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"Diameter sagital kanalis spinalis servikal merupakan pengukuran penting pada trauma. degeneratif dan inflamasi. Diameter kanalis spinalis yg kecil sangat berhubungan dengan kejadian resiko trauma. Oleh karena itu, Pavlov dkk menerangkan ratio antara diameter sagital kanalis spinalis dibandingkan dengan diameter sagital korpus vertebra yang diukur dari foto lateral servikal. Trauma pada servikal adalah penyebab terbanyak pada kelumpuhan. Yang bermanifestasi terhadap terjadinya defisit neurologis dan berhubungan dengan stenosis di servikal. Pavlov ratio kurang dari 0,8 menunjukkan suatu stenosis kanalis dan resiko untuk kejadian transient neuropraksia yang merupakan suatu defisit neurologis. Penelitian ini untuk menjelaskan hubugan antara Pavlov ratio dan defisit neurologis pada penderita trauma servikal. METODA Design penelitian adalah penelitian cross sectional pada 28 kasus trauma servikal. Pavlov ratio diukur dengan menggunakan foto polos lateral servikal, sedangkan defisit neurologis diperiksa melalui autoanamnesa dan pemeriksaan fisik. HASIL Hasil penelitian ini didapatkan 21 kasus pada laki-laki dan 7 kasus adalah perempuan. Nilai Pavlov ratio yang mengalami stenosis kanalis sebanyak 14%. Berdasarkan jenis trauma ditemui pada penelitian ini 16 kasus vulmis' laseratum, 4 kasus fraktur nasal, 3 kasus fraktur clavikula, 3 kasus fraktur mandibula. 1 kasus fraktur maxilla dan 1 kasus lain-lain. Untuk analisa hubungan Pavlov ratio dengan kejadian defisit neurologis menggunakan Fisher's Exact Test Exact Sig 1 sided column, didapatkan p = 0,481, tidak bermak.na secara statistik. Sedangkan analisa kejadian defisit neurologis pada trauma yang terjadi menggunakan pearson chi-square nilai p yang diambil yaitu p"" 0,754 tidak bermakna secara statistik KESIMPULAN Pavlov ratio bertujuan menseleksi pasien dengan resiko tinggi untuk terjadinya defisit neurologis pada olahraga kontak tetapi pada penelitian ini tidak bermakna untuk mendeteksi adanya defisit neurologis dengan jenis trauma ringan pada servical bukan trauma hebat. Perlu penelitian selanjutnya untuk meneliti dengan trauma servical yang lebih berat.

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The sagittal diameter of the cervical spinal canal is clinical importance in traumatic, degenerative, and inflammatory conditions. A small canal diameter has been associated with an increase risk of injury. For these reasons, Pavlov et al devised a ratio between the sagittal diameter of the canal and the sagittal diameter of the vertebral body, as measured on the lateral radiograph. Cervical spine injuries is commonest cause of disability. Cervical injury can manifests as neurologic deficits and correlates with stenosis of the cervical. Pavlov ratio less than 0,8 shows canalis stenosis and risks to transient neuropraxia which is a neurologic deficit. This study ~etermines the relation between Pavlov ratio and neurologic deficit in cervical trauma patients. METHOD This is a cross sectional study in 28 patient with cervical trauma Pavlov ratio was obtained from lateral cervical plain x-ray, while neurologic deficit status was obtained from the clinical appearance. RESULTS The study subject consists of 21 man and 7 woman. While Pavlov ratio with canal stenosis was found in 14% of the study subjects. From this study found 16 cases vulnus laceration, 4 cases nasal fracture, 3 cases clavicle fracture, 3 cases mandible fracture, 1 case maxilla fracture and 1 case corneal rupture. From Fisher's Exact Test Exact Sig 1 sided colwnn, p = 0,481, not significant. CONCLUSIONS Pavlov ratio was to screening patient with high risk of cervical trauma in contact sport but for this study is not satisfied to detect neurologic deficit. Further study is needed especially those with more severe cervical trauma."

"The study was a a quasi experimental study, to evaluate the effects of kyphosis correction to the improvement of neurological deficits in 33 adults patient with tuberculous spondylitis at Fatmawati General Hospital in Jakarta during the period of January 2002 - June 2004. The average age of the patients was 29 years old, there were a range between 15-80° preoperative kyphosis and 0-55° range of postoperative kyphosis. There was a significant differential between degrees of kyphosis for pre and post operative (Wilcoxon signed test = OM) but there was no significant effect of kyphosis correction to the improvement of neurological deficits in tuberculous spondylitis patients thoracal and thoracolumbal vertebrae ( 0,053 ; p > 0.05 ). There was no significant relationship between the degree of kyphosis with neurological status in spondylitis tuberculosis patients thoracal and thoracolumbal vertebrae (p . 0,05 ) and there -was no significant relationship between site of lesion to neurological status in spondylitis tuberculosis patients thoracal and thoracolumbal vertebrae (p > 0,05)."

