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"Latar belakang: Insufisiensi vena kronis IVK derajat berat atau C5-C6 membutuhkan penatalaksanaan yang lebih kompleks dan membawa dampak morbiditas yang lebih berat akibat lamanya waktu pengobatan dan angka kekambuhan yang tinggi. Tata laksana definitif IVK C5-C6 telah mengalami pergeseran dari terapi non operatif terapi kompresi dan medikamentosa menjadi terapi operatif dengan teknik non invasif seperti ablasi endovena. Penelitian ini bertujuan untuk melakukan evaluasi terhadap jenis terapi yang diberikan baik terapi definitif maupun terapi perawatan luka dengan keluaran berupa angka rekurensi dan lama rawat.Metode penelitian: Studi potong lintang analitik dilakukan dengan mengambil total sampel 54 pasien IVK C5-C6 yang datang ke RSCM pada periode Januari 2014-Desember 2015. Pasien IVK yang disertai dengan insufisiensi arteri, insufisiensi vena dalam, dan kelainan kulit akibat penyakit kulit primer, keganasan, trauma dieksklusi. Analisis statistik diolah dengan SPSS 21 for windows, untuk menilai keluaran dari terapi definitif berupa angka kekambuhan dan lama rawat.Hasil penelitian: Angka kekambuhan pasien IVK C5-C6 dengan terapi operatif lebih rendah dibandingkan dengan terapi non operatif yakni 7,1 berbanding 30,8 dalam follow up selama 2 tahun dengan nilai p 0,02 dan OR 0,17 95 IK 0,03-0,91. Lama perawatan rerata pasien IVK C5-C6 pada kelompok terapi operatif selama 10,6 hari dan kelompok non operatif selama 14,8 hari.Kesimpulan: Angka kekambuhan pasien IVK C5-C6 yang memperoleh terapi definitif operatif lebih rendah dari yang hanya memperoleh terapi non operatif dalam evaluasi selama 1-2 tahun

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Background: Severe degree C5-C6 of chronic venous insufficiency CVI require complex management and bring severe morbidity due to long duration of treatment and high recurrence rate. This leads to high treatment costs and interfered quality of patients life. Management of CVI C5-C6 in developed countries has changed from non operative therapy to operative therapy with non-invasive technique, i.e. endovascular treatment. In Indonesia CVI patient characteristics differ from developed countries, where the majority of patients come at advanced stage or C5-C6. This study aims to evaluate the management of CVI C5-C6, both definitive therapy and also wound care techniques, to afford an appropriate treatment in accordance with the characteristics of the patients in Indonesia. Method: a cross sectional analytic study carried out by taking the total sample of 54 patients who came with CVI C5-C6 to Cipto Mangunkusumo Hospital in the period of January 2014-December 2015. Those accompanied by arterial insufficiency, deep venous insufficiency, and skin disorders due to primary skin disease, malignancy, trauma were excluded. Statistical analysis is processed with SPSS 21 for windows, to assess the outcome of the definitive therapy in the form of recurrence rates and length of stay. Results: Recurrence rate of CVI C5-C6 patients with operative therapy is lower than non-operative therapy which is 7.1 versus 30,8 in 2-year follow-up with p-value of 0.02 and OR 0.17 95 CI 0, 03-.91. The mean treatment duration CVI C5-C6 patients in the operative therapy group is 10.6 days and non-operative group is 14.8 days Conclusions: recurrence rate of CVI C5-C6 patients who obtain definitive operative therapy was lower than non-operative therapy group in the evaluation for 1-2 years."

