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"Latar BelakangHemodialisa membutuhkan suatu akses vaskuler yang fungsional dan adekuat untuk mendapatkan hasil terbaik, bagi Negara berkembang seperti Indonesia tingginya biaya perawatan dan tenaga ahli masih merupakan hal yang harus ditanggapi serius oleh semua pihak. NKF-KDOQI menetapkan tiga Tujuan utama suatu unit hemodialisa antara lain meningkatkan pemakaian AV Fistula, Mengurangi pemakaian kateter hingga 10% dan Deteksi dini dari disfungsi akses vaskuler. Hingga saat ini belum ada gambaran akses vaskular yang terdapat di unit hemodialisa RSUPN Ciptomangunkusumo sehingga dapat dibandingkan dengan guideline, dan diharapkan mendapat masukan untuk pelayanan terbaik bagi pasien. MetodePenelitian ini berupa deskriptif retrospektif, Populasi penelitian adalah pasien gagal ginjal kronikyang menjalani hemodialisa dengan akses vaskuler fistula AV dan kateter vena sentral di RumahSakit Cipto Mangunkusumo pada bulan Mei – Desember 2012. Data dari rekam medis penderitadiketahui mengenai tanggal hemodialisa pertama kali, tanggal pembuatan akses vaskuler pertamakali, jenis akses vaskuler yang digunakan pertama kali serta konversi yang mengikutinya, sertalokasi akses vaskuler tersebut.HasilDidapatkan 234 data pasien yang aktif menjalani hemodialisa di unit hemodialisa RSUPNCiptomangunkusumno Jakarta dari bulan Mei – juni 2012, terdiri dari 146 laki laki dan 88perempuan , rerata umur 49.04 tahun dengan rentang umur 11 tahun sampai 78 tahun. Diantarapasien tersebut , 122 (52.1%) pasien dengan AV fistula, dan pasien yang membuat AV Fistulasebelum hemodialisa pertama hanya pada 7 pasien (1.2%) 1 pasien menggunakan graft PTFE,dengan lokasi tersering untuk AV Fistula adalah Radiocephalica sebanyak 29.4%, 48 pasienmenggunakan central venous catheter, dimana 28 pasien dengan longterm catheter (12%) dansisanya dengan shortterm catheter (8.5%). Direct Puncture digunakan oleh pasien sebagai carayang dipakai pertama kali melakukan hemodialisa, sebanyak 49.6%. dari keseluruhan pasienyang pernah menjalani pemasangan AV fistula mengalami primary failure sebanyak 10.65%, dansecondary failure sebanyak 7.37%.KesimpulanMasalah pada suatu unit hemodialisa tidaklah sederhana dan untuk mencapai suatu hasil yangterbaik diperlukan kerjasama dari sebuah tim multidisiplin vaskular akses yang terdiri dari ahliginjal hipertensi, ahli bedah vaskular, ahli radiologi, dan perawat dialisa. Dengan seorangkoordinator yang berdedikasi tinggi yang selalu memperbaharui data base pasien dan updateterbaru dari perkembangan akses vaskuler.

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Background

A vascular access that mantained to be functioning and adequate is a must to achieve the best

result in haemodialysis procedure. For a developing country like Indonesia, a high cost and

expertise in vascular access maintenance reluctantly a serious issues. NKF-KDOQI has

established three primary goals for a haemodialysis unit to achieve, to increase the placement of

native fistulas as vascular access at initiation of hemodialysis procedure until 65 %, to discourage

catheter insertion until 10% and early detection of vascular access dysfunction. Recently at Cipto

Mangunkusumo hospital, there are no profile of vascular access in haemodialysis unit to figure

out the condition and compare with guideline.

Method

This is a descriptive retrospective study with a CRF (Chronic Renal Failure) patients that undergo

hemodialysis with natve fistula and catheter as their vascular access in Cipto Mangunkusumo

hospital from May to December 2012. Data collected from medical record included dates when

initiates their hemodialysis procedure, diagnose of CRF, creation of fistula or other vascular

access, and complication that has occurred.

