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"Vitamin D memiliki efek mempertahankan fungsi endovaskular dan mengatur aktivitas inflamasi dalam dinding pembuluh darah. Lemak viseral, disebutkan sebagai prediktor risiko yang baik untuk penyakit vaskular karena berperan aktif secara metabolik serta bersifat meningkatkan pengeluaran sitokin proinflamasi Kedua hal ini berpengaruh dalam peningkatan risiko kejadian stroke akut. Sampai saat ini penelitian yang membahas korelasi antara kedua faktor tersebut masih inkosisten. Studi potong lintang dilakukan pada subyek berusia >18 tahun dengan stroke akut yang menjalani perawatan di RSUPN Dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Pengukuran kadar lemak viseral menggunakan bioelectrical impedance analysis bedridden multifrekuensi. Penilaian kadar serum vitamin D (25 (OH)D) menggunakan metode chemiluminescent immunoassay. Terdapat total 73 subyek penelitian, sebanyak 55 subyek (75,3%) dengan insufisiensi dan 15 subyek (20,5%) mengalami defisiensi vitamin D, dengan nilai rerata di 17,08±7,85 ng/mL. Sejumlah 78,1% subyek memiliki kadar lemak viseral yang tinggi. Terdapat korelasi negatif (r= -0,271) yang signifikan (p <0,021) antara kadar lemak viseral dan kadar vitamin D serum pada stroke akut. Dilakukan analisis multivariat lanjutan, didapatkan kadar lemak viseral dan jenis pakaian (pakaian tertutup) menjadi faktor paling signifikan dalam menilai kadar vitamin D serum.Terdapat korelasi yang signifikan antara kadar lemak viseral dengan kadar vitamin D 25 (OH) pada pasien stroke akut.

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Vitamin D has effects in maintaining endovascular function and regulating inflammatory activity in the vascular wall. Visceral fat is said to be a good risk predictor for vascular disease because it plays a metabolically active role and increases the release of pro-inflammatory cytokines, both of which are influential in increasing the risk of acute stroke events. Studies that discuss the correlation between these two factors are still inconsistent.  A cross-sectional study was conducted on subjects aged >18 years with acute stroke who underwent treatment at Dr. Cipto Mangunkusumo Hospital and University of Indonesia Hospital. Measurement of visceral fat levels using bioelectrical impedance analysis bedridden multifrequency. Assessment of serum vitamin D (25(OH)D) levels using chemiluminescent immunoassay method.  In a total of 73 subjects, 55 (75.3%) subjects had vitamin D insufficiency and 15 (20,5%) subject had deficiency, with mean values at 17.08±7.85 ng/mL. A total of 78.1% of subjects had high visceral fat levels. There was a significant (p<0.021) negative correlation (r= -0.271) between visceral fat and serum vitamin D levels in acute stroke. In a further multivariate analysis, visceral fat content and type of clothing (concealing clothing) was found to be the most significant factor in assessing serum vitamin D levels. There is a significant correlation between visceral fat levels and 25 (OH) vitamin D levels in acute stroke patients."

"Leukemia limfoblastik akut adalah penyakit keganasan hematologi yang paling sering ditemukan pada anak. Perubahan metabolisme pasien kanker dan pengobatan kemoterapi menyebabkan pasien mengalami anoreksia sehingga dapat mengakibatkan pasien mengalami malnutrisi. Kondisi tersebut dapat menurunkan respons terhadap terapi, rendahnya kualitas hidup, dan tingginya mortalitas. Terapi medik gizi yang adekuat diperlukan untuk mendukung proses penyembuhan anak dengan pasien kanker. Asam amino rantai cabang (AARC) merupakan salah satu zat gizi spesifik yang dapat memperbaiki asupan makan dengan cara berkompetisi dengan triptofan pada transporter di otak pada mekanisme lapar-kenyang sehingga menurunkan efek anoreksigenik. Penelitian sebelumnya menunjukkan efek positif pemberian AARC terhadap asupan makan dan menurunkan kadar triptofan bebas di otak pada pasien kanker. Serial kasus ini memaparkan tiga pasien laki-laki dan satu pasien perempuan, berusia 8-14 tahun dengan malnutrisi, mengalami penurunan asupan makan, dan peningkatan kadar inflamasi. Seluruh pasien mendapatkan terapi medik gizi sejak awal perawatan hingga sebelum pulang dari rumah sakit. Pemberian energi dan protein sesuai fase pada penatalaksanaan gizi buruk dan AARC yang berasal dari bahan makanan sumber serta makanan cair. Asupan energi tertinggi pasien kasus sebesar 54-140 kkal/kgBB dan asupan protein tertinggi sebesar 2-4,7 g/kgBB dengan AARC tertinggi sebesar 8,9-23,4 g. Terdapat penurunan kadar inflamasi pada seluruh pasien kasus. Skala lapar-kenyang terendah sebelum makan 2 dan setelah makan 5, perbaikan tingkat lapar-kenyang pada seluruh pasien kasus diikuti dengan peningkatan jumlah asupan. Satu orang pasien mengalami penurunan berat badan, dua orang tetap, dan satu orang mengalami peningkatan berat badan. Terapi medik gizi yang adekuat dengan pemberian AARC dapat menunjang keberhasilan pengobatan pasien anak malnutrisi dengan lekemia limfoblastik akut yang menjalani kemoterapi.