"Insidens insufisiensi adrenal pada pasien renjatan sepsis dilaporkan sekitar 40-65. Sitokin IL-1 dan IL-6 dapat menstimulasi sekresi kortisol sedangkan TNF-? serta MIF berperan dalam menghambat pembentukan kortisol. Penelitian ini bertujuan untuk mengetahui peran IL-1, IL-6, TNF-? dan MIF dalam terjadinya insufisiensi adrenal relatif pada renjatan sepsis.Penelitian eksperimental dilakukan di laboratorium FKH IPB berlangsung selama 6 bulan April-September 2015 . Model anak babi yang dipakai berumur 6-8 minggu dengan berat badan 5-10 kg. Pemilihan sampel dengan consecutive sampling dengan total n = 20. Anak babi diberikan infus endoktoksin dengan dosis 50 ug/kg BB. Sampel darah untuk analisis IL-1, IL-6, TNF-?, MIF, ACTH, kortisol, 17 OHP, DHEA, androstenedion diambil sebelum pemberian endotoksin dan tiap 15 menit hingga terjadi renjatan sepsis, kemudian dilakukan uji synacthen. Pemeriksaan imunohistokimia dilakukan pada kelenjar adrenal, hipofisis, dan hipotalamus.Dari 19 anak babi yang dianalisis mengalami renjatan sepsis dalam waktu 60 menit. Karakteristik sampel tidak berbeda bermakna antara kedua kelompok. Kadar IL-6 pada kelompok IAR dibandingkan dengan kelompok tanpa IAR berbeda bermakna pada menit ke-45 0,65 0,5-4,32 pg/dL vs. 0,54 0,51-0,61 pg/dL , p = 0,008 . Kadar IL-1 antara kelompok IAR dibandingkan kelompok tanpa IAR tidak berbeda bermakna. Kadar TNF-? pada kelompok IAR dibandingkan dengan kelompok tanpa IAR berbeda bermakna pada menit ke-15 1862,5 327,9-4511,14 pg/dL vs. 155,38 24,67-394,10 pg/dL , p = 0,002 dan menit ke-30 4295,76 246,9-5913,37 pg/dL vs. 422,90 101,05-4129,42 pg/dL , p = 0,007 . Kadar MIF kelompok IAR dibandingkan dengan kelompok tanpa IAR berbeda bermakna pada saat renjatan sepsis 25,28 18,45-30,64 ng/dL vs. 11,30 7,1-15,14 ng/dL p = 0,003 . Pemeriksaan imunohistokimia hanya pada hipotalamus yang menunjukkan pewarnaan terhadap IL-1, IL-6, TNF-? dan MIF pada kelompok dengan IAR. Pada renjatan sepsis dan insufisiensi adrenal relatif kadar TNF-? meningkat pada menit-menit awal, kemudian kadar IL-6 meningkat kemudian serta terakhir kadar MIF meningkat pada saat renjatan sepsis. Kadar IL-1 tidak terdapat perbedaan antara kedua kelompok. Kata kunci: IL-1, IL-6, insufisiensi adrenal relatif, MIF, renjatan sepsis, TNF-?

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Incidence of adrenal insufficiency in septic shock ranged between 40 ndash 65 . The mechanism of relative adrenal insufficiency in septic shock is caused by inflammatory mediators. This study aimed to identify the role of IL 6, IL 1 in stimulating ACTH and cortisol release, and the role of TNF and MIF in inhibiting the level of ACTH and cortisol in septic shock with relative adrenal insufficiency RAI in order to develop guidelines for relative adrenal insufficiency marker.Experimental study was conducted in Veterinary Faculty, Bogor Agricultural Institute for 6 months Apri ndash September 2015 . Piglet models Sus scrofa aged 6 ndash 8 weeks weighing 5 ndash 10 kg. Consecutive sampling was used with total 20 piglets. Piglet models were given 50 ug kg endotoxin infusion Escherichia coli O111 B4 Sigma chemical, St. Louis, MO, USA . Blood sample for analysis of IL 1, IL 6, TNF , MIF, ACTH, cortisol, 17 OHP, DHEA, androstenedione was collected before endotoxin administration and every 15 minutes until septic shock occurred. Piglet models were monitored using PiCCO monitor. Stimulation test was then performed using synthetic corticotropin Synacthen and blood sample was collected again along with immunohistochemistry examination of the adrenal, pituitary and hypothalamus glands.From 19 study subjects analized, all subject had septic shock in 60 minutes. Study subject characteristics in each group were similar. The level of IL 6 at 45 minutes had a significant different compared to the group without RAI 0.65 0.5 ndash 4.32 pg dL vs. 0.54 0.51 ndash 0.61 pg dL , p 0.008 . The level of IL 1 during septic shock were not significantly different between both groups. The level of TNF in RAI group had significant different compared to the group without RAI at 15 minutes 1862.5 327.9 ndash 4511.14 pg dL vs. 155.38 24.67 ndash 394.10 pg dL , p 0.002 and at 30 minutes 4295.76 246.9 ndash 5913.37 pg dL vs. 422.90 101.05 ndash 4129.42 pg dL , p 0.007 The level of MIF in group with RAI during septic shock had a significant different compared to the group without RAI t 25.28 18.45 ndash 30.64 ng dL vs. 11.30 7.1 ndash 15.14 ng dL , p 0.003 . Immunohisto chemistry staining of IL 1, IL 6, TNF , and MIF was observed only in the hypothalamus glands of the RAI group. In septic shock and relative adrenal insufficiency, TNF increased in earlier minutes, then IL 6 increased and later MIF increased in septic shock condition. IL 1 level had no difference increment for both group.Keywords IL 1, IL 6, MIF, relative adrenal insufficiency, septic shock, TNF"