Results

From 234 patients that undergo hemodialysis procedure from May to December 2012, there werre

146 male and 81 female, with median age of 49.04 years old and distance within 11 – 78 years

old. Among these patients 122(52%) with fistula an 1 patient with graft but only 7 patients (1.2%)

that use native fistula to initiate their hemodialysis procedure. The most location for fistula were

on left radiocephalic in 29.4% of patients, 48 patients use catheter for their vascular access that

ionclude 12% long term and 8.5 % long term catheter. There were 49.6% patients with direct

venous puncture to initiate their hemodialysis. From all fistulas that created there were 10.65%

primary failure and 7.37% secondary failure.

Conclusion

Problems in hemodialysis unit is not as simple as that, and to achieve the best result require the

concerted effort of multivariariate vascular access team that consist nephrologist, vascular

surgeon, radiologist, and nurse with a chief coordinator that updating vascular access patients

database and its development"

"Pendahuluan: Iskemia tungkai kritis (ITK) merupakan penyakit vaskular yang memiliki risiko mortalitas dan amputasi yang tinggi. Insidens dari penyakit arteri perifer (PAP) khususnya ITK di Amerika mencapai 500-1000 kasus per 1 juta orang setiap tahunnya. Intervensi endovaskular (EVI) merupakan salah satu metode terapi ITK yang menjadi pilihan utama karena secara signifikan menurunkan risiko amputasi dan meningkatkan limb salvage. Penatalaksanaan menggunakan EVI terbagi menjadi balloon angioplasty dan stent angioplasty. Penelitian ini bertujuan untuk mengetahui efektivitas dari metode EVI dalam pemyembuhan luka akibat ITK.Metode: Dilakukan studi cross sectional dengan 90 subjek ITK yang menjalani intervensi endovaskular berupa balloon angioplasty dan stent angioplasty di Rumah Sakit dr. Cipto Mangunkusumo dari Januari 2013 hingga Juli 2017. Lama penyembuhan luka diantara kedua metode dianalisis menggunakan uji T tidak berpasangan dengan nilai p<0,05 dianggap bermakna secara statistik. Data yang diambil berupa metode EVI, lama penyembuhan luka, dan data karakteristik subjek (usia, riwayat amputasi, IMT, riwayat merokok, DM, lokasi pembuluh darah, dan profil darah).Hasil: Persebaran data lama perawatan pada kelompok balloon angioplasty dan stent angioplasty menunjukan hasil yang normal dengan rerata 84,8 ± 2,423 hari dan 59,93 ± 2,423 hari dengan perbedaan rerata 25 hari. Perbedaan rerata antara kedua faktor bermakna secara statistik (p<0,05). Kejadian amputasi pada kelompok balloon angioplasty dan stent angioplasty adalah 22 dan 16 kejadian dengan perbedaan yang tidak bermakna secara statistik (p<0,05).Kesimpulan: Metode stent angioplasty lebih baik dibandingkan metode balloon angioplasty dalam hal lama penyembuhan luka pada pasien ITK.

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Introduction: Critical limb ischemia (CLI) is a vascular disease that has a significant amputation and mortality risk with diabetes mellitus, the most significant risk factor in CLI, is very common among Indonesian. Endovascular intervention (EVI) is preferred in treating CLI because it is non invasive and effective. Balloon angioplasty and stent angioplasty are the most common method of EVI in Indonesia. This study aims to compare the effectiveness of balloon angioplasty and stent angioplasty on wound healing in CLI.

Method: A cross sectional study enrolled 90 subjects of CLI who underwent endovascular intervention using balloon angioplasty and stent angioplasty from January 2013 to July 2017 in dr. Cipto Mangunkusumo General Hospital, Jakarta. The wound healing period between balloon angioplasty and stent angioplasty were analyzed using unpaired T-test with p<0,05 considered as statistically significant. Data of intervention method, wound healing period, and subjects characteristic data (age, amputation, BMI, smoking habit, DM, occlusion site, and blood profile) were obtained.

Result: The wound healing period in balloon angioplasty and stent angioplasty distributed normally. Mean value of wound healing period in balloon angioplasty and stent angioplasty is 84,8 ± 2,423 and 59,93 ± 2,423 days with mean difference of 25 days. The difference of wound healing period in both group is statically significant (p<0,05). The amputation event in balloon angioplasty and stent angioplasty is 22 and 16 event with no difference statistically.