"Latar belakang: Sepsis infeksi intra-abdomen SIA merupakan masalah klinik yang sampai saat ini merupakan mortalitas yang tinggi dan tantang tersendiri spesialis bedah. Dari data yang ada, insiden di Amerika Serikat pada tahun 2012 tercatat 3,5 juta penderita dengan mortalitas mencapai 60 , sedangkan di Eropa barat 30 . Timbul pertanyaan, faktor apa yang paling berperan dalam rantai perkembangan sepsis intra-abdomen. Dari informasi terkini tertuju pada biophenotype. Pada tahun 2007 istilah biophenotype diajukan oleh Human Nature Natural Health untuk menjelaskan suatu molekul yang terproyeksi dan melapisi permukaan seluruh sel yang ada di tubuh manusia. Tujuan Penelitian: Diketahuinya hubungan golongan darah tertentu dengan kejadian sepsis intra-abdomen pada pasien trauma abdomen dan infeksi gastrointestinal. Metode Penelitian: Penelitian ini merupakan penelitian deskriptif dan analtik dengan desain potong lintang. Subjek yang diambil merupakan pasien yang mengalami trauma abdmen dan infeksi gastrointestinal di RSCM melalui data rekam medis. Data yang diambil adalah usia, jenis kelamin, riwayat transfusi dengan golongan darah ABO, dan hasil kultur jaringan. Data tersebut dianalisis menggunakan SPSS dan dilakukan uji chi-square untuk mengetahui hubungan antara golongan darah ABO dengan kejadian sepsis. Hasil Penelitian: Pada penelitian ini ditemukan terdapat 22 subjek 9,6 pasien yang mengalami sepsis intra abdomen pasca operasi selama periode Januari 2014 ndash; Maret 2016. Studi ini mendapatkan hubungan yang bermakna antara pemberian transfusi OR = 0.02; p < 0.001 dan grup diagnosis OR = 4.7; P = 0.015 terhadap terjadinya sepsis intra abdomen. Namun demikian, tidak ditemukan hubungan yang bermakna pada usia, jenis kelamin, dan golongan darah terhadap terjadinya sepsis intra abdomen. Kesimpulan: Dari hasil penelitian ini belum dapat dibuktikan golongan darah tertentu berpotensi menyebabkan sepsis intra abdomen pada pasien dengan riwayat trauma abdomen dan infeksi gastro intestinal.

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Background: Intra abdominal sepsis is a clinical problem with high mortality and a special challenge for surgeons. Based on research about glycocalyx, we obtained information regarding the differences of biophenotype on glycocalyx. So far, the research that leads to the difference in biophenotype is only focused on the ABO blood type system. Until recently there has been no data on the relationship between sepsis especially intra abdominal sepsis with blood type.

Methods: This is a descriptive and analytic research with cross sectional design in patients with abdominal trauma and gastrointestinal infections at dr. Cipto Mangunkusumo General Hospital RSCM that fulfilled the inclusion and exclusion criteria.

Results: There were 230 subjects, who underwent post traumatic abdominal surgery as well as gastrointestinal infections at RSCM. There were 22 subjects incidence 9.6 who had postoperative intraabdominal sepsis. Most subjects who underwent surgery were aged around 41 60 years 50 , were men 56.1 , did not get transfusions 90.9 , had surgery caused by mechanical intestinal obstruction 24.8 , had blood type O 46.1 , had gastrointestinal infection 92.6 , and were living as the outcome of the procedure 96.5 . There was a significant correlation p 0,05 between transfusion p 0,0001 and diagnostic group p 0,015 on the occurrence of intra abdominal sepsis. In subjects receiving transfusion, the odds ratio OR was 0.02 and the group diagnosis OR was 4.7 at 95 confidence interval.

