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"ABSTRAKLatar Belakang. Biomarker dapat digunakan untuk memprediksi derajat keparahan trauma kepala.Tujuan. Mengetahui hubungan antara kadar S100B dengan derajat keparahan trauma kepala dan kelainan CT scan kepala.Metode Penelitian. Penelitian potong lintang di IGD RSUPN Cipto Mangunkusumo, RSUP Fatmawati, dan RS Permata Cibubur selama Juli-Desember 2015. Subjek adalah anak usia 1-18 tahun yang mengalami trauma kepala dengan onset <24 jam. Setiap subjek dilakukan pemeriksaan skor Skala Koma Glasgow Pediatrik, pemeriksaan CT scan kepala bila terdapat indikasi, serta pemeriksaan kadar S100B dari serum.Hasil Penelitian. Subjek penelitian terdiri atas 20 subjek trauma kepala ringan dan 18 subjek trauma kepala sedang. Hasil penelitian menunjukkan terdapat perbedaan bermakna kadar S100B kelompok trauma trauma kepala sedang dan kepala ringan; median (rentang) 0,173 (0,054-0,812) μg/L dibandingkan 0,067 (0,039-0,084) μg/L, p<0,001. Selain itu juga terdapat perbedaan bermakna antara kelompok yang terdapat kelainan CT scan kepala dibandingkan dengan yang tidak ada kelainan; 0,124 (0,051-0,812) μg/L dan 0,067 (0,039-0,084) μg/L, p=0,001. Berdasarkan analisis ROC, kadar S100B serum sangat kuat untuk memprediksi trauma kepala sedang (AUC 0,818, p=0,001 dan IK95% 0,668-0,969) dengan nilai cut-off 0,083 μg/L.Simpulan. Kadar S100B serum pada trauma kepala sedang secara bermakna lebih tinggi dari trauma kepala ringan serta memiliki kemampuan diskriminasi sangat baik untuk memprediksi derajat keparahannya.

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ABSTRACT

Background. Biomarker has ability to predict the severity of TBI and abnormal CT scan.

Objectives. To determine the association between S100B level with the severity of pediatric TBI and intracranial injury.

Methods. A cross-sectional study at Emergency Department of RSUPN Cipto Mangunkusumo, RSUP Fatmawati, and Permata Cibubur Hospital on July- December 2015. Subjects were 1-18 year-old children with TBI, onset within 24 hours before admission. We measured Pediatric GCS score, serum S100B level, and performed cranial CT scan if indicated.

Results. Twenty subjects had mild TBI and 18 subjects had moderate TBI were included. S100B levels were higher in children with moderate TBI as compared to children with mild TBI; 0,173 (0,054-0,812) μg/L vs 0,067 (0,039-0,084) μg/L, p<0,001. S100B levels were significantly elevated in children following TBI with abnormal cranial CT scan as compared to children with a normal CT scan (0,124 (0,051-0,812) μg/L vs 0,067 (0,039-0,084) μg/L, p=0,001). AUC for S100B was also significant (0,818, p=0,001, CI95% 0,668-0,969) as prediction of moderate TBI with cut-off point 0,083 μg/L.

Conclusions. Children with moderate TBI had significantly higher S100B levels as compared to children with mild TBI. Cut-off point S100B level at 0,083 μg/L has good ability to predict the severity of TBI."