Conclusion: Stent angioplasty is better method than balloon angioplasty for wound healing in patients with CLI."

"In Diabetes and peripheral vascular disease, a panel of distinguished leaders in the field of medicine, podiatry, and vascular and endovascular therapy assimilate the latest literature on these issues and others for an in-depth review of the management of peripheral vascular disease. Providing an overview of the management of diabetes and diabetic foot changes as well as providing a view of cutting-edge and emerging topics in optimization of arterial status, this important title addresses pathophysiology, anatomy, diagnosis and management of diabetic peripheral vascular disease, emphasizing a multi-disciplinary approach. The first chapter of the book provides an overview of this complex disease process and discusses the teamwork required for optimal management. The chapters continue with the basic pathophysiology of diabetic atherosclerosis and a contemporary review of the management of diabetes. The genesis of diabetic foot ulceration and prevention and management strategies is covered, as is the effects of neuropathy and microvascular changes in the diabetic foot. In addition, Diabetes and Peripheral Vascular Disease covers the microbiology of diabetic foot infections, the role of endovascular interventions and vascular surgery as well as the management of the complications of these procedures, the process of amputation for those patients who have progressed beyond a limb salvage situation, and the effects of diabetes on the cerebrovascular system as well as its implications in patients with aortoiliac disease."

"Perawat Spesialis Medikal Bedah berperan penting dalam praktik keperawatan sebagai pemberi asuhan keperawatan kompleks, melakukan analisa ilmiah dan pembuktian ilmiah serta sebagai agen pembaharu. Melalui tulisan ini digambarkan pemberian asuhan keperawatan kepada pasien dengan diagnosis Chronic Limb Threatening Ischemia. Tujuan dari penulisan ini adalah memberikan gambaran praktek keperawatan spesialis medikal bedah menggunakan pendekatan Model Adaptasi Roy. Dari hasil pengumpulan data dan pemeriksaan fisik didapatkan 10 diagnosis keperawatan. Pemberian asuhan keperawatanpun dilakukan kepada 30 pasien sebagai kasus resume, diperoleh perilaku maladaptif pada mode fisiologis dengan diagnose terbanyak yaitu resiko infeksi dan nyeri kronik. Evidence Based Nursing dengan melakukan foot exercises kepada 8 pasien yang mengalami ulkus kaki diabetik dengan hasil yang signifikan terhadap perubahan ukuran luka. Program inovasi menerapkan Hypoglycemia-Nursing Early Warning Score System pada pasien diabetes melitus tipe 2 yang terbukti memudahkan perawat menilai resiko kejadian hipoglikemi berat selama 1 tahun. Pendekatan Model Adaptasi Roy berpengaruh besar terhadap profesi keperawatan. Model ini menjadi salah satu yang banyak digunakan dalam penelitian, pendidikan dan pelayanan keperawatan.

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Surgical Medical Specialist Nurses play an important role in nursing practice as a provider of advanced nursing care, conduct scientific analysis and scientific evidence and as a reforming agent. Through of this paper we describe the provision of nursing care to patients with a diagnosis of Chronic Limb Threatening Ischemia. The purpose of this paper is to provide an overview of the nursing practice of Surgical Medical Specialists using Roy's Adaptation Model approach. From the results of data collection and physical examination obtained 10 nursing diagnoses. In nursing care was provided to 30 patients as a case of resume, obtained maladaptive behavior in physiological mode with the most diagnoses, the risk of infection and chronic pain. Evidence Based Nursing by performing foot exercises on 8 patients who suffered diabetic foot ulcers with significant results on changes in wound size. The innovative program implementated the Hypoglycemia-Nursing Early Warning Score System in patients with type 2 diabetes mellitus which was proven to make it easier for nurses to assess the risk of severe hypoglycemic events for 1 year. Roy's Adaptation Model approach greatly influencing the nursing profession. This model is one that was widely used in research, education and nursing services"

