Hasil Pencarian  ::  Simpan CSV :: Kembali

"Beban kompleks ventrikel prematur (KVP) memiliki tiga jenis ritme sirkadian, yaitu tipe cepat, tipe lambat, dan tipe independen. Nukleus suprakiasmatikus merupakan bagian dari hipotalamus dan berperan sebagai pusat yang mengatur ritme sirkadian tubuh. Nukleus suprakiasmatikus berhubungan dengan sumbu hipotalamus-pituitari-adrenal (HPA), sistem saraf autonom, dan aspek psikologis. Hubungan ketiga sistem ini dengan ritme sirkadian beban KVP belum diketahui. Oleh karena itu, perlu dilakukan penelitian untuk menganalisis hubungan sumbu HPA, sistem saraf autonom, dan aspek psikologis dengan ritme sirkadian beban KVP. Studi observasional potong lintang ini merekrut subjek penelitian di RS Jantung dan Pembuluh Darah Harapan Kita, RSUD Pakuhaji, dan RS Bun. Waktu penelitian adalah dari Juli 2022 sampai Desember 2022. Kriteria inklusi adalah pasien KVP idiopatik dengan beban ≥ 5%. Sebanyak 23 subjek KVP tipe-cepat, 20 subjek KVP tipe-lambat, 22 pasien KVP tipe-independen, dan 5 subjek kontrol diikutsertakan pada penelitian. Setiap subjek menjalani pemeriksaan Holter 24 jam untuk evaluasi beban KVP dan heart rate variability, mengumpulkan saliva untuk pemeriksaan kortisol dan norepinefrin pada pukul 06:00–07:00, 10:00–11:00, dan 22:00–23:00, serta mencatat skala kesehatan subjektif. Selanjutnya, dilakukan analisis univariat dan regresi linier multipel untuk menganalisis hubungan antara ritme sirkadian variabel independen dan ritme sirkadian beban KVP. Hasil pemeriksaan Holter menunjukkan bahwa rerata beban KVP idiopatik tipe-cepat adalah 15,7%; tipe-lambat 8,4%; dan tipe-independen 13,6%. Regresi liner multipel menunjukkan bahwa tingginya beban KVP idiopatik-tipe-cepat berhubungan dengan kadar kortisol yang lebih tinggi dan tonus sistem saraf parasimpatis yang lebih rendah. Di samping itu, tingginya beban KVP idiopatik-tipe-lambat berkaitan dengan kadar kortisol dan tonus sistem saraf simpatis yang lebih rendah atau tonus sistem saraf parasimpatis yang lebih tinggi. Sementara itu, pada KVP idiopatik-tipe-independen tingginya beban KVP berhubungan dengan kadar kortisol dan tonus sistem saraf simpatis yang lebih tinggi atau tonus sistem saraf parasimpatis yang lebih rendah serta skala kesehatan subjektif yang lebih rendah. Disimpulkan bahwa pola sirkadian beban KVP idiopatik tipe cepat, lambat, dan independen masing-masing berhubungan secara khas dengan sumbu HPA, sistem saraf autonom dan mekanisme psikologis. Penilaian tipe ritme sirkadian KVP idiopatik perlu dilakukan secara rutin mengingat perbedaan mekanisme yang mendasarinya dan kemungkinan perbedaan pada prognosisnya.

---

Recent data show that premature ventricular complex (PVC) burden exhibits one of the three circadian patterns, namely fast-type, slow-type, and independent-type PVC. The suprachiasmatic nucleus is part of the hypothalamus and serves as the center of circadian rhythm regulation. The suprachiasmatic nucleus is related to the hypothalamus-pituitary-adrenal (HPA) axis, the autonomic nervous system, and psychological aspects. The relationship between these three systems and the circadian rhythm of PVC is unknown. Therefore, it is important to evaluate the relationship between the HPA axis, the autonomic nervous system, and psychological aspects with the circadian rhythm of PVC burden. This cross-sectional observational study recruited 23 fast-, 20 slow-, and 22 independent-type idiopathic PVC subjects, as well as 5 control subjects. Each subject underwent a 24-hour Holter to examine PVC burden and heart rate variability, collected saliva for cortisol and norepinephrine level measurement at 6–7 am, 10–11 am, and 10–11 pm, and recorded their self-rated health scales. Furthermore, univariate and multiple linear regression were conducted to investigate the associations between circadian rhythms of the independent variables and circadian rhythms of PVC burden. The results of the Holter monitor showed that the average PVC burden was 15.7%, 8.4%, and 13.6% respectively in fast-, slow-, and independent-type idiopathic PVCs. Multiple linear regression showed that the high burden of fast-type idiopathic PVC was assosciated with higher cortisol levels and lower parasympathetic nervous system tone. On the other hand, the high burden of slow-type idiopathic PVC was associated with lower cortisol levels and lower sympathetic nervous system tone. Meanwhile, in independent-type idiopathic PVC, the high burden was associated with higher cortisol levels and sympathetic nervous system tone as well as lower self-rated health scales. The results of this study indicate that each circadian pattern of idiopathic PVC burden is uniquely related to the HPA axis, the autonomic nervous system and psychological mechanisms. Assessment of idiopathic PVC circadian rhythm types needs to be carried out routinely considering the differences in the underlying mechanisms and the possible differences in the prognosis."