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Acute lymphoblastic leukemia is the most common hematological malignancy in children. Metabolic changes in cancer patients and chemotherapy cause patients to experience anorexia which can increase the risk of malnutrition. These conditions can reduce the response to therapy, lower quality of life, and high mortality. Adequate nutritional management is needed to support the healing process of children with cancer patients. Branched-chain amino acids(BCAA) are specific nutrients that can improve calorie intake by competing with tryptophan on transporters in the brain on the hunger-satiety center, thereby reducing anorexigenic effects. Previous research has shown a positive effect of BCAAs on improving calorie intake and reducing levels of free tryptophan in the brain in cancer patients. This case series describes three male and one female patient, aged 8-14 years, malnutrition, decreased calorie intake, and inflammation. All patients received medical nutrition therapy from early treatment until before leaving the hospital. Provision of energy and protein according to the phase in the management of malnutrition and specific nutrients, BCAAs derived from food and liquid food. The highest energy intake of patients in the case of 54-140 kcal/kg BW, and the highest protein intake of 2-4.7 g/kg BW with the highest AARC of 8.9-23.4 g. All patients experienced a reduction in inflammation. The level of hunger-satiety is 2 before eating, and it is 5 thereafter. In all cases, patients increase their intake after experiencing improvements in their hunger-satiation levels. Two patients' weights remained the same, one gained weight, and one patient lost weight. Adequate nutritional therapy and AARC supplementation can support the successful treatment of malnourished pediatric patients with acute lymphoblastic leukemia on chemotherapy."

"Latar Belakang: Ileus pascaoperasi (IPO) terjadi pada 3 – 32% pascaoperasi abdomen mayor. Prevalensi IPO di RSUPN dr. Cipto Mangunkusumo (RSCM) sendiri belum diketahui. Imbang cairan perioperatif berkontribusi terhadap kejadian IPO. Berbagai studi menunjukkan imbang cairan intra- dan pascaoperasi yang positif berhubungan dengan peningkatan risiko IPO, namun peran status hidrasi praoperasi belum diketahui. Pemeriksaan bioelectrical impedance vector analysis (BIVA) mulai digunakan untuk evaluasi status hidrasi, namun metode ini belum umum digunakan untuk evaluasi cairan perioperasi. Penelitian ini dilakukan untuk mengetahui insidensi IPO di RSCM, serta mengetahui hubungan antara IPO dengan status hidrasi praoperasi berdasarkan BIVA. Metode: Penelitian ini adalah studi potong lintang pada pasien yang menjalani laparotomi elektif di RSCM, Jakarta. Diambil karakteristik praoperasi berupa data demografis, antropometri, dan status hidrasi yang meliputi BIVA, osmolalitas serum, imbang cairan, dan rasio blood urea nitrogen/creatinine (rasio BUN/Cr); karakteristik intraoperasi yaitu imbang cairan intraoperasi, lama operasi, dan jumlah perdarahan; serta status hidrasi pascaoperasi yang dinilai pada hari kedua pascaoperasi. Dilakukan analisis hubungan IPO dengan status hidrasi praoperasi berdasarkan BIVA, yang dilanjutkan dengan analisis multivariat untuk menyingkirkan faktor perancu.Hasil: Sebanyak 90 subjek menjalani laparotomi elektif untuk kasus digestif (37,8%), ginekologi (57,8%), urologi (2,2%), serta join digestif-vaskular dan digestif- ginekologi (2,2%). Status hiperhidrasi praoperasi berdasarkan BIVA didapatkan sebanyak 38,9% dan meningkat menjadi 74,4% pascaoperasi. Osmolalitas serum pra- dan pascaoperasi berada dalam rentang normal dan tidak menunjukkan perubahan yang bermakna, sedangkan imbang cairan dan rasio BUN/Cr meningkat bermakna pascaoperasi. Status hiperhidrasi praoperasi berhubungan bermakna dengan IPO (OR 3.386, 95%CI 1.319 – 8.601; p=0.009). Namun berdasarkan analisis multivariat, hanya jumlah perdarahan intraoperasi (> 500 mL) yang berhubungan dengan IPO (OR 7.95, 95% CI 1.41 – 44.78; p=0.019). Stratifikasi lebih lanjut menunjukkan status hiperhidrasi praoperasi meningkatkan risiko IPO pada subjek dengan jumlah perdarahan intraoperasi kurang dari 500 mL (OR 6.8, 95% CI 1.436 – 32.197; p =0.016). Kesimpulan: Status hidrasi praoperasi menentukan keluaran klinis pascaoperasi. Status hiperhidrasi praoperasi berdasarkan BIVA ditemukan berhubungan dengan peningkatan risiko IPO laparotomi, namun status hiperhidrasi praoperasi dapat dimodifikasi oleh jumlah perdarahan intraoperasi. Dibutuhkan studi lebih lanjut hubungan antara IPO dengan status hiperhidrasi praoperasi, terutama pada kelompok subjek dengan jumlah perdarahan intraoperasi kurang dari 500 mL.