"ABSTRAKLatar Belakang Biomarker dapat digunakan untuk memprediksi derajat keparahan trauma kepala Tujuan Mengetahui hubungan antara kadar S100B dengan derajat keparahan trauma kepala dan kelainan CT scan kepala Metode Penelitian Penelitian potong lintang di IGD RSUPN Cipto Mangunkusumo RSUP Fatmawati dan RS Permata Cibubur selama Juli Desember 2015 Subjek adalah anak usia 1 18 tahun yang mengalami trauma kepala dengan onset

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ABSTRACTBackground Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p;Background Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p;Background Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p;Background Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p"

"Latar Belakang. Cedera kepala merupakan salah satu masalah kesehatan masyarakat yang serius yang dapat menyebabkan kematian, kecacatan fisik dan kecacatan mental. Cedera kepala dapat menyebabkan sel astrosit rusak sehingga mengeluarkan protein S 100B yang dapat dideteksi didalam darah perifer, sehingga dapat dipakai untuk memprediksi tingkat keparahan cedera kepala yang terjadi. Penelitian ini bertujuan untuk mencari hubungan antara kadar protein S 100B dengan tingkat keparahan cedera kepala. Metode. Desain penelitian adalah potong lintang untuk mengetahui kadar protein S 100B pada pasien cedera kepala akut onset kurang dari 24 jam. Subyek penelitian sejumlah 85 pasien yang datang berobat ke Instalasi Gawat Darurat RSCM sejak bulan maret ? juni 2015. Dilakukan penilaian GCS, lamanya tidak sadarkan diri, lamanya amnesia pasca trauma dengan bantuan alat TOAG, pemeriksaan CT Scan dan pemeriksaan serum protein S 100B. Hasil. Didapatkan kadar rerata protein S 100B serum 0,77 μg/L, rerata durasi amnesia 21,22 jam, rerata nilai GCS 13. Terdapat perbedaan kadar protein S 100B pada CKR (rerata 0,4175) dibandingkan dengan pada CKS dan CKB (1,0722) (p=0,020), nilai titik potong kadar protein S 100B pasien yang meninggal 0,765 μg/L (p= 0,002). Simpulan. Kadar rerata protein S 100B pada cedera kepala ringan lebih rendah dibandingkan dengan kadar protein S 100B pada cedera kepala sedang dan berat, semakin tinggi kadar protein S 100B akan semakin tidak baik keluaran pasien cedera kepala.

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Background. Traumatic brain injury is still a serious community health problem can cause death, physical and mental disability. Protein S 100B release from destructive astrocyte from brain injury and detected in the peripheral blood, so that protein S 100B can serve as predictor of severity traumatic brain injury. This research aimed to find association between protein S 100B with traumatic brain injury severity.

Method. This was a cross sectional study focusing to protein S 100B value from acute traumatic brain injury patients with onset < 24 hours. Eighty five patients were recruited from emergency room RSCM. GCS value, duration of post traumatic amnesia with TOAG tools, duration loss of consciousness, brain CT scan and concentration serum protein S 100B were record.

Results. The mean concentration serum Protein S 100B were 0.77, mean PTA duration were 21,22 hours, and the mean GCS were 13. There is a significant differentiation value of concentration protein S 100B from mild trumatic brain injury compare moderate and severe traumatic brain injury (p=0,020), cut off point for death patients was 0,765 μg/L.

Conclusion. The mean serum Protein S 100 B from mild trumatic brain injury lower than moderate and severe traumatic brain injury higher consentration of protein S 100B have bad outcome."

