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"ABSTRAKLatar belakang: Konstipasi fungsional kronik adalah masalah yang seringditemukan di masyarakat dengan prevalensi sekitar 15-25%. Konstipasimenimbulkan berbagai gejala, meningkatkan angka kesakitan dan biaya kesehatan.Saat ini, penggunaan probiotik untuk pengobatan konstipasi kronik pada dewasatelah diteliti, namun, dari berbagai penelitian yang telah dilakukan hasil yangdiperoleh masih terbatas dan menimbulkan kontroversi.Tujuan: Untuk menilai manfaat Lactobacillus reuteri dalam memperbaiki skorkonstipasi Agachan, jumlah L. reuteri feses dan pH feses pada pasien konstipasifungsional kronik.Metode: Uji acak tersamar ganda dilakukan pada 40 pasien dewasa (12 laki-laki/28 perempuan), rerata usia 45,95+/-16 tahun, yang menderita konstipasi fungsionalkronik sesuai kriteria Rome III, selanjutnya dilakukan randomisasi dan diberikanL.reuteri atau Plasebo selama 4 minggu.Hasil: Pada minggu ke-4, setelah pemberian L.reuteri terjadi perbaikan gejalakonstipasi, yang dinilai dari penurunan skor konstipasi Agachan dari 17 menjadi 8dengan p <0.001. Terjadi peningkatan jumlah L.reuteri feses dari 6,80x10 menjadi 2,12x10 8 dengan p <0,001 dan penurunan pH feses dari 5,44 (SB 0,70) menjadi4,78 (SB 0,56) dengan p <0,001 pada kelompok L.reuteri, sedangkan padakelompok Plasebo tidak didapatkan hasil yang bermakna pada perbaikan skorkonstipasi Agachan, jumlah L.reuteri feses dan pH feses.Kesimpulan: L.reuteri lebih efektif dibandingkan Plasebo dalam memperbaikikonstipasi, meningkatkan jumlah L.reuteri feses dan menurunkan pH feses padapasien konstipasi fungsional kronik dewasa.

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ABSTRACTBackground: Chronic functional constipation is a common problem that affectsbetween 15-25% of the population and cause symptoms and disorders, that createsdiscomfort, morbidity and high costs for health care. Recently, the consumption ofprobiotics in treating chronic constipation in adults have been investigated.However, there are still limited and controversial evidences available fromcontrolled trials.Aim: To evaluate the effects of L. reuteri in improving the Agachan constipationscore, the number of L. reuteri in the feces and the fecal pH in the patients withchronic functional constipation.Methods: A double-blind, placebo RCT was conducted in 40 adult (12 male/ 28female with mean age 45,95+/-16 years) affected by chronic functional constipationaccording to Rome III criteria. Patients were randomly assigned to receive asupplementation of L.reuteri or Placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to8.00 with p <0.001, the increase number of L.reuteri was from 6,80x10with p <0,001 and the decrease of pH feces was from 5,44 (SB 0,70) to 4,78 (SB0,56) with p <0,001 in the L. reuteri group, otherwise in the Placebo group therewere no significant results in Agachan constipation score, the number of L.reuteriand fecal pH assessed.Conclusion: L.reuteri is more effective than the Placebo group in improving theAgachan constipation score, increasing the number of L. reuteri in the feces anddecreasing the fecal pH in adult with chronic functional constipation.;Background: Chronic functional constipation is a common problem that affectsbetween 15-25% of the population and cause symptoms and disorders, that createsdiscomfort, morbidity and high costs for health care. Recently, the consumption ofprobiotics in treating chronic constipation in adults have been investigated.However, there are still limited and controversial evidences available fromcontrolled trials.Aim: To evaluate the effects of L. reuteri in improving the Agachan constipationscore, the number of L. reuteri in the feces and the fecal pH in the patients withchronic functional constipation.Methods: A double-blind, placebo RCT was conducted in 40 adult (12 male/ 28female with mean age 45,95+/-16 years) affected by chronic functional constipationaccording to Rome III criteria. Patients were randomly assigned to receive asupplementation of L.reuteri or Placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to8.00 with p <0.001, the increase number of L.reuteri was from 6,80x10with p <0,001 and the decrease of pH feces was from 5,44 (SB 0,70) to 4,78 (SB0,56) with p <0,001 in the L. reuteri group, otherwise in the Placebo group therewere no significant results in Agachan constipation score, the number of L.reuteriand fecal pH assessed.Conclusion: L.reuteri is more effective than the Placebo group in improving theAgachan constipation score, increasing the number of L. reuteri in the feces anddecreasing the fecal pH in adult with chronic functional constipation.;Background: Chronic functional constipation is a common problem that affectsbetween 15-25% of the population and cause symptoms and disorders, that createsdiscomfort, morbidity and high costs for health care. Recently, the consumption ofprobiotics in treating chronic constipation in adults have been investigated.However, there are still limited and controversial evidences available fromcontrolled trials.Aim: To evaluate the effects of L. reuteri in improving the Agachan constipationscore, the number of L. reuteri in the feces and the fecal pH in the patients withchronic functional constipation.Methods: A double-blind, placebo RCT was conducted in 40 adult (12 male/ 28female with mean age 45,95+/-16 years) affected by chronic functional constipationaccording to Rome III criteria. Patients were randomly assigned to receive asupplementation of L.reuteri or Placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to8.00 with p <0.001, the increase number of L.reuteri was from 6,80x10with p <0,001 and the decrease of pH feces was from 5,44 (SB 0,70) to 4,78 (SB0,56) with p <0,001 in the L. reuteri group, otherwise in the Placebo group therewere no significant results in Agachan constipation score, the number of L.reuteriand fecal pH assessed.Conclusion: L.reuteri is more effective than the Placebo group in improving theAgachan constipation score, increasing the number of L. reuteri in the feces anddecreasing the fecal pH in adult with chronic functional constipation."