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Background: Postoperative ileus (POI) is a complication commonly found after major abdominal surgery, with a prevalence of 3 – 32%. Prevalence of POI at dr. Cipto Mangunkusumo Hospital (RSCM) is yet to be reported. Perioperative hydration status contributes to the risk of developing POI. Studies have shown that positive intra- and postoperative fluid balance are associated with increased risk of POI, but the role of preoperative hydration status is not yet known. Bioelectrical impedance vector analysis (BIVA) has started to be used widely to evaluate hydration status, nonetheless it is still not commonly used in evaluation of perioperative hydration status. This study aims to determine POI incidence in RSCM, and to explore the association between IPO and preoperative hydration status evaluated with BIVA. Methods: This study was a cross-sectional study done at RSCM, Jakarta. We recruited patients who were scheduled to undergo elective laparotomy. Preoperative characteristics were collected such as demographical data, anthropometry, and hydration status including BIVA, serum osmolality, fluid balance, and blood urea nitrogen/creatinine (BUN/Cr) ratio; intraoperative characteristics such as fluid balance, length of surgery, and total bleeding volume; and postoperative hydration status which was analyzed in postoperative day two. Analysis to determine the associatiob between POI and preoperative hydration status by BIVA was done, and continued with logistic regression analysis to control confounding factors.

Results: Ninety subjects recruited in this study underwent elective laparotomy for digestive (37,8%), gynecology (57,8%), urology (2,2%), also joined digestive-vascular and digestive-gynecology (2,2%) surgery. Preoperative hyperhydration by BIVA was found in 38,9% subjects, and increased to 74,4% postoperatively. Pre- and postoperative serum osmolality were within normal range and did not show any significant increment, while fluid balance and BUN/Cr ratio increased postoperatively. Preoperative hyperhydration was associated with POI (OR 3.386, 95%CI 1.319 – 8.601; p=0.009). Only total bleeding volume (> 500 mL) was found to increase the risk of POI after logistic regression analysis (OR 7.95, 95% CI 1.41 – 44.78; p=0.019). Further stratification analysis showed that preoperative hyperhydration increased the risk of POI in subjects with total bleeding less than 500 mL (OR 6.8, 95% CI 1.436 – 32.197; p =0.016). Conclusion: Preoperative hydration status has an impact on postoperative clinical outcome. Preoperative hyperhydration was found to increase the risk of POI, but preoperative hyperhydration status could be modified by the degree of intraoperative bleeding. Further study needs to be done to determine the link between POI and preoperative hyperhydration, especially in subjects with total bleeding less than 500 mL."

"Latar Belakang: Katabolisme pascalaparotomi menyebabkan imbang nitrogen negatif dan diduga tidak dapat dicegah dengan pemberian nutrisi. Nutrisi parenteral dapat meningkatkan faktor anabolisme. Belum diketahui apakah proporsi asupan energi dan protein dari jalur parenteral terhadap asupan total berkorelasi dengan imbang nitrogen pasien pascalaparotomi elektif.Metode: Studi potong lintang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM) pada pasien pascalaparotomi elektif yang memperoleh supplemental parenteral nutrition (SPN) antara 3 hari pertama pascalaparotomi. Pemeriksaan nitrogen urea urin (NUU) dilakukan terhadap pasien dengan asupan ≥ 12 kkal/kg BB pada hari ketiga pascalaparotomi. Pasien dengan gangguan ginjal dan hati tidak disertakan dalam penelitian.Hasil: Rerata imbang nitrogen hari ketiga pascalaparotomi sebesar -2,8 ± 3,8 g/hari, dengan median asupan energi 19 (12–34) g/kg BB dan protein 0,9 (0,4–1,9) g/kg BB. Proporsi asupan energi dari jalur parenteral sebesar 0,51 ± 0,26 dan protein 0,59 ± 0,28. Tidak ditemukan korelasi signifikan pada proporsi asupan energi dan protein dari jalur parenteral terhadap asupan total dengan imbang nitrogen. Korelasi signifikan ditemukan pada variabel total asupan energi (r = 0,697, p <0,001) dan protein (r = 0,808, p <0,001) dengan imbang nitrogen.Kesimpulan: Pemberian SPN dini penting dalam mencapai total asupan energi dan protein untuk mengimbangi kehilangan nitrogen hari ketiga pascalaparotomi elektif di RSCM meskipun korelasi proporsi asupan nutrisi dengan imbang nitrogen belum tampak pada penelitian ini.