"PENDAHULUAN : Cedera kepala menjadi penyebab kematian paling umum pada usia kurang dari 40 tahun di negara maju dan berkembang, luaran setelah cedera kepala masih menjadi masalah dan sulit diprediksi. GCS telah ditetapkan sebagai prediktor luaran cedera kepala akibat trauma maupun non-trauma, namun prediktor luaran cedera kepala lain saat ini telah banyak dipakai salah satu adalah biomarker neuroinflamasi yaitu Rasio Neutrofil Limfosit (RNL) yang masih jarang diteliti.METODE : Penelitian prospektif ini didasarkan pada kasus cedera kepala sedang dan berat yang dilakukan operasi kraniotomi di multisenter rumah sakit pada November 2019-November 2020. Uji chi-square digunakan untuk mengetahui kemaknaan statistik dari hubungan antara demografi (usia dan jenis kelamin), gejala klinis serta hubungan RNL dan GCS sebagai prediktor luaran pada penelitian ini. Dilakukan analisis ROC untuk mendapatkan cut off RNL.HASIL : Dari 54 pasien cedera kepala sedang dan berat (GCS 7-13) pada November 2019-November 2020 didapatkan dominasi laki-laki 41 (75,9%) pasien dan perempuan 13 (24,1) pasien, usia (mean±SD) 27,6±15,3, GCS preoperasi (median; min-maks) 13 (7-13), gejala klinis pupil anisokor 33 (61,1), kejang 5(9,3), hemiparesis 1 (1,86), GCS pascaoperasi hari kelima dan ketujuh (median; min-maks) 14 (6-15). RNL Preoperasi 7,4 (1,9-26,2) dan untuk nilai cut off RNL 9,8 dengan spesisfisitas dan sensitifitas 87% yang signifikan dengan nilai p=<0,001.KESIMPULAN: Terdapat hubungan bermakna secara statistik RNL dan GCS preoperasi. Dimana dimana dengan nilai RNL yang rendah memiliki luaran fungsional yang baik sebaliknya pada pasien dengan RNL yang tinggi dengan luaran fungsional yang buruk.

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INTRODUCTION: Traumatic brain injury (TBI) is the most common cause of death on population less than 40 years old in developed and developing countries. The clinical outcome after TBI is still an issue and difficult to predict. GCS has been used to predict outcome after either traumatic or non-traumatic brain injury. But several other outcome factors also can predict outcome after TBI, such as neutrophil to lymphocyte ratio (NLR) as one of neuroinflammation biomarkers.

METHOD : This prospective study included moderate and severe TBI patients were performed craniotomy in a multicenter hospital, from November 2019 to November 2020. Chi-square analytic test was used to determine the relationship between demographics (age and sex), clinical symptoms, RNL and GCS as a predictors outcome of moderate and severe TBI.

RESULT : 54 patients moderate and severe TBI (GCS 7-13) consist of 41 (75.9%) male and 13 (24.1%) female patients, age (mean±SD) 27.6±15.3, preoperative GCS (median; min-max) 13 (7-13), with asymmetric pupil 33 (61.1%), seizures 5 (9.3%), hemiparesis 1 (1.86%), and GCS postoperative on the fifth and seventh day (median; min-max) 14 (6 - 15). Preoperative NLR was 7.4 (1.9-26.2) and the cut off for NLR as a predictor for improved GCS was at 9.8 with a specificity and sensitivity of 87% with signification of p=<0.001.

CONCLUSSION : There was a statistically significant relationship between preoperative RNL and GCS. Whereas with a low RNL value has a good functional outcome in contrast to patients with high RNL with poor functional outcome.

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"Pasien sindrom koroner akut (SKA) dengan penyakit ginjal kronik (PGK) diketahui memiliki risiko mortalitas lebih tinggi dibandingkan dengan pasien SKA tanpa disertai PGK. Setiap tahunnya, dilaporkan 9% kematian akibat penyakit jantung koroner (PJK) yang disertai PGK, yaitu hampir 10 – 20 kali lebih tinggi dibanding populasi umum. Pada pasien SKA dengan PGK terjadi proses inflamasi kronik yang memainkan peranan penting dalam perubahan morfologi dan fungsional sel endotel yang mengakibatkan akselerasi proses aterosklerosis yang berkaitan dengan keparahan koroner pasien SKA dan berujung meningkatkan kejadian major adverse cardiac event (MACE). Penelitian ini bertujuan untuk mengetahui peran rasio neutrofil limfosit (RNL) sebagai prediktor MACE dan korelasinya dengan derajat keparahan koroner pada pasien SKA dengan PGK. Digunakan 2 desain pada penelitian ini, yaitu studi nested case control dengan 31 subjek yang mengalami MACE sebagai kelompok kasus dan 28 subjek yang tidak mengalami MACE sebagai kelompok kontrol dari total 59 pasien SKA dengan PGK, serta studi korelatif dengan pendekatan potong lintang. Pada penelitian ini didapatkan area under curve (AUC) sebesar 60,8% dengan nilai titik potong RNL terhadap kejadian MACE adalah 3,62 dengan sensitivitas 74,2% dan spesifisitas 42,9%. Tidak terdapat perbedaan dan hubungan yang bermakna antara nilai RNL dengan kejadian MACE (p>0,05; OR=2,16 [95%CI=0,63 – 7,51]) dan tidak terdapat korelasi antara nilai RNL dengan derajat keparahan koroner yang dinilai menggunakan skor Gensini (r=0,10; p=0,474).