"[ABSTRAK Latar Belakang : pengukuran VPW dari modalitas foto toraks merupakanpemeriksaan yang non invasif, cepat dan mudah untuk memprediksi kondisihipervolemia. Namun belum terdapat konsensus nilai rerata VPW yang dipakaisecara global, sehingga penggunaan nilai rerata VPW dari penelitian sebelumnyaterhadap populasi diluar populasi penelitian tersebut mungkin tidak relavan. DiIndonesia khususnya di Rumah Sakit Cipto Mangunkusumo belum terdapat datadasar nilai rerata VPW.Tujuan Penelitian: Mengetahui rerata nilai VPW dewasa normal IndonesiaDesain Penelitian: Retrospektif potong lintangMetode: Pengukuran jarak antara tepi terluar arteri subklavia kiri dengan tepiterluar vena kava superior yang melewati bronkus utama kanan (VPW),pengukuran rasio VPW terhadap diameter jantung terluas dan rasio VPW terhadapdiameter terluas rongga toraks. Pengukuran dilakukan pada radiografi toraks PAdari 104 subyek normal yang terdiri dari 52 laki-laki dan 52 perempuan, dihitungrerata dan standar deviasi. Pengukuran serupa juga dilakukan pada topogram CTscan toraks (radiografi toraks AP supine) dan CT scan toraks dari 103 subyekyang terdiri dari 51 laki-laki dan 52 perempuan.Hasil: Pada pemeriksaan toraks PA didapatkan rerata VPW 48,0 mm ± 5,5 mm,rerata VPCR 40,3% ± 4,6 %, dan rerata VPTR 17,2% ± 1,7%. Pada pemeriksaantopogram CT scan didapatkan rerata VPW 50,3 mm ± 6,2 mm, rerata VPTR 45%± 5,1%, dan rerata VPTR 19,8% ± 2,5%. Rerata VPW pada CT scan toraks 50,4 ±6,1 mm. Pengukuran pada foto toraks AP sekitar 10 % lebih besar dibandingkanpada foto toraks PA, dan pengukuranVPW pada foto toraks terbukti memilikiakurasi yang tinggi.Kesimpulan: Rerata VPW pada pemeriksaan foto toraks PA tegak dewasa normalIndonesia adalah 48 ± 5,5 mm, ternyata tidak berbeda bermakna dengan rerataVPW pada populasi barat ( 48 ± 5mm). Rerata VPCR pada foto toraks PAadalah 40,3 % ± 4,6 % dan VPTR adalah 17,2 % ± 1,7 %.

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ABSTRACTBackground: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).;Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm)., Background: Vascular pedicle width (VPW) is the distance, from a perpendicularline at the takeoff point of the left subclavian artery off the aorta to the point atwhich the superior vena cava. Measurement of VPW on chest x-ray is relativelynon-invasive, fast and easy technique as hypervolemia predictor, but nowordwide consensus has been proposed.Objective: to investigate mean vascular pedicle witdh of Indonesian adultStudy design: Retrospective cross sectionalMethods : VPW is the distance, measure in millimeters, from a perpendicular lineat the takeoff point of the left subclavian artery to the point at which the superiorvena cava crosses the right main bronchus, than calculate VPW ratio to a widesthorizontal diameter of cardiac dan thoracic wall.Results : Data from 104 PA chest x-ray of normal subjects and 103 thoracic CTscan of selected subjects. On PA chest x-ray obtained mean VPW 48,0 mm ± 5.5mm, mean VPCR 40.3% ± 4.6%, and mean VPTR 17.2% ± 1.7%. On CT scantopogram obtained mean VPW 50,3 mm ± 6.2 mm, mean VPTR 45% ± 5.1%, andmean VPTR 19.8% ± 2.5%. On thoracic CT scan obtained mean VPW 50.4 ± 6.1mm. Measurements on the AP chest x-ray about 10% greater than in the PAchest x-ray, and measurement of VPW on conventional chest x-ray aproved tohave high accuracy.Conclusions :The mean VPW on erect chest x-ray of Indonesian adult is 48 ± 5,5mm, no significant different between westerns population ( 48 ± 5mm).]"

