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"Latar belakang : Inflamasi dan stres oksidatif merupakan faktor risiko terhadap penyakit kardiovaskuler pada pasien penyakit ginjal kronis yang menjalani hemodialisis. Pasien hemodialisis kronis akan mengalami peningkatan kadar hs-CRP.hs-CRP merupakan marker inflamasi yang telah terbukti pada beberapa penelitian bermanfaat dalam memprediksi cardiovascular event. Pemberian N-Acetylcysteine(NAC)oral dapat digunakan sebagai strategi untuk menurunkan proses inflamasi yaitu disfungsi endotel dan stress oksidatif yang berperan pada atherosclerosis pada pasien hemodialisis sehingga dapat menurunkan angka morbiditas dan mortalitas karena penyakit kardiovaskuler. Tujuan penelitian : Mengetahui pengaruh pemberian N-Acetylcysteine oral terhadap penurunan kadar hs-CRP pada pasien hemodialisis kronis. Metode : Penelitian eksperimen dengan Randomized Double Blind Controlled Trial yang dilakukan selama periode Agustus sampai Oktober 2013 di unit hemodialisis RS.Cipto Mangunkusumo Jakarta. Subjek penelitian ini adalah pasien dengan penyakit ginjal kronis yang menjalani hemodialisis. Sebanyak 87 subjek direkrut, hanya 65 subjek yang memenuhi kriteria inklusi sebagai sampel. Sampel dirandomisasi menjadi dua kelompok, 33 subjek kelompok intervensi yang mendapatkan NAC 2x600 mg per hari dan 32 subjek kelompok kontrol yang menerima placebo 2x1 per hari selama dua bulan (60 hari). Terdapat 5 subjek yang drop out, sehingga hanya 60 subjek yang dapat menyelesaikan penelitian 30 subjek dalam kelompok NAC dan 30 subjek placebo. hs-CRP diukur dalam tiga interval waktu, sebelum (baseline), setelah bulan pertama (post 1), dan setelah bulan kedua (post 2). Hasil : Perlakuan dengan NAC oral selama 60 hari tidak memberikan perbedaan dibanding dengan plasebo. Analisis statistik dengan Mann Whitney menunjukkan bahwa tidak ada penurunan kadar hs-CRP yang signifikan diantara kedua kelompok dengan p value Δ post1-baseline, Δ post2-baseline, and Δ post2-post1 kelompok NAC disbanding kelompok placebo secara berurutan (p=0.796, p=0.379, p=0.712). Kami juga mencoba membandingkan penurunan kadar hs-CRP secara statistik pada tiap kelompok untuk tiga interval pengukuran hs-CRP dengan menggunakan uji Wilcoxon Signed Ranks hasilnya menunjukkan p value dari perbandingan kadar hs-CRP untuk masing-masing kelompok Baseline:Post1,Baseline:Post2,Post1:Post 2 (kelompok NAC vs kelompok plasebo) secara berurutan (0.821vs0.651; 0.845vs0.358; 0.905vs0.789).

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Background: Inflammation and oxidative stress are the risk factor for cardiovascular disease in patients with chronic kidney disease undergoing hemodialysis will have elevated levels of hs-CRP. hs-CRP is a marker of inflammation that has been provenin several studies use fulto predict cardiovascular events. The administration of oral N-Acetylcysteine (NAC) can be used as a strategy lowering the in flammatory process which end o the lialdys function and oxidative stress play a role in a the rosclerosis for hemodialysis patients there fore reduces morbidity and mortalitydue to cardiovascular disease. Objective: To determine the effect of oral N-Acetylcysteine in lowering the levels of hs-CRPin chronic hemodialysis patients. Methods: Randomized Double Blind Controlled Trialexperimental study conducted during the period August to November 2013 in the hemodialysis unit of Cipto Mangun kusumo Hospital. The subjects were patients with stage 5 chronic kidney disease undergoing hemodialysis. Eighty seven subjects were recruited, but only 65 subjects matched for inclusion criteria as samples. The samples were randomized into two groups : intervention group 33 subjects who received NAC2x600 mg per day and control group of 32 subjects who received placebo, both groups consumed the medicine for two months (60 days). There were 5 subjects dropped out, so there search completed by the end of 60 subjects with 30 subjects in NAC groupand 30 subjects in the placebo group. The hs-CRP levels were measuredin 3 interval of time, before (baseline), the first month (post1), and second month (post2). Result: Treatment with oral NAC for 60 days did not give any difference compare to PB. Statistically analysis with Mann Whitney test showed that there is no significant decrease of hs-CRP levels between two groups with the p value of Δ post1-baseline, Δ post2-baseline, and Δ post2-post1 NAC group compare to plasebo group respectively (p=0.796, p=0.379, p=0.712). We also try to compare the decrease of hs-CRP levels statistically in each group for 3 interval of hs-CRP check with Signed Ranks Wilcoxon test. The result showed p value of hs-CRP levels comparison within each group for Baseline : Post1, Baseline :Post2,Post1:Post2 (NAC group vs plasebo group)respectively (0.821vs0.651; 0.845vs0.358; 0.905vs 0.789). Conclusion: The administration of oral NAChas not been shown lowering the levels of hs-CRPin chronic hemodialysis patients."