Conclusions. The high risk of sepsis is especially high in the gastrointestinal infection group. Similarly, amongst factors affecting sepsis, history of transfusion may increase the risk of sepsis. Results of this study could not be prove that certain blood groups potentially cause intra abdominal sepsis in patients with a history of abdominal trauma and gastro intestinal infections. "

"Latar belakang: Sepsis (infeksi) intra-abdomen (SIA) merupakan masalah klinik yang sampai saat ini merupakan mortalitas yang tinggi dan tantang tersendiri spesialis bedah. Dari data yang ada, insiden di Amerika Serikat pada tahun 2012 tercatat 3,5 juta penderita dengan mortalitas mencapai 60%, sedangkan di Eropa barat 30%. Timbul pertanyaan, faktor apa yang paling berperan dalam rantai perkembangan sepsis intra-abdomen. Dari informasi terkini tertuju pada biophenotype. Pada tahun 2007 istilah biophenotype diajukan oleh Human Nature Natural Health untuk menjelaskan suatu molekul yang terproyeksi dan melapisi permukaan seluruh sel yang ada di tubuh manusia. Tujuan Penelitian: Diketahuinya hubungan golongan darah tertentu dengan kejadian sepsis intra-abdomen pada pasien trauma abdomen dan infeksi gastrointestinal. Metode Penelitian: Penelitian ini merupakan penelitian deskriptif dan analtik dengan desain potong lintang. Subjek yang diambil merupakan pasien yang mengalami trauma abdmen dan infeksi gastrointestinal di RSCM melalui data rekam medis. Data yang diambil adalah usia, jenis kelamin, riwayat transfusi dengan golongan darah ABO, dan hasil kultur jaringan. Data tersebut dianalisis menggunakan SPSS dan dilakukan uji chi-square untuk mengetahui hubungan antara golongan darah ABO dengan kejadian sepsis.Hasil Penelitian: Pada penelitian ini ditemukan terdapat 22 subjek (9,6%) pasien yang mengalami sepsis intra abdomen pasca operasi selama periode Januari 2014-Maret 2016. Studi ini mendapatkan hubungan yang bermakna antara pemberian transfusi (OR = 0.02; p < 0.001) dan grup diagnosis (OR = 4.7; P = 0.015) terhadap terjadinya sepsis intra abdomen. Namun demikian, tidak ditemukan hubungan yang bermakna pada usia, jenis kelamin, dan golongan darah terhadap terjadinya sepsis intra abdomen. Kesimpulan: Dari hasil penelitian ini belum dapat dibuktikan golongan darah tertentu berpotensi menyebabkan sepsis intra abdomen pada pasien dengan riwayat trauma abdomen dan infeksi gastro intestinal.

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Background: Intra-abdominal sepsis is a clinical problem with high mortality and a special challenge for surgeons. Based on research about glycocalyx, we obtained information regarding the differences of biophenotype on glycocalyx. So far, the research that leads to the difference in biophenotype is only focused on the ABO blood type system. Until recently there has been no data on the relationship between sepsis (especially intra-abdominal sepsis) with blood type. Methods: This is a descriptive and analytic research with cross sectional design in patients with abdominal trauma and gastrointestinal infections at dr. Cipto Mangunkusumo General Hospital (RSCM) that fulfilled the inclusion and exclusion criteria.Results: There were 230 subjects, who underwent post-traumatic abdominal surgery as well as gastrointestinal infections at RSCM. There were 22 subjects (incidence: 9.6%) who had postoperative intraabdominal sepsis. Most subjects who underwent surgery were aged around 41-60 years (50%), were men (56.1%), did not get transfusions (90.9%), had surgery caused by mechanical intestinal obstruction (24.8%), had blood type O (46.1%), had gastrointestinal infection (92.6%), and were living as the outcome of the procedure (96.5). There was a significant correlation (p < 0,05) between transfusion (p = 0,0001) and diagnostic group (p = 0,015) on the occurrence of intra-abdominal sepsis. In subjects receiving transfusion, the odds ratio (OR) was 0.02 and the group diagnosis OR was 4.7 at 95% confidence interval. Conclusions: The high risk of sepsis is especially high in the gastrointestinal infection group. Similarly, amongst factors affecting sepsis, history of transfusion may increase the risk of sepsis. Results of this study could not be prove that certain blood groups potentially cause intra-abdominal sepsis in patients with a history of abdominal trauma and gastro intestinal infections."