"[ABSTRAKLatar Belakang: Kusta merupakan penyakit infeksi penyebab neuropati perifer paling sering. Neuropati otonom merupakan salah satu neuropati perifer yang perlu dideteksi dini dengan pemeriksaan sederhana untuk mencegah kecacatan lebih lanjut karena memiliki gejala subklinis. Tujuan: Menguji sensitivitas dan spesifisitas pemeriksaan Stimulated Skin Wrinkle (SSW) terhadap Sudoscan dalam mendeteksi neuropati otonom pada kusta multibasiler. Metode penelitian: Penelitian menggunakan uji diagnostik pemeriksaan SSW terhadap Sudoscan pada penderita kusta multibasiler yang telah didiagnosis di poliklinik Kulit dan Kelamin RS Cipto Mangunkusumo, Jakarta. Penelitian dilakukan selama tiga bulan (Maret-Mei 2015). Anamnesis, pemeriksaan fisik, SSW dengan krim Eutectic mixture of local anesthetic (EMLA), dan Sudoscan dilakukan pada setiap subjek penelitian. Hasil dianalisis untuk mendapatkan nilai sensitivitas dan spesifisitas. Hasil: Diperoleh 70 subyek penelitian. Prevalensi gangguan otonom berdasarkan pemeriksaan SSW, Sudoscan dan klinis berturut-turut sebesar 64.3%, 32.9% dan 85.7%. Berdasarkan kurva ROC pemeriksaan SSW terhadap Sudoscan, didapatkan nilai AUC sebesar 0,779. Setelah diuji dengan tabel 2x2 didapatkan nilai sensitivitas 95.7%, spesifisitas 51.1%, nilai prediksi positif 48.9% dan nilai prediksi negatif 96%. Kesimpulan: Pemeriksaan SSW dapat menjadi pemeriksaan penyaring yang sederhana dalam mendeteksi neuropati otonom pada kusta tipe multibasiler, dengan sensitivitas yang tinggi.

---

ABSTRACTBackground: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.;Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity., Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.]"

"Latar Belakang: Dosen, tenaga kependidikan, dan staf lainnya di perguruan tinggi seringkali menghadapi beban kerja yang besar dalam melaksanakan pekerjaannya. Beban kerja yang besar dapat mengarah ke pengabaian perilaku sehat seperti istirahat yang cukup, olahraga, makan teratur, dan pengelolaan stress. Kebiasaan kurang sehat tersebut dapat menyebabkan gangguan keseimbangan otonom sebagai regulator fungsi organ internal yang kemudian mengarah ke kondisi patologis seperti gangguan metabolik, salah satunya pada regulasi glukosa darah.  Studi ini mengeksplorasi hubungan antara status fungsional sistem saraf otonom berdasarkan Index of Regulation System Activity (IRSA) sebagai salah satu alat ukur status fungsional sistem saraf otonom yang praktis digunakan dan faktor-faktor lainnya terhadap glukosa darah puasa pada pegawai perguruan tinggi sehingga dapat menyajikan pendekatan baru dalam mendeteksi risiko gangguan metabolisme glukosa. Metode: Penelitian ini menggunakan desain observasional potong lintang pada karyawan Fakultas X, Universitas Y. Pengambilan data melibatkan pengukuran IRSA dan profil glukosa darah dari data sekunder pemeriksaan kesehatan tahun 2022. Analisis statistik menggunakan metode univariat, bivariat, dan multivariat untuk menilai hubungan antara variabel studi. Hasil: Hasil pemeriksaan IRSA didapatkan sebanyak 151 pegawai (67,4%) memiliki status fungsional kondisi prenosologis-premorbid, 48 pegawai (21,4%) pada status fungsional fisiologis normal, dan 25 pegawai (11,2%) pada status fungsional kegagalan adaptasi. Pada pemeriksaan glukosa darah puasa, didapatkan 36 pegawai (16,1%) memiliki glukosa darah puasa ≥ 100 mg/dL. Status fungsional kegagalan adaptasi (p=0,001; OR=26,43; 95% CI = 3,10-225,25) dan juga status fungsional prenosologis-premorbid (p=0,001 OR=9,78; 95% CI = 1,29-74,08) memiliki hubungan yang bermakna dengan glukosa darah puasa. Kesimpulan: Pekerja  dengan IRSA abnormal memiliki kecenderungan lebih besar memiliki glukosa darah puasa ≥ 100 mg/dL jika dibandingkan dengan pegawai dengan status fungsional IRSA fisiologis normal. Diperlukan tidak lanjut dari hasil pemeriksaan kesehatan secara berkesinambungan dan holistik baik untuk individu maupun kelompok yang disesuaikan dengan karakteristik dan resiko sasaran demi kesehatan serta produktivitas pekerja.