"Latar belakang. Salah satu komplikasi paling umum dari diabetes mellitus (DM) adalah penyakit arteri perifer (PAD). Diperkirakan PAD mempengaruhi sebanyak 20% orang di atas 65 tahun. Banyak faktor yang berhubungan dengan terjadinya PAD. Golongan darah merupakan faktor risiko yang dikatakan mempengaruhi keparahan PAD namun belum banyak diteliti. Penelitian ini bertujuan untuk mengevaluasi hubungan golongan darah ABO dengan derajat keparahan PAD pada pasien DM tipe II.Metode. Studi cross-sectional dilakukan pada pasien DM tipe II yang didiagnosis dengan PAD dan datang ke Rumah Sakit Nasional Cipto Mangunkusumo, Indonesia selama periode Januari 2022 hingga Juni 2022. Diagnosis PAD didasarkan pada pengukuran indeks pergelangan kaki-brakialis. (ABI). Tingkat keparahan PAD dikelompokkan menjadi PAD ringan (ABI 0,7-0,9) dan PAD sedang-berat (ABI <0,7). Pasien dikategorikan menurut golongan darah ABO menjadi golongan darah O dan golongan darah non-O (A, B, dan AB).Hasil. Sebanyak 366 subjek dilibatkan dalam penelitian ini (A = 108, B = 52, AB = 12, O = 194). Tidak ada perbedaan kejadian PAD pada pasien PAD golongan darah O dan non golongan darah O (p = 0,780). PAD lebih parah pada golongan darah non-O (p = 0,041). Faktor risiko PAD yang lebih berat adalah periode diabetes yang lebih lama (OR 10,325 (95% CI 5,108-20,871), p < 0,001) dan hipertensi (OR 4,531 (95% CI 1,665-12,326), p < 0,003).Kesimpulan. Golongan darah ABO tidak berhubungan dengan terjadinya PAD. Golongan darah non-O dikaitkan dengan PAD yang lebih buruk di antara pasien DM tipe II. Faktor risiko lain untuk PAD yang lebih parah adalah periode diabetes dan hipertensi yang lebih lama.

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Introduction. One of the most common complications of diabetes mellitus (DM) is peripheral artery disease (PAD). It is estimated that PAD affects as many as 20% of people over 65 years. Many factors are associated with the occurrence of PAD. Blood type is a risk factor that is said to influence the severity of PAD but has not been widely studied. This study aims to evaluate the relationship between ABO blood group type and the severity of PAD in DM type II patients.

Method. A cross-sectional study was performed on DM type II patients who was diagnosed with PAD and came to Cipto Mangunkusumo National Hospital, Indonesia during the period of January 2022 to June 2022. The diagnosis of PAD was based on the measurement of ankle-brachial index (ABI). The severity of PAD was grouped into mild PAD (ABI 0.7-0.9) and moderate-severe PAD (ABI <0.7). The patients were categorized according to the ABO blood group into O blood type and non-O (A, B, and AB) blood type

Results. A total of 366 subjects were included in the study (A = 108, B = 52, AB = 12, O= 194). There was no difference of PAD occurrence in O blood type and non-O blood type PAD patients (p = 0.780). The PAD was more severe in non-O blood type (p = 0.041). The risk factors of more severe PAD were longer period of diabetes (OR 10.325 (CI95% 5.108-20.871), p < 0.001) and hypertension (OR 4.531 (CI95% 1.665-12.326), p

< 0.003).

Conclusion. The ABO blood type was not associated with the occurrence of PAD. The non-O blood type was associated with worse PAD among DM type II patients. Other risk factors of more severe PAD were longer period of diabetes and hypertension."

