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"Pada tahun 2000, harapan hidup wanita Indonesia meningkat menjadi 67,5 tahun dan kelompok usia tua akan mencapai 8,2% dari seluruh populasi Indonesia. Diperkirakan pada tahun 2010, usia harapan hidup wanita Indonesia akan mencapai 70 tahun. Seiring dengan peningkatan usia harapan hidup, maka akan terjadi peningkatan penyakit-penyakit tua, khususnya pada wanita kejadian penyakit usia ma ini dihubungkan dengan penurunan kadar hormon estrogen. Penurunan hormon ini telah dimulai sejak usia 40 tahun.Menopause sebagai akibat dari penurunan kadar hormon estrogen pada wanita akan memberikan gejala-gejala yang dapat bermanifestasi pada berbagai organ. Gejala-gejala yang mungkin timbul dibagi menjadi efek jangka pendek maupun jangka panjang. Efek jangka pendek adalah gejala vasomotorik (hot flushes, jantung berdebar, sakit kepala), gejala psikologik (gelisah, lekas marah, perubahan perilaku, depresi, gangguan libido), gejala urogenital (vagina kerng, keputihan, gatal pada vagina, iritasi pada vagina, inkontinensia urin), gejala pada kulit (kering, keriput), gejala metabolisme (kolesteroi tinggi, HDL turun, LDL naik). Sedangkan efek jangka panjang meliputi osteoporosis, penyakit jantung koroner, aterosklerosis, stroke sampai kanker usus besar.Usia menopause perempuan di negara maju seperti di Amerika Serikat dan Inggcis adalah 51,4, sedangkan di negara-negara Asia Tenggara adalah 51,09 tahum. Usia menopause untuk perempuan Indonesia adalah 50 tahun. Jika usia harapan hidup wanita Indonesia adalah 70 tahun, maka hampir 20 tahun lamanya mereka akan mengalami berbagai masalah kesehatan akibat kekurangan hormon estrogen. Dampaknya adalah kualitas hidup kaum perempuan akan berkurang. Gejala klimakterik disebabkan oleh kekurangan hormon estrogen, maka pengobatannya adalah dengan pemberian hormon estrogen dari luar tubuh, yang dikenal dengan dengan istilah Hormone replacement therapy (HRT) atau istilah dalam bahasa Indonesia Terapi Sulih Hormon (TSH). Berbagai penelitian telah membuktikan bahwa pemberian TSH pada perempuan menopause dapat menghilangkan keluhan klimakterik, bahkan mencegah terjadinya patah tulang, penyakit jantung koroner, kanker usus besar, dementia ripe Alzheimer dan katarak. Dengan kata lain pemberian TSH dapat meningkatkan kualitas hidup perempuan menopause."

"Dental caries is a unique multifactorial infectious disease. In recent years, the prevalence of dental caries in most western countries has steadily declined. By contrast study done in some developing countries such as Zambia, Nigeria, Thailand and Indonesia showed a marked increase in dental caries. Streptococcus mutans (S. mutans) is the most important agent of human caries. Cariogenic feature of these bacteria include synthesis intracellular polysaccharide, extracellular polysaccharide, lactic acid production and ability to survive at low pH levels. Potentially, caries can be reduced by interfering with transmission of S. mutans, eliminating, established S. mutans populations from the oral cavity, increasing the acid resistance of the teeth and control of the carbohydrate composition of the diet. Oral anti mutans vaccines have been demonstrated in the laboratory, the costs involved in the development for human are relatively high. Studies Strain replacement therapy is a great promise in implantation of benign oral microbial strain capable of successfully competing with S. mutans."