"ABSTRAKLatar belakangBerbagai studi terdahulu melaporkan bahwa alfacalcidol mampu meningkatkan kekuatan otot, keseimbangan dan signifikan dalam menurunkan kejadian jatuh pada ras Kaukasia. Namun belum ada penelitian yang membuktikan peran alfacalcidol terhadap mobilitas fungsional pada ras Asia.TujuanMengetahui pengaruh pemberian alfacacidol 0,5 µg selama 90 hari terhadap mobilitas fungsional dasar perempuan usia lanjut di Indonesia.MetodeDilakukan uji klinis acak tersamar ganda pada bulan April-September 2012 terhadap 95 pasien perempuan usia lanjut di Poliklinik Geriatri RS Cipto Mangunkusumo Jakarta, Indonesia. Subyek dibagi menjadi kelompok yang mendapat alfacalcidol dan kalsium 500 mg sehari sekali selama 90 hari dan kelompok yang mendapat plasebo dan kalsium 500 mg. Dilakukan uji timed-up and Go Test (TUG) pada awal dan akhir penelitian. Dilakukan analisis per protokol dan uji Mann-Whitney untuk melihat perbedaaan mobilitas fungsional pada kedua kelompok setelah intervensi.Hasil95 subyek dirandomisasi dan dibagi menjadi dua kelompok, terdiri dari 48 subyek yang mendapat plasebo dan 47 subyek mendapat alfacalcidol. Setelah tiga bulan pengamatan didapatkan perbaikan waktu uji TUG yang signifikan pada kedua kelompok (2,49 vs 1,83 detik; p<.0001). Terdapat perbaikan waktu uji TUG yang signifikan dari kelompok alfacalcidol dibandingkan dengan kelompok plasebo (9,01 vs.10,07 detik; p = 0.028).KesimpulanAlfacalcidol dengan dosis 0,5 µg satu kali per hari selama 90 hari terbukti mampu meningkatkan mobilitas fungsional dasar pada perempuan usia lanjut Indonesia.

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ABSTRACTBackgroundPrevious studies reported the D-analog alfacalcidol, increases muscle power and balance and lead to a highly significant decreases in the number of fallers and falls in Caucasian elderly community-dwelling population.ObjectiveTo determine the effect of alfacalcidol on functional mobility in Indonesian elderly women community-dwelling population.MethodsA randomized, double-blind controlled trial was conducted in elderly women subjects geriatric clinic of Cipto Mangunkusumo National Hospital Jakarta Indonesia on April-September 2012. Intervention group was given 0,5 mcg alfacalcidol and 500 mg calcium daily for 90 days and another group was given placebo and 500 mg calcium. Balance test, Timed-up and Go Test (TUG) was measured at the beginning and after 3 months. Per protocol analysis to functional mobility after intervention between the two groups was performed.Results95 subjects were fulfiling study criteria and randomized into 2 groups, containing 47 subjects in alfacalcidol group and 48 subjects in placebo group. Both groups were comparable in all important prognostic factors including age, BMI, nutritional status, muscle strength. After three months the mean time in alfacalcidol group used for the TUG was decrease significantly by 2,49 s (p<.0001). There were significant improvement of the median time for TUG in the group that received alfacalcidol compared to placebo (9,01 vs.10,07 p = 0.028).ConclusionTreatment with 0.5 mg alfacalcidol with calcium effectively improved functional mobility in Indonesian elderly women."