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Background: Post-laparotomy catabolism causes a negative nitrogen balance and is unlikely prevented by nutritional intervention. Parenteral nutrition can increase anabolic factor. It is not known whether the proportion of energy and protein intake from parenteral nutrition to total intake correlates with nitrogen balance in elective post-laparotomy patients.

Methods: A cross-sectional study was conducted at Cipto Mangunkusumo Hospital in elective post-laparotomy patients who received supplemental parenteral nutrition (SPN) within first 3 days after laparotomy. Urine urea nitrogen (UUN) examination was performed on patients with intake ≥ 12 kcal/kg BW on the third day after laparotomy. Patients with renal and hepatic impairment were excluded. Results: The mean nitrogen balance on the third day post-laparotomy was -2.8 ± 3.8 g/day, with median energy intake of 19 (12–34) g/kg BW and protein 0.9 (0.4– 1.9) g/kg BW. The proportion of energy intake from the parenteral route was 0.51 ± 0.26 and protein was 0.59 ± 0.28. No significant correlation was found in the proportion of energy and protein intake from the parenteral nutrition to total intake with nitrogen balance. Significant correlations were found for total energy intake (r= 0.697, p <0.001) and protein (r= 0.808, p <0.001) with nitrogen balance. Conclusion: Early administration of SPN is important in achieving total energy and protein intake to compensate nitrogen loss on the third day after elective laparotomy although the association between the proportion of nutrition intake and nitrogen balance has not been observed in this study."

"Kanker payudara merupakan penyebab kematian tersering pada wanita. Salah satu faktor risiko kanker payudara adalah obesitas. Obesitas merupakan masalah kesehatan global yang diderita 13% populasi dunia. Sekitar 56 % pasien kanker payudara mengalami obesitas. Sebagian besar pasien kanker payudara dengan obesitas mengalami peningkatan berat badan setelah diagnosis dan semakin memberat saat mejalani terapi anti-kanker. Peningkatan massa lemak berperan dalam progresivitas sel kanker dan resistensi kanker terhadap kemoradiasi. Asam lemak omega-3, yaitu eicosapentaenoic acid (EPA) dan docosahexaenoic acid (DHA) merupakan nutrien spesifik dalam terapi medik gizi pasien kanker. Penelitian menunjukkan EPA dan DHA dapat memiliki efek anti-kanker, antiinflamasi, dan anti-obesitas yang dapat menurunkan massa lemak, berat badan, dan meningkatkan sensitivitas terapi anti-kanker. Terapi medik gizi dilakukan pada empat pasien kanker payudara dengan obesitas dengan rentang usia 44–58 tahun. Satu pasien tidak mencapai target asupan energi dan satu pasien melebihi target asupan energi, dengan rentang rerata asupan 23–31 kkal/kgBB. Satu pasien tidak mencapai target asupan protein dengan rentang rerata asupan 1–1,4 g/kgBB. Asupan nutrien spesifik asam amino rantai cabang keempat pasien belum mencapai 10 g/hari dengan rentang rerata asupan 8,3–9,3 g/hari. Asupan EPA dan DHA keempat pasien memiliki rentang rerata 1,8–1,9 g/hari. Tiga dari empat pasien mengalami penurunan berat badan dan free fat mass index (FFMI), satu pasien mengalami peningkatan BB dan FFMI, dan dua dari empat pasien mengalami peningkatan kekuatan genggam. Satu pasien mengalami peningkatan C-reactive protein (CRP) dan satu pasien mengalami penurunan CRP. Keempat pasien memiliki rasio neutrofil limfosit diatas 3,49 yang mengindikasikan peningkatan risiko rekurensi. Keempat pasien mengalami toksisitas akur ringan selama radioterapi. Kendala utama dalam aplikasi terapi medik gizi pada keempat pasien adalah tingkat kepatuhan terhadap preskripsi yang semakin menurun menjelang minggu akhir pemantauan Dibutuhkan tatalaksana gizi lebih lanjut pasca radiasi untuk mencapai target nutrisi disertai peningkatan aktivitas fisik untuk mempertahankan atau meningkatkan massa otot.