"Menstruasi merupakan perdarahan karena meluruhnya lapisan endometrium yang terjadi secara periodik. Menstruasi sering kali dikaitkan dengan munculnya akne vulgaris. Hal ini didukung oleh fakta bahwa akne vulgaris sering terjadi akibat rendahnya hormon estrogen dan progesteron selama siklus menstruasi. Hormon estrogen dan progesteron juga dapat menghambat proses konsepsi dikarenakan hormon tersebut bekerja sebagai penghambat pengeluaran FSH dan LSH. Terapi hormonal tidak hanya digunakan untuk menghambat proses konsepsi saja, ketidakseimbangan hormon estrogen dan progesteron dalam tubuh pada wanita dapat menyebabkan beberapa penyakit di antaranya gangguan menstruasi dan akne vulgaris. Terdapat beberapa terapi hormonal yang digunakan sebagai pengobatan gangguan menstruasi, akne vulgaris, dan kontrasepsi di Apotek Roxy Hasyim Ashari. Pemilihan terapi tersebut dapat dilihat berdasarkan mekanisme kerja obatnya. Mekanisme kerja terapi hormonal dapat menjaga keseimbangan hormon estrogen dan progesteron dalam tubuh selama siklus menstruasi sehingga dapat digunakan sebagai pengobatan gangguan menstruasi. Terapi hormonal juga dapat melawan efek androgen pada kelenjar sebaseus sebagai pemicu terjadinya akne vulgaris. Pemakaian kontrasepsi hormonal membuat kadar estrogen dan progesteron dalam peredaran darah tidak mencapai titik puncaknya sehingga menghambat pelepasan hormon FSH dan LH yang pada akhirnya menghambat ovulasi.

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Menstruation is bleeding due to the shedding of the endometrial layer that occurs periodically. Menstruation is often associated with the appearance of acne vulgaris. This is supported by the fact that acne vulgaris often occurs due to low estrogen and progesterone hormones during the menstrual cycle. Estrogen and progesterone hormones can also inhibit the conception process because they work as inhibitors of FSH and LSH production. Hormonal therapy is not only used to inhibit the conception process, imbalance of estrogen and progesterone hormones in the body in women can cause several diseases including menstrual disorders and acne vulgaris. There are several hormonal therapies used as treatment for menstrual disorders, acne vulgaris, and contraception at Roxy Hasyim Ashari Pharmacy. The selection of these therapies can be seen based on the mechanism of action of the drug. The mechanism of action of hormonal therapy can maintain the balance of estrogen and progesterone hormones in the body during the menstrual cycle so that it can be used as a treatment for menstrual disorders. Hormonal therapy can also fight the effects of androgens on the sebaceous glands as a trigger for acne vulgaris. The use of hormonal contraceptives makes estrogen and progesterone levels in the blood circulation not reach their peak point, thus inhibiting the release of FSH and LH hormones which ultimately inhibit ovulation."

"Dr. Selma Rashid is a leading figure in hormone replacement therapy and anti-aging medicine. She is board-certified in internal medicine, yet refuses to practice medicine through standard medical protocols, which are not in her patients best interests. She passionately seeks answers to preventing the diseases and dysfunctions of aging.Her career in medicine was inspired by the complexity of the endocrine system. Very soon she was disheartened to learn that endocrinology operates like almost every other field of medicine, in a tight box of protocols, trying to treat diseases with medications and procedures, directed by the pharmaceutical and medical device companies.At every stage of her medical training she was perplexed as to why there was so little connection between the basic sciences learned in the first two years of medical school and the clinical training in the last two years. Although so much in medicine seemed noble and invaluable, most of what was going on did not make sense.The essence of her thought process is that the medical system should do everything possible to ensure that the diseases of aging are maximally prevented; and every person dies their natural death while fully functional, both physically and mentally."

"Here is a practical and resourceful guide that focuses on the effective, scientifically proven, natural alternative to current therapies used in combating the effects of menopause. This invaluable volume also contains a complete, non-prescription "hormone balance" program for optimal health, which lists foods, supplements, and herbs that can be used to balance a woman's hormones."

"Here is a practical and resourceful guide that focuses on the effective, scientifically proven, natural alternative to current therapies used in combating the effects of menopause. This invaluable volume also contains a complete, non-prescription "hormone balance" program for optimal health, which lists foods, supplements, and herbs that can be used to balance a woman's hormones."

"As a broadcaster and medical columnist, Dr Smith receives thousands of letters each year, many of them about hormone-replacement therapy. Here, he and his wife combine to discuss the menopause and its effects, weighing up carefully the pros and cons of HRT."

"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."