"ABSTRAK Latar Belakang. Pneumonia sering menjadi komplikasi medis yang timbul pada pasien-pasien stroke iskemik akut yang dirawat di rumah sakit, sehingga diperlukan suatu sistem skor yang valid dan mudah diterapkan untuk memprediksi dan menstratifikasi risiko timbulnya pneumonia pada pasien stroke iskemik akut. Tujuan. Menilai performa kalibrasi dan diskriminasi skor A2DS dalam memprediksi insiden pneumonia pada pasien stroke iskemik akut Metode. Penelitian dengan desain kohort retrospektif menggunakan rekam medik pasien stroke iskemik akut di ruang rawat neurologi dan stroke unit gedung A RSCM periode Januari 2014 ndash; Desember 2016 dengan metode total sampling. Usia, ada tidaknya fibrilasi atrium pada EKG, ada tidaknya disfagia, jenis kelamin laki-laki , dan tingkat keparahan stroke dinilai dengan NIHSS , dinilai pada awal perawatan di RSCM. Pasien diikuti hingga 7 hari sejak onset stroke iskemik untuk dilihat outcome-nya pneumonia atau tidak pneumonia . Performa kalibrasi skor A2DS2 dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor A2DS2 dinilai dengan Area Under The Curve AUC . Hasil. Sebanyak 281 subjek diikutsertakan ke dalam penelitian ini, dengan angka kejadian pneumonia dalam 7 hari sejak onset timbulnya stroke iskemik sebanyak 118 subjek 42 . Hosmer-Lemeshow menunjukkan p = 0,222. Plot kalibrasi menunjukkan koefisien korelasi r=0,982 dengan p = 0,000. AUC sebesar 0,885 IK95 0,845 - 0,924 .ABSTRACT Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. Aim. To assess the performance of calibration and discrimination of A2DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital. Methods. This was a retrospective cohort study of adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital. Age, presence or absence of atrial fibrillation, presence or absence of dysphagia, Sex male , and stroke severity rated with NIHSS were obtained at the beginning of admission. The subjects were followed up for up to 7 days after the onset of ischemic stroke to assess the outcome pneumonia or not . Calibration properties of A2DS2 score were assessed by Hosmer Lemeshow test and calibration plot. Discrimination properties of A2DS2 score were assessed by the area under the curve AUC . Results A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients 42 . Hosmer Lemeshow test of A2DS2 score showed p 0,222 and calibration plot showed r 0,982. Discrimination of A2DS2 score was shown by the AUC value of 0,885 95 CI 0,845 0,924 . Conclusion A2DS2 score have a good calibration and discrimination performance in predicting incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital."

"Latar Belakang : Salah satu dampak sistemik dari penyakit paru obstruktif kronik (PPOK) yaitu modifikasi tipe otot skeletal. Tujuan penelitian ini adalah untuk menilai tingkat kelelahan kaki dengan menilai skala Borg lelah dan asam laktat perifer sebagai penanda kelelahan kakiMetode : Desain penelitian ini adalah studi potong lintang, terdiri dari 34 subjek PPOK dan 25 subjek kontrol sehat yang seusia dengan usia subjek PPOK. Subjek dinilai skala Borg kelelahan kaki lelah dan asam laktat perifer sebelum dan sesudah uji jalan 6 menit (UJ6M).Hasil : Terdapat peningkatan lebih tinggi median asam laktat yang tidak bermakna (p > 0,05) secara statistik antara subjek PPOK (0,5) dibandingkan kontrol (0,45). Terdapat peningkatan median skala Borg lelah yang bermakna (p < 0,001) antara subjek PPOK (5,0) dibandingkan subjek kontrol (1,0). Terdapat jarak tempuh yang lebih besar secara bermakna pada subjek kontrol dibandingkan subjek PPOK (p < 0,05).Kesimpulan : Kelompok PPOK memiliki peningkatan asam laktat yang tidak bermakna dibandingkan kelompok kontrol. Kelompok PPOK memiliki peningkatan skala Borg kaki lelah yang lebih besar dan berbeda bermakna dibandingkan dengan kontrol.

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Background : One of systemic effects of COPD is a modification of skeletal muscle fiber types. The objective of this study is to determine the increase of leg fatigue by using Borg scale leg fatigue and lactic acid level.

Methods : This is a cross-sectional study design. The samples were 34 COPD patients and 25 healthy adults with the same age as COPD patients as the control. The lactic acid level and Borg leg fatigue scale were measured before and after six minute walking test (6MWT).

