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"Aspergilosis invasif AI merupakan infeksi jamur invasif disebabkan Aspergillus spp sedangkan aspergilosis paru invasif API merupakan manifestasi AI yang sering ditemukan Gejala klinis laboratorium rutin dan radiologis tidak khas sehingga sering terjadi keterlambatan diagnosis dan tatalaksana Pemeriksaan biopsi tidak selalu dapat dilakukan dan berisiko tinggi sedangkan pemeriksaan biakan memiliki keterbatasan sensitivitas dan waktu Deteksi antigen galaktomanan GM merupakan uji penapis AI yang dinilai baik tetapi di Indonesia kit GM tidak rutin tersedia dan mahal sehingga perlu dicari uji diagnostik alternatif antara lain menggunakan deteksi antibodi anti Aspergillus yang sederhana mudah murah dan terjamin ketersediaannya Tujuan penelitian ini membandingkan hasil pemeriksaan deteksi antibodi anti Aspergillus metode immunodiffusion test IDT menggunakan crude antigen Aspergillus dengan deteksi antigen GM serta mengetahui nilai sensitivitas dan spesifisitasnya Penelitian berdisain potong lintang ini merupakan bagian dari penelitian multisenter sebelumnya mengenai insidens API pada 405 pasien ICU di 6 rumah sakit di Jakarta Selanjutnya ditentukan 125 pasien non neutropenia diduga AI yang bahan klinisnya menjalani pemeriksaan uji diagnostik di atas Biakan Aspergillus sp tumbuh pada bahan klinis ekskreta paru yang dimiliki 26 dari 125 pasien tersebut 20 8 Diagnosis AI putative ditegakkan pada 26 pasien 6 2 dari 405 pasien keseluruhan Dari 125 pasien yang diperiksa uji GM positif ditemukan pada 62 pasien 48 6 sedangkan uji IDT positif pada 74 pasien 59 2 Analisis statistik menunjukkan tidak terdapat perbedaan bermakna antara hasil uji GM dan uji IDT tetapi nilai kesetaraannya sangat lemah nilai kappa 0 169 Uji IDT menggunakan crude antigen Aspergillus mempunyai sensitivitas 67 7 dan spesifisitas 49 1

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Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 "

"Latar belakang: Diagnosis aspergilosis paru invasif (API) cukup sulit dilakukan karena karakteristik klinis dan hasil pencitraan yang tidak spesifik. Biopsi tidak bisa dilakukan karena risiko komplikasi Deteksi antigen galaktomanan (GM) digunakan untuk metode noninvasif karena sensitivitas dan spesifisitas yang tinggi, namun mahal dan jarang tersedia. Uji imunodifusi (IDT) bisa menjadi alternatif karena lebih murah dan mudah, namun perlu diketahui akurasi IDT pada pasien terduga API. Tujuan: Mengetahui nilai diagnostik IDT dibandingkan terhadap deteksi GM dalam mendiagnosis API. Metode: Pengumpulan serum dilakukan di Laboratorium Departemen Parasitologi FKUI sejak Oktober 2019—Oktober 2020 pada pasien terduga API yang berasal dari berbagai rumah sakit di Jakarta. Serum diperiksan menggunakan IDT dan deteksi GM. Metode IDT menggunakan antigen crude Aspergillus buatan Laboratorium Departemen Parasitologi FKUI, sedangkan deteksi GM menggunakan kit PlateliaTM (Bio-Rad, Prancis). Hasil: Sebanyak 92 sampel serum pasien diuji. Proporsi hasil deteksi GM dan IDT berturut-turut sebesar 31.5% dan 42.4%. Hasil menunjukkan bahwa sensitivitas dan spesifisitas IDT berturut-turut sebesar 33.33% dan 69.81%. Selain itu, rasio kemungkinan positif dan negatif berturut-turut sebesar 1.10 dan 0.95. Nilai duga positif dan negatif serta akurasi berturut-turut sebesar 44.83%, 58.73%, dan 54.35%. Tidak ada beda proporsi IDT terhadap deteksi GM (P>0.05) Simpulan: Nilai diagnostik IDT sama dibandingkan terhadap deteksi GM.

