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"Latar Belakang: Pasien kanker ginekologi yang menjalani pembedahan mayor sering mengalami malnutrisi praoperasi, yang mengakibatkan penurunan kadar albumin serum dan hitung limfosit. Prognositc nutritional index (PNI) praoperasi, yang dihitung berdasarkan kedua parameter tersebut, digunakan sebagai indikator nutrisi praoperasi dan telah dikaitkan dengan komplikasi pascaoperasi. Penelitian ini bertujuan untuk mengetahui perbandingan PNI praoperasi berdasarkan komplikasi pascaoperasi pada pasien kanker ginekologi.Metode: Penelitian observasional prospektif dilakukan pada pasien kanker ginekologi yang menjalani pembedahan mayor di Rumah Sakit Cipto Mangunkusumo. PNI praoperasi dihitung berdasarkan kadar albumin serum dan hitung limfosit. Komplikasi pascaoperasi dinilai dalam 30 hari pascaoperasi menggunakan klasifikasi Clavien- Dindo. Analisis data dilakukan menggunakan uji Mann-Whitney dan uji t tidak berpasangan (p<0,05).Hasil: Penelitian ini melibatkan 56 subjek dengan rata-rata usia 47,8 ± 12,3 tahun, 50% di antaranya mengalami malnutrisi. Kadar albumin praoperasi adalah 3,9 (2,3- 4,8) g/dL, dan hitung limfosit praoperasi adalah 1750 (645-3655)/μL. PNI praoperasi adalah 50,2 (28,9-61,3). Proporsi komplikasi pascaoperasi adalah 35,7%, dengan sebagian besar komplikasi diklasifikasikan sebagai minor, dan infeksi daerah operasi sebagai komplikasi terbanyak. Tidak ditemukan perbedaan PNI praoperasi yang bermakna antara subjek dengan komplikasi pascaoperasi dan tanpa komplikasi. PNI praoperasi pada subjek dengan komplikasi lebih rendah, meskipun perbedaan ini tidak signifikan secara statistik.Kesimpulan: Tidak terdapat perbedaan bermakna PNI praoperasi berdasarkan komplikasi pascaoperasi. Namun, subjek yang mengalami komplikasi memiliki PNI praoperasi yang lebih rendah. Penilaian PNI praoperasi dapat dipertimbangkan sebagai bagian dari evaluasi praoperasi pada pasien kanker ginekologi yang menjalani pembedahan mayor.

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Background: Patients with gynecological cancer undergoing major surgery often experience preoperative malnutrition, resulting in decreased serum albumin levels and lymphocyte counts. The preoperative prognostic nutritional index (PNI), calculated based on these two parameters, is used as a nutritional indicator and has been associated with postoperative complications. This study aims to compare preoperative PNI based on postoperative complications in gynecological cancer patients. Methods: A prospective observational study was conducted on gynecological cancer patients undergoing major surgery at Cipto Mangunkusumo Hospital. Preoperative PNI was calculated based on serum albumin levels and lymphocyte counts. Postoperative complications were assessed within 30 days following surgery using the Clavien-Dindo classification. Data were analyzed using the Mann-Whitney test and independent t-test (p<0.05).

Results: The study included 56 subjects with a mean age of 47.8 ± 12.3 years, 50% of subjects being malnourished. Preoperative albumin levels and lymphocyte count were 3.9 (2.3-4.8) g/dL and 1,750 (645-3,655)/μL, respectively. The preoperative PNI was 50.2 (28.9-61.3). The proportion of postoperative complications was 35.7%, with the most complications classified as minor, and surgical site infections being the most frequent complication. No significant difference in preoperative PNI was found between subjects with and without postoperative complications. The preoperative PNI was lower in subjects with complications, although this difference was not statistically significant.

Conclusion: There was no significant difference in preoperative PNI based on postoperative complications. Nevertheless, subjects with complications had lower preoperative PNI. Preoperative PNI assessment may be considered as part of the preoperative evaluation in gynecological cancer patients undergoing major surgery."