---

Background: Faculty members, educational staff, and other university personnel often face significant workloads in performing their duties. Work overload can lead to unhealthy behaviors and stress which can disturb the autonomic balance. These unhealthy habits can disturb the autonomic balance leading to pathological conditions such as metabolic disorders, including blood glucose metabolism. This study aims to find the relationship between the functional status of the autonomic nervous system based on the Index of Regulation System Activity (IRSA) to fasting blood glucose (FBG) levels in university employees. Method: This observational cross-sectional study used the secondary data of university employees medical checkups (MCU) in 2022 with total sample of 242 people. Variables included were IRSA from Heart Rate Variability (HRV) examination, FBG level, and other sociodemographic profiles. The MCU was conducted in the university hospital. Results: The examination results of IRSA indicated that 151 employees (67.4%) had a prenosologic-premorbid functional status and 25 employees (11.2%) had a failure of adaptation functional status. FBG examination revealed that 36 employees (16.1%) had FBG levels of ≥ 100 mg/dl. Failure of adaptation functional status had a significant relationship with FBG (p=0.003; OR=26.43; 95% CI = 3.10-225.25), as well as prenosological-premorbid functional status (p=0.03; OR=9.78; 95% CI = 1.29-74.08). Conclusion: Employees with abnormal IRSA were more likely to have FBG levels ≥ 100 mg/dL compared to those with normal physiological functional status. Ongoing and holistic monitoring of health examination outcomes is essential, catered to the specific characteristics and risk profiles of both individual and group targets, aiming to maintain and enhance worker health and productivity."

"Latar Belakang: Penyakit Graves paling banyak diderita anak hipertiroid dengan akibat tumbuh kembang anak terganggu. Metode pengobatan optimal hipertiroid Graves saat ini masih dalam perdebatan. ATD masih digunakan oleh sebagian besar tenaga kesehatan. Relaps dengan ATD dapat mencapai 83% dengan pengobatan ATD. Pengalihan metode terapi salah satunya berdasarkan relaps. Pengalihan terapi saat awal dari ATD ke metode pengobatan lain pada anak yang diprediksi relaps akan menghemat waktu dan biaya serta meningkatkan potensi tumbuh kembang anak. Tujuan: Mengetahui insidens relaps hipertiroid Graves anak dan hubungannya terhadap kadar awal FT4 serta karakteristik usia dan jenis kelamin penderita. Metode: Penelitian bersifat kohort retrospektif dengan menelusuri data rekam medis pasien berusia 1-18 tahun mulai Januari 2000 hingga Juni 2013 di RS Cipto Mangunkusumo, RS Hermina Jatinegara, Bekasi dan Podomoro. Data ditabulasi untuk mendapatkan insiden relaps, median kadar awal FT4, median usia dan jenis kelamin penderita relaps. Analisis statistik dilakukan untuk mencari pengaruh kadar awal FT4 terhadap insiden relaps. Hasil: Penelitian dilakukan terhadap 25 subjek dengan 12 anak mengalami relaps. Kadar awal FT4 terhadap insiden relaps ditemukan tidak bermakna secara statistik (p=0,64) namun kelompok relaps cenderung memiliki kadar awal FT4 lebih tinggi. Relaps dialami lebih banyak oleh anak perempuan (3:1) dengan median usia 10,9 tahun. Penelitian ini mendapatkan hasil lain yaitu durasi eutiroid berbeda bermakna terhadap insiden relaps (p=0,002). Simpulan: Insiden relaps hipertiroid Graves anak 12/25 dengan kadar awal FT4 tidak bermakna secara statistik walau terdapat kecenderungan kadar awal FT4 lebih tinggi pada kelompok relaps. Relaps lebih banyak dialami anak perempuan (3:1) dengan median usia 10,9 tahun.

---

Background: Graves disease is most common causes in children with hyperthyroidism which affect growth and development. Optimal initial treatment method of hyperthyroid Graves in children is still under debate. Anti-thyroid drug (ATD) is still used as the initial treatment by the majority of health workers. Relapse can reach 83% with ATD treatment; and relapse is one of the causes to adjust therapeutic method. Alteration of initial ATD therapy to other treatment methods, in children who predicted relapse, will save time and costs as well as potentiate children’s growth and development.

Aim: To investigate the incidence of Graves hyperthyroidism relapse and its relationship to the initial FT4 levels, as well as age and gender characteristics of patients.

Method: This study is a retrospective cohort by investigate medical records of patients aged 1-18 years from January 2000 to June 2013 at Cipto Mangunkusumo hospital, Hermina Jatinegara Bekasi and Podomoro Hospital. Data were tabulated to obtain the incidence of relapse, the median of initial FT4 levels, the median of age, and sex of relapse patient. Statistical analysis was performed to find the effect of initial FT4 levels on the incidence of relapse.

