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"Trombo-emboli vena (TEV) umum dijumpai pada pasien rawat inap dan dipertimbangkan sebagai suatu komplikasi tidak hanya bagi pasien post bedah tetapi juga pada pasien dengan kondisi medis lainnya. Kebanyakan pasien rawat inap yang mengalami TEV ataupun emboli paru tidak menjalani prosedur bedah sebelumnya. Beberapa studi besar acak, tersamar ganda dan dengan plasebo seperti MEDENOX, PREVENT dan ARTEMIS telah memastikan manfaat dan keamanan dari tromboprofilaksis terhadap TEV terhadap pasien rawat inap dengan kondisi medis akut. Panduan tahun 2008 dari The American College of Chest Physicians (ACCP) merekomendasikan penilaian risiko bagi setiap pasien dengan kondisi medis tertentu pada saat masuk rumah sakit dan profilaksis VTE, baik dengan regimen antikoagulan ataupun pencegahan secara mekanik, sebaiknya diterapkan bagi mereka yang tergolong berisiko tinggi. Studi-studi lainnya menunjukkan bahwa banyak kasus VTE pada pasien medis terjadi setelah keluar dari perawatan rumah sakit, namun hingga kini belum ada publikasi perihal uji klinis maupun rekomendasi untuk mengevaluasi profilaksis VTE bagi pasien medis rawat jalan. Pada artikel ini, kami mencoba mengulas beberapa literatur untuk kepentingan penilaian risiko dan profilaksis VTE bagi pasien medis rawat inap.

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AbstractVenous thromboembolism (VTE) is commonly found in hospitalized patients, considered as complication not only in surgical patients but also in medical patients. The vast majority of hospitalized patients with VTE or pulmonary embolism have not undergone any recent surgery. Several large randomized, double-blind, placebo controlled trials including MEDENOX, PREVENT and ARTEMIS have confirmed the efficacy and safety of VTE thromboprophylaxis for acutely ill medical inpatients. The American College of Chest Physicians (ACCP) Guidelines 2008 recommend a risk assessment at the time hospital admission for every medical patients and VTE prophylaxis using either anticoagulant medications or mechanical prevention should be applied for those who have high risk condition. Other studies showed that many cases of VTE in medical patients occur after hospital discharge, but still no clinical trials and current recommendation evaluating VTE prophylaxis for medical outpatients have been published yet. In this article, we attempt to review the literatures on importance of risk assessment and VTE prophylaxis for hospitalized medical patients."

"Inflamasi periodontal merupakan kelainan periodontal dengan prevalensi tinggi di masyarakat. Periodontitis kronis dipengaruhi oleh akumulasi plak dan kalkulus sebagai faktor local, ditambah faktor sistemis misalnya diabetes mellitus (DM) dan infeksi HIV. Sitokin terutama IL-1β sebagai mediator inflamasi utama penyakit periodontal, menstimulasi ekspresi iNOS (inducible nitric oxide synthase) dan produksi NO (nitric oxide) oleh sel β, menyebabkan disfungsi sel β. Leukotoksin dan protease yang dihasilkan patogen periodontal menyebabkan jejas kemotaktik dan fagositotik, dan menurunkan fungsi fagositosis PMN. Hiperglikemia pada penyandang DM menyebabkan peningkatan kadar kalsium sitosol (Ca2+), yang menyebabkan disfungsi PMN dan menurunkan fungsi fagositosis. Advanced glycosilation endproduct pada DM tipe 2 berikatan dengan monosit menyebabkan peningkatan sitokin proinflamasi (IL-1, TNFα) dan menyebabkan aktivasi makrofag dan osteoklas. Hiperglikemia menyebabkan aktivasi diasil gliserol (DAG)-protein kinase C (PKC), yang menyebabkan peningkatan PGE2 dan ekspresi sitokin yang mempengaruhi proses inflamasi dan destruksi. Penelitian tentang pengaruh scaling (pembersihan karang gigi sebagai tindakan non-bedah pada terapi periodontal) pada penyandang DM terhadap kadar gula darah dan respons imun selular belum pernah dilakukan di Indonesia. Penelitian ini bertujuan menganalisis pengaruh pembersihan karang gigi terhadap kadar IL-1β, fungsi fagositosis PMN dan kadar glukosa darah penyandang DM tipe 2. Subyek penelitian adalah penyandang DM tipe 2, 60 penyandang DM Terkendali dan 60 penyandang DM Tidak Terkendali di Poliklinik Metabolik-Endokrin RSUPN Ciptomangunkusumo, umur 40-60 tahun. Subyek dibagi menjadi kelompok perlakuan dan kelonpok tanpa perlakuan, untuk menilai respons imun selular dan status DM, sebelum dan 6 minggu sesudah perlakuan. Analisis statistik (t test) dengan komputer menggunakan perangkat Stata 7,0 dilakukan untuk membandingkan parameter sebelum dan sesudah scaling pada kedua kelompok. Hasil penelitian menunjukkan bahwa scaling dapat menurunkan kadar IL-1β dan meningkatkan fungsi fagositosis secara bermakna (P<0,05), menurunkan kadar glukosa puasa, glukosa 2 jam PP dan kadar HbA1c, tetapi penurunannya secara statistik tidak bermakna (P>0,05), kecuali penurunan kadar HbA1c pada DM Tidak Terkendali (P=0,00).