Results : There was an unsignificantly difference change of median of lactic acid level (p > 0,05) between COPD (0,5 mMol) compared to control (0,45 mMol). There was a statistically significant difference (p < 0,001) change of leg fatigue Borg scale between COPD (5,0) compared to control (1,0). There was a significantly (p < 0,05) higher mean of distance of 6MWT in control subjects (411,62 meters) compared to COPD (364 meters).

Conclusion : COPD patients had an unsignificantly increase of lactic acid level after the 6MWT compared to control subjects. COPD patients had a significantly higher leg fatigue Borg scale compared to control after the 6MWT."

"Latar Belakang: Ikterus obstruktif merupakan salah satu komplikasi tersering keganasan sistem bilier. Keadaan ini akan memicu pelepasan sitokin proinflamasi. Terdapat kontroversi mengenai pengaruh drainase bilier terhadap perubahan kadar sitokin proinflamasi pada penderita kanker pankreatobilier.Tujuan: Untuk mengetahui kadar Tumor Necrosis Faktor alfa (TNF-alfa) dan Interleukin 6 (IL6) sebelum dan sesudah Endoscopic Retrograde Cholangio Pancreatography (ERCP) atau Percutaneus Transhepatic Biliary Drainage (PTBD) pada penderita ikterus obstruksi etiologi kanker pankreatobilier.Metode: Desain penelitian adalah one group before after study. Pemilihan sampel secara consecutive sampling. Sampel darah diambil sebelum dan lima hari sesudah ERCP atau PTBD. Pengukuran kadar TNF-alfa dan IL-6 dengan cara Enzyme Linked Immunosorbed Assay (ELISA).Hasil: Terdapat 40 orang responden yang diikutsertakan dalam penelitian ini, 22 laki laki dan 18 perempuan dengan usia rata rata 55,3 tahun. Berdasarkan imaging dan endoskopi, ditegakkan diagnosis kolangiokarsinoma sebanyak 22 orang, tumor ampula Vateri 10 orang, dan tumor pankreas 8 orang. Kadar rata-rata TNF- alfa sebelum tindakan 4,81 (2,91) pg/ml dan sesudah tindakan 8,05 (6,7) pg/ml, terdapat peningkatan yang bermakna setelah tindakan drainase bilier (p:0,02). Kadar rata-rata IL-6 sebelum tindakan 7,79 (1,57) pg/ml dan sesudah tindakan 7,75 (1,76) pg/ml, tidak terdapat perbedaan yang bermakna setelah tindakan drainase bilier (p:0.52). Kadar rata-rata bilirubin sebelum tindakan 15,5 mg% dan sesudah tindakan 11,3 mg%.Simpulan: Terjadi peningkatan kadar rata-rata TNF-alfa secara bermakna setelah drainase. Tidak ada penurunan yang bermakna kadar rata-rata IL-6.

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Background: Obstructive jaundice represents the most common complication of biliary tract malignancy. Obstructive jaundice causes releases of proinflammatory cytokine. There has been controversy about effect of biliary drainage on the change in proinflammatory cytokine level in pancreatobiliary cancer patients.Objective: The present study was designed to determine levels of Tumor Necrosis Factor Alpha (TNF-Alpha) and Interleukin 6 (IL-6) in preprocedure of either Endoscopic Retrograde Cholangio Pancreatography (ERCP) or Percutaneus Transhepatic Biliary Drainage (PTBD) and postprocedure of them in obstructive jaundice patient caused by pancreatobiliary cancer.Methods : The study method is before- and- after case study design with consecutive sampling. Blood was collected five days prior to either Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure or Percutaneus Transhepatic Biliary Drainage (PTBD) procedure and five days after either of them. Enzyme Linked Immunosorbed Assay (ELISA) was used to determine TNF-Alpha and IL-6.Results: Forty subjects were included in this study which consisted of 22 men and 18 women. The mean age was 55.3 years old. According to the results of imaging and endoscopy procedure, twenty two (22) people were diagnosed cholangi carcinoma, ten (10) people were diagnosed ampulla varteri and eigth (8) people were diagnosed pancreatic tumor. In preprocedure, the mean of TNF-Alpha concentration was 4.81 (2.91) pg/mL, the mean of IL-6 concentration was 7.79 (1.57) pg/mL and the mean of bilirubin concentration was 15.5 mg%. In postprocedure, the mean of TNF-Alpha concentration was 8.05 (6.7) pg/mL, there was significant increase in TNF-Alpha concentration (p:0.02). However, the mean of IL-6 concentration was 7.75 (1.76) pg/mL, there was not any significant chance in IL-6 concentration (p:0.52). The mean of bilirubin concentration was 11.3 mg%.Conclusions: On one hand, there was significant increase in mean concentration value of TNF-Alpha after biliary drainage procedure. On the other hand there was not any significant decrease in mean concentration value of IL-6 after biliary drainage procedure."