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Acute coronary syndrome (ACS) patients with chronic kidney disease (CKD) are known to have a higher risk of mortality compared to ACS patients without CKD. Every year, 9% of deaths due to coronary heart disease (CHD) accompanied by CKD reported, which is almost 10 – 20 times higher than the general population. In ACS patients with CKD, chronic inflammation play an important role in morphological and functional changes in endothelial cells that resulted in atherosclerosis acceleration associated with coronary severity in SKA patients, thus lead the increase in major adverse cardiac events (MACE). This study aims to determine the role of neutrophil lymphocyte ratio (NLR) as a predictor of MACE and its correlation with the degree of coronary severity in ACS patients with CKD. Two designs were used in this study, first using nested case control study with 31 subjects who experienced MACE as a case group and 28 subjects who did not experience MACE as a control group of a total of 59 ACS patients with CKD. Second using correlative study with a cross-sectional approach. Area under curve (AUC) of 60.8% was obtained with an NLR cutoff value for MACE is 3.62 with 74.2% sensitivity and 42.9% specificity. There is no significant difference and relationship between NLR and MACE (p>0.05; OR= 2.16 [95%CI=0.63 – 7.51]), also no correlation between NLR and coronary severity degree assessed using Gensini score (r = 0.10; p = 0.474)."

"Latar Belakang: Stroke iskemik merupakan penyebab kematian terbanyak kedua dan penyebab utama disabilitas di seluruh dunia. Beberapa faktor risiko yang sudah diketahui diantaranya pola hidup, penyakit komorbid, usia, jenis kelamin, dan ras. Namun, kadar serum vitamin D yang kurang ternyata juga dikaitkan dengan penyakit neurodegeneratif, serta luaran klinis yang lebih buruk. Penelitian ini dilakukan untuk mengetahui korelasi kadar serum vitamin D dengan derajat keparahan pada stroke iskemik yang dinilai berdasarkan NIHSS. Pada penelitian ini juga akan menilai asupan vitamin D serta pajanan sinar matahari.Metode: Penelitian ini merupakan studi potong lintang pada pasien stroke iskemik di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Karakteristik subjek penelitian berupa usia, jenis kelamin, faktor risiko, penyakit komorbid dengan komplikasi, asupan protein, asupan lemak, asupan vitamin D, pajanan sinar matahari, kadar serum vitamin D, serta derajat keparahan. Dilakukan analisis korelasi kadar serum vitamin D dengan derajat keparahan berdasarkan NIHSS.Hasil: Terdapat 59 subjek dengan diagnosis stroke iskemik dengan rerata usia 63 tahun dan mayoritas laki-laki (62,7%). Faktor risiko terbanyak adalah hipertensi (83,1%), berat badan lebih dan obesitas (64,4%), merokok (57,6%), dan diabetes melitus (42,4%). Penyakit komorbid dengan komplikasi tersering yang ditemukan adalah gangguan jantung (35,6%). Sebanyak 79,7% subjek penelitian memiliki asupan protein yang kurang, sedangkan asupan lemak seluruhnya tergolong cukup. Sebagian besar (52,5%) subjek penelitian memiliki status asupan vitamin D kurang, 5 orang mengonsumsi suplementasi vitamin D secara rutin, derajat pajanan sinar matahari rendah (89,8%). Sebanyak 59,3% memiliki status kadar serum vitamin D defisiensi dengan derajat keparahan terbanyak adalah skor NIHSS 5-15 (76,3%). Terdapat korelasi antara asupan vitamin D dengan derajat keparahan stroke iskemik (r -0,307, p 0,018).Kesimpulan: Kadar serum vitamin D memiliki korelasi dengan derajat keparahan stroke iskemik (r -0,469, p <0,001). Kadar serum vitamin D yang kurang berbanding terbalik dengan skor NIHSS yang didapatkan pada penderita stroke iskemik onset akut.