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AbstractPeriodontal inflammation is a periodontal disorder of high prevalence in the population. Chronic periodontitis is associated with the accumulation of plaque and calculus as local factors, and systemic factors such an diabetes mellitus (DM) and HIV infection. Cytokine, especially IL-1β as inflammatory mediator for periodontal disease, may directly stimulated iNOS (inducible nitric oxide synthase) expression and NO (nitric oxide) production by β-cells, resulting in NO-mediated β-cell damage. The leucotoxin and proteases produced by periodontal pathogens will induce chemotactic and phagocytotic defect; therefore causing decreased PMN phagocytotic function. Hyperglicemia which occurs in diabetic patients increases calcium influx to the cell, resulting in the increased cytosol?s calcium ([Ca 2+]i) level and; therefore, resulting in dysfunction of PMN and impaired PMN phagocytotic function. Advanced glycosilation endproduct in NIDDM binds to monocytes resulting in the increase of pro-inflammatory cytokines (IL-1, TNFβ) and produces activation of macrophages and osteoclasts. Hyperglicemia activates diacyl glycerol (DAG)-protein kinase C (PKC), thus increasing PGE2 and cytokine expression that induce inflammation and periodontal tissue destruction processes. Studies on the effect of scaling to remove calculus disposition on blood glucose control and cellular immune response in DM patient has never been carried out. The aim of the study was to analyze the effect of scaling as non-surgical periodontal therapy on immune response (IL-1β level and PMN phagocytotic function) and blood glucose level of type 2 diabetic patients. Subjects were diabetic patients, 60 controlled-DM (CDM) and 60 uncontrolled-DM (UCDM), in Metabolic-Endocrinology Clinic of Ciptomangunkusumo Hospital, aged 40-60 years. The subjects were divided into treatment (scaling) and control group, and cellular immune response and diabetic status, before and 6 weeks after treatment were evaluated. Statistical analysis (t test) were done using Stata 7.0 software, to compare the parameters before and after scaling in CDM and UCMD subjects. The results showed that scaling decreased IL-1β level and increased phagocytotic function significantly (P<0.05). Scaling decreased fasting and 2 hours post-prandial blood glucose levels and HbA1c level, but the decrease were not significant statistically (P>0.05), except for the decrease in HbA1c level in uncontrolled DM (P=0.00)."

"The present study investigated the effect of non-surgical periodontal therapy on serum level of anti-cardiolipin antibodies (aCLA), which are potentially involved in the pathogenesis of cardiovascular diseases in periodontal patients. Twenty volunteers (11 females and 9 males) with the mean age of 40.55 years participated in this study. Generalized chronic periodontitis was diagnosed through clinical periodontal examination at baseline visit. This examination included measuring the probing pocket depth and clinical attachment loss. Plaque index and gingival index were also recorded. After baseline examination, all the subjects received full-mouth non-surgical periodontal treatment. Subjects returned for a final visit 6 weeks after the last session of scaling for reevaluation of the periodontal parameters. At baseline and final visits 2 ml of venous blood was collected from each patient and an available commercially enzyme-linked immunosorbent assay was used for analyzing aCLA (IgM and IgG). The collected data were analyzed using the paired sample t test. Mean levels of both forms of aCLA, before and after treatment, showed statistically significant difference (P = 0.003 for IgM and P = 0.001 for IgG). In addition, study results showed significant reductions in periodontal parameters after non-surgical periodontal therapy (P < 0.001). The results of this study suggested that successful periodontal therapy can improve the serum level of one of the inflammatory biomarkers involved in the cardiovascular problems."