"Latar belakang: Laparotomi merupakan teknik operasi untuk membuka akses kavitas peritoneum dengan membentuk sayatan terbuka di area abdomen. Cedera mukosa akibat trauma pembedahan mengganggu homeostasis epitel, merusak ekosistem mikrobiom, meningkatkan produksi sitokin proinflamasi dan berkaitan dengan kejadian komplikasi pascaoperatif. Probiotik Lactobacillus acidophillus memperkuat sawar usus, mempertahankan ekosistem mikrobiom dan berpotensi memodulasi respon imun. Namun, belum terdapat penelitian mengenai dampak pemberian Lactobacillus acidophilus terhadap kadar c-reactive protein (CRP) pascalaparotomi gastrointestinal sebagai penanda inflamasiTujuan: Penelitian ini bertujuan untuk mengetahui dampak pemberian Lactobacillus acidophilus terhadap kadar CRP pascalaparotomi gastrointestinalMetode: Penelitian ini merupakan uji klinis acak tersamar ganda. Sebanyak 56 subjek yang akan menjalani operasi laparotomi gastrointestinal dimasukkan ke dalam penelitian. Subjek penelitian diberikan kapsul probiotik Lactobacillus acidophilus 109 (kelompok probiotik) atau diberikan kapsul laktosa (kelompok plasebo) selama 3 hari sebelum operasi. Kadar CRP diukur 3 hari sebelum prosedur dan 3 hari sesudah prosedur.Hasil: Lima puluh enam subjek dengan 28 subjek pada tiap kelompok, mengikuti penelitian hingga selesai. Pada hari ketiga pascaoperatif, probiotik secara efektif menurunkan peningkatan respon inflamasi dengan nilai akhir CRP pada kelompok probiotik lebih rendah dibandingkan kelompok plasebo (median probiotik 89,65 mg/L vs. plasebo 204 mg/L, p < 0,001). Perubahan peningkatan nilai CRP lebih rendah pada kelompok probiotik dibandingkan kelompok plasebo (median probiotik 84,8 mg/L vs. plasebo 187,6 mg/L, p < 0,001). Terdapat efek samping yang signifikan (mual, diare, muntah dan rasa kembung di perut) pada kelompok probiotik selama penelitian (p = 0,04).Simpulan: Pemberian probiotik preoperatif menurunkan secara signifikan peningkatan CRP pada pasien pascalaparotomi gastrointestinal

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Background: Laparotomy is a surgical technique to open access to the peritoneal cavity by forming an open incision in the abdominal area. Mucosal injury due to surgical trauma can disrupt epithelial homeostasis, impair the microbiome ecosystem, increase the production of proinflammatory cytokines and relating to the incidence of postoperative complications. Lactobacillus acidophillus probiotic administration improve the intestinal barrier function, maintains the microbiome ecosystem and potentially modulate immune responses. However, there has been no research on the impact of Lactobacillus acidophilus administration on C-Reactive Protein (CRP) levels after gastrointestinal laparotomy as a marker of inflammation.

Objective: This study aimed to determine the impact of Lactobacillus acidophilus on CRP levels after gastrointestinal laparotomy

Methods: This study is a randomized controlled trial. Fifty six subjects scheduled gastrointestinal laparotomy surgery were enrolled. Subjects received Lactobacillus acidophilus 109 probiotic capsules (probiotic group) or lactose capsules (placebo group) for 3 days before surgery. CRP levels were measured 3 days before the procedure and 3 days after the procedure.

Results: Fifty-six subjects with 28 subjects in each group completed the study. On the third postoperative day, probiotics effectively suppressed the elevating inflammatory response with the final CRP value in the probiotic group lower than the placebo group (median probiotic 89.65 mg/L vs. placebo 204 mg/L, p < 0.001). Elevated CRP values ​​were lower in the probiotic group than in the placebo group (median probiotic 84.8 mg/L vs. placebo 187.6 mg/L, p < 0.001). There was a significant side effects (nausea, diarrhea, vomiting, and bloating) in the probiotic group during study (p = 0.04).

Conclusions: Preoperative probiotic administration significantly reduced elevated CRP in patients After Undergoing Gastrointestinal Laporotomy."