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Background: Ischemic stroke is the second leading cause of death and the leading cause of disability worldwide. Some of the known risk factors include lifestyle, comorbid diseases, age, gender, and race. However, deficient serum vitamin D levels are also associated with neurodegenerative diseases, as well as worse clinical outcomes. This study was conducted to determine the correlation of serum vitamin D levels with severity in ischemic stroke as assessed by the NIHSS. This study will also assess vitamin D intake and sunlight exposure.

Methods: This study is a cross-sectional study on ischemic stroke patients at RSUPN dr. Cipto Mangunkusumo and University of Indonesia Hospital. Characteristics of the study subjects included age, gender, risk factors, comorbid diseases with complications, protein intake, fat intake, vitamin D intake, sun exposure, serum vitamin D levels, and severity. Correlation analysis of serum vitamin D levels with severity based on NIHSS was conducted.

Results: There were 59 subjects with a diagnosis of ischemic stroke with an average age of 63 years and the majority were male (62.7%). The most common risk factors were hypertension (83.1%), overweight and obesity (64.4%), smoking (57.6%), and diabetes mellitus (42.4%). Comorbid disease with the most common complication found were cardiac disorders (35.6%). A total of 79.7% of the study subjects had insufficient protein intake, while the fat intake was entirely considered adequate. Most (52.5%) of the study subjects had deficient vitamin D intake status, 5 people took vitamin D supplementation regularly, the degree of sun exposure was low (89.8%). A total of 59.3% had vitamin D deficiency serum level status with the most severity being NIHSS score 5-15 (76.3%). There was a correlation between vitamin D intake and ischemic stroke severity (r -0,307, p 0,018).

Conclusion: Serum vitamin D levels have a correlation with ischemic stroke severity (r -0,469, p <0,001). Insufficient serum vitamin D levels are inversely proportional to the NIHSS score obtained in patients with acute onset ischemic stroke."

"Latar Belakang: Hiperhomosisteinemia merupakan salah satu faktor risiko terjadinya penyakit kardiovaskular (PKV). Psoriasis vulgaris adalah penyakit kulit inflamasi kronis yang berhubungan dengan beberapa penyakit penyerta, misalnya aterosklerosis dan PKV. Defisiensi folat dapat terjadi pada pasien psoriasis, akibat utilisasi yang meningkat di kulit yang mengalami hiperproliferasi dan atau penyerapan oleh usus yang berkurang. Hal ini dapat mengakibatkan peningkatan kadar homosistein dalam darah. Penulis meneliti korelasi antara kadar homosistein serum dan derajat keparahan psoriasis vulgaris, yang diukur dengan metode psoriasis area severity index (PASI) dan luas permukaan tubuh (body surface area, BSA). Metode: penelitian ini menggunakan rancangan potong lintang, pada 36 pasien psoriasis vulgaris. Subyek terdiri dari16 perempuan dan 20 laki-laki. Kadar homosistein serum diukur dengan metode competitive immunoassay dan dikorelasikan dengan derajat keparahan psoriasis. Hasil: pada subyek psoriasis laki-laki, kadar homosistein serum berkorelasi positif dengan derajat keparahan penyakit yang diukur dengan PASI (korelasi Pearson, r = 0.615 , p < 0,05) dan BSA (korelasi Spearman , r = 0,476 , p < 0,05). Tidak ada korelasi antara kadar homosistein serum dengan PASI (korelasi Pearson , p > 0,05 ) dan BSA (korelasi Spearman, p > 0,05) pada subyek psoriasis perempuan. Kesimpulan: Terdapat korelasi positif yang signifikan secara statistik antara kadar homosistein serum dengan derajat keparahan psoriasis yang diukur dengan PASI dan BSA pada subyek psoriasis laki-laki.

