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Abstrak :
Latar Belakang: Penggunaan heparin inhalasi pada beberapa penelitian COVID-19 memberikan hasil dalam perbaikan klinis pasien, baik dalam menurunkan lama rawat, perbaikan oksigenasi paru, dan mortalitas. Dosis harian total heparin inhalasi yang bervariasi terutama bila diberikan bersamaan dengan antikoagulan sistemik, memiliki resiko komplikasi perdarahan yang memerlukan kajian terhadap keefektifan dan keamanannya. Tujuan: Meneliti keefektifan dan keamanan inhalasi heparin dosis 150,000 IU/hari dengan dosis 100.000 IU/hari dinilai dari AaDO2, aPTT dan d-Dimer dalam 7 hari pengamatan pada pasien ICU COVID-19. Metode: Penelitian ini merupakan penelitian observasional dengan studi kohort retrospektif menggunakan data sekunder rekam medis pasien ICU COVID-19 bulan September 2020 – September 2021. Terdapat 300 sampel menggunakan consecutive sampling. Pasien dikelompokkan menjadi kelompok heparin dosis 150.000 IU/hari dan 100.000 IU/hari. Pencatatan dilakukan dalam 7 hari pengamatan. Uji Statistik menggunakan uji Mann Whitney untuk menilai tingkat keparahan, Uji Wilcoxon rank test untuk melihat perbedaan variabel dependen hari pertama dengan hari ketujuh pada masing-masing dosis. Hasil: Heparin inhalasi baik dosis 150.000 IU/hari dan 100.000 IU /hari bermakna menurunkan AaDO2 pada 7 hari pengamatan (p 0.001). Nilai aPTT tidak memanjang pada kedua kelompok, dan kedua dosis heparin sama- sama menurunkan nilai d-Dimer pada 7 hari pengamatan (p 0.001). Simpulan: Heparin Inhalasi dosis 150.000 IU/hari sama efektif dinilai dari AaDO2, dan sama amannya terhadap aPTT dan d-Dimer dibandingkan heparin inhalasi dosis 100.000 IU/hari. ......Rationale: The use of inhaled heparin in several COVID-19 studies has resulted in clinical improvements in patients, both in reducing length of treatment, improving pulmonary oxygenation, and reducing mortality. The varying total daily dose of inhaled heparin, especially when given together with systemic anticoagulants, poses a risk of bleeding complications that require review of its effectiveness and safety. Objective: To analyze effectiveness and safety of heparin inhalation dosage 150,000 IU/day compare to 100,000 IU/day assessed from AaDO2, aPTT and d-Dimer from 7 days observation in ICU COVID-19 patients with invasive and non-invasive ventilator patterns. Methods: An observational cohort retrospective study used secondary data from medical records ICU COVID-19 patients with invasive and noninvasive ventilator patterns from September 2020 – September 2021. There were 300 samples using consecutive sampling. Patients divided into 2 groups, one received dosage 150,000 IU / day heparin inhalation, the other received heparin inhalation dosage 100,000 IU / day. Recording of the research from medical records is carried out at 7 days of ICU treatment. Statistical tests were carried out using Mann Whitney to assess severity, Wilcoxon rank test to see the difference in dependent variables day 1 and day 7 to dose. Measurements and Main Results: Heparin inhalation at dose of 150,000 IU/day and 100,000 IU/day both significantly decreased AaDO2 at 7 days of observation (p 0.001). The aPTT on both groups at 7 days of observation are within normal limits. Both doses of heparin inhalation decreased d-dimer at 7 days of observation (p 0.001). Conclusion: Inhaled heparin doses of 150,000 IU/day as effective and as safe as inhaled heparin doses of 100,000 IU/day.

Abstrak :
Latar Belakang: Janus Kinase (JAK)-inhibitors telah digunakan untuk terapi beberapa penyakit inflamasi dan autoimun karena kemampuannya untuk mengendalikan respon imun dan cytokine release syndrome. Saat ini penggunaan baru dari Janus Kinase (JAK)-inhibitors diperuntukan untuk terapi coronavirus disease 2019 (Covid-19), namun bukti mengenai kegunaannya masih belum jelas. Penelitian ini dilakukan untuk menganalisa efikasi dari Janus Kinase (JAK)-inhibitors untuk mengurangi mortalitas pasien Covid-19. Tujuan: Mengetahui efek pemberian terapi Janus Kinase (JAK)-inhibitors terhadap mortalitas pasien Covid-19. Metode: Dengan menggunakan kata kunci spesifik, dilakukan pencarian artikel potensial secara komprehensif pada PubMed, Europe PMC, and ClinicalTrials.gov database dengan pembatasan waktu sampai 2 Juni 2021. Semua penelitian tentang Covid-19 dan JAK-inhibitors dimasukan. Analisa statistik dilakukan denganReview Manager 5.4 software. Hasil: 13 penelitian dengan 4339 pasien Covid-19 dimasukan dalam meta-analisis. Data kami menyimpulkan bahwa terapi JAK-inhibitors berhubungan dengan menurunnya mortalitas pasien Covid-19 (RR 0.52; 95%CI: 0.36-0.76, p=0.0006, I2 = 33%, random-effect modelling). Kesimpulan: Penelitian ini menyimpulkan terapi JAK-inhibitors berhubungan dengan menurunnya mortalitas pasien Covid-19. Namun dibutuhkan randomized clinical trials yang lebih banyak untuk mengkonfirmasi hasil penelitian ini. ......Background: : Janus Kinase (JAK)-inhibitors have been used for treating several inflammatory and autoimmune disease because of its ability to restrains immune systems and cytokine release syndrome. Currently, JAK-inhibitors are repurposed for the treatment of coronavirus disease 2019 (Covid-19), however the evidence regarding their benefit are still unclear. This study sought to analyze the efficacy of JAK-inhibitors in improving the mortality outcomes of Covid-19 patients. Objective: To determine the effect of JAK-inhibitors as therapy in Covid-19 patients related to mortality. Methods: Using specific keywords, we comprehensively searched the potential articles on PubMed, Europe PMC, and ClinicalTrials.gov database until June 2nd, 2021. All published studies on Covid-19 and JAK-inhibitors were retrieved. Statistical analysis was conducted using Review Manager 5.4 software. Results: A total of 13 studies with 4,339 Covid-19 patients were included in the meta-analysis. Our data suggested that JAK-inhibitors was associated with reduction of mortality from Covid-19 (RR 0.52; 95%CI: 0.36 – 0.76, p=0.0006, I2 = 33%, random-effect modelling). Conclusion: Our study suggests that JAK-inhibitors may offer beneficial effects on Covid-19 mortality. However, more randomized clinical trials warrant to confirm the findings of our study.