"Skabies penyakit kulit yang disebabkan oleh Sarcoptes scabiei yang sering terjadi pada orang-orang yang hidup di dalam lingkungan yang padat misalnya di ruang perawatan penderita kusta. Penelitian ini dilakukan di Rumah Sakit Kusta Sitanala, Tangerang. Semua penderita kusta yang dirawat di rumah sakit ini diperiksa secara klinis maupun parasitologis untuk menetapkan diagnosis skabies. Hasil penelitian menunjukkan bahwa prevalensi skabies pada penderita kusta cukup tinggi dan lebih banyak terdapat pada penderita kusta lepromatosa."

"Tujuan : untuk mengetahui kejadian VTE pada pasien Indonesia yang menjalani bedah ortopedi mayor dan tidak menerima tromboprofi laksis.Metode Uji klinik terbuka pada pasien Indonesia yang menjalani bedah ortopedi mayor, dilakukan di 3 senter di Jakarta. Venografi bilateral dilakukan antara 5 dan 8 hari pasca bedah untuk menemukan VTE yang asimptomatik dan memastikan VTE yang simptomatik. Pasien dievaluasi hingga 1 bulan pasca bedah.Hasil Telah diteliti 17 pasien dengan median usia 69 tahun dan 76,5% di antaranya perempuan. Enam belas dari 17 pasien (94,1%) menjalani bedah fraktur panggul. Median waktu antara fraktur dengan tindakan adalah 23 hari (antara 2 sampai 197 hari), median lamanya tindakan bedah 90 menit (antara 60 sampai 255 menit), dan median lamanya imobilisasi 3 hari (antara 1 sampai 44 hari). Tiga belas dari 17 pasien menjalani venografi kontras untuk mendeteksi VTE yang asimtomatik. VTE ditemukan pada 9 dari 13 pasien (69,2%) saat akan keluar dari rumah sakit (RS). VTE yang simtomatik ditemukan pada 3 pasien (23,1%), semuanya dengan tanda-tanda klinis DVT dan tidak seorangpun dengan tanda klinis embolisme paru (PE). Pasien tersebut diobati dengan heparin berat molekul rendah, dilanjutkan dengan antikoagulan oral warfarin. Tidak ada kematian mendadak sampai pasien keluar dari RS. Tidak ada kasus VTE simtomatik baru sejak keluar dari RS sampai 1 bulan kemudian. Tidak ditemukan kematian mendadak, komplikasi pendarahan, ataupun perawatan ulang di RS dalam studi ini.Kesimpulan Insidens VTE asimtomatik sebesar 69,2% dan simtomatik 23,1% setelah bedah ortopedi mayor tanpa tromboprofi laksis. Studi yang lebih besar dibutuhkan untuk memastikan insidens yang benar, dan yang lebih penting, untuk menggunakan tromboprofi laksis pada pasien-pasien ini.

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Aim To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis.

Methods This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confi rm the symptomatic VTE. These patients were followed up to one month after surgery.

Results A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1%) underwent hip fracture surgery (HFS). The median time from injury to surgery was 23 days (range 2 to 197 days), the median duration of surgery was 90 minutes (range 60 to 255 minutes), and the median duration of immobilization was 3 days (range 1 to 44 days). Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2%) at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%), all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study.

Conclusion The incidence of asymptomatic (69.2%) and symptomatic (23.1%) VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA), and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted."

"Liver cirrhosis is a chronic and irreversible disease. The patients quality of life (QOL) may be impaired because of long-standing burden of the disease. This research was a cross-sectional study conducted at Dr. Sardjito Hospital, Yogyakarta to determined the QOL of patients with liver cirrhosis who hospitalized in this institution. The parameter for the QOL was measured according to Spitzer index. Sixty-five patients with liver cirrhosis of various etiology were abled to be studied. The number of male and female patients were almost equal (30 and 35 respectively). There was a reduction in QOL in both male (21/30) and female (28/ 35) but no significant different between this variable. There was a significant positive correlation between Child criteria, and nutritional status with QOL (r=0.68, p<0.05 and r=0.37, p<0.05). It was concluded that Child criteria and nutritional status were positively correlated with QOL."