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Background: hyperhomocysteinemia is an independent risk factor for the development of cardiovascular disease (CVD). Psoriasis vulgaris is a chronic inflammatory skin disease associated with several comorbidities, such as atherosclerosis and CVD. Psoriatic patients often presents low levels of folic acid as a result of an increasing vitamin utilization in the skin and/or reduced gut absorption. This may result in raised levels of homocysteine. The authors investigated the correlation between serum homocysteine levels and the severity of psoriasis vulgaris measured by psoriasis area and severity index (PASI) and body surface area (BSA). Method: we performed a cross-sectional study in 36 patients with psoriasis vulgaris. The subjects comprised 16 women and 20 men. The serum levels of homocysteine were measured by competitive immunoassay method and were correlated with the severity of psoriasis (PASI and BSA). Result: in male psoriasis subjects, serum homocysteine levels positively correlated with disease severity as measured by PASI (Pearson's correlation; r = 0.615, p < 0.05) and BSA (Spearman's correlation; r = 0.476, p < 0.05). There was no correlation between serum homocysteine levels with PASI (Pearson's correlation, p > 0.05) and BSA (Spearman's correlation, p > 0.05) in female psoriasis subjects. Conclusion: a significant correlation between serum homocysteine levels with disease severity measured by PASI and BSA in male psoriasis subjects was evidenced."

"ABSTRAKLatar Belakang: Pasien cedera kepala sedang (CKS) dan cedera kepala berat (CKB) memerlukan perawatan di rumah sakit sehingga beresiko terkena infeksi nosokomial seperti pneumonia yang dapat memperburuk keluaran. Karena banyaknya faktor yang dapat mempengaruhi keluaran pasien cedera kepala dengan pneumonia, diperlukan suatu sistem skoring untuk menilai derajat keparahan pneumonia.Tujuan: Untuk mengetahui apakah sistem skoring CURB-65 dapat dipakai untuk memprediksi keluaran pasien CKS dan CKB yang mengalami pneumonia.Metode: Penelitian ini merupakan studi prospektif. Subjek penelitian adalah seluruh pasien CKS dan CKB yang dirawat di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta selama periode penelitian. Diagnosis pneumonia ditegakkan sesuai kriteria The Center for Disease Control (CDC). Penilaian derajat keparahan pneumonia dilakukan dengan skoring CURB-65. Keluaran yang dinilai adalah hidup atau meninggal.Hasil: Dari 176 pasien CKS dan CKB, terdapat 26 pasien yang menderita pneumonia. Rentang usia subjek penelitian adalah 15 - 71 tahun. Sebagian besar berjenis kelamin laki-laki dan berusia < 65 tahun. Nilai maksimal dari CURB-65 pada penelitian ini adalah 3. Sedangkan nilai yang terbanyak adalah 2. Nilai CURB-65 ditemukan tidak bermakna sebagai prediktor keluaran pasca cedera kepala. Keluaran pasien cenderung dipengaruhi variabel usia, penurunan kesadaran, peningkatan kadar BUN, dan peningkatan frekuensi napas. Diantara 5 pasien yang meninggal, ada 2 pasien yang memiliki nilai CURB-65 = 3, sehingga tampak adanya kecenderungan peningkatan mortalitas pada pasien-pasien dengan nilai CURB-65 = 3.Kesimpulan: Walaupun skoring CURB-65 tidak bermakna sebagai prediktor keluaran pada pasien CKS dan CKB dengan pneumonia, penelitian pendahuluan ini menemukan adanya kecenderungan pengaruh masing-masing komponen CURB-65 (penurunan kesadaran, frekuensi napas, kadar BUN, serta usia) terhadap resiko kematian pasien