Result: The study was conducted on 25 subjects with 12 children experienced a relapse. Initial FT4 levels of relapse patients was found statistically insignificant (p=0,64), but the relapse group tended to have higher levels of initial FT4. Relapse is predominant in girls (3:1), with median age of 10.9 years. This study found that duration of euthyroid differ significantly in the incidence of relapse (p=0,002).

Conclusion: The incidence of hyperthyroid Graves relapse in children is 12/25 with inital FT4 levels were not statistically significant although there was tendency initial FT4 levels were higher in relapse group. Girls experienced more relapses (3:1) with median age of 10.9 years."

"Praktik Spesialis Keperawatan Medikal Bedah Kekhususan Respirasi di RSUP Perasahabatan Jakarta merupakan aplikasi peran dan fungsi sebagai ners spesialis dengan menerapkan Model Adaptasi Roy dalam memberikan asuhan keperawatan pada pasien dengan gangguan sistem respirasi baik pada pasien kelolaan utama maupun 30 pasien resume. Selain sebagai pemberi asuhan keperawatan peran perawat spesialis respirasi adalah menerapkan tidakan berbasis bukti ilmiah pada area respirasi yaitu dengan memberikan terapi suara berbasis alam dalam mengurangi kecemasan, agitasi, dan stress pada pasien terpasang ventilator mekanik. Peran selanjutnya dari perawat spesialis respirasi adalah melakukan inovasi melalui analisi situasi dan studi literature dalam hal ini adalah penerapan The Respiratory Distress Observation Scale (RDOS) dalam menilai risiko terjadinya distress pernapasan. Hasil praktik menunjukan bahwa teori Model Adapatasi Roy dalam memberikan asuhan keperawatan pada pasien dengan gangguan sistem respirasi dan suara berbasis alam cukup efektif dalam mengurangi kecemasan, agitasi, dan stress pada pasien terpasang ventilator mekanik. Serta RDOS dapat diterapkan pada pasien dengan gangguan respirasi dalam menilai risiko distress pernapasan.

---

The Practice of Medical Nursing Specialists Specialized in Respiration in RSUP Perasahabatan Jakarta is the application of roles and functions as specialist nurses by applying Roy's Adaptation Model in providing nursing care to patients with respiratory system disorders in both the main managed patient and 30 resume patients. Aside from being a nursing care provider, the role of respiration specialist nurses is to apply scientific evidence-based nursing actions to the area of ​​respiration by providing nature-based sound terapi to reduce anxiety, agitation, and stress in patients with mechanical ventilators. The next role of respiration specialist nurses is to innovate through situation analysis and literature studies in this case is the application of The Respiratory Distress Observation Scale (RDOS) in assessing the risk of respiratory distress. Practical results show that Roy's adaptation theory in providing nursing care to patients with respiratory and natural-based sound disorders is quite effective in , agitation, and stress in patients with mechanical ventilators. As well as RDOS can be applied to patients with respiratory disorders in assessing the risk of respiratory distress."

"Latar belakang. Acute respiratory distress syndrome (ARDS) merupakan salah satu komplikasi fatal sepsis berat. Penggunaan cairan koloid sebagai cairan resusitasi dapat menurunkan kejadian ARDS lebih banyak karena memiliki berat molekul yang lebih tinggi dibandingkan cairan kristaloid. Peningkatan extravascular lung water (EVLW), kadar interleukin-8 (IL-8) dan vascular cell adhesion molecule-1 (VCAM-1) telah diteliti sebagai indikator penting yang berperan dalam patogenesis ARDS. Penelitian pada hewan coba diharapkan dapat memberikan penjelasan yang lebih baik mengenai patofisiologi ARDS yang kompleks dan sulit dimengerti. Tujuan. Mengungkap pengaruh cairan koloid atau kristaloid terhadap kejadian ARDS pada model hewan coba babi dengan sepsis berat, serta menganalisis pengaruh cairan kristaloid atau koloid terhadap peningkatan EVLW, IL-8, dan VCAM-1. Metode. Penelitian ini merupakan studi eksperimental acak tersamar ganda, dilakukan di Laboratorium Bedah Eksperimental, Fakultas Kedokteran Hewan, Institut Pertanian Bogor, dengan menggunakan babi (Sus scrofa) yang sehat berusia 2-3 bulan, berat badan 8-12 kg. Subjek dialokasikan secara acak menjadi dua kelompok, yaitu yang mendapatkan cairan resusitasi koloid atau kristaloid. Setelah pemberian endotoksin 50 μg/kg, tanda klinis ARDS, EVLW, IL-8, dan VCAM-1 dipantau saat sepsis, sepsis berat, 1 jam, dan 3 jam pasca-resusitasi cairan. Tiga jam pasca-resusitasi, dilakukan eutanasia pada babi, kemudian spesimen jaringan paru diambil untuk pemeriksaan histopatologi. Hasil Utama. ARDS kategori ringan lebih banyak terdapat pada kelompok koloid, sedangkan ARDS kategori sedang lebih banyak pada kelompok kristaloid. Rerata skor cedera paru pada kelompok koloid lebih rendah dibandingkan dengan kristaloid (0,4 vs. 0,7; p=0,001). Peningkatan EVLW lebih sedikit terjadi pada kelompok koloid dibandingkan dengan kristaloid pada 1 jam (1,0 vs. 3,0 mL/kgbb; p=0,030) dan 3 jam pasca-resusitasi (2,7 vs. 6,3 mL/kgbb; p=0,034). Pada kedua kelompok, kadar IL-8 meningkat secara bermakna setelah pemberian endotoksin (103,1 vs. 3854,5 pg/mL; p=0,012 pada kelompok koloid dan 125,0 vs. 4419,3 pg/mL; p=0,003 pada kelompok kristaloid). Nilai kadar IL-8 dan VCAM-1 tidak berbeda bermakna antara kedua kelompok. Simpulan. Penggunaan cairan koloid sebagai cairan resusitasi tidak menurunkan kemungkinan kejadian ARDS dibandingkan kristaloid. Cairan koloid berhubungan dengan peningkatan EVLW dan skor cedera paru yang lebih rendah dibandingkan dengan cairan kristaloid, tetapi tidak pada kadar IL-8 dan VCAM-1.