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Background: The diagnosis of invasive pulmonary aspergillosis (API) is quite challenging because of non-specific clinical characteristics and imaging results. A biopsy cannot be performed because of the risk of complications. Galactomannan antigen (GM) detection is used as a noninvasive method because of its high sensitivity and specificity, but it is expensive and rarely available. Immunodiffusion test (IDT) can be an alternative method, because it is cheaper and easier, but it is necessary to know the accuracy of IDT in patients suspected of API.

Objective: Determine the diagnostic value of Aspergillus IDT compared to GM detection in diagnosing API.

Methods: Serum collection was carried out at the Parasitology Laboratory of FMUI from October 2019-October 2020 in patients suspected of API from various hospitals in Jakarta. The sera were examined using the Aspergillus IDT and GM detection. The IDT method uses crude Aspergillus antigen that was conducted at the Parasitology Laboratory of FMUI, while GM detection uses the PlateliaTM kit (Bio-Rad, France).

Results: A total of 92 patient serum samples were tested. The proportion of detection results for GM and IDT was 31.5% and 42.4%, respectively. The results showed that the sensitivity and specificity of IDT were 33.33% and 69.81%, respectively. Also, the positive and negative likelihood ratios are 1.10 and 0.95, respectively. Positive and negative predictive values and accuracy were 44.83%, 58.73%, and 54.35%, respectively. There was no difference in the proportion of IDT to GM detection (P> 0.05).

Conclusion: IDT diagnostic value is the same as compared to GM detection."

"Infeksi jamur paru dapat disebabkan Aspergillus spp. menyebabkan aspergillosis paru kronik (APK) yang sering mengikuti penyakit kronik lain, termasuk tuberkulosis (TB) paru. Data APK dan metode diagnosisnya pada pasien TB paru di Indonesia masih terbatas. Penelitian ini bertujuan untuk mengetahui perbandingan sensitivitas deteksi antibodi spesifik Aspergillus pada pasien TB paru. Penelitian berdesain nested case-control ini merupakan bagian dari penelitian payung tentang diagnosis APK pada pasien TB paru di Jakarta. Serum pasien yang memenuhi kriteria inklusi diperiksa menggunakan imunokromatografi kit ICT LDBio Aspergillus sebanyak 2 kali, yaitu saat awal dan akhir pengobatan TB. Pemeriksaan dilakukan pada Maret-Oktober 2022 sesuai protokol di Laboratorium Parasitologi FKUI. Dari 71 pasien TB paru yang memenuhi kriteria inklusi, rerata usia 44,35 ± 17,43. Pemeriksaan ICT LDBio Aspergillus pada awal terapi OAT menunjukkan hasil positif pada 4 dari 71 (5,6%) pasien, dengan sensitivitas 11,54%, spesifisitas 97,78%. Pada akhir terapi OAT, pemeriksaan ICT LDBio Aspergillus juga menunjukkan hasil positif pada 5,6% pasien, dengan sensitivitas 25% serta spesifisitas 96,83%. Hasil ICT LD Bio Aspergillus pada 71 pasien TB paru dalam penelitian ini menunjukkan hasil positif yang setara pada awal dan akhir OAT (5,6%), dengan sensitivitas yang lebih rendah pada awal OAT (11,54%) dibandingkan akhir OAT (25%).