"LATAR BELAKANG: Keputihan adalah keluhan kewanitaan yang paling sering dijumpai pada pelayanan kesehatan primer, dengan kunjungan berdasarkan data CDC di Amerika Serikat sebanyak 2,7-3,6 juta pasien dengan keluhan keputihan pada tahun 2008. Keputihan abnormal tersering yang disebabkan infeksi adalah Bacterial Vaginosis BV pada 22-50 wanita, Kandidosis VulvoVaginal KVV sebesar 17-39 dan Trikhomoniasis TV sebesar 4-35. Beberapa di antara komplikasi serius yang dapat terjadi pada Bacterial Vaginosis antara lain keguguran, peradangan rongga panggul, persalinan prematur, khorioamnionitis, endometritis postpartum, serta infeksi pascaoperasi ginekologis. Timbulnya keputihan abnormal erat kaitannya dengan perubahan derajat keasaman pH dari keadaan normalnya yaitu 3,5-4,7 yang disebabkan penurunan flora normal laktobasili dan peningkatan mikroba patologis yang menghasilkan keputihan. Diagnosis keputihan dapat ditegakkan berdasarkan pendekatan sindromik, empirik, maupun laboratoris. Probiotik sebagai mikroorganisme hidup yang dapat memberikan keuntungan kesehatan kepada inangnya, dalam hal ini Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 pada beberapa penelitian uji klinis acak tersamar ganda di luar negeri telah terbukti memberikan kesembuhan yang signifikan dibanding terapi standar, baik sebagai terapi utama maupun ajuvan. Penelitian serupa belum pernah dilakukan di Indonesia.TUJUAN: Diketahuinya efektivitas klinis dan dibuktikannya tingginya proporsi kesembuhan dan tingkat kepuasan pascaterapi pasien kombinasi antimikroba-probiotik oral Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 dibanding kombinasi antimikroba-placebo pada pengobatan pasien usia reproduksi dengan keputihan di poliklinik rawat jalan obstetrik dan ginekologi RSCM.METODE: Penelitian ini merupakan penelitian uji klinis acak tersamar ganda dengan jumlah sampel inisial 84 subjek, dan terealisasi 50 subjek dengan populasi target wanita usia reproduksi yang berkunjung dengan keluhan keputihan ke poliklinik rawat jalan RSCM dan RSUD Arifin Achmad Pekanbaru, Riau dan memenuhi kriteria inklusi dan eksklusi, terbagi dalam 25 subjek pada kelompok kontrol dan 25 subjek pada kelompok perlakuan. Data dikumpulkan melalui pemeriksaan klinis dengan pendekatan sindromik, pemberian probiotik yang mengandung masing-masing 2,5x109 CFU Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 sebagai ajuvan terapi antimikroba standar pada kelompok perlakuan dan terapi antimikroba standar ditambah plasebo pada kelompok kontrol, dicatat respon terapi 4 mingggu kemudian menggunakan instrumen formulir pelaporan kasus khusus penelitian dan formulir peniliaian tingkat kepuasan berdasarkan Treatment Satisfaction Questionnaire For Medication TSQM VERSI II . Nilai risiko relatif, dan Uji chi square dilakukan untuk menilai hubungan antar variabel. Analisis interim dengan penilaian conditional power dan uji futilitas dilakukan di tengah penelitian karena jumlah sampel insial tidak tercapai. Penelitan ini sudah lolos kaji etik dan mendapat persetujuan pelaksanaan dari Komite Etik Penelitian Kesehatan FKUI-RSCM pada bulan Maret 2016.HASIL: Sebanyak 50 subjek dapat terkumpul dan dianalisa, terdiri dari 25 subjek perlakuan dan 25 subjek kontrol, dimana sebanyak 14 subjek 56 dari kelompok perlakuan sembuh dan 11 subjek 44 tidak sembuh, serta sebanyak 15 subjek 60 dari kelompok kontrol sembuh dan 10 subjek 40 tidak sembuh, sehingga menghasilkan risiko relatif sebesar 1,1 untuk subjek yang tidak sembuh, dan uji Chi-Square didapatkan nilai p 0,77, IK 95 ; 0,57-2,11 . Pada tingkat kepuasan didapatkan bahwa proporsi tingkat kepuasan tinggi skor 67-100 justru lebih besar pada kelompok plasebo sebesar 52,6 10 subjek dibanding kelompok probiotik sebesar 47,4 9 subjek . Berdasarkan uji statistik didapatkan nilai p sebesar 0,65 ge;0,05 , sehingga tidak ada perbedaan tingkat kepuasan responden pada kelompok perlakuan probiotik maupun kelompok kontrol plasebo . Kekurangan jumlah sampel telah dianalisis dengan kurva conditional power dan uji futilitas untuk mengetahui kemungkinan signifikansi pada jumlah sampel total, dan didapatkan nilai Z = -0.2865, sesuai dengan conditional power antara 0,11-0,13 sehingga indeks futilitas 0,88-0,87, dengan interpretasi bahwa kemungkinan kecil penelitian akan bermakna bila dilanjutkan hingga tercapai sampel total.KESIMPULAN: Tidak ditemukan perbedaan proporsi yang bermakna secara klinis maupun statistik pada tingkat kesembuhan maupun tingkat kepuasan pada pasien usia reproduksi dengan keputihan pada pemberian kombinasi antimikroba-probiotik oral Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 dibanding kombinasi antimikroba-plasebo setelah terapi selama 4 minggu, namun dalam penelitian ini hipotesis awal proporsi kesembuhan kelompok perlakuan probiotik yang lebih tinggi daripada kelompok kontrol plasebo belum bisa ditolak, karena jumlah sampel belum memadai.KATA KUNCI : Keputihan, Bacterial Vaginosis, Kandidosis VulvoVaginal, Trikhomoniasis, Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14, uji klinis acak randomisasi ganda.