"Latar belakang: Hipertensi pulmonal (HP) telah banyak dilaporkan terjadi pada populasi hemodialisis (HD). Namun data mengenai insidensi HP serta bagaimana mekanisme terjadinya masih sangat sedikit. Beberapa faktor risiko dan protektif terjadinya HP telah diidentifikasi melalui studi-studi di mancanegara. Penelitian ini bertujuan untuk mengevaluasi hubungan penggunaan penghambat kanal kalsium dengan kejadian hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialisis. Metode: Penelitian potong lintang dilakukan terhadap 100 pasien HD rutin di unit HD RSCM yang sedang mengkonsumsi penghambat kanal kalsium jenis dihidropiridin (nifedipin, amlodipin, felodidpin) 1x sehari per oral selama minimal 1 tahun. Hipertensi pulmonal dinilai dengan menggunakan ekokardiografi doppler yang dilakukan 1 jam pasca HD oleh satu orang operator independen yang tidak mengetahui latar belakang klinis pasien. Selanjutnya dilakukan analisis uji statistik chi square dengan batas kemaknaan < 0.05, serta analisis multivariat dengan regresi logistik antara variabel penghambat kanal kalsium dengan hipertensi pulmonal untuk mendapatkan Crude OR, antara variabel perancu dengan hipertensi pulmonal untuk mendapatkan nilai P < 0.25, dan antara variabel penghambat kanal kalsium dengan variabel perancu untuk mendapatkan fully adjusted OR. Hasil: Dari 100 subyek penelitian, HP didapatkan pada 27 subjek (27%). Pada kelompok pasien HP, 21 subjek (29.2%) memiliki akses fistula AV di brakial, TAP rata-rata 36 ± 20.6 mmHg, curah jantung ³ 5 l/min sebanyak 13 subjek (28.8%) dengan fraksi ejeksi ³ 50% sebanyak 18 subjek (20.7%). Etiologi PGK terbanyak pada kelompok HP adalah nefropati DM dengan 10 subjek (37%). Setelah dilakukan adjustment dengan disfungsi diastolik ventrikel kiri, fraksi ejeksi dan diabetes melitus sebagai faktor perancu, penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal (adjusted OR 0.258; IK 95% 0.085 – 0.783; nilai P 0.017). Kesimpulan: Penggunaan penghambat kanal kalsium berhubungan dengan penurunan risiko terjadinya hipertensi pulmonal pada pasien gagal ginjal terminal yang menjalani hemodialis.

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Background and Aim of Study: Pulmonary hypertension (PH) has been reported in hemodialysis (HD) patients. However data regarding its incidence and mechanism are scarce. Many published journal abroad had been identify the risk and protective factors in this syndrome. This study evaluated the use of Calcium Channel Blocker (CCB) on Pulmonary Hypertension at End-Stage Renal Disease (ESRD) patients who undergo hemodialysis.

Methods: A Cross – Sectional study conducted on hundreds HD patients in RSCM who consumed CCB for at least a year with oral single dose. PH was screened by Doppler echocardiography one hour following dialysis done by one independent operator without knowing clinical background of the patients. Furthermore, statistical analysis was done using chi square and define as significance if the value is <0.05. Moreover, multivariate analysis with logistic regression between CCB and PH variable in order to get Crude OR, between confounder variables and PH in order to get P value < 0.25, and between CCB and confounder variables in order to get fully adjusted OR.

Results: Out of 100 HD patients, PH was detected in 27 patients (27%). Of those with PH, brachial AV shunt was seen in 21 patients (29.2%), mean PAP was 36 ± 20.6 mmHg, and cardiac output ³ 5 l/min was seen in 13 patients (28.8%) with EF ³ 50% seen in 18 patients (20.7%). The common etiology of CKD in group of PH was diabetic nephropathy seen in 10 patients (37%). The used of CCB is associated with lower risk of PH (adjusted OR 0.258; 95% CI 0.085 – 0.783; P value 0.017) after adjusted with variable left ventricular diastolic dysfunction, ejection fraction, and diabetes melitus as confounders.

Conclusion: This study demonstrates that the use of CCB is associated with lower risk of PH in ESRD patients with hemodialysis."