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Lung fungal infection can be caused by Aspergillus spp. causes chronic pulmonary aspergillosis (CPA) which often follows other chronic diseases, including pulmonary tuberculosis (TB). CPA data and its method of diagnosis in pulmonary TB patients in Indonesia are still limited. This study aims to compare the sensitivity of Aspergillusspecific antibody detection in pulmonary TB patients. This nested case-control design study is part of an umbrella study on the diagnosis of CPA in pulmonary TB patients in Jakarta. Sera of patients who met the inclusion criteria were examined using the ICT LDBio Aspergillus kit 2 times, namely at the beginning and at the end of TB treatment. The examination was carried out in March-October 2022 according to the protocol at the FKUI Parasitology Laboratory. Of the 71 pulmonary TB patients who met the inclusion criteria, the mean age was 44.35 ± 17.43. The result of ICT LDBio Aspergillus examination at the start of anti-tuberculosis therapy showed positive results in 4 of 71 (5.6%) patients, with a sensitivity of 11.54%, a specificity of 97.78%. At the end of antituberculosis therapy, the result of ICT LDBio Aspergillus examination also showed positive results in 5.6% of patients, with a sensitivity of 25% and a specificity of 96.83%. ICT LDBio Aspergillus results in 71 pulmonary TB patients in this study showed equivalent positive results at the beginning and end of anti-tuberculosis (5.6%), with lower sensitivity at the start of anti-tuberculosis (11.54%) than at the end of anti-tuberculosis (25%)."

"[ABSTRAKInfark Miokard Akut dan lingkungan perawatan mempengaruhi kondisi fisik, psikologis dan sosial pasien. Penerapan perilaku caring dapat meningkatkan perubahan positif serta membangun kepercayaan dan kepuasan pasien beserta keluarganya. Penelitian ini bertujuan mendapatkan gambaran pengalaman perawat dalam menerapkan perilaku caring pada pasien IMA di Unit Perawatan Intensif. Desain kualitatif fenomenologi dipilih untuk mendapatkan informasi yang mendalam dengan wawancara pada dua belas perawat yang ditentukan melalui teknik purposive. Content analisis Collaizi menghasilkan delapan tema yang terpola dalam fenomena spirit of caring, penerapan caring dan hambatan caring. Diharapkan adanya program untuk meningkatkan penerapan perilaku caring untuk menangani pasien dalam kondisi akut dan kritis;

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ABSTRACTAcute Myocardial Infarction and the environment care affects physical conditions,psychologis and social of the patient. The implementation of caring behavior canincrease positive changes and to build trust, satisfaction of patients with theirfamilies too. The aims of this study was to explore the nurse?s experience inapplying caring behavior for patients with IMA at Intensive Care Unit. Aphenomenological qualitative design was chosen to obtain in-depth informationwith interviews were conducted on twelve nurses were determined throughpurposive technique. The content analysis Collaizi produced eight themes ispatterned in the phenomenon of spirit of caring, implementation of caring andbarriers caring implementation. Therefore expected the program to improve theimplementation caring behavior to treat with patients in acute and criticalconditions;Acute Myocardial Infarction and the environment care affects physical conditions,psychologis and social of the patient. The implementation of caring behavior canincrease positive changes and to build trust, satisfaction of patients with theirfamilies too. The aims of this study was to explore the nurse?s experience inapplying caring behavior for patients with IMA at Intensive Care Unit. Aphenomenological qualitative design was chosen to obtain in-depth informationwith interviews were conducted on twelve nurses were determined throughpurposive technique. The content analysis Collaizi produced eight themes ispatterned in the phenomenon of spirit of caring, implementation of caring andbarriers caring implementation. Therefore expected the program to improve theimplementation caring behavior to treat with patients in acute and criticalconditions;Acute Myocardial Infarction and the environment care affects physical conditions,psychologis and social of the patient. The implementation of caring behavior canincrease positive changes and to build trust, satisfaction of patients with theirfamilies too. The aims of this study was to explore the nurse?s experience inapplying caring behavior for patients with IMA at Intensive Care Unit. Aphenomenological qualitative design was chosen to obtain in-depth informationwith interviews were conducted on twelve nurses were determined throughpurposive technique. The content analysis Collaizi produced eight themes ispatterned in the phenomenon of spirit of caring, implementation of caring andbarriers caring implementation. Therefore expected the program to improve theimplementation caring behavior to treat with patients in acute and criticalconditions, Acute Myocardial Infarction and the environment care affects physical conditions,psychologis and social of the patient. The implementation of caring behavior canincrease positive changes and to build trust, satisfaction of patients with theirfamilies too. The aims of this study was to explore the nurse’s experience inapplying caring behavior for patients with IMA at Intensive Care Unit. Aphenomenological qualitative design was chosen to obtain in-depth informationwith interviews were conducted on twelve nurses were determined throughpurposive technique. The content analysis Collaizi produced eight themes ispatterned in the phenomenon of spirit of caring, implementation of caring andbarriers caring implementation. Therefore expected the program to improve theimplementation caring behavior to treat with patients in acute and criticalconditions]"