---

Background. Acute respiratory distress syndrome (ARDS) is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW) elevation and levels of interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been studied as indicators playing a role in the pathogenesis of ARDS. The use of animal models may provide a better understanding of the complex and poorly understood pathophysiology of ARDS.

Objectives. To determine the effects of colloid or crystalloid fluid resuscitation on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis.

Methods. This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, Institut Pertanian Bogor, using healthy swine (Sus scrofa) models aged 2 to 3 months with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of 50 μg/kgbw of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Three hours after resuscitation, euthanasia was performed on the animal and the lung tissue specimen was taken for histopathological examination.

Results. Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. Mean lung injury score was lower in colloid compared to crystalloid group (0.4 vs. 0.7; p=0.001). The increase in EVLW was lower in the colloid compared to the crystalloid group both at one hour (1.0 vs. 3.0 mL; p=0.030) and three hours post-resuscitation (2.7 vs. 6.3 mL/kg; p=0.034). In both groups, IL-8 levels were significantly higher after endotoxin administration (103.1 vs. 3854.5 pg/mL; p=0.012 in the colloid group and 125.0 vs. 4419.3 pg/mL; p=0.003 in the crystalloid group). There was no significant difference in IL-8 and VCAM-1 levels between the two groups.

Conclusion. The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI and a lower mean lung injury score, but not with IL-8 or VCAM-1 levels."

"ABSTRAKLatar Belakang: Angka mortalitas ARDS khususnya di RSCM masih tinggi, sebesar 75,3%. Prokalsitonin dan CRP bisa dipakai sebagai prediktor mortalitas pada ARDS. Saat ini belum didapatkan penelitian yang fokus pada peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di Indonesia.Tujuan: Mengetahui peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di RSCM.Metode: Penelitian ini menggunakan disain kohort prospektif yang dilakukan secara konsekutif pada pasien ARDS di RSCM, November 2015-Januari 2016. Saat pasien didiagnosis ARDS, dalam 6-24 jam dilakukan pemeriksaan PCT dan CRP, diobservasi selama tujuh hari, lalu dilakukan analisis statistik. Data kategorikal disajikan dalam jumlah dan persentase. Data numerik dengan sebaran tidak normal disajikan dalam bentuk median dan rentang. Variabel faktor-faktor yang memengaruhi mortalitas diuji dengan analisis bivariat (menggunakan uji Mann Whitney bila memenuhi persyaratan distribusi tidak normal). Untuk menentukan cutoff PCT dan CRP dipakai kurva ROC dengan mencari sensitivitas dan spesifisitas yang terbaik.Hasil: Dari 66 pasien ARDS, didapatkan 40 (60,61%) meninggal dan 26 (39,39%) hidup. Uji normalitas PCT dan CRP didapatkan distribusi dari data-data tersebut tidak normal. Dengan uji Kolmogorov-Smirnov didapatkan p<0,05. Median PCT pada yang meninggal sebesar 4,18 (0,08-343,0) dibandingkan yang hidup sebesar 3,01 (0,11-252,30) p=0,390, AUC 0,563 (IK 95% 0,423-0,703). Median CRP pada yang meninggal sebesar 130,85 (9,20-627,78) dibandingkan yang hidup sebesar 111,60 (0,10-623,77) p=0,408, AUC 0,561 (IK 95% 0,415-0,706).Simpulan: Pemeriksaan PCT dan CRP hari pertama pada penelitian ini belum dapat digunakan sebagai prediktor mortalitas tujuh hari pada pasien ARDS.Kata kunci: ARDS, CRP, mortalitas, PCT