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Breast cancer is a leading cause of death in women. One risk factor for breast cancer is obesity, a global health problem affecting 13% of the world's population. About 56% of breast cancer patients are obese. Most breast cancer patients with obesity gain weight after diagnosis and get worse while undergoing anti-cancer therapy. Increased fat mass plays a role in the progression of cancer cells and cancer resistance to chemoradiation. Omega-3 fatty acids, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are specific nutrients in medical nutrition therapy for cancer patients. Research shows that EPA and DHA have anti-cancer, anti-inflammatory, and anti-obesity effects that can reduce fat mass and body weight and increase the sensitivity of anti-cancer therapy. Medical nutrition therapy was done on four obese breast cancer patients aged 44–58. One patient did not reach the energy intake target, and one exceeded the energy intake target, with a mean intake range of 23–31 kcal/kg BW. One patient did not achieve the target protein intake with an average intake of 1–1.4 g/kg BW. The intake of specific nutrients for branched-chain amino acids in the four patients had not yet reached ten g/day with a mean intake range of 8.3–9.3 g/day. The EPA and DHA intakes of the four patients had a mean range of 1.8–1.9 g/day. Three of four patients experienced weight loss and free fat mass index (FFMI), one patient experienced an increase in weight and FFMI, and two of four patients experienced an increase in grip strength. One patient had an increase in C-reactive protein (CRP), and one had a decrease in CRP. All four patients had a neutrophil-lymphocyte ratio above 3.49, indicating an increased risk of recurrence. All four patients experienced mild acute toxicity during radiotherapy. The main obstacle in applying medical nutrition therapy to the four patients was the level of adherence to prescriptions which decreased towards the end of the monitoring week. Further nutritional management after radiation was needed to achieve nutritional targets with increased physical activity to maintain or increase muscle mass."

"Rasio neutrofil limfosit (RNL) adalah salah satu biomarker prognostik yang sudah banyak dipakai untuk memprediksi luaran klinis berbagai penyakit. Nilai RNL yang tinggi berhubungan dengan luaran klinis yang buruk pada pasien stroke iskemik. Asupan energi dan protein yang cukup selama rawatan di rumah sakit (RS) dapat membantu menurunkan kadar RNL yang tinggi saat admisi. Asupan nutrisi yang cukup selama rawatan membantu mempertahankan sistem imun, meningkatkan proliferasi limfosit dan produksi antibodi. Penelitian ini bertujuan untuk melihat hubungan kecukupan energi dan protein selama rawatan di RS terhadap perubahan nilai RNL pada pasien stroke iskemik di RSCM dan RSUI. Penelitian menggunakan desain kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di RSCM dan RSUI. Diperoleh 52 subjek dengan kelompok cukup asupan energi dan protein sebanyak 26 subjek dan kelompok yang tidak cukup sebanyak 26 subjek. Rerata usia subjek 62,34 + 11,8, laki – laki 61,5%, subjek dengan status nutrisi obesitas derajat 1 berdasarkan indeks massa tubuh (IMT) 23,1%, dan faktor risiko hipertensi sebanyak 82,7%. Tidak terdapat hubungan bermakna antara kecukupan energi dan protein dengan penurunan nilai RNL selama rawatan. Namun, sebagian besar subjek yang mendapat asupan cukup energi dan protein mengalami penurunan nilai RNL. Penelitian lanjutan diperlukan dengan menggunakan subjek lebih banyak dan menganalisis faktor – faktor lain yang dapat memengaruhi penurunan nilai RNL dan asupan makan pada pasien stroke iskemik yang dirawat.

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Neutrophil-lymphocytes ratio (NLR) is one of the prognostic biomarkers that has been widely used to predict clinical outcomes of various diseases. High NLR values are associated with poor clinical outcomes in ischemic stroke patients. Adequate energy and protein intake during hospitalization can help reduce high NLR levels at admission. Adequate nutritional intake during treatment helps maintain the immune system, increase lymphocyte proliferation and antibody production. This study aims to look at the relationship between energy and protein adequacy during hospitalization and changes in NLR values in ischemic stroke patients at RSCM and RSUI. The study used a prospective cohort design on subjects aged ≥18 years who were hospitalized at RSCM and RSUI. Total 52 subjects and then divided into two groups, an adequate energy and protein groups 26 subjects and an insufficient groups 26 subjects. The mean age of the subjects was 62.34 + 11.8, male 61.5%, subjects with nutritional status of grade 1 obesity based on body mass index (BMI) 23.1%, and risk factors for hypertension were 82.7%. There was no significant relationship between energy and protein adequacy group and the decrease in NLR values during hospitalization. However, most subjects who received energy and protein adequate experienced a decrease in NLR. Further research is needed by using more subjects and analyzing other factors that can affect the decrease in NLR value and food intake in stroke patients during hospitalization."