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BACKGROUND Vaginal discharge is one of the most frequent complain encountered in primary health care, as much as 2,7 to 2,6 million visits per year according to data from the CDC in the United States in 2008. The most common abnormal vaginal discharge caused by infection is Bacterial Vaginosis BV in 22 50 of women, vulvovaginal candidosis KVV of 17 39 and Trikhomoniasis TV of 4 35 . Some of the serious complications that may be caused bacterial Vaginosis include miscarriage, pelvic inflammation, premature delivery, chorioamnionitis, postpartum endometritis, as well as gynecological postoperative infection. Abnormal vaginal discharge is closely related to changes in the degree of acidity pH from the normal state which is 3.5 to 4.7 caused a decrease in the normal flora lactobacilli and an increase in microbes that produce pathological vaginal discharge. Diagnosis of vaginal discharge may be established based on syndromic, empirical, and laboratory approach. Probiotics known as living microorganisms that can provide health benefits to the host, in this case Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14, in several randomized clinical trials, double blinded, have been proven to provide healing significantly compared to standard therapy, either as primary or adjuvant therapy. Such researchs have not been done in Indonesia.OBJECTIVES To acknowledge the clinical effectiveness and prove the high proportion of cure and satisfaction levels of post treatment patients with a combination of antimicrobial probiotic oral Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 compared to a combination of antimicrobial placebo in the treatment of patients of reproductive age with vaginal discharge in the clinic outpatient obstetrics and gynecology RSCM.METHODS This study is a randomized, double blind, clinical trial with initial total sample was 84 subjects, and only 50 subjects were able to be analyzed with target population of reproductive age women who visited with complain of vaginal discharge to outpatient clinic at RSCM and Arifin Achmad Pekanbaru, Riau and met the inclusion criteria and exclusion, divided into 25 subjects in the control group and 25 subjects in the treatment group. Data were collected through a clinical examination with syndromic approach, administration of probiotics containing each 2,5x109 CFU Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 as an adjuvant standard antimicrobial therapy in the treatment group and placebo plus standard antimicrobial therapy in the control group, therapeutic response was recorded 4 weeks after treatment using the trial spesific case report form and level of satisfaction using a form based on treatment satisfaction Questionnaire For Medication TSQM VERSION II . Relative risk values, and chi square test was performed to assess the relationship between variables. The interim analysis with conditional power assesment and futility testing in the middle of the study was performed due to insufficient sample size. Research has already qualified and approved by Ethics Commitee for Health Researches Faculty of Medicine University of Indonesia RSCM in March 2016.RESULTS A total of 50 subjects has participated and analyzed, consisting of 25 subjects treated and 25 control subjects, with 14 subjects 56 of the treatment group cured and 11 subjects 44 not cured, and as many as 15 subjects 60 cured of the control group and 10 subjects 40 not cured, resulting in a relative risk of 1.1 for subjects that is not cured, and the Chi square test p value 0.77, 95 CI 0.57 to 2 , 11 . On the treatment staisfaction level analysis, it was found that high level of satisfaction score ge 67 unexpectedly higher in the placebo group of 52,6 10 subjetcs compared to probiotic group, of 47,4 9 subjects . Based on statistical test, p value was 0,65 ge 0,05 , equals to no difference in the level of satisfaction of respondents in treatment group probiotic and control group placebo . Lacking number of samples collected 50 subjects have been analyzed with conditional power and futility test curve for possible significancy provided the total number of samples able to be collected, and obtained the value of Z 0.2865, corresponds to conditional power between 0.11 to 0.13 and futility index of 0.87 to 0.88, which may be interpreted as low possibility of reaching statistical significance even if the trial was continued to initially calculated minimum sample.CONCLUSION There was no clinical and statistical difference in the proportion of cure and the level of satisfaction in patients of reproductive age with vaginal discharge in the treatment with combination of antimicrobial oral probiotic Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 compared to combination of antimicrobial placebo after treatment for 4 weeks. However in this study, the initial hypothesis of higher proportion of cure at the treatment group probiotic compared to placebo still cannot be excluded, due to insufficient samples collected. KEYWORDS Vaginal discharge, Bacterial Vaginosis. Vulvovaginal candidiasis, Trikhomoniasis, Lactobacillus rhamnosus GR 1, Lactobacillus reuteri RC 14, randomized double blind controlled trial."

