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"LATAR BELAKANG: Infeksi Saluran Reproduksi (ISR) merupakan masalah yang berdampak penting pada wanita hamil. Banyak faktor yang mempengaruhi terjadinya ISR, namun jarang sekali dilakukan penelitian mengenai hal ini.METODE: Dilakukan studi potong lintang dengan analisis kasus kontrol. Subyek ialah wanita hamil, yang tidak mengalami inkompetensia serviks, plasenta praevia, perdarahan per vaginam, ketuban pecah dini, atau karsinoma serviks, yang datang ke Poliklinik Antenatal Bagian Kebidanan dan Kandungan RSUPN Dr. Cipto Mangunkusumo Jakarta Juni-September 1998. Dari duh tubuh vagina dan serviks dibuat sediaan apus dengan pewarnaan Gram, sediaan basah dengan larutan NaCl fisiologis, biakan untuk gonokokus, dan pemeriksaan enzyme immuno assay untuk deteksi infeksi Chlamydia trachomatis. Dari darah vena dilakukan tes serologi sifilis. Analisis data menu unakan cara regresi logistik multinomial.HASIL: Dari 300 wanita hamil yang diperiksa, terdapat 28,4% menderita ISR dengan jenis terbanyak ialah kandidosis vaginalis (15%) , diikuti oleh vaginosis bakterial (9,3%), serta infeksi menular seksual (4%). Duh tubuh vagina bergumpal, dan duh tubuh vagina melekat di dinding berhubungan kuat dengan kandidosis vaginalis dengan berturut-turut odds ratio suaian (OR) 10,4 dengan 95% confidence interval (CI) 2,73 ; 39,59 dan OR suaian 4,05 (95% CI 1,16 ; 14,11) . Umur 17-24 tahun berisiko lebih tinggi mendapat PMS dengan OR suaian 9,91 (95% Cl 1,08 ; 90,68).KESIMPULAN: Pada wanita hamil, lebih dari seperempatnya dapat ditemukan ISR, sehingga perlu dipertimbangkan untuk menjadikan skrining ISR sebagai bagian dari pemeriksaan rutin antenatal. Faktor yang paling berhubungan dengan kejadian kandidosis vaginalis pada wanita hamil ialah duh tubuh bergumpal atau melekat di dinding. Risiko penyakit menular seksual paling tinggi pada kelompok umur 17-24 tahun.

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Risk factors of reproductive tract infection among pregnant women in Antenatal Clinic Dr. Cipto Mangankusumo General HospitalBACKGROUND: Reproductive tract infection (RTI) is an important problem especially for pregnant women. However, factors that can affect the occurrence of this infection are not well known.METHODS: We analyzed data derived from cross-sectional study. Study's subjects were pregnant women, who didn't experience cervix incompetence, placenta praevia, vaginal bleeding, premature rupture of the membrane, or carcinoma of the cervix, visited Antenatal Clinic of Obstetric and Gynecology Department dr. Cipto Mangunkusumo Hospital Jakarta July-September 1998, and the vaginal and cervical discharge were examined with Gram staining and wet mount, gonococcal culture, and for Chlamydia detection with enzyme immuno assay technique. Serology test of syphilis was also done. Data were then analyzed using the polytomous logistic regression.RESULTS: From 300 pregnant women examined, RTI was found in 28,4% with vaginal candidosis being the most prevalent (15%) followed by bacterial vaginosis (9,3%), sexually transmitted infection (4%). The thick and curdy vaginal discharge, and vaginal discharge adhered to vaginal wall were strongly associated with vaginal candidosis with adjusted odds ratio (OR) 10,40 with 95% confidence interval (95% CI) 2,73 ; 39,59 and adjusted OR 4,05 (95% Cl 1,16 ; 14,11) respectively. Pregnant women aged 17-24 years has a higher risk for sexually transmitted diseases with adjusted OR 9,91 (95% Cl 1,08 ; 90,68).CONCLUSION: RTI can be found in more than one-fourth pregnant women visiting antenatal clinic, so it was recommended to screen every pregnant women for RTI. The associated factor of candidosis vaginalis was thick and curdy vaginal discharge or discharge adhered to the vaginal wall The risk of sexually transmitted infection was more prominent among young aged pregnant women."