"Latar Belakang: Laparotomi merupakan pembedahan mayor yang dapat menyebabkan penurunan massa otot rangka dan kapasitas fungsional, seperti kekuatan genggam tangan (KGT). Berbagai studi membuktikan penurunan KGT pascaoperasi menimbulkan komplikasi pascaoperasi, serta KGT berkorelasi erat dengan appendicular skeletal muscle index (ASMI). Pengaruh ASMI praoperasi terhadap KGT pascaoperasi belum banyak dilakukan penelitian, sehingga penelitian ini bertujuan menilai korelasi ASMI praoperasi dengan KGT pascaoperasi.Metode: Studi observasional prospektif dilakukan pada subjek berusia 18 – 65 tahun di RS pendidikan tersier, RSUPN Dr. Cipto Mangunkusumo, yang dirawat untuk laparotomi elektif pada Maret sampai Juni 2023. Pengukuran ASMI praoperasi menggunakan bioimpedance analysis (BIA) multifrequency seca® mBCA 525 dengan cutoff laki-laki > 7,0kg/mg2 dan perempuan >5,7 kg/m2. Pengukuran KGT pada tangan kanan dan kiri pascaoperasi pada hari ke-6 pascaoperasi (POD-6) dengan dinamometer tangan spring-type CAMRY® dengan cutoff laki-laki >28 kg/m2 dan perempuan >18 kg/m2. Analisis bivariat dan multivariat digunakan untuk menilai hubungan variabel bebas dan terikat, serta mengidentifikasi faktor perancu yang berhubungan dengan KGT pascaoperasi.Hasil: Pada 85 subjek penelitian, sebanyak 98,82% subjek memiliki ASMI praoperasi rendah, 72,94% subjek memiliki KGT pascaoperasi tangan kanan menurun, dan 80% subjek memiliki KGT pascaoperasi tangan kiri menurun dari cutoff. Didapatkan hasil signifikan pada korelasi ASMI praoperasi dengan KGT pascaoperasi tangan kanan (r=0,444, p<0,001) dan kiri (r=0,423, p<0,001). Analisis lanjutan dengan regresi linier untuk faktor perancu didapatkan indeks massa tubuh (IMT) adalah faktor paling signifikan meningkatkan KGT tangan kanan dan kiri pascaoperasi.Kesimpulan: Terdapat hubungan yang bermakna secara statistik pada korelasi ASMI praoperasi dengan KGT pascaoperasi laparotomi elektif.

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Background: Laparotomy is a major surgery that can lead to a decrease in skeletal muscle mass and functional capacity, such as handgrip strength (HGS). Various studies have shown that HGS is decreasing after surgery can result in postoperative complications, and HGS is closely correlated with the appendicular skeletal muscle index (ASMI). Research on the preoperative influence of ASMI on postoperative HGS is limited, so this study aims to assess the correlation between preoperative ASMI and postoperative HGS.

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Methods: A prospective observational study was conducted on subjects aged 18-65 years at the tertiary education hospital, RSUPN Dr. Cipto Mangunkusumo, who underwent elective laparotomy from March to June 2023. Preoperative ASMI measurements were taken using multifrequency bioimpedance analysis (BIA) with seca® mBCA 525, with a cutoff for males > 7.0 kg/m2 and females > 5.7 kg/m2. Postoperative HGS measurements for the right and left hands on postoperative day 6 (POD-6) were conducted using a spring-type hand dynamometer CAMRY® with a cutoff for males > 28 kg/m2 and females > 18 kg/m2. Bivariate and multivariate analyses were employed to assess the association between independent and dependent variables, as well as to identify confounding factors associated with postoperative HGS.

Results: In 85 research subjects, 98.82% had low preoperative ASMI, 72.94% experienced a decrease in postoperative right HGS, and 80% had a decrease in postoperative left HGS from the cutoff. Significant results were obtained in the correlation between preoperative ASMI and postoperative right HGS (r=0.444, p<0.001) and left HGS (r=0.423, p<0.001). Further analysis with linear regression for confounding factors revealed that body mass index (BMI) was the most significant factor in increasing postoperative HGS for both right and left hands.

Conclusion: There is a statistically significant in the correlation between preoperative ASMI and postoperative HGS in elective laparotomy."