"Aspergilosis paru merupakan infeksi oportunistik yang disebabkan oleh jamur Aspergillus spp. Insidensi aspergilosis paru cenderung semakin meningkat seiring dengan peningkatan penggunaan obat-obatan imunosupresan seperti kortikosteroid dan terapi sitotoksik. Sulitnya penegakan diagnosis aspergilosis paru menjadi tantangan disebabkan tanda dan gejala klinis yang tidak spesifik serta biopsi jaringan sebagai baku emas yang bersifat invasif. Pemeriksaan kultur sputum dan deteksi antibodi merupakan pemeriksaan yang rutin dilakukan pada pasien suspek aspergilosis paru yang dikirim ke Laboratorium Mikologi Departemen Parasitologi FKUI, namun belum tersedia data mengenai nilai diagnostik deteksi antibodi dalam mendiagnosis aspergilosis paru. Tujuan penelitian ini adalah membandingkan pemeriksaan deteksi antibodi dengan crude antigen Aspergillus dengan metode imunodifusi dengan kultur sputum sebagai tes rujukan. Penelitian berdesain potong lintang dengan sampel berjumlah 689 rekam medis dari pasien suspek aspergilosis paru yang melakukan pemeriksaan kultur sputum dan deteksi antibodi di Laboratorium Mikologi Departemen Parasitologi FKUI tahun 2008-2015. Dari analisis deskriptif didapatkan prevalensi aspergilosis paru berdasarkan hasil positif kultur sebesar 0,4. Dari uji diagnostik deteksi antibodi dengan tabel 2x2, nilai sensitivitas 33,33 dan spesifisitas 95,62 serta terdapatnya perbedaan yang bermakna.

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Pulmonary aspergillosis is an opportunistic infection caused by Aspergillus spp mold. The incidence of this infection has dramatically increased which is related to the increasing utilization of immunosuppressive drugs such as corticosteroids and cytotoxic therapy. Diagnosis of pulmonary aspergillosis has been challenging since not only the signs and symptoms of the disease are nonspecific, but also tissue biopsy as gold standard is considered invasive. Sputum culture and antibody detection has been routine examinations done to the patient with suspected pulmonary aspergillosis sent to the Mycology Laboratory of Department of Parasitology FMUI, but the diagnostic value of antibody detection is not available.

The aim of this study is to compare antibody detection with immunodiffusion method using crude antigen of Aspergillus with sputum culture as reference test. This cross sectional study used 689 samples obtained from medical records of patients with suspected pulmonary aspergillosis who undergo both sputum culture examination and antibody detection in Mycology Laboratory of Department of Parasitology FMUI in 2008 2015. Descriptive analysis showed the prevalence of pulmonary aspergillosis based on positive culture result is 0,4. The sensitivity and specificity of antibody detection are 33,33 and 95,62 respectively, resulted from diagnostic test using 2x2 table. Statistical analysis using McNemar rsquo. test shows significant difference between mentioned examinations and low level of agreement Kappa 0,026."