"ABSTRAKLatar Belakang: Skor Clinical Disease Activity Index CDAI , sebagai salah satu metode pengukur derajat aktivitas artritis reumatoid AR , dipandang memiliki kelebihan dibandingkan metode skor lain karena tidak memerlukan pemeriksaan laboratorium penunjang. Studi-studi yang dilakukan pada pasien AR di luar Indonesia mengungkap bahwa korelasi, validitas dan reliabilitas CDAI dinilai baik saat diuji dengan pembanding skor lain. Namun demikian studi-studi tersebut hanya mengikutsertakan subjek pasien AR murni tanpa komorbiditas. Pasien AR di Indonesia memiliki karakteristik klinis yang berbeda, terutama dalam aspek adanya kondisi komorbiditas, perbedaan predisposisi genetik dan perbedaan fenotipe penyakit. Tujuan: Menilai validasi skor CDAI pada profil pasien AR di Indonesia. Metode: studi potong lintang pada subjek pasien AR yang berobat di poliklinik Reumatologi RS Cipto Mangunkusumo bulan April s.d. Mei 2016. Setiap subjek dilakukan anamnesis, pemeriksaan fisik, pencatatan hasil pemeriksaan penunjang dan pencatatan data komorbiditas yang tertera di rekam medis. Dua pengukur melakukan penghitungan skor CDAI dan skor Disease Activity Score 28 DAS28-CRP sebagai baku emas pembanding pada tiap subjek. Luaran berupa data numerik. Penilaian model validasi data numerik dilakukan dengan analisis performa model prediktor menggunakan indeks R 2 . Hasil: Terdapat 119 subjek penelitian yang memenuhi kriteria inklusi. Seluruh subjek memiliki kondisi komorbiditas selain AR. Indeks R 2 =0,831 83,1 ;

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ABSTRACTBackground Clinical Disease Activity Index CDAI stands out amongst other methods in measuring disease activity of rheumatoid arthritis RA patient. CDAI is considered to be more practical and cost effective in daily practice because it requires no laboratory examination. Previous studies conducted overseas revealed that CDAI has good correlation, validity, and reliability compared with other scoring methods. However, those studies included only pure RA subjects. Indonesian RA patients have distinct clinical profiles, in terms of comorbidity diseases, genetic predisposition, and fenotype of the disease. Objectives To analyze validation of CDAI in distinct clinical profiles of RA patients in Indonesia. Methods A cross sectional study in RA outpatients, who were visiting Rheumatology Clinic in RSCM on monthly basis from April to May 2016. Assesement of each patient include history taking and physical examination. All recent laboratory results and other data in medical record were documented in reseacher form. CDAI and Disease Activity Score 28 CRP DAS28 CRP , as gold standard, were measured by two observers. Outcomes were in numeric. Validation measurement were done in terms of validating a model prediction and quantifying how good the predictions from the model are. Overall perforomance were measured with R 2 index. Result A total of 119 subjects met the inclusion criteria. All subjects were RA patients with comorbidities and were representing quite numbers of Indonesian races characteristic profile. R 2 0,831 83,1 p"

"Indonesia termasuk ke dalam kriteria negara 'high-burden' dengan insidensi TB yang masih tinggi. Indonesia masuk kedalam kriteria ini karena tingginya data epidemiologis kasus TB-HIV dan TB-MDR. Spesimen klinis terbanyak yang diolah untuk kultur TB adalah sputum, yang mengandung banyak kontaminan dari flora normal tenggorok. Salah satu metode kultur TB yang ideal adalah dengan mengembangkan larutan yang mudah didapat serta efektif tanpa banyak membunuh basil TB. Bleach adalah larutan yang murah dan diketahui secara luas sebagai disinfektan yang baik sehingga dapat dijadikan alternatif. Penelitian dilaksanakan di laboratorium TB LMK FK UI RSCM menggunakan 35 sampel dengan BTA positif. Setiap sampel dibagi dalam 4 kelompok dengan metode dekontaminasi yang berbeda. Keempat metode tersebut menggunakan 4 NaOH, 2 NALC-NaOH, 5 asam oksalat dan 1 bleach. Larutan 1 bleach disiapkan dari larutan pemutih komersial yang ada di pasaran. Setiap kelompok perlakuan dihitung proprsi kontaminasi dan kultur positif. Kultur positif divalidasi menggunakan MPT 64. Hasil penelitian menunjukkan subyek dengan BTA 1 sebanyak 46, BTA 2 37 dan BTA 3 sebanyak 17. Bleach merupakan kelompok dengan proporsi kontaminasi terbaik sebesar 2.8 dibanding 4 NaOH sebesar 5.7, dengan perbedaan proporsi kontaminasi yang signifikan p=0.000. Terdapat perbedaan signifikan antar kelompok dalam proporsi kultur positif p=0.006, tetapi pada uji post hoc tidak ada perbedaan bermakna antara 1 bleach, 4 NaOH dan 2 NALC-NaOH. Kesimpulan penelitian ini, 1 bleach dapat digunakan untuk dekontaminan pada kultur TB dengan harga yang lebih murah, terutama pada sampel BTA 2 keatas serta terkontaminasi berat.

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Indonesia remains one of 22 high burden countries with highly tuberculosis TB incidence according to WHO. There are a lot of numbers of TB HIV and TB ndash MDR in Indonesia. As most processed clinical specimen for TB culture, sputum is contaminated by normal flora from oropharyngeal tract.

The best method to establish appropriate culture from sputum is establishing a safe solution for the laboratory worker without kills numerous TB bacilli, preferred economic and easy prepared solution. Bleach is well known as cheap and good disinfectant that could use as an alternative. The research was aimed to compare the capability as bleach as decontaminat solution to other solution.