---

ABSTRACTBackground: The mortality rate of ARDS, specifically in RSCM is still high, that is of 75.3%. Procalcitonin and CRP can be used as mortality prediktor on ARDS. Until today there is no research focusing in the role of PCT and CRP as seventh day mortality predictor on ARDS patients in Indonesia.Objectives: To identify the role of PCT and CRP as mortality predictors on seventh day of ARDS patients in RSCM.Methods: This research used a prospective cohort design that was done consecutively on ARDS patients in RSCM during November 2015 to January 2016. When a patient was diagnosed with ARDS, within the next 6-24 hours, the PCT and CRP test were run and an observation was done for seven days, and a statistical analysis followed after. The categorical data descriptions are presented in numbers and percentage. Numerical data with abnormal distribution are presented in the forms of medians and spans. The variables of the factors that influence mortality were tested by using bivariate analysis (using Mann Whitney’s test whenever they met the conditions of abnormal distribution). To determine the PCT and CRP cutoff (values), the ROC curve is used to search for the best sensitivity and specificity.Results: Out of the 66 patients ARDS, 40 (60.61%) died and 26 (39.39%) survived. The PCT and CRP normality tests results obtained from the distribution of those data are not normal. By using the Kolmogorov-Smirnov the value of p<0.05 was obtained. The PCT median on those who died is 4.18 (0.08-343.0) compared to those who survived that is 3.01 (0.11-252.30) p=0.390, AUC 0.563 (CI 95% 0.423-0.703). CRP median on those who died is 130.85 (9.20-627.78) compared to those who survived that is 111.60 (0.10-623.77) p=0,408, AUC 0.561 (CI 95% 0.415-0.706).Conclusions:, The PCT and CRP tests on first day in this research are not yet available to be used as mortality predictor on seventh day of ARDS patients.Key words : ARDS, CRP, mortality, PCT"

"Tujuan : Mengetahui nilai ambang hitung badan lamelar pada usia kehamilan di atas 28 minggu dan perannya dalam memprediksi terjadinya RDS apabila dibandingkan dengan tes busa.Metode : Sampel cairan ketuban diperoleh melalui amniotomi saat melakukan sectio sesarea pada wanita hamil dengan usia kehamilan di atas 28 minggu. Nilai hitung badan lamelar dihitung menggunakan mesin hematologi Advia 120. Tes busa juga dilakukan terhadap sampel cairan ketuban, sementara bayi diobservasi dan dinilai apakah mengalami RDS. Titik potong nilai hitung badan lamellar dalam memprediksi RDS dihitung menggunakan grafik Receiver Operating Characteristic.Hasil : 59 sampel cairan ketuban diperoleh dari wanita dengan usia kehamilan 29-42 minggu. Angka kejadian RDS pada penelitian ini adalah 15,3 %. Didapatkan nilai Area Under the Curve 0,94 untuk pemeriksaan hitung badan lamelar. Pada titik potong 50.000 sel/μL, hitung badan lamelar memiliki nilai sensitivitas 89 % dan spesifisitas 92 %, sementara tes busa memiliki nilai sensitivitas 67 % dan spesifisitas 90 %. Nilai negative predictive value untuk hitung badan lamelar pada titik potong 50.000 sel/μL adalah 98 %, sedikit lebih tinggi dari tes busa yaitu 94 %.Kesimpulan : Pemeriksaan tes busa dan nilai hitung badan lamelar merupakan alat yang dapat dipakai dalam memprediksi terjadinya RDS, namun nilai hitung badan lamelar memiliki nilai sensitivitas dan spesifisitas yang lebih tinggi dan memiliki beberapa kelebihan, yaitu lebih objektif, mudah dan cepat dikerjakan, serta hanya memerlukan sedikit sampel cairan ketuban.

---

Purpose : The study was designed to compare lamellar body count and foam stability test in predicting the presence of Respiratory Distress Syndrome in pregnancy with gestational age above 28 weeks.Method : Amniotic fluid specimens were collected by amniotomy during cesarean section from women with gestational age above 28 weeks. A haematology analyzer (Advia 120) was used to determine the lamellar body counts. We also performed foam stability test and observed the development of respiratory distress syndrome. Receiver operating characteristics curve was estimated to assess the threshold of lamellar bodies count that may predict the presence of Respiratory Distress Syndrome.Result : 59 specimens were collected from woman with 29 - 42 weeks gestational age. The incidence of Respiratory Distress Syndrome was 15,3 %. Area under the curve for lamellar body count was 0,94. Lamellar body count, with the best cut off point of 50.000 cell/μL had sensitivity 89% and specifity 92% for predicting the presence of RDS, while the sensitivity of foam stability test was 67% and specifity was 90 %. The negative predictive value of the lamellar body count was 98% slightly better than the negative predictive value of the foam stability test 94 %.Conclusion : Although both test are good predictor of RDS, lamellar body has higher sensitivity and specitivity. It also has more advantages as it only requires small amount of sample, fast, easy and more objective."