"Latar belakang: Beberapa studi telah melaporkan bahwa banyak pasien stroke berat mengalami sepsis selama fase akut, hal ini berpengaruh pada luaran yang buruk. Pada stroke, terjadi pergeseran dari predominasi limfosit Th1 yang memiliki karakter proinflamasi menjadi predominasi limfosit Th2 yang dapat mengaktifasi respon antiinflamasi yang dapat berakibat pada menurunnya respon imun terhadap invasi patogen.Tujuan: Penelitian ini bertujuan menilai apakah rasio netrofil terhdap limfosit (RNTL) dapat memprediksi berkembangnya kejadian sepsis pada pasien stroke akut.Metode: melakukan penilaian pada pasien stroke akut yang dirawat di Unit Perawatan Intensif (UPI) RSUP Fatmawati sejak September 2019 sampai Mei 2020.Hasil: Rata–rata RNTL pada pasien stroke akut selama perawatan di UPI 16,8 ± 12,5. Dilakukan uji Mann–Whitney, didapatkan mean rank dari beberapa parameter RNTL seperti RNTL awal, RNTL hari ke–3 , RNTL tertinggi, dan delta RNTL (dRNTL) pada pasien stroke akut di UPI berkaitan dengan kejadian sepsis. Terdapat perbedaan nilai median pada RNTL hari ke–3, RNTL tertingggi, dan dRNTL pada kelompok stroke yang mengalami sepsis dengan kelompok stroke yang tidak mengalami sepsis.Kesimpulan: RNTL diperkirakan dapat menjadi penanda awal yang potensial terjadinya sepsis pada stroke akut, sehingga dapat menghindari keterlambatan diagnosa dan tatalaksana sepsis pasa pasien stroke sakit kritis.

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BACKGROUND: Several studies have reported that many severe stroke patients developed sepsis during their acute phase, which leads to poor outcomes. In stroke, there is a shift from predominant Th1 lymphocytes, which have proinflammatory characteristics, to predominant Th2 lymphocytes which activate anti-inflammatory responses that induce hyporesponsiveness of the immune system against an invasion of pathogen, known as stroke-induced immunodepression syndrome.

AIM: This study aims to examine whether the neutrophils-to-lymphocytes ratio (NLR) could predict the development of sepsis in acute stroke patients.

METHODS: Patients were admitted to Fatmawati hospital intensive care unit from September 2019 to May 2020.

RESULTS: The mean NLR of acute stroke patients during their stay in ICU was 16.8 ± 12.5. We performed Mann– Whitney test, which revealed that the mean rank of several NLR parameters, such as initial NLR, day-3 NLR, highest NLR, and dNLR in stroke patients at ICU, was associated with the incidence of sepsis. The median difference in day-3 NLR, highest NLR, and dNLR in the stroke group with sepsis differed from those of the non-sepsis group.

CONCLUSION: NLR is assumed to have potential as an early predictor to distinguish septic conditions from non- septic conditions, to prevent delay in establishing diagnosis and management of sepsis, especially in acute, critically- ill stroke patients."

"Pasien trauma akibat kecelakaan merupakan pasien yang paling banyak datang ke Instalasi Gawat Darurat (IGD). Pasien-pasien tersebut selain mengalami nyeri akibat luka trauma yang dialaminya, juga merasakan kecemasan terkait pembiayaan dan kecemasan meninggalkan pekerjaan serta keluarganya. Penelitian ini mengidentifikasi hubungan kecemasan dengan tingkat nyeri yang dialami pada pasien trauma. Metode penelitian dengan desain cross-sectional pada 107 responden yang dipilih dengan purposive sampling. Menggunakan alat ukur Kuisioner Zung Self Rating Anxiety Scale (ZSAR-S) dan kuesioner Numerical Rating Scale (NRS). Hasil penelitian menunjukkan terdapat hubungan antara kecemasan dengan tingkat nyeri pada pasien trauma akibat kecelakaan (p value < 0,05). Kecemasan yang tinggi dapat mempengaruhi tingkat nyeri pada pasien trauma. Perawat IGD dapat mengindentifikasi lebih dini kecemasan yang dialami pada pasien trauma. Sehingga, kecemasan yang terjadi tidak semakin memperburuk tingkat nyeri yang dialami pasien yang kemudian dapat meningkatkan tingkat keparahan.

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Trauma patients due to accidents are the most frequent patients who come to the Emergency Department (IGD). These patients, in addition to experiencing pain due to the trauma injuries they experienced, also felt anxiety related to financing and anxiety about leaving their jobs and families. This study identified a relationship between anxiety and the level of pain experienced in trauma patients. The research method was conducted with a cross-sectional design on 107 respondents who were selected by purposive sampling. Using the Zung Self Rating Anxiety Scale (ZSAR-S) questionnaire and Numerical Rating Scale (NRS) questionnaire. The results showed that there was a relationship between anxiety and pain levels in patients with accidental trauma (p value < 0.05). High anxiety can affect pain levels in trauma patients. Emergency room nurses can identify anxiety experienced early in trauma patients. Thus, the anxiety that occurs does not worsen the level of pain experienced by the patient, which can then increase the severity."