"Peningkatan jumlah lanjut usia di Indonesia sering diiringi dengan peningkatan gangguan kognitif. Leptin diketahui memiliki fungsi protektif terhadap fungsi kognitif pada lanjut usia, namun hingga saat ini hasil temuan peran leptin pada fungsi kognitif masih beragam, dan belum banyak dibahas di Indonesia. Selain itu peneliti melakukan analisis tambahan menggunakan Food Record dan penilaian antropometri pada subjek. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar plasma leptin dengan fungsi kognitif pada lanjut usia di Jakarta. Penelitian ini merupkan penelitian analitik deskriptif potong lintang yang menggunakan purposive sampling sebagai metode pengambilan sampel. Subjek merupakan lanjut usia yang bertempat tinggal di Panti Sosial yang kemudian dilakukan pemeriksaan fungsi kognitif menggunakan instrumen MoCA-INA, kuesioner IADL, GPAQ, Food Record, plasma leptin, komposisi tubuh serta antropometri, yang dianalisis secara univariat, bivariat dan multivariat. Hasil dari penelitian, karakteristik subjek berusia 60-74 tahun, dengan mayoritas jenis kelamin wanita (69,1%), dengan status gizi normal (45,5%), massa lemak berkisar antara 18,10-57,10 %, massa otot berkisar antara 20,20-57,50 kg. Mayoritas tidak merokok, tingkat pendidikan rendah (≤ 12 tahun wajib belajar), aktifitas fisik sedang dengan keseluruhan kapasitas fungsional subjek mandiri. Sebesar (96,4%) lanjut usia mengalami gangguan fungsi kognitif, kadar leptin plasma memiliki nilai terendah 1,4 ng/mL, tertinggi 119,48 ng/m dengan median 6,2 ng/mL. Pada analisis bivariat ditemukan kadar leptin, IMT (Indeks Massa Tubuh), massa lemak, pendidikan, dan IADL memiliki hubungan bermakna dengan fungsi kognitif pada lanjut usia di Jakarta. Korelasi kadar leptin plasma dengan fungsi kognitif pada lanjut usia di Jakarta memiliki korelasi positif sedang dengan nilai r 0,52 dan signifikansi 0,000.

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The increasing of elderly population often accompanied by a rise in cognitive disorders. Leptin is known to have a protective function against cognitive decline in elderly. However, current finding regarding the role of leptin in cognitive function is vary, and has not been extensively discussed in Indonesia. Food record and anthropometric assessment is conducted as an additional analyses on subject. Aim of this study is to determine the relationship between plasma leptin levels and cognitive function in the elderly in Jakarta. This is a cross sectional descriptive analytical research using purposive sampling as the sampling method. Subject are elderly residing in social welfare home, and being assessed using MOCA-INA instrument, IADL and GPAQ questionnaire, plasma leptin, body composition, anthropometric and Food Record are measured. The data is analysed through univariate, bivariate and multivariate analysis. Result of this study are subject characteristic of age ranging from 60-74 years, with female as the majority (67.5%), normal nutritional status (46.2%), body fat ranging from 18.10 to 57.10 %, muscle mass 20.20 to 57.50 kg. Majority of subject do not smoke, have a low education level (≤ 12 year of education), engage in moderate physical activity, and having independent functional capacity. A total of 96.2% of the subject experience cognitive impairment. Plasma leptin levels ranging from 1.4 to 8.5 ng/mL, with median of 5.9 ng/mL. There is a significant relationship between leptin levels, body mass index, body weight, total body fat, education and IADL with cognitive function in the elderly in Jakarta. The correlation between plasma leptin levels and cognitive function in the elderly in Jakarta, shows a moderately positive correlation with r value of 0.47 and a significance of 0.000."

"Beban penyakit akibat pajanan timbel terus meningkat. Timbel mengganggu hidroksilasi 25(OH)D dan transportasi kalsium sehingga aktivitas osteoklastik dan resorpsi tulang meningkat. Pyridinoline crosslinks (PYD) sebagai indikator kerusakan tulang lebih dini dari pencitraan. Penelitian ini merupakan penelitian sekunder dari penelitian primer yang berjudul Korelasi Kadar Serum 25(OH)D dengan Penanda Biologis Kardiovaskular pada Pekerja Terpajan Timbel. Penelitian berdesain potong lintang ini dilakukan untuk mengetahui hubungan kadar 25(OH)D serum dengan rasio PYD/kreatinin urin pada pekerja terpajan timbel. Penelitian berlokasi di Kabupaten Tegal, Kabupaten Tangerang, Kota Surabaya, dan Kabupaten Bogor. Subjek adalah bagian dari seluruh pekerja terpajan timbel yang terdaftar sebagai responden dalam penelitian primer dan memenuhi kriteria, didapatkan total 104 subjek. Instrumen yang digunakan adalah formulir karakteristik subjek, pemeriksaan fisik, Global Physical Activity Questionnaire, Semi-Quantitative Food Frequency Questionnaire, hasil pemeriksaan fungsi ginjal dan hepar, kadar timbel dalam darah, kadar 25(OH)D serum, dan sampel urin pagi. Median kadar timbel dalam darah 6,3 (1,2-35,5) µg/dL, indeks pajanan timbel kronik 35,3 (1,2-535,8) tahun µg/dL, kadar 25(OH)D serum 22 (8-52) ng/mL, dan rasio PYD/kreatinin urin 5,3 (3,6-28,1).10^-6. Sebagian besar (86,5%) subjek memiliki kadar 25(OH)D serum yang tidak adekuat. Studi menunjukkan terdapat hubungan negatif yang signifikan antara kadar 25(OH)D serum dengan rasio PYD/kreatinin urin pada pekerja terpajan timbel (r = -0,39, p < 0,001), dan terdapat hubungan positif yang signifikan antara indeks pajanan timbel kronik dengan rasio PYD/kreatinin urin (r = 0,21, p = 0,036).