"Ekstubasi merupakan salah satu upaya manajemen jalan napas bertujuan untuk mencegah resiko penggunaan EndoTrakeal Tube (ETT) dan ventilasi mekanik. Keberhasilan ekstubasi adalah tidak terjadinya reintubasi dalam waktu 24-72 jam pasca ekstubasi. Pasien dengan kondisi penyulit jalan napas beresiko besar terhadap kejadian reintubasi. Penelitian kohort prospektif ini dilakukan di Intensive Care Unit (ICU) Dewasa, ICU IGD dan ICU luka bakar RSUPN dr. Cipto Mangunkusumo (RSCM) untuk mengetahui faktor-faktor prediktor keberhasilan ekstubasi pada kasus jalan napas dengan penyulit. Uji statistik menggunakan regresi logistik ganda. Hasil analisis didapatkan faktor-faktor yang memiliki hubungan dengan keberhasilan ekstubasi pada penyulit jalan napas yaitu lama terintubasi (p value=0,034), hemodinamik (p value=0,001) dan refleks batuk (p value=0,005), sedangkan faktor yang tidak memiliki hubungan dengan keberhasilan ekstubasi pada penyulit jalan napas yaitu adalah usia, jenis kelamin, penyulit jalan napas, tingkat kesadaran, sikap koperatif pasien, hasil AGD, lama Spontaneous Breathing Trial (SBT) dan kesiapan pasien. Faktor yang paling berpengaruh terhadap keberhasilan ekstubasi adalah refleks batuk (OR=20,805 95%CI 1,298-333,422) dan hemodinamik (OR=17,746 95% CI 2,083-151,213). Penatalaksaan ekstubasi dengan melakukan asesmen pra ekstubasi menggunakan ceklist akan mampu mendeteksi keberhasilan ekstubasi, sehingga prosedur ekstubasi dapat dilakukan dengan lebih aman untuk menghindari kejadian reintubasi

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Extubation is an airway management that aimed to prevent the risk of using ETT and Mechanical Ventilation. Extubation success is no reintubation within 24-72 hour. Patients with difficult airway condition has greater risk of reintubation events. This prospective cohort study was conducted at General ICU, ICU IGD and ICU burns RSCM to find out predictor factors of extubation success in difficult airway cases.. Statistical tests use multiple logistic regression. The results of the analysis obtained factors that have a relationship with extubation success in the difficult airway are the length of intubation (p value = 0.034), hemodynamics (p value = 0.001) and cough reflexes (p value = 0.005), and factors that have no relationship are age, gender, difficult airway, level of Consciousness (LoC), cooperative attitude, AGD results, SBT duration and patient readiness. The most influential factors on extubation success are cough reflexes (OR = 20,805 95% CI 1,298-333,422) and hemodynamics (OR = 17,746 95% CI 2,083-151,213). Management of extubation by conducting pre-extubation assessment using a checklist methode will be able to detect the extubation success and the procedure can be done more safely."