"Latar Belakang: Komplikasi pascaoperasi pembedahan abdomen mayor merupakan salah satu masalah klinis yang sering terjadi dan dapat meningkatkan morbiditas dan mortalitas pasien. Resistensi insulin praoperasi merupakan salah satu faktor utama yang memengaruhi kejadian komplikasi. Indeks Trigliserida-Glukosa (TyG) merupakan salah satu marker sederhana dan terjangkau untuk menilai resistensi insulin. Hingga saat ini belum banyak penelitian yang mengevaluasi hubungan antara indeks TyG praoperasi dengan komplikasi pascaoperasi pembedahan abdomen mayor. Metode: Studi kohort prospektif ini melibatkan pasien dewasa yang akan menjalani pembedahan abdomen mayor elektif di RS pendidikan tersier, RSCM. Dilakukan pengukuran kadar trigliserida dan glukosa darah untuk menentukan indeks TyG yang dihitung dengan formula logaritmik Ln[trigliserida (mg/dL) x glukosa darah (mg/dL)]/2. Kadar trigliserida dan glukosa darah diambil pada hari pasien akan menjalani operasi setelah pasien menjalani puasa minimal 3 jam per-oral maupun per- parenteral. Komplikasi pasca operasi dipantau selama 30 hari yang diklasifikasikan berdasarkan grading Clavien-Dindo. Ada komplikasi pascaoperasi didefinisikan bila pasien termasuk dalam grading Clavien-Dindo derajat II-V. Analisis bivariat digunakan untuk menilai hubungan antara indeks TyG praoperasi dan komplikasi pascaoperasi.Hasil:Dari total 92 subjek penelitian, didapatkan nilai tengah indeks TyG 4,69±0,30. Sebanyak 47,8% subjek mengalami komplikasi pasca operasi dengan derajat komplikasi terbanyak adalah derajat III (17,4%) dan jenis komplikasi tersering adalah infeksi daerah operasi (26%). Analisis bivariat menunjukkan adanya hubungan antara indeks TyG praoperasi dengan komplikasi pascaoperasi pasien pembedahan abdomen mayor. (RR=1,588, p=0,037, CI=1,014-2,487).Kesimpulan: Pasien pembedahan abdomen mayor dengan indeks TyG praoperasi tinggi memiliki peningkatan risiko 1,58 kali lebih tinggi dibandingkan dengan populasi dengan indeks TyG normal terhadap terjadinya komplikasi pascaoperasi. Identifikasi dini menggunakan indeks TyG dapat membantu klinis dalam menerapkan pencegahan untuk meningkatkan hasil klinis dan mengurangi beban komplikasi pascaoperasi.

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Background: Postoperative complications following major abdominal surgery remain a significant challenge in perioperative management, directly impacting patient morbidity and mortality. One of the key factors influencing these complications is insulin resistance, which is often exacerbated by surgical stress. The Triglyceride-Glucose (TyG) index is a simple, cost-effective, and accessible marker for assessing insulin resistance. However, there is limited evidence evaluating the relationship between preoperative TyG index levels and the incidence of postoperative complications in major abdominal surgery.

Methods: This prospective cohort study included 92 adult patients undergoing elective major abdominal surgery at Dr. Cipto Mangunkusumo National General Hospital, a tertiary teaching hospital. Triglyceride and blood glucose levels were mearsured to calculate the TyG Index using the formula Ln[trigliserida (mg/dL) x glukosa darah (mg/dL)]/2. Blood triglyceride and glucose levels were taken on the day of surgery after the patient has undergone a minimum of 3 hours of fasting, either orally or parenterally. Patients were monitored for postoperative complications within 30 days, classified according to the Clavien-Dindo grading system. Postoperative complications were defined as patients included in Clavien-Dindo grading II-V. Bivariate analysis was used to evaluate the relationship between preoperative TyG Index levels and postoperative complications.

Results: The mean TyG index in this study was 4.69 ± 0.30. Postoperatvie complications occurred in 47,8% of patients, with the most frequent severity was grade III complications (17.4%), while surgical site infections were the most common type (26%). Bivariate analysis showed a relationship between preoperative TyG index and postoperative complications of major abdominal surgery patients. (RR = 1.588; p = 0.037; 95% CI: 1.014–2.487).