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ABSTRACTBackground: Patients with moderate and severe traumatic brain injury (TBI) require hospitalization, therefore they have higher risk in developing nosocomial infections such as pneumonia which can worsen their outcomes. Since there are many factors that can affect outcome of head-injured patients with pneumonia, a scoring system for evaluating the severity of pneumonia is needed.Objective: To know whether the CURB-65 scoring system can be used to predict the outcome of moderate and severe TBI patients who developed pneumonia during hospitalization.Methods: This was a prospective study. The study subjects were all moderate and severe TBI patients who had been hospitalized in Cipto Mangunkusumo Hospital during the research period. Diagnosis of pneumonia was confirmed if the patient fulfiled the criteria from The Center for Disease Control (CDC). The severity of pneumonia was determined by using CURB-65 scoring system. The outcome would either be dead or alive.Results: Of 176 patients with moderate and severe TBI, there were 26 patients who developed pneumonia. The age of the subjects ranged between 15 to 71 years. Most of them were male and over the age of 65. The maximum score of CURB-65 was 3. The mode of CURB-65 score was 2. CURB-65 was shown to be not useful in predicting outcome of head-injured patients with pneumonia. The outcome was seemingly associated with age, loss of consciousness, BUN, and respiratory rate. Among 5 patients who were dead, there were 2 patients who had a CURB-65 score of 3, thus there was a trend of increasing mortality in patients with a CURB-65 score of 3.Conclusions: Although the CURB-65 scoring system was not found to be useful in predicting outcome of moderate and severe TBI patients, this preliminary study have found that there were a tendency that each component of CURB-65 (loss of consciousness, respiratory rate, BUN, age) have some effects on mortality. "

"ABSTRAKNama : Rulifa SyahroelProgram Studi : Program Pendidikan Dokter Spesialis-II Ilmu Kesehatan AnakJudul : Hipokalsemia sebagai Penanda Derajat Keparahan Infeksi Virus Dengue pada AnakLatar belakang. Kalsium plasma memegang peran vital pada berbagai proses fisiologis tubuh. Hipokalsemia telah didokumentasikan pada infeksi virus dengue terutama pada kasus berat. Masih sedikit data tentang kalsium ion serum pada infeksi virus dengue anak.Tujuan. Menilai kadar kalsium ion serum pada DD, DBD dan SSD serta membuktikan hipokasemia dapat menjadi penanda derajat keparahan infeksi .Metode. Studi potong lintang dilakukan di tujuh RS rujukan Provinsi DKI Jakarta, Sumatera Barat dan Kepulauan Riau selama November 2017 - Februari 2018 pada anak usia 1 - 45vol , nilai hemokonsentrasi >20 dan kadar albumin

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ABSTRACTName Rulifa Syahroel Specialty Pediatric Consultant Program majoring in Infection and Tropical Diseases Title Hypocalcemia as A Marker of Dengue Severity in Children Background. The plasma calcium plays a vital role for physiological process of body. Hypocalcemia has been documented in dengue infection and seen more frequently in severe cases. There is still lack of data about serum ionized calcium in pediatric dengue.Objective. To asses the serum ionized calcium level in DF, DHF, DSS and evaluate hypocalcemia as a marker of dengue severity.Methods. A cross sectional study was done in seven top referral hospitals in Jakarta, West Sumatera and Riau Islands Province from November 2017 Februari 2018. Children aged 1 45vol , hemoconcentration level 20 and albumin serum level "