"Latar belakang: merupakan salah satu tindakan pembedahan yang mempengaruhi motilitas gastrointestinal. Penelitian Cihoric et al menunjukkan sebanyak 12,5% pasien pasca laparotomi mengalami komplikasi disfungsi gastrointestinal. Disfungsi pada motilitas gastrointestinal merupakan komplikasi yang sering terjadi pada prosedur pembedahan abdomen. Dari 100 pasien operasi laparotomi digestif, ditemukan sebanyak 40% pasien di ICU mengalami peningkatan gastric residual volume pada pasien pasca operatif laparotomi digestif. Pemberian suplementasi dengan Lactobaciillus acidophilus diketahui dapat meningkatkan motilitas gaster.Tujuan: Penelitian ini bertujuan untuk mengetahui efek hubungan antara pemberian probiotik Lactobacillus acidophillus dengan GRV.Metode: Desain penelitian yang digunakan adalah eksperimental atau uji klinis acak tersamar ganda. Sebanyak 55 subjek yang mengikuti randomisasi, 54 subjek yang akan menjalani operasi laparotomi gastrointestinal dimasukkan ke dalam penelitian, 1 subjek drop out karena sepsis. Subjek penelitian diberikan kapsul probiotik Lactobacillus acidophilus 109 (kelompok probiotik) atau diberikan kapsul laktosa (kelompok plasebo) selama 3 hari sebelum operasi. Kadar GRV diukur 2 hari sesudah prosedur.Hasil: Dari 54 subjek dengan 27 subjek tiap kelompok mengikuti penelitian hingga selesai. Pada hari pertama (24 jam), GRV 24 jam dengan pemberian probiotik dan kelompok kontrol menunjukkan hasil yang tidak signifikan (p value 0,669). Pada hari ke 2 (48 jam), GRV 48 jam dengan pemberian probiotik dan kelompok kontrol menunjukkan hasil yang tidak signifikan (p value 1,000). Hasil yang tidak signifikan pada GRV 24 jam dan 48 jam dapat dipengaruhi faktor perancu yaitu geriatri, riwayat kelainan saraf, obesitas, riwayat penggunaan vasopressor, riwayat konsumsi opioid, hiperkapnia dan hiperglikemia selama di ICU.Simpulan: Pemberian probiotik Lactobacillus acidophilus dengan GRV tidak mempunyai efek hubungan dibandingkan dengan placebo.

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Background: Laparotomy is a surgical procedure that affects gastrointestinal motility. Research by Cihoric et al showed that 12.5% ​​of post-laparotomy patients experienced complications of gastrointestinal dysfunction. Dysfunction in gastrointestinal motility is a frequent complication of abdominal surgical procedures. Out of 100 patients with digestive laparotomy surgery, it was found that as many as 40% of patients in the ICU experienced an increase in gastric residual volume in postoperative digestive laparotomy patients. Supplementation with Lactobaciillus acidophilus is known to increase gastric motility.

Aim: This study aims to determine the effect of the relationship between administration of Lactobacillus acidophillus probiotics and GRV.

Methods: The study design used was an experimental or double-blind randomized clinical trial. A total of 55 subjects who followed the randomization, 54 subjects who would undergo gastrointestinal laparotomy were included in the study, 1 subject dropped out due to sepsis. Research subjects were given probiotic capsules Lactobacillus acidophilus 109 (probiotic group) or given lactose capsules (placebo group) for 3 days before surgery. GRV levels were measured 2 days after the procedure.

Results: Of the 54 subjects with 27 subjects in each group, they followed the research to completion. On the first day (24 hours), the 24-hour GRV with the administration of probiotics and the control group showed insignificant results (p value 0.669). On day 2 (48 hours), GRV 48 hours with probiotic administration and the control group showed insignificant results (p value 1,000). Results that were not significant at GRV 24 hours and 48 hours could be influenced by confounding factors, geriatrics, history of neurological disorders, obesity, history of vasopressor use, history of consumption of opioids, hypercapnia and hyperglycemia while in the ICU.

Conclusion: Administration of Lactobacillus Acidophilus probiotics with GRV had no association effect compared to placebo."

"Ventilasi mekanik digunakan pada pasien ARDS ( Acute Respiratory distress syndrome) akibat Covid-19 di ruang Intensive Care Unit ( ICU). Salah satu intervensi yang direkomendasikan untuk meningkatkan saturasi oksigen yaitu dengan posisi prone. Metode yang digunakan berupa laporan kasus yang telah dikelola selama 4 hari pada pasien terdiagnosa positif Covid-19 yang dirawat di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dengan penyakit komorbid jantung dan terpasang ventilasi mekanik. Hasil menunjukkan bahwa terdapat peningkatan saturasi oksigen sebesar (11%) pada hari pertama, (8%) pada hari kedua, dan penurunan oksigen pada alat ventilasi mekanik sebesar (14%) dan peningkatan kadar oksigen pada hasil analisa gas darah sebesar 21mmhg. Kesimpulannya, prone position dapat meningkatkan saturasi oskigen pada pasien yang terpasang ventilasi mekanik, dan merupakan rekomendasi intervensi yang murah dan efektif