Conclusion: The preoperative TyG index is an effective predictive marker for postoperative complications in patients undergoing major abdominal surgery. Patients with high TyG index levels are at increased risk of complications. Early identification using the TyG index could assisst clinicians in implementing preventive interventions to improve clinical outcomes and reduce the burden of postoperative complications."

"The increasing prevalence of obesity in many countries means that it should now be considered a pandemic. It is widely recognized that obesity increases the risk of a variety of life-threatening conditions, including heart disease, diabetes, and hypertension. Bariatric surgery is often the most effective way to treat such morbid obesity. Nevertheless, while various bariatric procedures have been proposed, to date standards have been lacking. In this book, leading experts from around the world discuss all aspects of bariatric surgery and present their own favored versions of surgical procedures with the aid of informative illustrations. Technical nuances are carefully described, and detailed attention is devoted to potential complications and how to avoid them. "

"ABSTRAKInfeksi daerah operasi IDO adalah infeksi yang terjadi hingga 30 hari setelah operasi pada pasien non implan atau satu tahun pada pasien menggunakan implan. IDO memberikan dampak morbiditas maupun mortalitas. Antibiotik profilaksis merupakan antibiotik yang digunakan 30-60 menit sebelum insisi bertujuan untuk mengurangi risiko IDO. Tujuan penelitian ini mengevaluasi penggunaan antibiotik profilaksis pada pasien IDO dan menghitung angka IDO di RSUP Fatmawati periode Januari-April 2017. Penelitian dilakukan secara observational dengan metode deskriptif. Data diperoleh secara prospektif dan retrospektif. Pengambilan data dilakukan dengan teknik total sampling. Evaluasi penggunaan antibiotik profilaksis berupa evaluasi kesesuaian penggunaan antibiotik profilaksis dengan pedoman penggunaan antibiotik PPAB RSUP Fatmawati dan formularium RSUP Fatmawati, kesesuaian waktu pemberian serta kesesuaian berdasarkan kelas operasi. Pasien IDO yang memenuhi kriteria sebagai subjek penelitian terdapat 38 pasien dan hanya 31 pasien IDO yang menggunakan antibiotik profilaksis. Data menunjukkan, antibiotik yang banyak digunakan oleh pasien IDO adalah sefazolin 45,16 . Hasil evaluasi didapatkan sebesar 38,89 antibiotik profilaksis yang digunakan pasien IDO dinyatakan sesuai dengan PPAB dan 83,87 dinyatakan sesuai dengan formularium. Evaluasi terhadap waktu pemberian didapatkan 7 pasien IDO 20,33 dinyatakan sesuai penggunaannya dan 70,49 sesuai terhadap kelas operasi bersih kontaminasi. Analisis bivariat terlihat adanya hubungan antara IDO dengan penggunaan antibiotik profilaksis p-value 0,004 dan tidak adanya hubungan antara IDO dengan kesesuaian penggunaan antibiotik berdasarkan pedoman p-value 0,542.

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ABSTRACTSurgical site infection (SSI) is an infection that occurs up to 30 days after non implant surgery or one year in patients that using implants. This infection will have an impact on morbidity and mortality. Prophylactic antibiotics are antibiotics that used 30 60 minutes before the incision that aimed to reduce the risk of infection on the surgical area. The purpose of this study to evaluate the use of prophylactic antibiotic in SSI patients and calculate the incidence surgical site infection in RSUP Fatmawati from January to April 2017. This research was observational with descriptive method based on the perspective and retrospective data that collected by total sampling technique. The evaluation of antibiotic with guidance of antibiotic usage of Fatmawati General Hospital 2014 and formulary of Fatmawati General Hospital 2014, conformity of timing and conformity with operation class. SSI patients who met the criteria for the study subjects were 38 patients with only 31 SSI patients on prophylactic antibiotics. The data shown the antibiotics that used by SSI patients was cefazoline 45.16 . The results of the evaluation obtained that 38.89 of prophylactic antibiotic used by SSI patients in accordance with guidance of antibiotic usage of Fatmawati General Hospital, 83.87 use of prophylactic antibiotics according to formulary, Only 7 IDO patients were declared using prophylactic antibiotics timely and 70.49 are suitable with the use of antibiotics in accordance with the class of clean contamination operations. Bivariate analysis showed that there was a correlation between SSI incidence with prophylactic antibiotic usage with p value 0.004 and aren rsquo t correlation between SSI incidence and suitability of antibiotic use based on guidance with p value 0.524."

