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"ABSTRACTBackground: to identify other factors other than the TIMI scores that can be used as predictors of 30-day mortality in STEMI patients by including variables of left ventricle ejection fraction (LVEF) and glomerulus filtration rate (GFR) at Cipto Mangunkusumo National Central General Hospital. Methods: a retrospective cohort study was conducted in 487 STEMI patients who were hospitalized at RSUPN Cipto Mangunkusumo between 2004 and 2013. Sample size was calculated using the rule of thumbs formula. Data were obtained from medical records and analyzed with bivariate and multivariate method using Coxs Proportional Hazard Regression Model. Subsequently, a new scoring system was developed to predict 30-day mortality rate in STEMI patients. Calibration and discrimination features of the new model were assessed using Hosmer-Lemeshow test and area under receiver operating characteristic curve (AUC). Results: bivariate and multivariate analyses showed that only two variables in the new score system model were statistically significant, i.e. the Killip class II to IV and GFR with a range of total score between 0 and 4,6. Thirty-day mortality risk stratification for STEMI patient included high, moderate and low risks. The risk was considered high when the total score was >3,5 (46,5%). It was considered moderate if the total score was between 2,5 and 3,5 (23,2%) and low if the total score was <2,5 (5,95%). Both variables of the score had satisfactory calibration (p > 0,05) and discrimination (AUC 0,816 (0,756-0,875; CI 95%). Conclusion: There are two new score variables that can be used as predictors of 30-day mortality risks for STEMI patients, i.e. the Killip class and GFR with satisfactory calibration and discrimination rate."

"Latar belakang dan tujuan: Dari berbagai literatur, salah satu penyebab kegagalan respons klinis pasien pneumonia komunitas adalah akibat pemberian terapi antibiotik yang tidak tepat. Pemberian terapi antibiotik yang tidak tepat dapat meningkatkan risiko kematian dan resistensi antibiotik di kemudian hari. Tujuan penelitian ini adalah untuk mengevaluasi ketepatan penggunaan antibiotik dengan menggunakan metode Gyssens yang merupakan alat penilaian kualitatif yang dipakai oleh PPRA di Indonesia serta membandingkannya dengan luaran pasien pneumonia komunitas.Metode: Penelitian ini merupakan penelitian kohort retrospektif di Rumah Sakit Umum Pusat Persahabatan. Data diambil dari rekam medis pasien berusia di atas 18 tahun yang didiagnosis pneumonia komunitas dan dirawat inap selama periode Januari- Desember 2019. Penelitian ini menganalisis pemberian antibiotik empiris pada saat pasien pertama kali didiagnosis pneumonia komunitas.Hasil: Jumlah sampel pada penelitian ini adalah 108 subjek. Proporsi pasien yang diberikan antibiotik empiris tidak tepat berdasarkan metode Gyssens adalah 58,3% dan yang diberikan antibiotik empiris telah tepat adalah 41,7%. Pasien yang mendapatkan terapi antibiotik empiris tidak sesuai dengan pedoman PDPI memiliki risiko meninggal sebesar 2,875 kali lipat (IK 95% 1,440 – 5,739, p=0,004). Pasien yang diberikan antibiotik empiris dalam waktu setelah 8 jam didiagnosis pnemunia komunitas memiliki risiko meninggal sebesar 3,018 kali lipat (IK 95% 1,612 – 5,650, p=0,002). Dari analisis multivariat, faktor prediktor independen yang berhubungan dengan kejadian mortalitas pasien pneumonia komunitas dalam 30 hari adalah kejadian pneumonia berat dengan risiko sebesar 7,3 kali lipat (IK 95% 2,24-23,88, p=0,001), penyakit CVD dengan risiko sebesar 5,8 kali lipat (IK 95% 1,28-26,46, p=0,023), dan ketidaktepatan pemberian antibiotik empiris dengan risiko sebesar 4,2 kali lipat (IK 95% 1,02-17,74, p=0,048).Kesimpulan: Pada penelitian ini terdapat hubungan yang bermakna antara penggunaan antibiotik empiris tidak tepat berdasarkan metode Gyssens dengan luaran pasien yaitu kejadian mortalitas 30 hari (p=0,001).

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Background and Purpose: From many literatures, one of the causes of clinical response failure in community-acquired pneumonia patients is due to the inappropriate empirical antibiotics use. Improper administration of empirical antibiotics can increase the risk of death and antibiotic resistance later in life. The purpose of this study is to evaluate the appropriateness of the empirical antibiotics use using the Gyssens method which is a qualitative assessment tool used by the antibiotic stewardship program in Indonesia and to compare it with the outcome of community-acquired pneumonia patients.