Abstrak :
Pembedahan abdomen atas berkaitan disfungsi diafragma. Disfungsi diafragma merupakan penyebab PPC (postoperative pulmonary complication). Terapi oksigen konvensional (TOK) merupakan terapi standar pada pasien pasca pembedahan abdomen atas. Terapi HFNC (high-flow nasal cannula) memiliki berbagai mekanisme yang berbeda dengan TOK dan dipikirkan dapat membantu fungsi diafragma pascapembedahan abdomen atas. Studi ini bertujuan untuk membandingkan kemampuan HFNC terhadap TOK dalam mempertahankan fungsi diafragma pascapembedahan abdomen atas. Studi ini dilakukan di RSUPN Dr. Cipto Mangunkusumo dari November 2018 – September 2019. Tujuh puluh satu pasien dibagi secara acak menjadi dua kelompok: kelompok TOK dan HFNC. Enam puluh enam pasien mendapat intervensi setelah ekstubasi di ICU (intensive care unit). Seluruh subjek dilakukan pencatatan nilai DTF (diaphragm thickening fraction) menggunakan ultrasonografi, ΔTIV (perubahan tidal impedance variance), ΔEELI-G dan ΔEELI-ROI (perubahan end expiratory lung impedance global dan region of interest) menggunakan EIT (electrical impedance tomography), PaO2 dan PaCO2 (tekanan parsial oksigen dan karbon dioksida arteri) secara berkala pada dua seri. Efek samping dan keluhan yang muncul dicatat dan ditatalaksana. Total 66 subjek disertakan dalam bivariat menggunakan t-test dan mann whitney, sedangkan analisis tren menggunakan general linear model atau generalized estimating equation. Durasi ventilasi mekanik di ICU, persentase prediksi mortalitas dan skor P-POSSUM antara kedua kelompok berbeda signifikan (p=0,003; 0,001; dan 0,019, secara berurutan). Tidak ada perbedaan tren yang ditemukan antarkelompok pada seri pertama parameter DTF, ΔTIV, ΔEELI-G, ΔEELI-ROI dan PaCO2 (p=0,951; 0,100; 0,935; 0,446; dan 0,705, secara berurutan) maupun pada seri kedua (p=0,556; 0,091; 0,429; 0,423; dan 0,687, secara berurutan). Tren PaO2 pada seri pertama dan kedua berbeda sangat signifikan (p<0,001) karena protokol pengaturan fraksi oksigen yang lebih tinggi pada kelompok TOK. Penggunaan HFNC tidak lebih baik daripada TOK dalam membantu mempertahankan fungsi diafragma pascapembedahan abdomen atas. ...... Upper abdominal surgery is related to diaphragmatic dysfunction. Diaphragmatic dysfunction is the main factors causing postoperative pulmonary complication (PPC). Conventional oxygen therapy (TOK) in the form of nasal cannula, is a standard therapy in post upper abdominal surgery patients. High-flow nasal cannula (HFNC) therapy has a variety of mechanisms that differ from TOK and is thought to be able to maintain diaphragm function in post upper abdominal surgery patients. This study aims to compare the ability of HFNC vs TOK in maintaining diaphragm function for post upper abdominal surgery patients. This study was conducted at RSUPN dr. Cipto Mangunkusumo from November 2018 - September 2019. Seventy-one patients were randomly divided into two groups: TOK and HFNC groups. Sixty-six patients received intervention after extubation in the intensive care unit (ICU). This given data were all collected periodically in 2 series; diaphragm thickening fraction (DTF) values using ultrasonography, changes in tidal impedance variance (ΔTIV), changes in global end expiratory lung impedance and region of interest (ΔEELI-G and ΔEELI-ROI) using electrical impedance tomography, arterial oxygen and carbon dioxide partial pressure (PaO2 and PaCO2). Side effects and complaints that arise were collected and managed. A total of 66 subjects were included in the bivariate using t-test and mann whitney test, while trends were analyzed by general linear models or generalized estimating equations. The baseline characteristics of mechanical ventilation duration in the ICU, the predicted mortality rate and P-POSSUM score between the two groups were significantly different (p = 0.003; 0.001; and 0.019, respectively). No trend differences were found between groups in the first series of DTF, ΔTIV, ΔEELI-G, ΔEELI-ROI and PaCO2 parameters (p = 0.951; 0.100; 0.935; 0.446; and 0.705, respectively) and in the second series (p = 0.556, 0.091, 0.429, 0.423 and 0.687, respectively). The PaO2 trends in the first and second series differed very significantly (p<0.001) due to the higher oxygen fraction regulation protocol in the COT group. The use of HFNC is no better than COT in maintaining diaphragm function for post upper abdominal surgery patients.