"This handbook is aimed at first-line health care providers involved in the perioperative care of adult and pediatric neurosurgical patients. It is unique in its systematic focus on how to deal with common and important clinical challenges encountered in day-to-day practice in the OR, the PACU, and the ICU and is designed as a problem-solving tool for all members of the perioperative medicine team: trainees and faculty in anesthesiology, neurosurgery, and critical care; nurses; nurse anesthetists; and physician’s assistants. • Encompasses clinical continuum from neurosurgical pre-op to critical care – plus anesthesia in neuroradiology• Adult and pediatric care• Structured algorithmic approach supports clinical decision-making• Succinct presentation of clinically relevant basic science• End-of-chapter summaries, with suggestions for further reading• Collaborative approach and multidisciplinary nature of perioperative medicine emphasized• Extensive summary tables• Portable and formatted for quick retrieval of information• Ideal for use in the OR, the PACU, and the ICU"

"Latar Belakang: Gagal ginjal akut (GGA) yang terjadi pasca operasi adalah komplikasi yang sering terjadi pada pasien yang menjalani operasi mayor risiko tinggi. Data dari ICU Rumah Sakit Umum Pusat Fatmawati, pada tahun 2018, angka GGA pasca operasi mencapai 73,56% dari seluruh pasien GGA yang dirawat di ICU. Mortalitasnya mencapai 52% dan sebanyak 42% membutuhkan terapi pengganti ginjal mulai dari terapi pengganti ginjal kontinu sampai hemodialisa konvensional. GGA selanjutnya dihubungkan dengan komplikasi, morbiditas dan mortalitas yang tinggi, lama rawat ICU yang memanjang, meningkatnya risiko infeksi nosokomial dan beban pembiayaan rumah sakit yang lebih tinggi.Terapi pengganti ginjal menjadi pilihan terapi utama untuk kasus GGA berat. Untuk pasien kritis dalam perawatan di ICU, salah satu mode terapi pengganti ginjal yang umum digunakan pada pasien GGA-PO di ICU adalah terapi pengganti ginjal kontinu (continuous renal replacement therapy/CRRT). CRRT dapat menurunkan kadar sitokin inflamasi dan menekan reaksi inflamasi yang berlebihan sehingga mengurangi cedera ginjal dan mendorong pemulihan ginjal. Saat ini belum ada konsensus tentang waktu optimal inisiasi RRT. Waktu inisiasi RRT sebaiknya ditegakkan tidak hanya mempertimbangkan indikasi renal, tetapi juga mempertimbangkan terapi purifikasi darah ekstrakorporeal.Penelitian ini bertujuan untuk membandingkan waktu inisiasi CRRT dini yaitu <8 jam sejak diagnosis GGA ditegakkan dengan waktu inisiasi lambat yaitu >8 jam sejak diagnosis GGA pasca operasi ditegakkan dalam mempengaruhi perubahan kadar sitokin inflamasi pada pasien GGA pasca operasi risiko tinggi di UPI.Metodologi: Penelitian ini menggunakan desain kohort prospektif. Penelitian dilakukan di Unit Perawatan Intensif Rumah Sakit Umum Pusat Fatmawati. Populasi target penelitian adalah seluruh pasien dewasa dengan diagnosis gangguan ginjal akut pasca operasi mayor risiko tinggi yang menjalani CRRT. Kadar sitokin IL-6 dan IL-10 diperiksa sebelum CRRT dimulai dan 12 jam pasca terapi.Hasil: Terdapat perbedaan bermakna kadar IL-6 pada 12 jam setelah terapi pada kelompok inisiasi dini (p= 0,047 vs. p=0,676). Tidak didapatkan perbedaan kadar IL-10 antara CRRT dini dan lambat pada jam awal CRRT maupun 12 jam setelah terapi (p=0,989 vs p=0,616). Ditemukan perbedaan kadar IL-6 pada jam ke-12 setelah terapi dengan perbedaan yang bermakna (p=0.002) dengan nilai lebih rendah pada kelompok hidup. Selain itu ditemukan perbedaan bermakna pada kadar mediator inflamasi IL-10 (p=0,016) dengan nilai lebih rendah saat jam ke-12 setelah terapi pada kelompok hidup (OR=2,29, CI 1,19 – 4,38).Kesimpulan: CRRT inisiasi dini dengan onset <8jam sejak pasien terdiagnosis AKI dapat dipertimbangkan untuk pasien pascaoperasi risiko tinggi yang mengalami GGA di UPI dengan mempertimbangkan faktor risiko dan tingkat keparahan penyakit pasien. Perlu dikembangkan kriteria klasifikasi yang dipersonalisasi sesuai kondisi tingkat keparahan penyakit pasien pasca operasi untuk melakukan inisiasi CRRT di UPI.

