratio OR age 31,30 p value 0,031, rehabilitation program OR 28,21, p value 0,056 and length of treatment OR 12,99, p value 0,018. Based on the result, this case study group recommends for further research to do exercise enhancing functional status integrated with attention to ability and age group."

"ABSTRAKKaki diabetik merupakan komplikasi yang sangat menakutkan bagi pasien DM karenaresiko amputasi yang sangat tinggi. Tujuan Penelitian: menganalisis faktor-faktor yangberkontribusi terhadap kejadian kaki diabetik. Peuelitian ini merupakan penelitiandeskriptif analitik dengan pengumpulan data secara cross sectional. Sampel sebanyak136 pasien DM yang mempunyai kelainan benluk kaki dan Iuka kaki. Pada penelitian inipengumpulan data yang digunakan yaitu dengan cara observasi dan kuesioner. Hasilpenelitian analisis bivariat menunjukkan bahwa ada hubungan senam kaki, perawatankaki, kepatuhan dalam pencegahan Iuka, kontrol gula darah, pengetahuan, dan dietdengan kejadian kaki diabetik. Scdangkan secara analisis multivariat hanya ada 3variabel yang merupakan faktor paling berkontribusi yaitu senam kaki, kepatuhan dalam pencegahan luka dan pengetahuan. Rekomendasi hasil penelitian ini adalah melakukan konseling secara rutin, klub diabetes, dan rutinitas melakukan senam diabetes."

"Latar belakang: Efusi pleura merupakan salah satu penyebab utama distres pernapasan di seluruh dunia. Pasien dengan efusi pleura memiliki mortalitas 30 hari 15% – 21% dan mortalitas 1 tahun 25% - 57%. Keterlambatan diagnosis dapat mengakibatkan tingginya angka morbiditas dan mortalitas. Torakoskopi medik merupakan prosedur diagnostik yang dapat ditoleransi dengan baik. Kesintasan dan faktor-faktor yang mempengaruhi pasien dengan efusi pleura tanpa etiologi yang jelas belum diketahui. Tujuan: Mengetahui kesintasan pasien efusi pleura tanpa etiologi yang jelas dan faktor-faktor yang mempengaruhinya, seperti usia, jenis kelamin, ECOG Performance Status, distribusi efusi pleura, adanya keganasan, kadar serum albumin, efusi pleura eksudat, dan mendapatkan terapi definitif setelah diagnosis pada pasien efusi pleura tanpa etiologi yang jelas. Metode: Penelitian berupa kohort prospektif pada pasien efusi pleura tanpa etiologi yang jelas yang berusia > 18 dan menjalani tindakan torakoskopi medik. Penelitian dilakukan selama bulan Januari 2023 hingga Mei 2024 di ruang rawat inap Rumah Sakit Cipto Mangunkusumo. Pemantauan akan dilakukan pada hari ke-30, dan 90. Hasil: Penelitian ini mengikutsertakan 57 pasien efusi pleura tanpa etiologi yang jelas dengan rerata kesintasan 30 hari 27,51% (IK 25,29 – 29,72) dan 90 hari 74,63% (IK 66,36-82,88). Tidak mendapatkan terapi definitif meningkatkan risiko mortalitas 30 hari [HR 4,066 (IK 0,508-32,532), p=0,077] dan ECOG PS yang buruk [HR 3,928 (IK 0,887-17,391), p=0,077] meningkatkan risiko mortalitas 90 hari pasien efusi pleura tanpa etiologi yang jelas. Kesimpulan: Rerata kesintasan 30 hari dan 90 hari pasien efusi pleura tanpa etiologi yang jelas adalah 27,51% (IK 25,29 – 29,72) dan 74,63% (IK 66,36-82,88). Tidak ada hubungan signifikan antara usia, jenis kelamin, ECOG Performance Status, efusi pleura bilateral, keganasan, kadar serum albumin rendah, efusi pleura eksudat dan tidak mendapatkan terapi definitif setelah diagnosis dengan kesintasan pasien efusi pleura tanpa etiologi yang jelas. Kesimpulan: Rerata kesintasan 30 hari dan 90 hari pasien efusi pleura tanpa etiologi yang jelas adalah 27,51% (IK 25,29 – 29,72) dan 74,63% (IK 66,36-82,88). Tidak ada hubungan signifikan antara usia, jenis kelamin, ECOG Performance Status, efusi pleura bilateral, keganasan, kadar serum albumin rendah, efusi pleura eksudat dan tidak mendapatkan terapi definitif setelah diagnosis dengan kesintasan pasien efusi pleura tanpa etiologi yang jelas.Kesimpulan: Rerata kesintasan 30 hari dan 90 hari pasien efusi pleura tanpa etiologi yang jelas adalah 27,51% (IK 25,29 – 29,72) dan 74,63% (IK 66,36-82,88). Tidak ada hubungan signifikan antara usia, jenis kelamin, ECOG Performance Status, efusi pleura bilateral, keganasan, kadar serum albumin rendah, efusi pleura eksudat dan tidak mendapatkan terapi definitif setelah diagnosis dengan kesintasan pasien efusi pleura tanpa etiologi yang jelas.Kesimpulan: Rerata kesintasan 30 hari dan 90 hari pasien efusi pleura tanpa etiologi yang jelas adalah 27,51% (IK 25,29 – 29,72) dan 74,63% (IK 66,36-82,88). Tidak ada hubungan signifikan antara usia, jenis kelamin, ECOG Performance Status, efusi pleura bilateral, keganasan, kadar serum albumin rendah, efusi pleura eksudat dan tidak mendapatkan terapi definitif setelah diagnosis dengan kesintasan pasien efusi pleura tanpa etiologi yang jelas.Kesimpulan: Rerata kesintasan 90 hari pasien efusi pleura tanpa etiologi yang jelas adalah 74,63% (IK 66,36-82,88). Tidak ada hubungan antara usia, jenis kelamin, ECOG Performance Status, efusi pleura bilateral, keganasan, kadar serum albumin rendah, efusi pleura eksudat dan tidak mendapatkan terapi definitif setelah diagnosis dengan kesintasan pasien efusi pleura tanpa etiologi yang jelas.Kesimpulan: Rerata kesintasan 90 hari pasien efusi pleura tanpa etiologi yang jelas adalah 74,63% (IK 66,36-82,88). Tidak ada hubungan antara usia, jenis kelamin, ECOG Performance Status, efusi pleura bilateral, keganasan, kadar serum albumin rendah, efusi pleura eksudat dan tidak mendapatkan terapi definitif setelah diagnosis dengan kesintasan pasien efusi pleura tanpa etiologi yang jelas..."