"Diagnosis kanker ovarium stadium lanjut memberikan kontribusi terbesar terhadap tingginya kasus kematian. Imunoterapi sebagai alternatif pengobatan diharapkan dapat mengobati pasien dengan kanker ovarium secara lebih cepat menggunakan sel imun bawaan yang dapat membunuh sel kanker secara permanen. Studi imunoterapi pada penelitian ini dilakukan dengan memanfaatkan interaksi antara ligan di dalam lingkungan mikro tumor dan reseptor sel NK. Reseptor NKP44 merupakan satu-satunya reseptor dengan dua mekanisme persinyalan berbeda yang secara aktif berperan penting dalam fungsi sel NK teraktivasi. Salah satu ligan potensial yang dapat meningkatkan fungsi pengenalan sel tumor melalui reseptor NKP44 adalah Nidogen-1 (NID1). Penelitian ini bertujuan untuk mengembangkan studi imunoterapi pasien dengan kanker ovarium serta mempelajari pengaruh interaksi ligan NID1 dengan reseptor NKP44 terhadap aktivitas sel NK. Metode penelitian yang dilakukan mencakup analisis ekspresi granul sitotoksik, analisis ekspresi NID1, uji keberhasilan ikatan ligan NID1 dengan sel NK, hingga analisis ekspresi NKP44. Hasil menunjukkan bahwa kelompok sel NK terinduksi memiliki aktivitas sitotoksik yang lebih baik dibandingkan kelompok sel NK tidak terinduksi melalui peningkatan ekspresi granul sitotoksik. Terdapat ekspresi NID1 meskipun dalam jumlah yang sedikit dan terkonfirmasi berhasil berikatan dengan sel NK. Namun, terjadi penurunan ekspresi NKP44 pada kelompok sel NK terinduksi sehingga perlu dilakukan analisis lanjutan penyebab penurunan ekspresi NKP44.

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Diagnosis of advanced ovarian cancer provides the largest contribution to the high number of deaths. Immunotherapy as an alternative treatment is expected to treat patients with ovarian cancer more quickly using innate immune cells that can permanently kill cancer cells. The development of immunotherapy in this study was carried out by utilizing the interaction between ligands in the tumor microenvironment and NK cell receptors. NKP44 is the only receptor with two different signaling mechanisms that actively play the most important role in the function of activated NK cells. One of the potential ligands that can improve tumor cell recognition function through the NKP44 receptor is Nidogen-1 (NID1). This research is aimed to develop immunotherapy studies for patients with ovarian cancer and to study the effect of the interaction of the NID1 ligand with the NKP44 receptor on NK cell activity. The research methods carried out included analysis of cytotoxic granule expression, analysis of NID1 expression, success test of NID1 ligand bonding with NK cells, and NKP44 expression analysis. The results showed that the induced NK cell group had better cytotoxic activity than the uninduced NK cell group through increased cytotoxic granule expression. There is expression of NID1 even in small numbers and it is confirmed that it binds successfully to NK cells. However, there was a decrease in the expression of NKP44 in the induced NK cell group so that further analysis needs to be carried out on the causes of the decrease in NKP44 expression."

"Praktik residensi keperawatan medikal bedah merupakan praktik klinik untuk meningkatkan kemampuan residen dalam mengelola kasus dengan mengintegrasikan peran perawat spesialis dalam memberikan asuhan keperawatan Askep Peran perawat sebagai care provider dan case manager residen mengelola kasus utama pasien DM dan 32 kasus resume dengan menggunakan pendekatan model Adaptasi Roy Peran sebagai reseacher residen menerapkan tindakan keperawatan berbasis bukti EBN yaitu ROM ankle pasien DM dengan venous ulcer Hasil tindakan ROM ankle menunjukkan terdapat peningkatan sudut dorsofleksi dari baseline 9 61 derajat menjadi 11 45 derajat dan sudut plantarfleksi dari baseline menjadi 30 59 derajat menjadi 35 5 derajat serta menurunkan nyeri luka dari baseline skala 4 8 menjadi skala 3 63 Peran sebagai inovator residen menerapkan pedoman pengkajian distress diabetes scale DDS bagi pasien DM Pengkajian DDS dilakukan untuk mengidentifikasi masalah psikososial pasien DM di Rumah Sakit dengan memberikan rekomendasi intervensi berdasarkan 4 domain Kata kunci Praktik residensi Peran perawat model adaptasi Roy pengkajian DDS.