Method: This study is a retrospective cohort study at the Persahabatan General Hospital. Data is taken from the medical records of patients over the age of 18 who are diagnosed with community-acquired pneumonia and hospitalized during the January- December 2019 period. This study analyzes the administration of empirical antibiotics when the patient is first diagnosed with community-acquired pneumonia.

Results: The number of samples in this study were 108 subjects. The proportion of patients who were given empirical antibiotics incorrectly based on the Gyssens method was 58.3% and those given empirical antibiotics were appropriate was 41.7%. Patients who received empirical antibiotic therapy not in accordance with PDPI guidelines had a 2.875-fold risk of death (95% CI 1.440 - 5.739, p = 0.004). Patients who were given empirical antibiotics after 8 hours of being diagnosed by the community-acquired pneumonia had a risk of death of 3,018-fold (95% CI 1.612 – 5.650, p = 0,002). From a multivariate analysis, independent predictors related to the mortality of community- acquired pneumonia patients within 30 days were the incidence of severe pneumonia with a risk of 7.3-fold (95% CI 2.24-23.88, p = 0.001), CVD with a risk of 5.8-fold (95% CI 1.28-26.46, p = 0.023), and inappropriate empirical antibiotics use with a risk of 4.2 fold (95% CI 1.02-17.74, p = 0.048).

Conclusion: In this study there was a significant relationship between the use of inappropriate empirical antibiotics use based on the Gyssens method and the outcome of community-acquired patients, which was the 30-days mortality (p = 0.001)."

"Pendahuluan: Kembar siam adalah gangguan kongenital yang langka dengan insiden 1/50.000 hingga 1/500.000 kelahiran di seluruh dunia.1 Operasi pemisahan adalah pengobatan utama yang memiliki tingkat kematian tinggi hingga 60%. Penelitian sebelumnya menunjukkan bahwa kembar siam memiliki tingkat kejadian penyakit jantung kongenital hingga 66%, dengan kejadian tertinggi terlihat pada kembar siam thorakopagus.2 Penelitian ini bertujuan untuk mengevaluasi hubungan antara penyakit jantung kongenital (PJK) dan mortalitas kembar siam setelah operasi pemisahan. Metode: Kami melakukan studi retrospektif, pada semua pasien kembar siam yang menjalani operasi pemisahan di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) dari tahun 2009 hingga 2022. Dua puluh enam subjek ditemukan telah memenuhi kriteria inklusi dan eksklusi kami. Kompleksitas penyakit jantung kongenital didefinisikan oleh klasifikasi kompleksitas penyakit Bethesda. Hubungan antara kompleksitas PJK dan mortalitas dalam satu tahun pada pasien kembar siam yang menjalani operasi pemisahan dianalisis menggunakan uji Fisher. Hasil: Penyakit jantung kongenital terjadi pada kembar omfalopagus di RSCM. Tingkat kematian kembar siam dengan PJK yang menjalani operasi pemisahan di pusat kami adalah 40%, menunjukkan tidak adanya korelasi signifikan antara PJK dan mortalitas setelah operasi pemisahan, (p= 0,369). Kesimpulan: Kembar siam dengan PJK tidak menunjukkan korelasi dengan tingkat mortalitas setelah operasi pemisahan dalam studi awal ini. Penelitian lebih lanjut diperlukan dengan lebih banyak subjek untuk mendapatkan hasil yang lebih konklusif.

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Introduction: Conjoined twins are a rare congenital disorder with an incidence of 1/50.000 up to 1/500.000 births around the world.1 Separation surgery is the mainstay treatment which yields a high mortality rate of up to 60%. Previous studies show conjoined twins have a high incidence of congenital heart disease up to 66%, with the highest incidence evident in thoracopagus conjoined twins.2 This study aimed to evaluate the relationship between congenital heart disease (CHD) and conjoined twins mortality after separation surgery.

Methods: We performed a retrospective study, on all conjoined twin patients who underwent separation surgery in Dr. Cipto Mangunkusumo Hospital (CMH) from 2009 until 2022. Twenty-six subjects were found to have fulfilled our inclusion and exclusion criteria. Congenital heart disease complexity was defined by Bethesda disease complexity classification. The relationship between CHD complexity within one-year mortality in conjoined twins patients who underwent separation surgery was analysed using Fischer’s exact test.

Results: Congenital heart disease occurs in omphalopagus twins in CMH. The mortality rate of conjoined twins with CHD who underwent separation surgery in our centre was 40%, showing no significant correlation between CHD and mortality after separation surgery, (p= 0,369).

Conclusion: Conjoined twins with CHD showed no correlation to mortality rates following separation surgery in this preliminary study. Further research is needed with more subjects to make more conclusive results."