"Latar belakang. Pengaruh Diabetes Melitus Tipe-1 (DMT1) terhadap massa dan fungsi ventrikel kiri pada anak masih menjadi perdebatan.Tujuan. Untuk mengetahui gambaran massa dan fungsi ventrikel kiri pada anak DMT1.Metode. Dilakukan penelitian potong lintang dengan membandingkan massa, fungsi diastolik dan sistolik ventrikel kiri 30 anak DMT1 berusia 4 sampai dengan 18 tahun dengan 30 anak sehat sebagai kontrol yang bersesuaian jenis kelamin dan umur. Massa dan fungsi ventrikel kiri diperiksa dengan ekokardiografi.Hasil. Massa ventrikel kiri anak DMT1 lebih besar dari pada anak sehat, perbedaan ini bermakna. Faktor yang berhubungan dengan peningkatan massa tersebut adalah lama sakit dan tekanan darah. Fungsi diastolik pada anak dengan DMT1 berbeda bermakna dibanding anak sehat. Pola perubahan parameter fungsi diastolik anak DMT1 sesuai dengan gambaran disfungsi diastolik gangguan pola relaksasi. Faktor yang berhubungan dengan perubahan fungsi diastolik pada anak DMT1 adalah lama sakit. Untuk fungsi sistolik tidak ditemukan perbedaan yang bermakna.Kesimpulan. Pada anak dengan DMT1 terdapat peningkatan massa ventrikel kiri dan gangguan diastolik pola relaksasi. Perubahan massa jantung dan gangguan fungsi diastolik tersebut berhubungan dengan lama sakit dan tekanan darah.

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Background. The impact of Diabetes Mellitus type 1 (DMT1) on the left ventricular mass and functions in children remains controversial.

Objective: The aim of the study is to measure the left ventricular mass and function in children with DMT1.

Methods. A cross-sectional study was conducted to compare the mass and diastolic-systolic function of the left ventricle of 30 children with DMT1 and normal children aged 4 to 18 years that matched in sex and age. The left ventricular mass and diastolic-systolic function was assessed by echocardiography.

Results.Ventricular mass of children with DMT1 were significantly heavier than healthy ones. Factors associated with increased mass were the duration of illness and blood pressure. Diastolic functions in children with DMT1 were significantly different compared to healthy children. The patterns of changes were appropriate with the relaxation pattern of diastolic dysfunction. The factor associated with the change of diastolic parameters is the duration of illness. Significant differences were not found in the systolic function.

Conclusion. In children with DMT1 there was an increase of left ventricular mass and also diastolic dysfunction with the relaxation pattern. Changes in cardiac mass and diastolic dysfunction are associated with duration of illness and blood pressure."

"Latar belakang. Penyakit jantung bawaan PJB merupakan kelainan kongenital yang paling sering terjadi pada anak dibandingkan dengan kelainan kongenital lainnya. Upaya memperbaiki struktur anatomi PJB mengharuskan dilakukannya bedah jantung korektif. Di balik perkembangan pintas jantung paru dan tata laksana pasca-bedah, sindrom curah jantung rendah low cardiac output syndrome, LCOS masih menjadi komplikasi mayor, sehingga diperlukan parameter untuk membantu diagnosis LCOS secara dini. Kadar laktat, gap pCO2 dan SvO2 dilaporkan berkorelasi terhadap penurunan curah jantung, morbiditas dan mortalitas pasca-bedah jantung. Tujuan. Mengetahui peran kadar laktat, gap pCO2 arteri-vena dan SvO2 dalam deteksi dini sindrom curah jantung rendah pasca-bedah jantung terbuka pada anak. Metode. Penelitian ini menggunakan desain kohort prospektif dilaksanakan dari 1 Agustus hingga 30 Oktober 2017 di ICU Pelayanan Jantung Terpadu RSUPN Dr. Cipto Mangunkusumo. Subyek adalah pasien anak yang menjalani bedah jantung terbuka. Pasca-bedah saat perawatan di ICU pasien dimonitor waktu terjadinya tanda-tanda klinis sindrom curah jantung rendah, serta dilakukan pemeriksaan kadar laktat, gap pCO2 dan SvO2 pada 15 menit, 4 jam dan 8 jam pasca-bedah. Analisis perbedaaan dilakukan menggunakan uji indepent T-test dan alternatifnya Mann-Whitney dengan nilai kemaknaan P

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Background. Congenital heart disease CHD is the most common congenital disorder in children compared with other congenital abnormalities. To fix CHD requires corrective cardiac surgery. Behind the development of cardiopulmonary bypass surgery and post surgical intensive care, low cardiac output syndrome LCOS still become a major complication that require parameter to diagnose LCOS early lactate level, pCO2 gap and SvO2 were reported have correlation with decreasing of cardiac output, morbidity and post cardiac surgery mortality.