"ABSTRAKTerapi metformin berpotensi untuk memperbaiki sindrom frailty dengan memodifikasi resistensi insulin, inflamasi, dan konsentrasi miostatin.Penelitian ini bertujuan untuk mengkaji peran metformin terhadap kekuatan genggam tangan, kecepatan berjalan, konsentrasi miostatin serum, dan kualitas hidup terkait kesehatan pada pasien usia lanjut dengan pre-frail.Uji klinis acak tersamar ganda dilakukan pada pasien rawat jalan berusia 60 tahun dengan status pre-frail yang direkrut secara konsekutif Maret 2015 ndash;Juni 2016 di RSCM. Pasien dieksklusi bila menyandang diabetes melitus, skor Geriatric Depression Scale ge; 10, skor Abbreviated Mental Test < 8, fase akut penyakit, dan kontraindikasi terhadap metformin. Evaluasi luaran penelitian dilakukan sebelum dan pasca-intervensi selama 16 minggu.Randomisasi terhadap 120 subjek menempatkan 60 subjek untuk tiap kelompok perlakuan. Sebanyak 43 subjek kelompok metformin 3 x 500 mg dan 48 subjek kelompok plasebo menyelesaikan penelitian. Terdapat peningkatan kecepatan berjalan yang bermakna dengan rerata sebesar 0,39 0,77 detik atau 0,13 0,24 meter/detik pada kelompok metformin dan tetap bermakna setelah dilakukan penyesuaian terhadap faktor prognostik penting yang tidak setara p = 0,024 . Pada analisis ITT ada tidaknya peningkatan kecepatan berjalan > 0,1 meter/detik didapatkan ARR 8,3 IK95 -7,9 ndash;24 , dengan NNT sebesar 12. Tidak terdapat perbedaan bermakna kekuatan genggam tangan, konsentrasi miostatin serum, dan kualitas hidup terkait kesehatan antara kedua kelompok perlakuan. Konsentrasi miostatin serum berkorelasi negatif lemah r = -0,247; p = 0,018 dengan kecepatan berjalan, namun tidak berkorelasi dengan kekuatan genggam tangan. Skor indeks EQ-5D berkorelasi positif sedang dengan kecepatan berjalan r = 0,566; p = 0,000 dan berkorelasi positif lemah dengan kekuatan genggam tangan r = 0,355; p = 0,001.Sebagai simpulan, pemberian metformin 3 x 500 mg selama 16 minggu secara statistik dan klinis bermakna dalam meningkatkan kecepatan berjalan sebagai salah satu dimensi kualitas hidup terkait kesehatan, namun belum dapat meningkatkan skor indeks EQ-5D, tidak meningkatkan kekuatan genggam tangan, dan belum menurunkan konsentrasi miostatin serum.Kata kunci. kecepatan berjalan, kekuatan genggam tangan, kualitas hidup terkait kesehatan, metformin, miostatin, pre-frail, usia lanjut.

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ABSTRACT

Metformin is considered to have potential effects to improve frailty syndrome by modifying insulin resistance, inflammation, and myostatin serum level.

This study aimed at investigating the effect of metformin on handgrip strength, gait speed, myostatin serum level, and health related quality of life HR QoL in pre frail elderly.

A double blind randomized controlled trial was conducted on elderly outpatients aged 60 years and older with pre frail status consecutively recruited from March 2015 to June 2016 at Cipto Mangunkusumo Hospital. Patients with history of diabetes mellitus, Geriatric Depression Scale score ge 10, Abbreviated Mental Test score 8, acute phase of diseases, and contraindication s to metformin were excluded. The measurement of study outcomes was conducted at baseline and after 16 weeks of intervention.

One hundred twenty subjects were randomized and equally assigned into metformin 3 x 500 mg or placebo group. There were 43 subjects in metformin group and 48 subjects in placebo group completed the intervention. The mean gait speed in metformin group significantly improved by 0.39 0.77 second or 0.13 0.24 meter second, even after adjusted for importance prognostic factors p 0,024 . Intention to treat analysis on the presence or absence of increased gait speed 0.1 meter second showed ARR 8.3 95 CI 7.9 ndash 24 , with NNT of 12. There were no significant differences on handgrip strength, myostatin serum level, and HR QoL between the two intervention groups. Myostatin serum level had weak negative correlation with gait speed r 0.247 p 0.018 , but did not correlate with handgrip strength. EQ 5D index had moderate positive correlation with gait speed r 0.566 p 0.000 and weak positive correlation with handgrip strength r 0.355 p 0.001.

In conclusion, metformin 3 x 500 mg for 16 weeks significantly improved gait speed as one of the HR QoL dimensions, but not significantly improved the EQ 5D index score and handgrip strength nor decreased myostatin serum level.