"ABSTRAKInflamasi sistemik pada renjatan sepsis dapat menyebabkan insufisiensi adrenal. Kadar asam lemak bebas ALB yang tinggi diketahui menyebabkan inflamasi steril dan menghambat adrenocorticothropic hormone dan sekresi kortisol. Pemberian hidrokortison pada renjatan sepsis diharapkan memperbaiki hemodinamik, menurunkan ketergantungan terhadap obat vasoaktif dan memperbaiki disfungsi organ.Penelitian bersifat studi eksperimental yang bertujuan menilai pengaruh ALB dan pemberian hidrokortison terhadap hemodinamik, kadar laktat, cedera paru dan kadar kortisol darah pada renjatan sepsis model anak babi. Penelitian dilaksanakan di Divisi Bedah dan Radiologi Departemen Klinik Reproduksi dan Patologi Fakultas Kedokteran Hewan Institut Pertanian Bogor FKH IPB pada April -September 2015 dan telah disetujui oleh Komisi Etik Hewan FKH IPB.Delapan model anak babi Sus scrofa berusia 6-8 minggu dengan berat 5-10 kg dibagi dalam 2 kelompok, yaitu kelompok lipid dan kelompok kontrol. Kelompok lipid diberi lipid 20 sebanyak 3 gram/kgbb intravena dan kelompok kontrol tanpa pemberian lipid sebelum induksi sepsis. Pengukuran parameter hemodinamik dengan Pulse Contour Cardiac Output PiCCO . Pengukuran kadar laktat dengan i-Stat. Cedera paru ditentukan dengan pengukuran extravascular lung water index EVLWI dan rontgen toraks. Tes synacthen dilakukan untuk mengetahui adanya insufisiensi adrenal relatif IAR .Pengaruh ALB terhadap hemodinamik dinilai dengan rerata cardiac index 60 menit setelah pemberian hidrokortison yang berbeda bermakna [2,14 0,06 l/menit/m2 vs. 2,75 0,04 l/menit/m2 p 0,002 ]. Jumlah cairan dan obat vasoaktif yang dibutuhkan kelompok lipid untuk mempertahankan mean arterial blood pressure > 65 mmHg lebih banyak dibandingkan kelompok kontrol. Kadar laktat meningkat sebelum induksi sepsis pada kelompok lipid [2,28 0,52 vs. 1,28 0,45 mmol/L p 0,001 ]. Bersihan laktat pada kelompok lipid lebih buruk dibandingkan kelompok kontrol. Extravascular lung water index kelompok lipid lebih tinggi bermakna dibanding kelompok kontrol setelah 60 menit resusitasi [21 4,04 mL/kg vs. 12,38 2,32 mL/kg p 0,004 ]. Gambaran radiologi efusi pleura dan edema pulmonal terjadi pada seluruh model anak babi kelompok lipid. Insufisiensi adrenal relatif terjadi pada 7 model anak babi di kelompok lipid dan 4 di kelompok kontrol.Kesimpulan penelitian ini adalah kadar ALB yang tinggi memperberat inflamasi dan merupakan faktor risiko terjadinya IAR. Kata kunci: Asam lemak bebas, cedera paru, hemodinamik, hidrokortison insufisiensi adrenal relatif, laktat, renjatan sepsis, sepsis.