"Masalah kesehatan pada usia balita di Indonesia yang saat ini dihadapi adalah masih tingginya angka kesakitan dan kematian.Salah satu penyebabnya adalah Infeksi Saluran Nafas Akut (SKRT, 1995). Pola penyakit terbanyak di Puskesmas ISPA 5,05 %, dan dirawat nginap di rumah sakit ISPA 11,16 % di KabupatenfKotamadya se Jawa Barat masih tetap merupakan urutan dua besar setelah cliare (Profil Kesehatan Propinsi Jawa Barat, 2000). Untuk mengatasi masalah Infeksi Saluran Pernafasan Akut (ISPA) pada balita diperlukan upaya program penanganan yang terintegrasi antara masyarakat dan pemerintah. Pelaksanaan program pemberantasan penyakit Infeksi Saluran Pernafasan Akut (ISPA) merupakan upaya untuk mendukung peningkatan kualitas sumber daya manusia serta menipakan bagian clan upaya pencegahan dan pemberantasan penyakit menular (Diijen P2M DepkesRí, 2000).Penelitian ini bertujuan untuk mengetahui besarnya pola masak sebagai faktor resiko terjadinya Infeksi Saluran Pernafasan Akut (ISPA) pada balita. Rancangan penelitiannya adalah Kasus-Kontrol, dengan jumlah sampel 252 kasus dan 252 kontrol. Teknik pengambilan sampel secara simple random yang dilakukan terhadap setiap kasus ISPA yang berobat ke Puskesmas Garuda dengan kontrol sebagal tetangganya. Hipotesa yang diajukan adalah lnfeksi. Saluran Pemafasan Akut (ISPA) pada balita dapat diterangkan dan faktor resiko pola masak yang meliputi bahan bakar yang digunakan, frekuensi masak, lama masak, ventilasi tempat masak dan keberadaan anak di tempat masak. Analisa yang dipergunakan adalah uji statistik Regresi Logistik Ganda. Kesimpulan penelitian menunjukan bahwa pola masak merupakan faktor resiko terjadinya ISPA path balita. Penggunaan bahan bakar minyak tanah-kayu bakar memupunyai Rasio Odds 4,45 (selang kepercayaari 95 % 2,68 - 740),nilai Attributable fraction 0,59 (selang kepercayaan 95 % 0,50 - 0,66). Frekuensi memasak mempunyal Rasio Odds 3,86 (selang kepercayaan 95 %, 1,91 - 7,81), nilai Attribu.table fraction 0,20 (selang kepercayaan 95 % 0,16 - 0,23). Lama memasak mempunyai Rasio Odds 3,06 (selang kepercayaan 95 % 1,89 - 4,97), nilai Attributable fraction 0,40 (selang kepercayaan 95 % 0,30 - 0,47). Ventilasi mempunyai Rasio Odds 11,93 (selang kepercayaan 95 % 6,83 - 20,84), dengan Attributable fraction 0,52 (selang kepercayaan 95 % 0,50 - 0,94). Keberadaan anak di tempat masak mempunyaí Rasio Odds 4,01 (selang kepercayaan 95 % 2,46 - 6,52) dengan Attributabk fraction 0,46 (selang kepercayaan 95 % 0,38 - 0,52). Selain itu merokok merupakan faktor perancu (konfowider) dengan Rasio Odds 5,16 (selang kepercayaan 95 % 2,32- 11,48), nilai Attributable fraction 0,65 (selang kepercayaan 95 % 0,42 - 0,78). Imunisasi mempunyai Rasio Odds 2,87 (selang kepercayaan 95 % 1,50 - 5,49) dengan Attributable fraction 0,15 (selang kepercayaan 0,09 - 0,19). Adapun saran adalah petugas kesehatan (Puskesmas) hendaknya membenkan penyuíuhan kepada keluarga balita untuk menyedialcan ventilasi yang optimal di tempat masak, menjauhkan anak dan tempat memasak, serta setiap anggota keluarga untuk tidak merokok disekitar balita. Program imunisasi untuk tetap digalakan terutama BCG, DPT dan Campak dalam upaya mcncegah ISPA.

---

The health problem suffered by under five years old in Indonesia recently relates to the high rates of illness and death. One of their causal factor's reffered to Acute Infection of Repiratory Tract (SKRT, 1995). The most disease pattern at puskesmas (Public Health Center) ISPA 5,05 % and hospitalization at hospital (ISPA 11,16 %) in West Java Regency/Municipality still places the second level after diarrea ( Profil Kesehatan Propinsi Jawa Barat, 2000).