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The burden of disease due to lead exposure continues to increase. Lead interferes with 25(OH)D hydroxylation and calcium transport, increasing osteoclastic activity and bone resorption. Pyridinoline crosslinks (PYD) as an indicator of bone damage that can be seen earlier than imaging. This study is a secondary study of the primary study entitled Correlation of Serum 25(OH)D Levels with Cardiovascular Biological Markers in Workers Exposed to Lead. This cross-sectional study was conducted to determine the correlation between serum 25(OH)D levels and the urinary PYD/creatinine ratio in workers exposed to lead. The study was located in Tegal Regency, Tangerang Regency, Surabaya City, and Bogor Regency. The subjects were part of all lead-exposed workers who were registered as respondents in the primary study and met the criteria, resulting in a total of 104 subjects. The instruments used were subject characteristic form, physical examinations, Global Physical Activity Questionnaire, Semi-Quantitative Food Frequency Questionnaire, kidney and liver function test results, blood lead levels, serum 25(OH)D levels, and morning urine samples. Median blood lead levels were 6.3 (1.2-35.5) µg/dL, chronic lead exposure index 35,3 (1,2-535,8) years µg/dL, serum 25(OH)D levels were 22 (8-52) ng/mL, and urinary PYD/creatinine ratio was 5.3 (3.6-28.1).10^-6. Among the most population (86.5% of subjects) had inadequate serum 25(OH)D  the study showed a significant negative correlation between serum 25(OH)D levels and urinary PYD/creatinine ratio in workers exposed to lead (r = -0.39, p < 0.001). There was also a significant positive correlation between chronic lead exposure index and the urinary PYD/creatinine ratio (r = 0.21, p = 0.036)."

"Kadar kalium merupakan salah satu biomarker prognostik yang banyak digunakan untuk memprediksi luaran klinis berbagai penyakit. Kadar kalium yang rendah atau hipokalemia berhubungan dengan perlunya pemasangan ventilasi mekanik pada pasien sakit kritis. Berbagai kondisi seperti status nutrisi dan komorbid dapat menyebabkan hipokalemia. Hipokalemia dapat memengaruhi fungsi otot respirasi dan memengaruhi durasi penggunaan ventilasi mekanik. Penelitian ini bertujuan untuk melihat hubungan antara status kalium terhadap kejadian sulit weaning ventilasi mekanik pada pasien sakit kritis di ICU RSCM dan RSUI. Penelitian ini menggunakan desain kohort retrospektif pada subjek berusia ≥18 tahun yang dirawat di ICU RSCM dan RSUI. Diperoleh 52 subjek dengan kelompok yang hipokalemia sebanyak 26 subjek dan kelompok yang normokalemia sebanyak 26 subjek. Rerata usia subjek 49,3±15,1 tahun, jenis kelamin laki-laki 65,4%, status nutrisi berdasarkan indeks massa tubuh (IMT) berat badan normal 34,6%, dan komorbid penyakit keganasan 36,5%. Tidak terdapat hubungan bermakna antara status kalium dengan kejadian sulit weaning ventilasi mekanik selama perawatan di ICU. Sebagian besar subjek yang mengalami hipokalemia tidak mengalami sulit weaning ventilasi mekanik. Penelitian lanjutan diperlukan dengan menggunakan subjek yang lebih banyak dan menganalisis faktor-faktor lain yang dapat memengaruhi kejadian sulit weaning ventilasi mekanik dan status kalium pada pasien sakit kritis yang dirawat di ICU.

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Potassium levels are one of the prognostic biomarkers that are widely used to predict clinical outcomes of various diseases. Low potassium levels or hypokalemia are associated with the need for mechanical ventilation in critically ill patients. Various conditions such as nutritional status and comorbidities can cause hypokalemia. Hypokalemia can affect respiratory muscle function and influence the duration of mechanical ventilation. This study aims to examine the relationship between potassium status and the incidence of mechanical ventilation weaning difficulty in critically ill patients in the ICU at RSCM and RSUI. This study used a retrospective cohort design on subjects aged ≥18 years who were treated in the ICU at RSCM and RSUI. Total 52 subjects obtained, with 26 subjects in the hypokalemia group and 26 subjects in the normokalemia group. The mean age of the subjects was 49.3±15.1 years old, male gender 65.4%, nutritional status based on body mass index (BMI) of normal weight 34.6%, and comorbid of malignant disease 36.5%. There was no significant relationship between potassium status and the incidence of mechanical ventilation weaning difficulty during treatment in the ICU. Most subjects who experienced hypokalemia did not experience mechanical ventilation weaning difficulty. Further research is needed using more subjects and analyzing other factors that may influence the incidence of mechanical ventilation weaning difficulty and potassium status in critically ill patients treated in the ICU."