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ABSTRACTCortisol deficiency is associated with increased morbidity and mortality during critical illness. Dysregulation of immune system in septic shock triggers adrenal insufficiency. Free fatty acid FFA is known to induced sterile inflammation and inhibit adrenocorticothropic hormone and cortisol secretion. Hydrocortisone administration is expected to improve hemodynamic, decrease dependency of vasoactive drugs and improve organ dysfunction in septic shock.The aim of this study is to find out the effect of FFA and hydrocortisone administration on hemodynamic parameters, lactate, lung injury and blood cortisol levels in septic shock piglet models, conducted in April September 2015 in the Division of Surgery and Radiology School of Veterinary Medicine, Institut Pertanian Bogor IPB and has been approved by the Animal Ethics Committee of School of Veterinary Medicine IPB. Sixteen piglet models Sus scrofa entered the study. The piglets were 6 8 weeks old, weighing 5 10 kg divided into two groups, lipids and control groups. Administration of 3 g kg BW of lipid 20 were performed intravenously before sepsis induction for lipid group. Hemodynamic measurement by Pulse Contour Cardiac Output PiCCO by Picco. Lactate measurement by i Stat. Lung injury was determined by Extravascular lung water index EVLWI and chest X ray. Synacthen test to determine relative adrenal insufficiency RAI .FFA influences was shown on cardiac index 60 min after adminstration of hydrocortisone in lipid group 2.14 0.06 L min m2 and control group 2.75 0.04 L min m2 p 0.002 . Lipid group require fluids and vasoactive drugs more than the control grup to maintain mean arterial blood pressure 65 mmHg. Lactate levels before induction of sepsis lipid group 2.28 0,52 mmol L and control group 1.28 0.45 mmol L p 0.001 . Lactate clearance in lipid group was worse than the control group. Extravascular lung water index at 60 minutes after resuscitation in lipid group 21 4.04 mL kg and control group 12.38 2.32 mL kg p 0.004 . Pleural effusion and pulmonary edema were found in all piglet models in lipid group. Relative adrenal insufficiency occured to 7 piglet model in lipid gorup and 4 in control group.Conclusion High level FFA aggravate inflammation in septic shock and is a risk factor for RAI. Hydrocortisone administration improve circulation and lactate levels. Keywords FFA, hemodynamic, hydrocortisone, lactate, lung injury, relative adrenal insufficiency, sepsis, septic shock"

"Latar belakang: Insufisiensi vena kronis IVK derajat berat atau C5-C6 membutuhkan penatalaksanaan yang lebih kompleks dan membawa dampak morbiditas yang lebih berat akibat lamanya waktu pengobatan dan angka rekurensi yang tinggi. Hal ini menyebabkan biaya pengobatan yang tinggi dan menurunkan kualitas hidup penderita. Tata laksana definitif IVK C5-C6 telah mengalami pergeseran dari terapi non operatif terapi kompresi dan medikamentosa menjadi terapi operatif dengan teknik non invasif seperti ablasi endovena. Namun karakteristik pasien IVK di Indonesia berbeda dengan di negara maju, dimana sebagian besar pasien datang pada stadium lanjut atau C5-C6. Penelitian ini bertujuan untuk melakukan evaluasi terhadap jenis terapi yang diberikan baik terapi definitif maupun terapi perawatan luka, sehingga didapatkan penanganan IVK C5-C6 yang sesuai dengan karakteristik pasien di Indonesia. Metode penelitian: Studi potong lintang analitik dilakukan dengan mengambil total sampel 54 pasien IVK C5-C6 yang datang ke RSCM pada periode Januari 2014-Desember 2015. Pasien IVK yang disertai dengan insufisiensi arteri, insufisiensi vena dalam, dan kelainan kulit akibat penyakit kulit primer, keganasan, trauma dieksklusi. Analisis statistik diolah dengan SPSS 21 for windows, untuk menilai keluaran dari terapi definitif berupa angka rekurensi dan lama rawat. Hasil penelitian: Angka kekambuhan pasien IVK C5-C6 dengan terapi operatif lebih rendah dibandingkan dengan terapi non operatif yakni 7,1 berbanding 30,8 dalam follow up selama 2 tahun dengan nilai p 0,02 dan OR 0,17 95 IK 0,03-0,91 . Lama perawatan rerata pasien IVK C5-C6 pada kelompok terapi operatif selama 10,6 hari dan kelompok non operatif selama 14,8 hari. Kesimpulan: Angka kekambuhan pasien IVK C5-C6 yang memperoleh terapi definitif operatif lebih rendah dari yang hanya memperoleh terapi non operatif dalam evaluasi selama 1-2 tahun.

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Background: Severe degree C5 C6 of chronic venous insufficiency CVI require complex management and bring severe morbidity due to long duration of treatment and high recurrence rate. This leads to high treatment costs and interfered quality of patients life. Management of CVI C5 C6 in developed countries has changed from non operative therapy to operative therapy with non invasive technique, i.e. endovascular treatment. In Indonesia CVI patient characteristics differ from developed countries, where the majority of patients come at advanced stage or C5 C6. This study aims to evaluate the management of CVI C5 C6, both definitive therapy and also wound care techniques, to afford an appropriate treatment in accordance with the characteristics of the patients in Indonesia.

Method: a cross sectional analytic study carried out by taking the total sample of 54 patients who came with CVI C5 C6 to Cipto Mangunkusumo Hospital in the period of January 2014 December 2015. Those accompanied by arterial insufficiency, deep venous insufficiency, and skin disorders due to primary skin disease, malignancy, trauma were excluded. Statistical analysis is processed with SPSS 21 for windows, to assess the outcome of the definitive therapy in the form of recurrence rates and length of stay.