Keywords. gait speed, handgrip strength, health related quality of life, metformin, myostatin, pre frail, elderly."

"Pendahuluan. Pengkajian nyeri kronik komprehensif tidak hanya berfokus pada aspek biologis nyeri, namun juga kondisi fungsional dan psikososial. Tenaga kesehatan, termasuk mahasiswa kedokteran, lebih berfokus pada aspek biomedis pasien. Mnemonic PQRST adalah alat bantu pengkajian nyeri yang berfokus pada aspek biomedis. Mnemonic ACT-UP dapat membantu melakukan pengkajian fungsional dan psikososial. Gabungan kedua mnemonic sebagai alat bantu pembelajaran belum pernah diteliti. Penelitian ini bertujuan membandingkan tingkat pengetahuan dan keterampilan mahasiswa Fakultas Kedokteran Universtias Indonesia (FKUI) dalam pengkajian nyeri kronik setelah mendapatkan pelatihan dengan mnemonic PQRST dan ACT-UP dengan yang mendapatkan mnemonic PQRST saja.Metode. Penelitian ini adalah uji acak tersamar ganda dalam bentuk pelatihan pengkajian nyeri kronik berbasis simulasi yang diikuti 40 mahasiswa FKUI. Pengetahuan mahasiswa dinilai dengan pre-test dan post-test. Keterampilan mahasiswa dinilai dalam simulasi pengkajian nyeri.Hasil. Tidak ada perbedaan tingkat pengetahuan dan keterampilan antara kelompok uji dan kelompok kontrol. Nilai post-test 85,71 (71,43 -95,24) berbeda bermakna dari pre-test 61,90 (25,87 – 90,48) dengan p=0,000. Tingkat kepuasan mahasiswa atas pelatihan pengkajian nyeri kronik tinggi.Simpulan. Pelatihan dengan mnemonic PQRST dan ACT-UP tidak lebih baik daripada pelatihan dengan mnemonic PQRST saja dalam meningkatkan pengetahuan dan keterampilan pengkajian nyeri kronik mahasiswa FKUI. Pelatihan pengkajian nyeri kronik bermanfaat untuk meningkatkan pembelajaran mahasiswa.

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Introduction. Chronic pain assessment should be comprehensive, exploring the biomedical process and the functional and psychosocial condition. Health professionals, including medical student, put more attention on the biomedical aspect. PQRST mnemonic is used in chronic pain assessment focusing biomedical aspect. ACT-UP mnemonic can help perform a comprehensive assessment. The combination of both in education has not been studied. This study aimed to compare the knowledge and skills of medical student in the Faculty of Medicine Universitas Indonesia (FMUI) in the chronic pain assessment after being trained using PQRST and ACT-UP with ones using PQRST only.Methods. This is a double-blinded randomized controlled trial. 40 medical students joined a simulation-based chronic pain assessment workshop. Pre-test and post-test were used to assess knowledge. The skills were evaluated in a simulation by two independent raters.Results. There is no difference in the knowledge and skills between groups. There is a significant difference between the post-test 85,71 (71,43 - 95,24) and the pre-test 61,90 (25,87 – 90,48) with p=0,000. Students reported high satisfaction upon the workshop.Conclusion. Training with PQRST and ACT-UP mnemonic is not better than one with PQRST only to improve the knowledge and skills of chronic pain assessment of the students. Nevertheless, this workshop was beneficial for students’ learning."

"Latar belakang: Kardioplegia merupakan komponen penting proteksi miokard. Pada pasien dewasa, kardioplegia darah dinyatakan unggul dibanding kardioplegia kristaloid. Pada bedah jantung anak belum ada penelitian yang membuktikan hal ini, khususnya pada operasi jantung bawaan sianotik. Metode: Penelitian eksperimental dengan simple randomization pada 70 populasi pasien TOF yang dibagi menjadi dua kelompok; 35 pasien kelompok kardioplegia kristaloid CC sebagai kontrol dan 35 pasien kelompok kardioplegia darah BC . Dilakukan pemeriksaan metabolik jantung: selisih kadar laktat dan ekstraksi oksigen darah arteri dan sinus koronarius ; segera, menit ke-15 dan menit ke-30 setelah CPB dihentikan. Dilakukan juga observasi klinis terhadap; mortalitas, penggunaan inotropik, durasi ventilasi mekanik, aritmia, fungsi jantung kanan, lama rawat ICU, lama rawat rumah sakit dan major adverse cardiac events. Hasil: Selisih kadar laktat tidak berbeda bermakna p>0,05 . Selisih ekstraksi oksigen koroner ditemukan berbeda bermakna pada menit ke-0 dan menit ke-15 p=0,038 dan p=0,015 . Tidak ada perbedaan pada luaran klinis. Kesimpulan: Tidak ditemukan perbedaan klinis maupun cedera miokard yang bermakna antara kedua kardioplegia. Kardioplegia darah ditemukan unggul secara metabolik pascabedah dan dapat dipakai sebagai alternatif untuk operasi jantung pasien sianosis.