"[Pendahuluan: Trauma akibat benda tumpul pada kepala adalah salah satu traumayang dapat bersifat fatal, berkaitan dengan organ intrakranial yang bersifat vitalbagi kehidupan. Namun, luka kekerasan tumpul pada kepala tidak seluruhnya dapatmenyebabkan kerusakan organ intrakranial, berkaitan dengan berbagai faktor yangmenyebabkan luka, antara lain lokasi, besar gaya, arah gaya. Pada penelitian iniakan dilihat hubungan antara luka kekerasan tumpul dengan adanya kerusakan otak.Penelitian epidemiologi forensik ini digunakan untuk menunjang opini ahli dokterforensik pada temuan luka akibat kekerasan tumpul di kepala dengan kerusakanorgan intrakranial. Metode: Penelitian ini merupakan penelitian cross-sectionaldengan data sekunder yang berasal dari visum et repertum pasien di DepartemenForensik dan Medikolegal FKUI-RSCM. Hasil: Sebanyak 1% hubungan antaramemar pada kepala memiliki hubungan yang bermakna dengan kerusakan otak, 1%hubungan antara ekskoriasi pada kepala memiliki hubungan yang bermakna dengankerusakan otak, sebanyak 82% hubungan antara laserasi pada kepala memilikihubungan yang bermakna dengan kerusakan otak, dan sebanyak 95,3% hubunganantara fraktur pada kepala memiliki hubungan yang bermakna dengan kerusakanotak. Diskusi: Hasil penelitian menunjukkan bahwa terdapat variasi hubunganantara luka kekerasan tumpul dengan adanya kerusakan otak berdasarkan jenis sertalokasi luka luar dan lokasi kerusakan intrakranialnya. Variasi hasil ini terjadi karenaluka kekerasan tumpul, yaitu memar, ekskoriasi, laserasi, dan fraktur, masingmasingmemiliki mekanisme yang berbeda, dan timbul akibat besar gaya yangberbeda. Memar dan ekskoriasi, luka kekerasan tumpul yang disebabkan oleh gayayang kecil dan menyebabkan diskontinuitas jaringan luar hanya sedikit hanyamemiliki sedikit hubungan dengan kerusakan otak. Laserasi dan fraktur memilikibanyak hubungan dengan kerusakan otak oleh karena gaya penyebab lukakekerasan tumpul tersebut bersifat lebih besar, Introduction: Blunt head trauma had a high fatality rate, as the head protectsintracranial organs that are vital to the continuity of life. However, not all blunthead trauma cause the same damage to intracranial organs, due to the variousfactors such as location, the strength of the force, and the direction from which thestriking force came. This forensic epidemiological study is designed to supportexpert opinions in forensic practice regarding the findings of blunt head trauma andintracranial organ damage. In this study, the correlation between blunt head traumaand traumatic brain injury were analyzed. Methods: This study is a cross-sectionalstudy with secondary data from patients’ visum et repertum in the Forensic andMedicolegal Department of Cipto Mangunkusumo General Hospital. Results:Results show that 1% of the correlations between bruise findings on the head hadsignificant association with traumatic brain injury, 1% of the correlations betweenexcoriation findings on the head had significant association with traumatic braininjury, 82% of the correlations between laceration findings on the head hadsignificant association with traumatic brain injury, and 95,3% of the correlationsbetween fracture findings on the skull had significant association with traumaticbrain injury. Discussion: This study showed that the relationship between blunthead injury with traumatic brain injury varied based on the location and type of theexternal injury and the location of the intracranial organ. This variation in resultshappened as external blunt head trauma such as bruise, excoriation, laceration, andfracture each had different mechanisms, and were caused by various force intensity.Bruising and excoriation, which were usually caused by smaller force and onlycaused little damage externally, were found to have little correlation with traumaticbrain injury findings. On the other hand, laceration and fracture were found to havemore correlation with traumatic brain injury findings, since both traumas wereusually caused by a greater force.]"