Objective. To find out the role of lactate levels, pCO2 gap arterial vein and SvO2 in early detection of low cardiac output syndrome in post open heart surgery in children.

Method. This study used a prospective cohort design. From 1 August until 30 October 2017 in ICU of Integrated Cardiac Centre Dr. Cipto Mangunkusumo Hospital. Subjects were pediatric patients who underwent cardiac surgery. Post surgery procedure the patient's was monitored in ICU for clinical signs of low cardiac output syndrome and examined for lactate levels, gap pCO2 and SvO2 at 15 minutes, 4 hours and 8 hours. The difference analysis was performed using indepent T test and Mann Whitney as alternative with significance value P"

"ABSTRAKPada operasi koreksi penyakit jantung bawaan PJB dengan teknik pintas jantung paru PJP , proses sindrom respons inflamasi sistemik SRIS sering menjadi penyulit pascaoperasi. Disfungsi mitokondria pada SRIS diawali dengan pelepasan mediator inflamasi TNF-. Dampak cedera neurologis pascabedah belum dapat dihindari. Biomarker Brain derived protein S100B dapat digunakan sebagai penanda hipoksia serebral akibat disfungsi mikrosirkulasi dan mitokondria pada operasi PJB. Pemantauan keadaan hipoksia serebral diperlukan karena kejadian awal defisit neurologis sering tidak menimbulkan manifestasi klinis. Near infrared spectroscopy NIRS merupakan salah satu alat yang dapat memantau penghantaran oksigen ke otak dengan mengukur saturasi oksigen serebral SctO 2 . Penelitian ini bertujuan untuk mengevaluasi peran S100B, sTNFR-1, laktat, saturasi vena cava superior dan saturasi oksigen serebral sebagai prediktor kejadian defisit neurologis pada operasi koreksi PJB. Penelitian ini bersifat kohort propsektif. Kriteria inklusi adalah pasien anak dengan PJB usia 1 bulan minus;6 tahun yang menjalani operasi koreksi. Kriteria eksklusi adalah pasien anak dengan sindrom Down, dengan arteri koroner tunggal, dan yang orang tuanya menolak berpartisipasi dalam penelitian. Dalam analisis, subjek dibagi menjadi 2 kelompok yakni kelompok 1 mengalami defisit neurologis dan kelompok 2 tidak mengalami defisit neurologis . Semua subjek dipantau selama perawatan di ICU, dan tetap diikuti sampai keluar rumah sakit. Pemeriksaan darah dilakukan dalam tiga kali pemantauan: pra-operasi, akhir PJP, dan 4 jam pasca-PJP. Monitoring NIRS dilakukan selama 24 jam pascabedah di ICU. Selama periode Maret 2015 minus;Oktober 2015, didapatkan 51 pasien yang diteliti. Terdapat perbedaan proporsi yang bermakna antara konsentrasi S100B, sTNFR-1, laktat, dan NIRS AUC 20 baseline saturasi serebral pasien PJB pascabedah koreksi dengan PJP pada kelompok berdasarkan defisit neurologis. Parameter tersebut dapat dipakai sebagai model prediktor kejadian defisit neurologis pascabedah jantung dengan PJP. Nilai S100B, sTNFR-1, laktat, dan nilai NIRS AUC 20 dari baseline saturasi serebral dapat digunakan sebagai prediktor kejadian defisit neurologis pascabedah pada operasi PJB dengan mesin PJP.

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In congenital heart disease CHD surgery using cardiopulmonary bypass CPB machine, systemic inflammation response syndrome SIRS process often causes post-operation complication. Mitochondria dysfunction in SRIS starts with the release of inflammation mediator TNF-? and sTNFR-1. Neurological injury after pediatric congenital heart surgery still cannot be avoided. Study about brain derived protein S100B as a biomarker for cerebral hypoxia caused by microcirculation and mitochondria disfunction as SRIS consequence in PJP in pediatric CHD surgery has yet to be conducted. Observation to find cerebral hypoxia is needed because the early stages of cerebral hypoxia often not show any symptoms. NIRS is one of the tools for observing oxygen delivery to the brain by measuring the cerebral oxygen saturation SctO 2 . In Indonesia, NIRS is still not common to be used and there are no studies about it yet. This study aimed to evaluate the role of S100B, sTNFR-1, lactate, saturation of superior vena cava and cerebral saturation as the predictor of neurological deficiency incidence on correction of CHD. This was a prospective cohort research. Inclusion criteria were children with CHD aged 1 month minus;6 years old who underwent corrective operation. Exclusion criterias were children with Down syndrome, with single coronary artery, and whose parents declined to participate in this study. In analysis, subjects were divided into 2 groups; group 1 with neurological deficit and group 2 without neurological deficit. All subjects were observed closely while they were in ICU, observed until they discharge from hospital. Blood examination were done 3 times: before surgery, after CPB, and 4 hours after CPB. Monitoring of NIRS was done during 24 hours after surgery in ICU. During March minus;October 2015, there were 51 patients included. There are significant difference for value of S100B, STNFR-1, lactate, and NIRS AUC 20 baseline of cerebral saturation between groups based on neurological deficit occurrence. Those parameters could be used as predictor of neurologic deficiency incidence post operation using CPB in CHD children. In CHD patients who underwent corrective operation with CPB, S100B value, sTNFR1, lactate, and AUC 20 baseline of cerebral saturation could be used as predictor of neurologic deficit after corrective operation."