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Backgrounds Cardioplegia is an integral part of myocardial protection. Several authors reported the superiority of blood cardioplegia in adult patients. However, this is yet to be studied in cyanotic pediatric patients. Methods This study is a double blind randomized controlled trial. 70 TOF patients were devided into two groups 35 patients in crystalloid cardioplegia group CC as control, and 35 in blood cardioplegia group BC . Lactate and coronary oxygen extraction in arterial blood and coronary sinu, were measured immediate, 15 and 30 minutes after CPB caessation. Postoperative mortality, major adverse cardiac events, mechanical ventilation time, inotropic administrations, arrhytmias, right ventricular function, ICU and hospital length of stay were observed. Results There were no significant difference in clinical outcomes and difference in lactate levels p 0.05 . There is a significant difference in coronary oxygen extraction immediate and 15 minutes post CPB off p 0,038 dan p 0,015 . Conclusions Blood cardioplegia gave a better postoperative myocardial metabolism value. However, there are no statistical difference in myocardial damage or clinical outcome between the two groups."

"Latar belakang: Berdasarkan pilot study di divisi Bedah Jantung Dewasa Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita, SIRS lebih sering terjadi pada OPCAB dibandingkan dengan on-pump CABG, 67% vs 33% (30 sampel, 2017). Berangkat dari hal tersebut, peneliti melakukan uji klinis memberikan deksametason pada pasien yang menjalani operasi OPCAB. Metode: Pengumpulan sampel dilakukan secara konsekutif di divisi Bedah Jantung Dewasa Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita antara Agustus 2018 - Januari 2019. Sampel yang memenuhi kriteria inklusi dan eksklusi dirandomisasi menjadi grup deksametason (n=30) dan grup plasebo (n=30). Intervensi deksametason intravena dosis 1 mg/KgBB (maksimal 100 mg) atau plasebo menggunakan normal salin (NaCl 0,9%). Analisis statistik digunakan independent t-test, Mann-Whitney test, fisher exact test dan AUC. Hasil: Insiden MACE pada grup deksametason dibandingkan grup plasebo (RR 0,385, CI 95%: 0,157-0,945, p = 0,024). Keluaran klinis lebih baik ditemukan pada grup deksametason dibandingkan grup plasebo untuk durasi ventilasi mekanik (6 (5-16) jam vs 8 (5-72) jam, p = 0,029), lama rawat ICU (17,5 (12-32) jam vs 19 (13-168) jam, p = 0,028), lama rawat rumah sakit (5 (5-8) hari vs 6,5 (5-30) hari, p = 0,04) dan VIS (0 (0-15) vs 5 (0-100), p = 0,045). Hasil penanda inflamasi, terdapat perbedaan rata-rata yang bermakna antara grup deksametason dibandingkan grup plasebo pada IL-6 (217,4 pg/mL, CI 95%: 107,9-326,8, p = 0,0001), PCT (3,41 µg/L, CI 95%: 2,1-4,71, p = 0,0001) dan CRP (52,3 mg/L, CI 95%: 28.8-75,8, p = 0,0001). Pada analisis AUC terdapat hubungan signifikan antara penanda inflamasi dengan insiden MACE pada IL-6 (AUC 0,728, CI 95%: 0,585-0,871, p = 0,005) dan PCT (AUC 0,723, CI 95%: 0,578-0,868, p = 0,007). Kesimpulan: Pemberian deksametason praoperasi OPCAB, efektif memperbaiki keluaran klinis dan mengendalikan reaksi inflamasi pascaoperasi dibandingkan plasebo.

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Background: Based on a pilot study in the Adult Heart Surgery division of Harapan Kita Heart and Vascular Center Hospital, SIRS is more common in OPCAB compared to on-pump CABG, 67% vs 33% (30 samples, 2017). Based from this result, this research conducted a clinical trial to provide dexamethasone in patients undergoing OPCAB surgery. Methods: Samples were collected consecutively in the Adult Heart Surgery division of Harapan Kita Heart and Vascular Center Hospital between August 2018 - January 2019. Samples that fulfill inclusion and exclusion criteria were randomized to dexamethasone group (n=30) and placebo group (n=30). Intervention using intravenous dexamethasone dose of 1 mg/KgBB (maximum 100 mg) or placebo using normal saline (0.9% NaCl). Statistical analysis were used independent t-test, Mann-Whitney test, fisher exact test and AUC. Results: MACE incidence in dexamethasone group compared to placebo group (RR 0.385, 95% CI: 0.157-0.945, p = 0.024). Clinical output of dexamethasone group was better than placebo group in duration of mechanical ventilation (6 (5-16) hours vs 8 (5-72 ) hours, p = 0.029), ICU length of stay (17.5 (12-32) hours vs 19 (13-168) hours, p = 0.028), hospital length of stay (5 (5-8) days vs 6.5 (5-30) days, p = 0.04) and VIS (0 (0-15) vs 5 (0-100), p = 0.045). As a result of the inflammatory markers, there was a significant average difference between dexamethasone group compared to the placebo group in IL-6 (217.4 pg/mL, 95% CI: 107.9-326.8, p = 0,0001), PCT ( 3.41 µg/L, 95% CI: 2.1-4.71, p = 0.0001) and CRP (52.3 mg/L, 95% CI: 28.8-75.8, p = 0.0001 ) In the AUC analysis there was a significant association between inflammatory markers with the incidence of MACE in IL-6 (AUC 0.728, 95% CI: 0.585-0.871, p = 0.005) and PCT (AUC 0.723, 95% CI: 0.578-0.868, p = 0.007). Conclusion: Preoperative dexamethasone OPCAB is effective to improving clinical output and controlling postoperative inflammatory reactions compared to placebo."