"Background: older people contributed to 38.6% of death cases related to COVID-19 in Indonesia. Data regarding clinical profile of hospitalised elderly with COVID-19 in Indonesia were still lacking. Older people are at-risk population in the pandemic, whom we should pay attention to. Methods: this single centre descriptive study utilised complete data of elderly inpatients with COVID-19 in Indonesia’s national general hospital from April to late August 2020. The data consisted of clinical characteristics, symptoms, comorbidities, multimorbidity, and mortality outcome. Results: among elderly patients (n=44), a majority of patients were aged 60-69 years (68%), were male (66%), and had no history of close contact with COVID-19 patient (86%). The most common symptoms were fever, cough and shortness of breath (classic symptoms of COVID-19), whereas the most common chronic diseases were diabetes mellitus, hypertension, and malignancy. Multimorbidity was only found in 14% of patients, all of whom remained alive following SARS-CoV-2 infection. The death rate among elderly inpatients with COVID-19 in this study was 23%, and male older adults contributed to 90% of death cases. Conclusion: male patients dominated both confirmed cases and death cases among elderly with COVID-19. Classic symptoms of COVID-19 were only found in about half of the study patients. Non-survivors had higher percentage of the classic symptoms of COVID-19 than survivors. Atypical COVID-19 presentations are possible in older adults. We postulated that immunosenescence and sex-specific immunoregulatory function play an important role in causing death in this study cohort."

"AbstrakVenous thromboembolism (VTE) is a fatal yet potentially preventable complication of surgery. Routine thromboprophylaxis is still unequivocal prescription is problematic due to perception of low VTE incidence among Asian population. This study aims to investigate the incidence of VTE and thromboprophylaxis prescription among patients undergoing major surgery in a Singapore hospital.Methods: This was a cross-sectional study. Data were obtained from medical record of 1,103 patients who had underwent major orthopaedic or abdominal surgery in 2011-2012 at Khoo Teck Puat Hospital, Singapore. Incidence of VTE events either in the same admission or re-admission in less than one month time were noted as study parameters.Results: Incidence of VTE was 2.1% (95% CI: 1.67 - 2.53) of which 1.3% and 0.8% were DVT and PE cases respectively. Age, gender, history of VTE, ischemic heart disease, and mechanical prophylaxis were associated with VTE incidence based on bivariate analysis. The prescription of pharmacological thromboprophylaxis was associated with prior anticoagulant medication, type of surgery, and incidence of new bleeding.Conclusion: Subsequent to major surgeries, VTE is as common in Asian patients as published data in other populations. Pharmacologic thromboprophylaxis should be considered as recommended in non-Asian guidelines."

"Chronic venous insufficiency (CVI) merupakan salah satu gangguan pada sistem vaskular Bagian dari sistem vaskular yang dipengaruhi oleh CVI yaitu sistem vena pada ekstremitas bawah. Hal ini menganggu aliran darah pada ekstremitas bawah sehingga dapat menimbulkan komplikasi luka, nyeri, dan keterbatasan rentang gerak pergelangan kaki. Masalah keperawatan yang ditegakkan yaitu nyeri akut dan gangguan integritas kulit. Karya Ilmiah Akhir Ners (KIAN) ini menguraikan analisis asuhan keperawatan dan penerapan range of motion pada pasien dengan CVI untuk meningkatkan keterbatasan rentang gerak pada pergelangan kaki dan penyembuhan luka. Hasil evaluasi dari penerapan tersebut menunjukkan peningkatan rentang gerak pergelangan kaki dari 100 menjadi 150 tetapi tidak ada peningkatan penyembuhan luka selama 6 hari perawatan. Selain itu, terdapat penurunan nyeri dari skala 6 menjadi 5. Berdasarkan hasil tersebut diharapkan latihan ROM dapat diterapkan pada pelayanan kesehatan terutama pada pasien CVI dengan keterbatasan rentang gerak pergelangan kaki.