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Mechanical ventilation is used in ARDS (acute respiratory distress syndrome) patients due to Covid-19 in the Intensive Care Unit (ICU). One of the recommended interventions to increase oxygen saturation is the prone position. The method used is a case report that has been managed for 4 days in patient diagnosed as positive for Covid-19 at Jantung dan Pembuluh Darah Harapan Kita Hospital with comorbid heart disease and mechanical ventilation installed. The result showed that there was an increase in oxygen saturation (11%) on first day, (8%) on the second day, and a decrease in oxygen on mechanical ventilation devices by 14% and an increase in oxygen levels on the results of blood gas analysis by 21 mmhg. In conclusion, the prone position can increase oxygen saturation in mechanically ventilated patients, and is a recommended inexpensive and effective intervention."

"Latar Belakang: Secara global diperkirakan terdapat 313 juta pembedahan yang dilakukan, dengan angka kematian 30 hari pascaoperasi mencapai 4.2 juta jiwa. Penilaian kondisi pasien preoperatif diperlukan untuk memprediksi morbiditas danmortalitas pasien pascabedah, maka modalitas yang digunakan dalam menilai risiko pembedahan sebaiknya memiliki akurasi dan objektivitas yang baik. Salah satu modalitas yang rutin digunakan di RSUPN Cipto Mangunkusumo (RSUPNCM) adalah skor ASA-PS. Namun skor ini sudah banyak ditinggalkan oleh negara maju dan beralih pada skor P-POSSUM yang dinilai lebih objektif, dan akurat. Studi ini menguji kesahihan skor P-POSSUM dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ICU, yang mencerminkan keparahan morbiditaspascabedah. Tujuan: Studi ini menguji kemampuan kalibrasi dan diskriminasi skor P-POSSUM dalam memprediksi lama perawatan di ICU, dan menganalisis hubungan antar variabel skor P-POSSUM dengan lama perawatan di ICU pada pasien pasabedah digestif mayor. Metode: Studi ini merupakan studi kohort retrospektif di RSUPNCM selama Januari 2017 hingga Desember 2018. Sebanyak 289 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Lama perawatan pascabedah di ICU dan skor P-POSSUM subjek dicatat sesuai dengan data rekam medis. Variabel PPOSSUM yang berpengaruh terhadap lama perawatan subjek dianalisis dengan analisis bivariat dan regresi logistik multivariat. Kesahihan skor dinilai menggunakan uji kalibrasi Hosmer-Lemeshow dan uji diskriminasi dengan melihatnilai Area Under Curve. Hasil: Hasil analisis statistik menghasilkan bahwa skor P-POSSUM memiliki kemampuan kalibrasi yang baik (uji Hosmer-Lemeshow p=0.815) dan kemampuandiskriminasi yang cukup baik (AUC 77.8%, IK 95% 0.717-0.827). Variabel PPOSSUM yang secara statistik berpengaruh signifikan (p<0.05) terhadap lama perawatan di ICU adalah kadar natrium, jumlah perdarahan, laju jantung, dan EKG.Kesimpulan: Skor P-POSSUM sahih dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ruang intensif (ICU).