"ABSTRAK Latar Belakang : Pada studi invivo, seperti indometasin dan diklofenak,, ketoprofen menghambat aktifitas enzim fosfolipase A2 yang memainkan peran penting dalam patogenesis pankreatitis. Tujuan : Mengetahui efektifitas ketoprofen suppositoria terhadap pencegahan pankreatitis pasca ERCP Metode : Uji klinis acak tersamar ganda ini dilakukan di Pusat Endoskopi Saluran Cerna dan ruang rawat inap Rumah Sakit Pusat Nasional Dr Cipto Mangunkusumo pada bulan oktober 2016 sampai dengan Januari 2017 terhadap 74 pasien ikterus obstruktif dewasa atau dengan indikasi ERCP lainnya. Pasien yang memenuhi kriteria penerimaan diberikan ketoprofen suppositoria atau plasebo dosis tunggal sesaat sebelum tindakan ERCP dan dievaluasi tanda dan gejala pankreatitis akut serta evaluasi ulang amilase lipase 24 jam pasca tindakan untuk menentukan adanya pankreatitis pasca ERCP. Derajat pankreatitis akut dinilai berdasarkan kriteria imrie modified glasgow pada 48 jam pasca ERCP Hasil : 74 subjek yang memenuh kriteria penelitian dirandomisasi menjadi dua kelompok, masing-masing terdiri dari 37 pasien, terdapat 1 pasien dari setiap kelompok yang tidak dapat dikanulasi. Dilakukan analisis dengan prinsip intention to treat analysis, kedua kelompok sebanding dalam karakteristik demografis dan klinis termasuk faktor risiko terkait pasien dan prosedur. Insidens PPE pada kelompok ketoprofen sebanyak 13,5 5 sedangkan pada kelompok plasebo sebanyak 21,6 8 , Absolute Risk Reduction ARR = 0,081, Relative Risk RR = 0,625, Relative risk reduction RRR = 0,375, Number Needed to Treat NTT =12 95 IK=-9-25 . Terdapat laporan adverse event berupa perforasi usus pada 1 subjek. Kesimpulan: ketoprofen suppositoria menurunkan insidens pankreatitis pasca ERCP Kata Kunci : ketoprofen, insidens, pankreatitis pasca ERCP

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ABSTRACT Background An invitro study showed ketoprofen as well as indomethacin and diclofenac inhibits the activity of phospholipase A2 that is supposed to play a major role in the pathogenesis of pancreatitis. Objectives To determine the effect of rectal suppository ketoprofen to prevent post ERCP pancreatitis Methods This randomized double blind controlled trial performed at Gastrointestinal Endoscopy Center and inpatient unit in Cipto Mangunkusumo National General Hospital during October 2016 to January 2017 among patients with obstructive jaundice and patients with other indications of ERCP. All subjects with inclusion criteria were treated with rectal ketoprofen or rectal placebo suppository single dose immediately before ERCP. Sign and symptoms of acute pancreatitis and serum amylase and lipase level observed in 24 hours after ERCP to determine post ERCP pancreatitis. Acute pancreatitis was graded according to the Imrie rsquo s modified Glasgow severity criteria in 48 hours after ERCP. Result In total, 74 subjects were randomized into two groups containing 37 subjects in each group. One patient in each group was failed for cannulation. We used intention to treat analysis, both groups were comparable regarding demographic and clinical factors. The incidence of PEP was 13,5 5 in ketoprofen group and 21,6 8 in placebo group, Absolute Risk Reduction ARR 0,081, Relative Risk RR 0,625, Relative risk reduction RRR 0,375, and Number Needed to Treat NTT 12 95 CI 9 ndash 25 . Reported adverse event was bowl perforation in 1 subject. Conclusion Rectal ketoprofen reduced the incidence of post ERCP pancreatitis Key Words Ketoprofen, Incidence, Post ERCP pancreatitis"