"Penggantian katup aorta dengan katup mekanik memerlukan biaya mahal, meningkatkan risiko endokarditis dan tromboemboli, serta memerlukan antikoagulan seumur hidup. Perikardium autolog merupakan alternatif untuk penggantian katup aorta. Tujuan penelitian ini adalah membandingkan luaran penggantian katup aorta antara katup mekanik dan perikardium autolog dengan teknik strip tunggal perikardium. Penelitian ini merupakan uji klinis terandomisasi di Pelayanan Jantung Terpadu Rumah Sakit Cipto Mangunkusumo (PJT-RSCM). Subjek dibagi ke dalam 2 kelompok berdasarkan jenis katup yang diterima, yaitu katup mekanik (kelompok mekanik) dan strip perikardium (kelompok strip). Luaran left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), dan kadar soluble suppression of tumorigenicity-2 (sST-2) diperiksa preoperasi, 3 bulan, dan 6 bulan pascabedah. Terdapat 34 subjek yang ikut serta dari Juli 2016-Februari 2022, 17 subjek pada masing-masing kelompok. Tidak terdapat beda kejadian LVRR pada kedua kelompok, yaitu 26,7% pada kelompok mekanik dan 29,4% pada kelompok strip (p = 0,703). Pada pemeriksaan jarak 6 minute walking test (6MWT) tidak terdapat perbedaan bermakna jarak 6MWT antara kelompok strip perikardium dan kelompok mekanik pada 6 bulan pascabedah, yaitu 431,93 (SB 93,41) m vs. 404,28 (SB 79,25) m, p = 0,427 pascabedah. Kadar sST-2 kelompok mekanik 16,12 (SB 5,92) pg/mL secara bermakna lebih tinggi dibandingkan kelompok strip 11,52 (SB 6,96) pg/mL, p = 0,023) pada 6 bulan pascabedah. Disimpulkan teknik strip tunggal perikardium memiliki luaran yang sebanding dengan katup mekanik sehingga dapat digunakan sebagai alternatif penggantian katup aorta.

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Aortic valve replacement with mechanical valves are quite expensive, increased the risk of adverse events such as endocarditis and thromboembolism, and requires patients to take anticoagulants for the rest of their life. Autologous pericardium is an alternative for aortic valve replacement. This study aims to compare outcomes of aortic valve replacement using mechanical valve and prosthetic valve with single-strip pericardium technique. This was a randomized clinical trial conducted at the Cipto Mangunkusumo Hospital (PJT-RSCM). Eligible subjects were randomized to either receive mechanical valve (mechanical group) or single-strip pericardium (single-strip group). Outcome assessments of left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), and soluble suppression of tumorogenicity-2 (sST-2) were carried out at preoperation, 3 months, and 6 months postoperation. There were 34 subjects recruited from July 2016 to February 2022, 17 subjects in each groups. There was no difference in postoperative LVRR incidence between both groups, 26.7% in mechanical group vs. 29.4% in single strip group (p = 0.703). There was no significant difference of 6MWT between the mechanical and pericardial strip at six months post-operation, 404.28 (SD 79.25) m vs. 431.93 (SD 93.41) m, p = 0.427. The sST-2 level is significantly higher in mechanical group 16.12 (SD 5.92) pg/mL compared to single strip group 11.52 (SD 6.96) pg/mL, p = 0.023 at six months post-operation. We concluded that single strip pericardium technique showed comparable outcomes to mechanical valve and is considered a feasible alternative for aortic valve replacement."