A certain effort of handling program which's integrated between society and government needs to be applied to solve Acute Infection of Respiratory Tract problem suffered by under five years old. The application of elimination program towards the disease of Acute infection of Respiratory Tract (ISPA) is a way to support the increasing of human resources quality, beside as a part of preventive methode and elimination attainment againts contagious disease (Dùjen P2M Depkes RI, 2000).

The aim of this reseach.is gaining the knoledge of cooking patern as a risk factor towards the accurace of Acute Infection of Respiratory Tract.

The design used this research is Case Control, take from 252 sample and 252 controls. The technique conducted in collecting the samples is simple random, which's carried out from each case of ISPA treated at Puskesmas Garuda and its neigbor as a comparison. The hipothesis made is that Acute Infection of Respiratory Tract (ISPA) suffer by under five years old can be explained in relation to risk factor of cooking pattern covering the usage of fuel , cooking frequency, cooking duration of time, kitchen ventilation, and existance of children under five year old in the kichen. Logistic Regression analysis was uses to test the hypothesis in it's Study.

The research result shows that cooking pattern is a risk factor of ISPA suffered by under fiye years. The usage of kerosene and firewod as fuel has Odds Ratio of 4,45 (95 % Confidence Interval/Cl 2,68 - 7,40), its value of Attributable fractionis 0,95 ( 95 % CI 0,50 - 0,66). Cooking frequency has Odds Ratio of 3,86 ( 95 % Cl 1,91 - 7,8 1). Its value if Attributable fraction 0,20 (95 % CI 0,16 - 0,23). Cooking duration if time has Odds Ratio of 3,06 (95 % CI 1,89 - 4,97 ), its value of Attributable fraction'S 0,40(95 % CI 0,30 - 0,47). Kichen Ventilation has Odds Ratio of 11,95 ( 95 % CI 683 - 20,84), its imfact 's 0,52 (95 % CI 0,50 0,94). The existance of under five years old in the kichen has Odds Ratio of 4,01 (95 % CI 2,46 - 6,52).Smoking is a conpounding with Odds Ratio of(95 % CI 2,32 - 11,48) and its im1ct fraction is 0,65 (95 % CI 0,452 -0,78). limmunization has Odds Ratio of 2,87(95 % CI 1,50- 5,.49)) and its Attributable fraction of 0,15 ( 95 % CI 0,09-0,19).

However, there are several suggestions offered to medical attendant at Puskesmas (Public Health Center) those are : They should give and illumination about the optimum ventilation provided in the kichen to the family member, keeping away their under five years, and the family member must not around their under five years when they smoke. Furtherm, the iniunization program still has to be held continually in order to prevent ISPA."

"

Respiratory distress syndrome (RDS) merupakan penyakit yang umum terjadi pada bayi prematur akibat defisiensi surfaktan dan ketidakmatangan fungsional paru-paru sehingga menyebabkan terjadinya gangguan pernapasan. Salah satu masalah muncul akibat hal tersebut adalah pola napas tidak efektif akibat imaturitas neorologis. Karya ilmiah ini bertujuan untuk menganalisis efektifitas side lying position pada neonatus dengan RDS yang mengalami pola napas tidak efektif. Pasien By. Ny. E perempuan berusia 1 hari mendapatkan bantuan ventilasi dengan NK CPAP FiO₂ 25% PEEP 6 tetapi masih menunjukkan adanya retraksi dinding dada dan saturasi oksigen 97 – 99%, HR: 138 x/menit, RR: 40 x/menit dengan jeda 1-2 detik setiap 4-5 napas. Pemberian side lying positon diberikan selama 3-4 jam setiap dinas dan hasil yang didapatkan setelah 7 hari perawatan, yaitu retraksi dada sudah tidak ada, saturasi oksigen stabil dalam rentang 98 – 100 % RA dan RR: 43 x/menit regular. Hasil karya ilmiah ini diharapkan dapat menjadi rujukan bagi perawat untuk memberikan side lying position sebagai intervensi keperawatan non-farmakologi untuk mengatasi masalah pernapasan pada bayi prematur dengan RDS.

---

Respiratory Distress Syndrome (RDS) is a common disease in premature babies due to surfactant deficiency and functional immaturity of the lungs therefore can causing respiratory problems. One of the problems that come up is an ineffective breathing pattern due to neurological immaturity. This scientific work aims to analyze the effectiveness of the side lying position in neonates with RDS who experience ineffective breathing patterns. Patient By. Ny. E receiving assisted ventilation with NK CPAP FiO2 25% PEEP 6 but still showing chest wall retraction and oxygen saturation 97 – 99%, HR: 138 x/minute, RR: 40 x/minute with 1-2 intervals seconds every 4-5 breaths. Intervention of side lying position is given for 3-4 hours and the results obtained after 7 days of treatment namely chest retraction is gone, oxygen saturation is stable in the range of 98 – 100% RA and RR: 43 x/minute regular. The results of this scientific work are expected to be a reference for nurses to provide a side lying position as a non-pharmacological nursing intervention to treat respiratory problems in premature infants with RDS.

"