The study was conducted at TB laboratory of FMUI, by using 35 samples sputum with positive AFS, 3 5 ml. Each sample was divided into 4 groups which was decontaminated by different methods. The methods are 4 NaOH, 2 NALC NaOH, 5 oxalic acid and 1 bleach. 1 Bleach was prepared from commercially bleach. Each group was assessed for contamination and culture positive rate. The positive culture was validated using MPT 64.

The number of positive AFS were 1 46, 2 37 and 3 17. Bleach had the best contamination rate which was 2.8 compared to 4 NaOH 5.7, and significant difference among 4 groups p 0.000. There was also significant difference among 4 groups in positive culture proportion p 0.006, but there wasn rsquo t signficant different between 1 bleach, 4 NaOH and 2 NALC NaOH.

Conclusion of this study is, 1 bleach can be used as an alternative solution for decontamination of TB culture from highly contaminated sputum with AFB higher than 2."

"Latar belakang: Angka morbiditas dan mortalitas meningkat pada pasien fibrilasi atrium (FA) yang mengalami gagal jantung akut. Pada pasien irama sinus, left atrial volume index (LAVI) dan heart rate variability (HRV) merupakan prediktor kuat terjadinya komplikasi kardiovaskular. Penelitian LAVI dan HRV pada pasien FA hingga saat ini belum konklusif.Tujuan: Mengetahui hubungan LAVI dan HRV dengan kejadian gagal jantung akut pada pasien FAMetode: Studi kohort retrospektif dengan populasi terjangkau pasien dewasa FA di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) 1 Januari 2020 hingga 31 Desember 2021 yang berasal dari registri Optimal INR measures for Indonesians (OPTIMA). Data sekunder LAVI diukur dengan ekokardiografi dan parameter HRV terdiri dari standar deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), rasio low frequency dan high frequency (LF/HF) diukur menggunakan alat HRV portabel. Pasien diikuti hingga 30 Januari 2023, luaran dinilai dengan melihat catatan medik atau melalui telepon.Hasil: Dilakukan analisis pada 144 sampel. Proporsi kejadian gagal jantung akut sebesar 15,3%. Tidak terdapat hubungan antara SDNN dengan kejadian gagal jantung akut (RR 1,75; IK95% 0,260 – 11,779, p=0,565). Tidak terdapat hubungan antara LF/HF dengan kejadian gagal jantung akut (RR 2,865; IK 95% 0,765 – 10,732, p=0,118). Terdapat hubungan antara LAVI dengan kejadian gagal jantung akut (adjusted RR 2,501; IK 95% 1,003 – 6,236, p=0,049). Diabetes melitus dan hipertensi merupakan faktor perancu pada penelitian ini.Kesimpulan: Peningkatan LAVI berhubungan dengan kejadian gagal jantung akut pada pasien FA. HRV tidak berhubungan dengan kejadian gagal jantung akut pada pasien FA.

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Background Morbidity and mortality rates increase in patients with atrial fibrillation (AF) who experience acute heart failure. In patients with sinus rhythm, left atrial volume index (LAVI) and heart rate variability (HRV) are strong predictors of cardiovascular complications. Research on LAVI and HRV in AF patients has so far not been conclusive.

Objectives: To determine the relationship between LAVI and HRV and the incidence of acute heart failure in AF patients.

Methods: A retrospective cohort study was conducted with an accessible population of adult AF patients at RSCM from January 1, 2020, to December 31, 2021, originating from the Optimal measures INR for Indonesians (OPTIMA) registry. LAVI was measured by echocardiography, and HRV parameters consist of the standard deviation of NN intervals (SDNN), the root mean square of successive differences (RMSSD), and the ratio of low frequency and high frequency (LF/HF) measured using a portable ECG device. Patients were followed until January 30, 2023, and outcomes were assessed by looking at medical records or by telephone.

Result: A total of 144 subjects were analysed. The proportion of acute heart failure is 15.3%. There was no relationship between SDNN and the incidence of acute heart failure (RR 1.75; 95% CI 0.260–11.779, p=0.565). There was no relationship between LF/HF and the incidence of acute heart failure (RR 2.865; 95% CI 0.765–10.732, p=0.118). There is a relationship between LAVI and the incidence of acute heart failure (adjusted RR 2.501; 95% CI 1.003–6.236, p = 0.049). DM and hypertension were confounding factors in this study.

Conclusion: The elevation of LAVI is associated with the incidence of acute heart failure in AF patients. HRV is not associated with the incidence of acute heart failure in AF patients."