"Kanker prostat adalah angka kematian terkait kanker tertinggi kedua pada pria setelahkanker paru-paru. Neutrophyl to lymphocyte ratio (NLR), salah satu parameterinflamasi, ditemukan sebagai faktor prognostik pada beberapa jenis tumor padat,seperti kanker prostat. Penelitian ini bertujuan untuk menilai ada tidaknya hubunganantara NLR dengan hasil skor Gleason pasien biopsi adenokarsinoma prostat di RSUDHaji Adam Malik Medan. Sebanyak 121 pasien menjalani biopsi prostat dari awalJanuari 2013 - Desember 2015 di RS Adam Malik dan 30 tidak dikeluarkan. Data dari91 pasien kemudian diambil meliputi umur, data hematologi pra biopsi, pemeriksaanPSA awal, estimasi berat prostat, dan skor gleason dari hasil biopsi. Data diolah denganSPSS versi 22. Ditemukan pasien dengan usia rata-rata 68,34 tahun dengan rentang usia52-85 tahun. Tidak ada hubungan bermakna antara NLR dan TBP dengan r = 0,077 danp = 0,469 serta tidak ada hubungan bermakna antara NLR dan PSA dengan r = 0,072dan p = 0,496. Ada hubungan yang signifikan antara rasio neutrofil / limfosit denganhasil pemeriksaan gleason score pada pasien kanker prostat di RSUP Haji Adam Malik.Diperlukan penelitian lebih lanjut, apakah rasio neutrofil / limfosit dapat digunakanuntuk memprediksi skor gleason score pada pasien suspek kanker prostat

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Prostate cancer is the second highest cancer-related mortality rate in men after lung

cancer. Neutrophyl to lymphocyte ratio (NLR), one of the inflammatory parameters, is

found as a prognostic factor in several types of solid tumors, such as prostate cancer.

This study aims to assess whether there is a correlation between NLR with the results

of Gleason score of patients with prostate adenocarcinoma biopsy at Haji Adam Malik

Hospital Medan. A total of 121 patients underwent a prostate biopsy from early January

2013 - December 2015 at Adam Malik Hospital and 30 were not excluded. Data from

91 patients were then taken, including age, hematologic data pre biopsy, PSA on initial

examination, prostate weight estimation, and gleason score from biopsy results. The

data is processed with SPSS version 22. We found patients with a mean age of 68.34

years with an age ranging from 52 to 85 years. There is no significant correlation

between NLR and TBP with r = 0.077 and p = 0.469 and also there is no significant

correlation between NLR and PSA with r = 0.072 and p = 0.496. There is a significant

correlation between the ratio of neutrophils/lymphocytes with the results of gleason

score examination in prostate cancer patients at Haji Adam Malik Hospital. Further

studies are needed, whether the ratio of neutrophils / lymphocytes can be used to predict

the gleason score score in patients with suspected prostate cancer."

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

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

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

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

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

"Children development stage is determined by physical growth. The sequence of growing process is usually constant, however the age at which children reach a certain sequence varies individually. Determining skeletal maturation by evaluating carpal bone and cervical vertebrae is very helpful in conducting orthodontic diagnosis and in planning proper treatment. Such evaluation enables to estimate the time of growing process to accelerate or decelerate. The purpose of this study is to evaluate the stage of carpal bone and cervical vertebrae maturation in orthodontic patients at the age of 9 to 18. Samples were 83 cephalograms and hand wrist x-ray from 52 girls and 31 boys. The result of this study showed that the stage of carpal bone and cervical vertebrae maturation in girls and boys in the same age group varies greatly. Girls at the age of 11 to 12 demonstrated highes variation in the stage maturationn. In the same age group of sample, all stages of the maturation indicator were found, such as epiphysis is as wide as diaphysis, the capping of epiphysis, as well as variation in epiphysis fusion. These kinds of variations also occured in the cervical vertebrae maturation stage, where it varies from cervical vertebrae stage 2 to 6. On the other hand, boys showed highest variation at the age of 13 to 14. This study suggests that there was a matching pattern between carpal bone and cervical vertebrae maturation."