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Background: Acute renal failure (ARF) that occurs after surgery is a common complication in patients undergoing major high-risk surgery. Data from the ICU of Fatmawati General Hospital, in 2018, the number of post-operative ARF reached 73.56% of all ARF patients treated in the ICU. Mortality reached 52% and as many as 42% required renal replacement therapy ranging from continuous renal replacement therapy to conventional hemodialysis. ARF is further associated with complications, high morbidity and mortality, prolonged ICU stay, increased risk of nosocomial infection and higher hospital cost burden.

Renal replacement therapy is the main therapy of choice for severe ARF cases. For critical patients in the ICU, one of the common modes of renal replacement therapy used in ARF-PO patients in the ICU is continuous renal replacement therapy (CRRT). CRRT can reduce inflammatory cytokine levels and suppress excessive inflammatory reactions, thereby reducing kidney injury and promoting kidney recovery. Currently, there is no consensus on the optimal timing of RRT initiation. The timing of RRT initiation should be established not only considering renal indications, but also considering extracorporeal blood purification therapy.

This study aims to compare the early initiation time of CRRT, which is <8 hours since the diagnosis of ARF was established with the late initiation time, which is >8 hours since the diagnosis of ARF postoperatively was established in influencing changes in inflammatory cytokine levels in high-risk postoperative ARF patients at UPI.

Methodology: This study used a prospective cohort design. The study was conducted in the Intensive Care Unit of Fatmawati General Hospital. The target population of the study was all adult patients with a diagnosis of high-risk post-major surgical acute kidney injury undergoing CRRT. IL-6 and IL-10 cytokine levels were examined before CRRT was started and 12 hours after therapy.

Results: There was a significant difference in IL-6 levels at 12 hours after therapy in the early initiation group (p= 0.047 vs. p=0.676). There was no difference in IL-10 levels between early and late CRRT in the early hours of CRRT or 12 hours after therapy (p=0.989 vs. p=0.616). A significant difference was found in IL-6 levels at 12 hours after therapy (p=0.002) with lower values ​​in the living group. In addition, a significant difference was found in the levels of the inflammatory mediator IL-10 (p=0.016) with lower values ​​at 12 hours after therapy in the living group (OR=2,29, CI 1,19 – 4,38).

Conclusion: Early initiation CRRT with onset <8 hours since the patient was diagnosed with AKI can be considered for high-risk postoperative patients with AKI in UPI by considering the patient's risk factors and disease severity. It is necessary to develop personalized classification criteria according to the severity of postoperative patient disease to initiate CRRT in UPI."

"The demand for cosmetic procedures is increasing worldwide. This book presents all the potential side-effects and complications of the most frequently used procedures in aesthetic dermatology and provides sound practical advice on their management. It will be helpful not only to beginners but also to experienced dermatologists who want to start performing new procedures. The text is fully illustrated and very simple to consult. For each procedure, the book discusses both common and uncommon side-effects and complications, provides tips on how to avoid them, and explains clearly how they are best treated."