"Latar Belakang: Saat ini masih terdapat perdebatan mengenai usia terbaik untuk dilakukan koreksi total pada tetralogi Fallot (TF). Koreksi lebih dini mempunyai keuntungan serta kerugian. Koreksi total TF saat usia yang terlambat dapat mengakibatkan disfungsi ventrikel kanan dan terkadang disfungsi ventrikel kiri. Parameter disfungsi ventrikel yaitu TAPSE, MPI, franksi ejeksi. Tujuan: Untuk mengevaluasi durasi QRS, TAPSE, dan lama rawat ICU pasien TF yang dilakukan koreksi total ≤ 3 tahun lebih panjang dibandingkan koreksi total pada usia > 3 tahun. Metode: Studi kohort retrospektif pada subjek pasien anak dan dewasa yang menjalani koreksi total, minimum pemantauan 6 bulan pasca-koreksi total. Analisis data menggunakan Mann Whitney U Test serta uji Chi square. Hasil: Sebanyak 358 pasien TF telah menjalani koreksi total sejak 1 januari 2007 sampai 31 Juni 2013 dan sebanyak 52 subjek (18 subjek pada usia koreksi < 3 tahun dan 34 subjek dengan usia koreksi > 3 tahun) dengan median rentang lama pemantauan 24,5 dan 30 bulan. Rentang usia pada kelompok koreksi ≤ 3 tahun 1,8 (0,7-3) tahun dan kelompok koreksi > 3 tahun 5,2 (3,1-25,5) tahun. Rerata waktu PJP 79,1 (27,5) menit dibanding 78,8 (28,7) menit dan rerata aortic cross clamp 35,6 (13,2) dibanding 34,7 (19,1) menit tidak bermakna pada kedua kelompok. Penggunaan ventilator dengan median 1 hari, penggunaan chest tube dengan median 3 hari, lama penggunaan inotropik dengan median 2 hari tidak berbeda pada kedua kelompok. Terdapat abnormalistas rerata pengukuran RVMPI dan LVMPI pada kedua kelompok. Sebagian besar terdapat gangguan irama berupa complete RBBB, dan sekitar 50% didapatkan regurgitasi tricuspid. Residual stenosis pulmonal didapatkan pada 3/34 dan residual DSV pada 2/34 subjek pada koreksi > 3 tahun. Median lama rawat ICU [2 (1-9) hari dibanding 1,5 (1-46) hari, p=0,016] serta median durasi QRS [118 (78-140) ms dibanding 136 (80-190) ms, p=0,039] berbeda bermakna pada kedua kelompok, sedangkan tidak terdapat hubungan antara TAPSE dengan usia koreksi dengan RR 0,85; IK 95% 0,26-2,79 p=0,798. Simpulan: Pasien TF yang dilakukan koreksi total ≤ 3 tahun memiliki durasi QRS lebih pendek, TAPSE yang tidak lebih baik dibandingkan dengan koreksi > 3 tahun, dan waktu rawat ICU lebih panjang.

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Background: Timing for correction in patients with tetralogy of Fallot (TF) is controversial. Repair at < 3 years old shows good myocardial performance. Late repair can shows prolonged QRS duration, ventricular dysfunction with parameters myocardial performance index (MPI) and TAPSE, but longer intensive care unit (ICU) stays.

Aims: To evaluate QRS duration, right ventricle function measured by TAPSE, ICU length of stays (LOS) of patients after correction TF which is repaired in age ≤ 3 versus > 3 years old.

Methods: Cohort retrospective study was performed in children and adults who were underwent correction with minimal follow up was 6 months. The TAPSE and QRS duration was evaluated during follow up. We compared using Mann Whitney U test and Chi square test analyses.

Results: Among 358 children recruited, there were 52 subject completed the study, 18 in correction age ≤ 3 years old group and 34 at age > 3 years old group who underwent total correction since January 2007 – June 2013. Age when underwent total correction ranging from 7 months – 25 years old, with follow up data was took at 24-30 months after discharge. There were abnormalities at right ventricle and left ventricle MPI, but weren’t different between groups. There were a significant difference between ICU LOS [2 (1-9) days vs. 1.5 (1-46) days p=0.016] and QRS durations [118 (78-140) ms vs 136 (80-190) ms, p=0.039]. Aged repaired didn’t increase risk of having abnormality TAPSE (RR 0.85; 95% CI 0.26-2.79; p = 0.798).

Conclusion: TF total correction at ≤ 3 years old has shorter QRSdurations at follow up and longer ICU LOS. Correction at > 3 years old didn’t proven as a risk to have abnormality TAPSE."