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A practical residency of medical surgical nursing KMB is a clinical practice for increasing resident rsquo s ability to manage cases by integrating the role of specialist nurse for giving nursing care The role of nursing as a care provider and case manager is the resident manages main cases of DM patient and 32 resume cases of patients with endocrin disorder by using an approach of Roy adaptation model The role of the researcher is the resident implements nursing care and treatment based on the evidence EBN which is called ankle ROM of DM patient with venous ulcer The ROM treatment research shows an increasing values of dorsofleksi angle from the baseline 9 61 becomes 11 45 and plantar fleksi from the baseline 30 59 becomes 35 5 and also reducing wound pain from the baseline 4 8 becomes 3 63 The practical inovator role implements an assessment guideline of distress diabetes scale DDS The DDS rsquo s assessment can be done for screening the psychosocial problem of DM patient in the hospital by recommending an intervention based on four 4 domains Key words Practical residency Nurse role Roy Adaptation model DDS assessment."

"Latar belakang. Durasi AV delay (DAVD) pada pasien dengan pacu jantung dual chamber menentukan derajat sinkroni atrioventrikular (AV). Pengaturan DAVD yang optimal pada pasien dapat meningkatkan kualitas hidup dan memperbaiki parameter hemodinamik jika dibandingkan dengan pasien yang tidak dilakukan optimalisasi. Namun optimalisasi DAVD merupakan prosedur yang memakan waktu dan biaya. Perlu dicari faktor-faktor yang mempengaruhi nilai DAVD yang optimal. Metode. Penelitian ini merupakan studi potong lintang. Evaluasi dilakukan pada 35 pasien blok AV total dengan pacu jantung permanen dual chamber yang datang ke poliklinik RS Jantung Nasional Harapan Kita periode bulan Oktober sampai dengan pertengahan November 2014. Dilakukan pemeriksaan ekokardiografi terhadap parameter fungsi diastolik pada saat DAVD awal (DAVD pabrikan), lalu dicari DAVD optimal menggunakan VTI-LVOT terbesar. Hasil. Terdapat korelasi lemah antara paramater fungsi diastolik rasio E/A dan nilai DAVD optimal (r - 0,356 dengan p 0,036). Analisa regresi linear antara rasio E/A dengan nilai DAVD optimal (adjusted analysis sesuai usia, fraksi ejeksi, dan DAVD pabrikan) menunjukan nilai koefisien -0.477 dengan nilai p 0,007 (IK 95% - 84.4 s.d. -14.1). Analisa regresi linear antara nilai e' medial dengan DAVD optimal menunjukkan tingkat kemaknaan dengan nilai koefisien -0.390 dan nilai p 0.026 (IK 95% -16.3 s.d. -1.1). Terdapat perbedaan rerata DAVD optimal, 173.46 ±42.23 ms untuk pasien dengan rasio E/A ≥ 1, dan 128.89 ± 42.5 ms untuk rasio E/A <1 (p:0.01). Kesimpulan. Terdapat korelasi negatif yang bermakna antara parameter fungsi diastolik (E/A dan e' medial) dengan DAVD optimal pada pasien dengan pacu jantung permanen dual chamber.

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Background. AV Delay Duration (AVD) in patient with dual chamber pacemaker defines atrioventricular synchrony. Optimazation of AVD could improve quality of life and hemodynamic parameters compared to factory setting. Despite that, AVD optimization is a time consuming procedure and not cost effective. factors that influence the optimal AVD should be sought.

Methods. This is a cross sectional study on 35 total AV block patients that came to National Cardiovascular Center Harapan Kita from October to November 2014. Echocardiography on left ventricle diastolic indices was performed in factory setting AVD. The AVD that gives to the biggest LVOT VTI was set as the optimal AVD. Statistical analysis was done to correlate between diastolic indices and optial AVD.

Results. Weak correlation was noted between diastolic indices (E/A ratio) and optimal AVD (r: - 0,356; p: 0,036). Linear regression analysis showed a negative correlation between E/A ratio {coefficient -0.477; p: 0,007 (CI 95% - 84.4 to -14.1)} and medial e' {coefficient -0.390; p: 0.026 (CI 95% -16.3 to -1.1)} with optimal AVD (adjusted with age, ejection fraction, and factory setting AVD). Different E/A ratio showed a different optimal AVD mean, 173.46 ±42.23 ms for E/A ≥ 1 vs. 128.89 ± 42.5 ms for E/A <1 (p:0.01).

Conclusion. This paper shows a negative correlation between echocardiographic diastolic function indices (E/A ratio and medial e') with optimal AVD."