"Pertumbuhan mukosa usus manusia belum sempurna saat dilahirkan, karena itu usus bayi sering dikatakan sebagai leaky gut. Probiotik diketahui dapat membantu maturasi saluran cerna. Apakah dalam ASI memang terdapat probiotik ataukah suatu kontaminasi, masih diperdebatkan.Penelitian ini bertujuan untuk mengetahui apakah probotik ada dalam ASI bila diberikan suplementasi probiotik pada ibu hamil sejak trimester III dan menyusui, efek terhadap probiotik lain dan IL-8 dalam ASI, IFABP urin dan alfa-1-antitripsin (AAT) serta kalprotektin tinja, saat bayi lahir dan usia tiga bulan, dalam rangka menilai integritas mukosa usus.Dilakukan penelitian uji klinis, paralel dua kelompok dengan randomisasi, samar ganda yang dilakukan di RS Budi Kemuliaan dan klinik-klinik satelitnya sejak Desember 2014 sampai dengan Desember 2015. Jumlah subjek 35 per kelompok. Digunakan probiotikBifidobacterium animalis lactis HNO19 karena bukan merupakan resident bacteria.Lima subjek positif DR10 dalam kolostrum (V0) dan 7 subjek positif saat bayi usia 3 bulan (V3) pada kelompok probiotik. Hasil negatif didapati pada kelompok plasebo. Apusan kulit sekitar payudara negatif pada kedua kelompok. Nilai median IL-8 kelompok probiotik dibanding kelompok plasebo pada V0 dan V3 berturut-turut 2810,1 pg/mL vs. 1516,4 pg/mL (p = 0,327) dan 173,2 pg/mL vs. 132,7 pg/mL (p = 0,211). IFABP V0 dan V3 211,7 ng/mL vs. 842,5 ng/mL (p = 0,243) dan 25,3 ng/mL vs. 25,1 ng/mL (p = 0,466). AAT 136,2 mg/dL vs. 148,1 mg/dL (p = 0,466) dan 24 mg/mL vs. 29,72 mg/mL (p = 0,545). Kalprotektin 746,8 ng/mL vs. 4645,2 ng/mL (p = 0,233) dan 378,6 ng/mL vs. 391,3 ng/mL (p = 0,888).Probiotik DR10 yang diberikan pada ibu hamil sejak trimester III dapat ditemukan dalam kolostrum dan usia 3 bulan pada kelompok probiotik, dan bukan suatu kontaminasi .Tidak terdapat perbedaan bermakna terhadap probiotik lain, kadar IL-8 dalam ASI, IFABP urin, AAT dan kalprotektin tinja pada kelompok probiotik dibanding dengan kelompok plasebo.

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Newborn infants have intestinal hyperpermeability because their gut mucosa is not fully mature yet. It is known that probiotics helps gut maturity. It remains unclear whether probiotics pass through breast milk or whether the positive cultures are the result of contamination. This study aimed to evaluate the effect of probiotic supplementation in pregnant and lactating mothers, with regards to probiotic presence and IL-8

concentration in breast milk, infant urine intestinal fatty acid binding protein (IFABP), as well as fecal ?-1 anti-trypsin (AAT) and calprotectin at birth (V0) and at infant 3

months of age (V3) .

This randomized, controlled trial was double-blind, two parallel groups, probiotic and placebo with 35 subjects in each group. The sudy was done at Budi Kemuliaan Hospital and it’s satellite clinics from December 2014 until December 2015. We used Bifidobacterium

animalis lactis HNO19 (commonly known as DR10) as the supplemental probiotic, as it is not a member of the normal flora.

Probiotik DR10 were found in colostrum at 5 subjects and 7 subjects in V3 breastmilk probiotics group, but none in placebo group. Skin swab of DR10 were negative in both group. Median breast milk IL-8 in probiotic group compare to placebo group at V0 and V3 respectively were 2810.1 pg/mL vs. 1516.4 pg/mL (p = 0.327) and 173.2 pg/mL vs. 132.7 pg/mL (p = 0.211). Infant urine IFABP 211.7 ng/mL vs. 842.5 ng/mL (p = 0.243) and 25.3 ng/mL vs. 25.1 ng/mL (p = 0.466). Infant stool AAT 136.2 mg/dL vs. 148.1 mg/dL (p = 0.466) and 24 mg/mL vs. 29.72 mg/mL (p = 0.545). Stool calprotectin 746.8 ng/mL vs. 4645.2 ng/mL (p = 0.233) and 378.6 ng/mL vs. 391.3 ng/mL (p = 0.888).

Probiotic DR10 were found in colostrum and 3 month-breast milk of women in the probiotic group, but no DR10 in placebo group. However, breast milk IL-8, the presence of other probiotics, and infant gut mucosal integrity were not significantly different between the two groups."