Results: Recurrence rate of CVI C5 C6 patients with operative therapy is lower than non operative therapy which is 7.1 versus 30,8 in 2 year follow up with p value of 0.02 and OR 0.17 95 CI 0, 03 .91 . The mean treatment duration CVI C5 C6 patients in the operative therapy group is 10.6 days and non operative group is 14.8 days.

Conclusions: Recurrence rate of CVI C5 C6 patients who obtain definitive operative therapy was lower than non operative therapy group in the evaluation for 1 2 years."

"Tujuan: Mengetahui dosis terapi vitamin D yang optimal untuk ibu hamil dengan defisiensi dan insufisiensi vitamin DMetode: Uji klinis acak terkontrol dilakukan Juni 2019–Desember 2022 di RSUPN Cipto Mangunkusumo dan RSUD Koja, Jakarta. Subjek adalah wanita hamil usia kehamilan ≤14 minggu dengan defisiensi atau insufisiensi vitamin D (25(OH)D<30 ng/ml). Subjek dibagi menjadi 2 kelompok, kelompok pertama mendapatkan terapi vitamin D3 50.000 IU/minggu dan kelompok kedua mendapatkan terapi vitamin D3 5.000 IU/hari. Intervensi diberikan selama 4 minggu. Pengukuran kadar 25(OH)D dan 1,25(OH)2D dilakukan pada awal dan akhir intervensi.Hasil: Subjek awal berjumlah 60 orang, dan 8 subjek mengalami drop out. Karakteristik dasar subjek pada kedua kelompok setara. Kadar awal 25(OH)D tidak menunjukkan perbedaan bermakna di antara kedua kelompok (p=0,552). Pemberian terapi vitamin D3 50.000 IU/minggu selama 4 minggu meningkatkan kadar 25(OH)D secara signifikan (dari 14,5±4,3 menjadi 27,9±9,3 ng/mL, p<0,001) dan meningkatkan kadar 1,25(OH)2D namun secara statistik tidak signifikan (p=0,257). Pemberian terapi vitamin D3 5.000 IU/hari selama 4 minggu meningkatkan kadar 25(OH)D secara signifikan (dari 15,3±4,7 ng/mL menjadi 26,9±6,1 ng/mL, p<0,001) dan juga meningkatkan kadar 1,25(OH)2D secara signifikan (p=0,042). Namun tidak didapatkan perbedaan yang bermakna baik pada delta 25(OH)D (p=0,694), maupun delta 1,25(OH)2D di antara kedua kelompok dosis (p=0,641).Kesimpulan: Terapi vitamin D3 50.000 IU/minggu selama 4 minggu sama efektifnya dengan vitamin D3 5.000 IU/hari dalam meningkatkan kadar 25(OH)D serum pada wanita hamil dengan defisiensi dan insufisiensi vitamin D. Kedua dosis tersebut juga aman dan dapat ditoleransi oleh ibu hamil.

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Objective: To determine the optimal therapeutic dose of vitamin D for pregnant women with insufficiency or deficiency of Vitamin D

Methods: A randomized controlled trial was conducted from June 2019 to December 2022 at Cipto Mangunkusumo National Center General Hospital and Koja District Hospital in Jakarta, Indonesia. Subjects were ≤14 weeks gestation pregnant women with insufficiency or deficiency of Vitamin D (25(OH)D<30 ng/ml]. Two intervention groups were randomly assigned: 5,000 IU vitamin D3 daily or 50,000 IU weekly. Maternal blood samples were collected before and after four weeks of interventions to assess changes in serum concentrations of 25(OH)D and 1,25(OH)2D).

Result: Sixty subjects were randomized into two groups, and eight subjects were dropped out. The basic demographics of subjects in both groups were equivalent. There were no differences in baseline levels of 25(OH)D between two groups (p=0.552). In the 50,000 group, 25(OH)D levels increased from 15.3 ± 4.7 ng/mL to 26.9 ± 6.1 ng/mL (p<0.001). The 1,25(OH)2D levels increased however, the increase is not statistically significant. While in the 5,000 group, the 25(OH)D levels increased from 14.5 ± 4.3 ng/mL to 27.9 ± 9.3 ng/mL (p<0.001) and the 1,25(OH)2D levels increased significantly (p=0.042). However, the increment 25(OH)D and 1,25(OH)2D were not statistically significant between two groups.

Conclusion: Vitamin D3 50,000 IU weekly is equally effective and safe as 5,000 IU daily in increasing 25(OH)D serum levels in pregnant women with insufficiency or deficiency of Vitamin D."