"Latar Belakang: Hingga saat ini belum ada publikasi yang melakukan pembahasan mengenai sistem stratifikasi risiko pasien STEMI pada populasi dewasa muda. Selain itu rokok dan riwayat PJK dini dalam keluarga yang merupakan faktor risiko utama kejadian STEMI pada dewasa muda juga belum terlihat perannya dalam sistem stratifikasi risiko manapun. Skor TIMI yang paling banyak digunakan dalam menilai prognosis pasien STEMI juga masih dipertanyakan keakuratannya pada kelompok dewasa muda.

Tujuan: Studi ini bertujuan mengetahui proporsi mortalitas pasien STEMI dewasa muda yang di RS Cipto Mangunkusumo, melakukan validasi skor TIMI pada pasien dewasa muda, dan mengembangkan sistem stratifikasi risiko untuk pasien STEMI dewasa muda.

Metode: Penelitian ini adalah studi prognosis dengan desain kohort retrospektif menggunakan data rekam medis RSCM pada pasien berusia ≤50 tahun yang dirawat dengan STEMI dari tahun 2018 hingga tahun 2022. Dilakukan analisis univariat untuk mendapatkan data karakteristik subjek dan proporsi mortalitas 30 hari pasien STEMI dewasa muda. Dilakukan analisis bivariat untuk melihat hubungan merokok dan Riwayat PJK dini dalam keluarga dengan mortalitas 30 hari. Dilakukan uji validasi skor TIMI pada subjek penelitian dewasa muda. Dilakukan analisis multivariat untuk mendapatkan model prediksi baru dan dilakukan uji performa diskriminasi dan kalibrasi model modifikasi atau kombinasi baru.

Hasil: Didapatkan 164 subjek penelitian. Pasien yang memiliki faktor risiko merokok adalah sebanyak 107 orang (65,2%). Sementara yang memiliki riwayat PJK dini dalam keluarga adalah sebanyak 39 orang (23,9%). Pasien yang memiliki komorbid hipertensi sebanyak 80 orang (48,8%) dan yang menderita diabetes sebanyak 71 orang (43,3%). Proporsi mortalitas 30 hari pasien dewasa muda sebanyak 7,9% (13 orang). Tidak terdapat korelasi dengan mortalitas 30 hari pasien STEMI dewasa muda untuk riwayat merokok (HR 0,0441 (IK 95% 0,148-1,312) dan nilai p 0,141) dan riwayat PJK dini dalam keluarga (HR 0,567 (IK 95% 0,126-2,559) dan nilai p 0,461). Skor TIMI memperlihatkan kemampuan prediksi mortalitas 30 hari pasien STEMI dewasa muda yang baik, dimana didapatkan nilai AUC 0,836 (IK 95% 0,717-0,956) dengan nilai p <0,0001. Kombinasi skor TIMI dengan variabel riwayat merokok memperlihatkan performa diskriminasi yang baik dalam prediksi mortalitas 30 hari pasien STEMI dewasa muda dengan nilai AUC 0,875 (p<0,0001). Namun ketika dilakukan perbandingan antara nilai AUC skor TIMI dengan skor TIMI dengan tambahan faktor riwayat merokok tidak didapatkan peningkatan akurasi yang bermakna (nilai p 0,2146).

Simpulan: Proporsi mortalitas 30 hari pasien STEMI dewasa muda adalah sebanyak 7,9%. Skor TIMI memiliki performa diskriminasi dan kalibrasi yang baik dalam memprediksi mortalitas 30 hari pasien STEMI dewasa muda. Skor TIMI dengan penambahan faktor riwayat merokok memiliki performa diskriminasi dan kalibrasi yang lebih baik dalam memprediksi mortalitas 30 hari pasien STEMI dewasa muda dibandingkan skor TIMI murni, namun tidak memiliki signifikansi peningkatan akurasi.

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Background: Until now, there have been no publications discussing the risk stratification system for STEMI patients in the young adult population. Additionally, the role of smoking and a family history of early coronary artery disease (CAD) as major risk factors for STEMI in young adults has not been addressed in any risk stratification system. The accuracy of the widely used TIMI score in assessing the prognosis of STEMI patients in the young adult group is also questionable.

Objective: This study aims to determine the proportion of mortality among young adult STEMI patients at Cipto Mangunkusumo Hospital, validate the TIMI score in young adult patients, and develop a risk stratification system for young adult STEMI patients.

Methods: This research is a retrospective cohort prognosis study using medical record data from Cipto Mangunkusumo Hospital on patients aged ≤50 years who were hospitalized with STEMI from 2018 to 2022. Univariate analysis was conducted to obtain subject characteristics and the proportion of 30-day mortality among young adult STEMI patients. Bivariate analysis was performed to examine the relationship between smoking, a family history of early CAD, and 30-day mortality. The validation of the TIMI score was conducted in the young adult study subjects. Multivariate analysis was conducted to obtain a new prediction model, and performance tests for discrimination and calibration of the modified or combined model were performed.