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Chronic venous insufficiency (CVI) is one of the disorders that affects vascular system. Part of the vascular system that is affected by CVI is venous system in the lower extremities. This disrupts blood flow in the lower extremities which may cause complications such as venous leg ulcer. The main nursing problem in this case is impaired skin integrity. This nursing scientific paper aims to elaborate analysis of nursing care and range of motion application in patient with CVI to increase ankle ROM limitation and wound healing. Evaluation of the ROM application shows increase in ankle ROM from 100 to 150 during 6 days of care. However, there is no increase in the healing rate after 6 days of application. According to the evaluation, ROM exercise is proposed to be applied in healthcare services particularly for CVI patients with ankle ROM limitations"

"ABSTRAKLatar belakang : Kunjungan dan angka mortalitas pasien di Instalasi Gawat Darurat (IGD) semakin meningkat dengan kondisi penyakit yang bervariasi, sehingga deteksi yang cepat dan tepat pada pasien dengan risiko mortalitas tinggi sangat penting. Skor Hypotension, Oxygen Saturation, Low Temperature, ECG Changes, and Loss of Independence (HOTEL) sangat baik dan penting untuk diterapkan pada pasien gawat darurat karena menggunakan variabel-variabel yang mudah dan cepat diperoleh. Namun demikian skor tersebut belum divalidasi di Indonesia.Tujuan : untuk menilai performa skor HOTEL dalam memprediksi mortalitas 24 jam pasien non bedah di IGD Rumah Sakit Cipto Mangunkusumo (RSCM).Metode: Penelitian ini merupakan studi kohort retrospektif. Subjek penelitian adalah pasien non bedah yang masuk ke IGD RSCM pada bulan Oktober hingga November 2012. Variabel bebas yang dinilai adalah tekanan darah sistolik, saturasi oksigen perifer, suhu tubuh, perubahan elektrokardiogram (EKG), dan kemampuan berdiri tanpa bantuan. Luaran yang dinilai adalah mortalitas dalam 24 jam setelah masuk IGD. Performa kalibrasi dinilai dengan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC).Hasil: Terdapat 815 pasien non bedah yang datang ke IGD RSCM selama bulan Oktober hingga November 2012. Sebanyak 804 (98,7%) subjek memenuhi kriteria inklusi dengan mortalitas 24 jam sebesar 30 (3,7%) subjek. Performa kalibrasi HOTEL dengan uji Hosmer-Lemeshow menunjukkan p = 0,753. Performa diskriminasi ditunjukkan dengan nilai AUC 0,86 (IK 95% 0,781; 0,931).Simpulan: Skor HOTEL memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 24 jam pada pasien non bedah yang masuk ke IGD RSCM.

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ABSTRACT

Background: The number of visit and mortality rate of emergency patients at Emergency Department (ED) have been increasing from time to time. Those patients have wide spectrum conditions. Appropriate identification of the patients with high mortality risk is crucial. The Hypotension, Oxygen Saturation, Low Temperature, ECG changes, and Loss of Independence (HOTEL) score is easy and important to be applied in the ED, however, the score has not been validated in Indonesia.

Objective: to evaluate performance of HOTEL score in predicting the 24-hour mortality non-surgical patients in ED of Sakit Cipto Mangunkusumo hospital.

Method: This was a retrospective cohort study. The research subjects were the non-surgical patients who admitted to ED of RSCM between October-November 2012. We collected systolic blood pressure, peripheral oxygen saturation, body temperature, ECG changes, and loss of independence. Those data were evaluated based on the HOTEL scoring system. The outcome were evaluated in 24- hour after admission (alive or dead). The calibration was evaluated with the Hosmer-Lemeshow test. The discrimination performance was evaluated with area under the curve (AUC).

Results: There were 815 non-surgical patients admitted to the ED between October until November 2012. There were 804 (98,7%) subjects included. The 24-hour mortality rate was 30 subjects (3,7%). The calibration performance with the Hosmer-Lemeshow test showed p = 0,753. The discrimination performance was shown with the AUC score 0,86 (95% CI 0.781; 0.931).

Conclusion: The HOTEL score has a good calibration and discrimination performance in predicting the 24-hour mortality of the non-surgical patients in ED of Cipto Mangunkusumo hospital."