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Background: It was estimated that there was 313 million surgery underwent worldwide, with the 30-days postoperative mortality rate reaching 4.2 million cases. The evaluation of preoperative patients’ conditions is encouraged to predict

postoperative morbidity and mortality, thus the modality used to assess surgery risk should be accurate and objective. RSUPN Cipto Mangunkusumo (RSUPNCM) routinely uses ASA-PS score to assess patients’ condition. Nonetheless, ASA-PS has

been regarded as subjective. Developed countries has started to replace this score with P-POSSUM score which was considered to be more accurate and objective. This study finds out the validity of P-POSSUM Score in predicting the length of

hospital stay in the ICU in patients who underwent digestive surgery, which reflects the severity of postoperative morbidity. Goals: This study investigated the calibration and discrimination ability of PPOSSUM score in predicting the length of stay in the ICU, and also explored the relationship between variables in P-POSSUM score and the length of stay in the ICU in patients who underwent digestive surgery.

Methods: This retrospective cohort study was conducted in RSUPNCM in January 2017 to December 2018 on 289 subjects who met the inclusion criteria. P-POSSUM score and the length of stay in the ICU unit were recorded, the data was taken from

medical record. Bivariate and multivariate logistic regression was used to investigate the relationship between P-POSSUM variables and the length of stay. The validity of P-POSSUM score was assessed by Hosmer-Lemeshow calibration

test and the measurement of the Area Under Curve (AUC).

Results: Statistical analysis showed that P-POSSUM had a good calibration ability (p=0.815 for Hosmer-Lemeshow test) and moderate discrimination ability (AUC 77.8%, CI 95% 0.717-0.827). Four P-POSSUM variables were found to be significantly associated with length of stay in the ICU (p<0.05), namely natrium level, total blood loss, heart rate and ECG. Conclusion: P-POSSUM score is valid in predicting the length of stay in the ICU in patients who underwent digestive surgery."

"Bedah merupakan salah satu prosedur medis yang dilakukan secara manual dan menyebabkan banyak perlukaan dan berisiko tinggi menyebabkan infeksi Adanya infeksi harus ditangani dengan antibiotika empiris yang tepat dan rasional. Penelitian ini dilakukan untuk memperoleh data penggunaan antibiotika empiris pada pasien pascabedah di Ruang ICU RSAL Dr Mintohardjo selama periode 2012 2013 dan melakukan evaluasi kerasionalannya dilihat dari ketepatan pasien ketepatan indikasi ketepatan obat ketepatan dosis dan interaksi obat. Penelitian dilakukan dengan pengambilan data penggunaan antibiotik empiris dari rekam medis pasien pascabedah dengan metode retrospektif dengan desain cross sectional. Pengambilan sampel penelitian dilakukan dengan tekniktotal sampling. Populasi penelitian berjumlah 299 pasien dan 35 pasien diterima sebagai sampel penelitian. Pada penilaian terhadap jumlah pasien pascabedah terdapat 100 pasien mendapatkan terapi antibiotik tepat dengan kondisi pasien 11 43 pasien mendapatkan antibiotik sesuai indikasi 0 pasien mendapatkan antibiotik tepat obat 85 71 pasien sudah mendapatkan dosis yang tepat dan 51 43 pasien tidak mengalami interaksi obat. Sehingga dapat disimpulkan pengobatan antibiotik empiris pada pasien pascabedah di RSAL Dr Mintohardjo tidak rasional.

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Surgery is a manual medical procedure which causes many wounds and has a high infection risk Patient who has infection must be given antibiotic immediatelyand rationally. The aim of this study was to collect empiric antibiotics usage data in Intensive Care Unit of Naval Hospital Dr Mintohardjo 2012 2013 and to evaluate rationality of the administration through the appropriate patient appropriate indication appropriate drug appropriate dose and drugs interaction. This retrospective cross sectional study was done by collecting empiric antibiotics usage data from medical record of postoperative patients on 2012 2013 using total sampling. Population of study included 299 patients and 35 patients were accepted as samples of study. Appropriate assessment based on number of postoperative patients showed 100 appropriate patient 11 43 appropriate indication 0 appropriate drug 85 71 appropriate dose and 31 43 no drugs interaction. It was concluded that empirical antibiotic treatment in postoperative patients in Naval Hospital Dr Mintohardjo were irrational."