Results: A total of 164 study subjects were included. There were 107 patients (65.2%) with a smoking risk factor, while 39 patients (23.9%) had a family history of early CAD. The proportion of 30-day mortality among young adult patients was 7.9% (13 individuals). There was no correlation between 30-day mortality in young adult STEMI patients and a history of smoking (HR 0.0441 (95% CI 0.148-1.312) and p-value 0.141) or a family history of early CAD (HR 0.567 (95% CI 0.126-2.559) and p-value 0.461). The TIMI score showed good predictive ability for 30-day mortality in young adult STEMI patients, with an AUC value of 0.836 (95% CI 0.717-0.956) and p-value <0.0001. The combination of the TIMI score with the smoking history variable demonstrated good discriminatory performance in predicting 30-day mortality among young adult STEMI patients, with an AUC value of 0.875 (p<0.0001). However, when comparing the AUC values between the TIMI score and the TIMI score with the addition of the smoking history factor, no significant increase in accuracy was observed (p-value 0.2146).

Conclusion: The proportion of 30-day mortality among young adult STEMI patients is 7.9%. The TIMI score demonstrates good discrimination and calibration in predicting 30-day mortality among young adult STEMI patients. The TIMI score, when combined with the smoking history factor, shows improved discriminatory performance and calibration in predicting 30-day mortality among young adult STEMI patients compared to the pure TIMI score but does not significantly enhance accuracy."

"Latar belakang: Pneumonia berat yang membutuhkan tatalaksana ventilasi mekanik prevalensnya terus meningkat. Tindakan trakeostomi dilakukan untuk memfasilitasi penyapihan ventilasi mekanik. Studi sebelumnya dalam menilai faktor terkait kegagalan penyapihan ventilasi mekanik pasca trakeostomi masih sedikit dan menunjukkan hasil yang berbeda.Tujuan: Studi ini bertujuan untuk mengetahui proporsi dan faktor-faktor yang memengaruhi kegagalan penyapihan ventilasi mekanik pasca trakeostomi pada pasien pneumonia berat.Metode: Studi ini menggunakan desain kohort retrospektif dari data rekam medik pasien yang dirawat di ICU/HCU RSUPN dr. Cipto Mangunkusumo antara tahun 2018-bulan Juni 2022. Faktor-faktor yang memengaruhi kegagalan penyapihan ventilasi mekanik pasca trakeostomi pada pasien pneumonia berat didapatkan dari hasil analisis multivariat dengan regresi logistik.Hasil: Dari total 328 subjek yang memenuhi kriteria didapatkan proporsi kegagalan penyapihan ventilasi mekanik adalah 70,73%. Faktor yang memengaruhi kegagalan penyapihan ventilasi mekanik adalah durasi ventilasi mekanik >14 hari dengan RR 2,079 (IK 95% 1,566-2,760, p<0,0001), obesitas dengan Indeks Massa Tubuh (IMT) ≥25 dengan RR 1,188 (IK 95% 1,016-1,389, p=0,031) dan Neutrofil Limfosit Rasio (NLR) pasca trakeostomi ≥11 dengan RR 1,244 (IK 95% 1,071-1,445, p=0,004).Simpulan: Proporsi kegagalan penyapihan ventilasi mekanik pasca trakeostomi pada pasien pneumonia berat adalah 70,73%. Faktor-faktor yang memengaruhi kegagalan penyapihan ventilasi mekanik adalah durasi ventilasi mekanik >14 hari, obesitas (IMT ≥25 kg/m2) dan NLR pasca Trakeostomi ≥11

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Background: The prevalence of severe pneumonia requiring mechanical ventilation continues to increase. A tracheostomy was performed to facilitate weaning from mechanical ventilation. Previous studies assessing factors related to weaning failure from mechanical ventilation after tracheostomy are few and show varying result.

Objective: This study aims to determine proportion and factors that influence failure to wean from mechanical ventilation after tracheostomy in patients with severe pneumonia.

Methods: This study used a retrospective cohort design from medical record data of patients treated in the ICU/HCU of RSUPN dr. Cipto Mangunkusumo between 2018-June 2022. Factors affecting failure to wean mechanical ventilation after tracheostomy in patients with severe pneumonia were obtained from the result of multivariate regression analysis.

Results: From a total 328 subjects who met the criteria, the proportion of weaning failure was 70,73%. Factors that influence failure to wean are duration of mechanical ventilation >14 days RR 2,079 (95% CI 1,566-2,760, p<0,0001), obesity (BMI ≥25 kg/m2) RR 1,188 (95% CI 1,016-1,389, p=0,031) and post-tracheostomy Neutrofil Lymphocyte Ratio (NLR) ≥11,RR 1,244 (95% CI 1,071-1,445, p=0,004).

Conclusion: The proportion of weaning failure from mechanical ventilation after tracheostomy in patients with severe pneumonia was 70,73%. Factors that influence weaning failure are duration of mechanical ventilation > 14 days, obesity (BMI ≥25 kg/m2) and post-tracheostomy NLR ≥11."