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"Latar Belakang: Ikterus obstruktif merupakan salah satu komplikasi tersering keganasan sistem bilier. Keadaan ini akan memicu pelepasan sitokin proinflamasi. Terdapat kontroversi mengenai pengaruh drainase bilier terhadap perubahan kadar sitokin proinflamasi pada penderita kanker pankreatobilier.Tujuan: Untuk mengetahui kadar Tumor Necrosis Faktor alfa (TNF-alfa) dan Interleukin 6 (IL6) sebelum dan sesudah Endoscopic Retrograde Cholangio Pancreatography (ERCP) atau Percutaneus Transhepatic Biliary Drainage (PTBD) pada penderita ikterus obstruksi etiologi kanker pankreatobilier.Metode: Desain penelitian adalah one group before after study. Pemilihan sampel secara consecutive sampling. Sampel darah diambil sebelum dan lima hari sesudah ERCP atau PTBD. Pengukuran kadar TNF-alfa dan IL-6 dengan cara Enzyme Linked Immunosorbed Assay (ELISA).Hasil: Terdapat 40 orang responden yang diikutsertakan dalam penelitian ini, 22 laki laki dan 18 perempuan dengan usia rata rata 55,3 tahun. Berdasarkan imaging dan endoskopi, ditegakkan diagnosis kolangiokarsinoma sebanyak 22 orang, tumor ampula Vateri 10 orang, dan tumor pankreas 8 orang. Kadar rata-rata TNF- alfa sebelum tindakan 4,81 (2,91) pg/ml dan sesudah tindakan 8,05 (6,7) pg/ml, terdapat peningkatan yang bermakna setelah tindakan drainase bilier (p:0,02). Kadar rata-rata IL-6 sebelum tindakan 7,79 (1,57) pg/ml dan sesudah tindakan 7,75 (1,76) pg/ml, tidak terdapat perbedaan yang bermakna setelah tindakan drainase bilier (p:0.52). Kadar rata-rata bilirubin sebelum tindakan 15,5 mg% dan sesudah tindakan 11,3 mg%.Simpulan: Terjadi peningkatan kadar rata-rata TNF-alfa secara bermakna setelah drainase. Tidak ada penurunan yang bermakna kadar rata-rata IL-6.

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Background: Obstructive jaundice represents the most common complication of biliary tract malignancy. Obstructive jaundice causes releases of proinflammatory cytokine. There has been controversy about effect of biliary drainage on the change in proinflammatory cytokine level in pancreatobiliary cancer patients.Objective: The present study was designed to determine levels of Tumor Necrosis Factor Alpha (TNF-Alpha) and Interleukin 6 (IL-6) in preprocedure of either Endoscopic Retrograde Cholangio Pancreatography (ERCP) or Percutaneus Transhepatic Biliary Drainage (PTBD) and postprocedure of them in obstructive jaundice patient caused by pancreatobiliary cancer.Methods : The study method is before- and- after case study design with consecutive sampling. Blood was collected five days prior to either Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure or Percutaneus Transhepatic Biliary Drainage (PTBD) procedure and five days after either of them. Enzyme Linked Immunosorbed Assay (ELISA) was used to determine TNF-Alpha and IL-6.Results: Forty subjects were included in this study which consisted of 22 men and 18 women. The mean age was 55.3 years old. According to the results of imaging and endoscopy procedure, twenty two (22) people were diagnosed cholangi carcinoma, ten (10) people were diagnosed ampulla varteri and eigth (8) people were diagnosed pancreatic tumor. In preprocedure, the mean of TNF-Alpha concentration was 4.81 (2.91) pg/mL, the mean of IL-6 concentration was 7.79 (1.57) pg/mL and the mean of bilirubin concentration was 15.5 mg%. In postprocedure, the mean of TNF-Alpha concentration was 8.05 (6.7) pg/mL, there was significant increase in TNF-Alpha concentration (p:0.02). However, the mean of IL-6 concentration was 7.75 (1.76) pg/mL, there was not any significant chance in IL-6 concentration (p:0.52). The mean of bilirubin concentration was 11.3 mg%.Conclusions: On one hand, there was significant increase in mean concentration value of TNF-Alpha after biliary drainage procedure. On the other hand there was not any significant decrease in mean concentration value of IL-6 after biliary drainage procedure."

"Jumlah lanjut usia dengan Penyakit Pam Obstruktif Kronik yang melakukan perjalanan penerbangan jarak tempuh lama seperti jemaah Haji semakin banyak. Kondisi lingkungan di ketinggian meningkatkan risiko kejadian hipoksia pada lanjut usia dengan PPOK. Tujuan penelitian ini adalah untuk mengevaluasi pengaruh latihan fisik Apolap (Aerobik, Peregangan Otot, dan Latihan Pemapasan) secara teratur pada lanjut usia dengan penyakit pam obstruktif kronik sebagai persiapan penerbangan jarak tempuh lama. Sebanyak 20 orang lanjut usia dengan diagnosis PPOK yang datang ke Poliklinik RSAU dr. Esnawan Antariksa diberikan latihan fisik Apolap tiga kali seminggu selama 4 minggu. Pemeriksaan spirometri, saturasi oksigen, dan nilai CAT dilakukan sebelum dan sesudah intervensi. Dari 20 responden, 17 pasien menyelesaikan peneiirian. Hasil penelitian menunjukan latihan fisik Apolap tidak menunjukan basil berma1cna pada variabel spirometri FEVI (p=O,570) dan FVC (p=0,156) dan menunjukan hasil berma1cna pada variabel saturasi oksigen (p=O,032), dan nilai CAT (p=O,OOO). Latihan fisik Apolap tidak menghasilkan perubahan yang berma1cna pada variabel spirometri (FEVI dan FVC) tetapi menghasilkan perubahan bermakna untuk variabel saturasi oksigen dan nilai CAT.

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The number of elderly with Chronic Obstructive Pulmonary Disease who travel by plane in a long-haul flight like Hajj pilgrims has increased. High-altitude environment increased the risk of hypoxia in elderly patients with COPD. The aim of this study was to evaluate the influence Apolap physical exercise consists of aerobic, muscle stretching, and breathing exercise in elderly patients with Chronic Obstructive Pulmonary Disease as a long-haul flight preparation. A total of 20 elderly patients diagnosed wih COPD in RSAU dr. Esnawan Antariksa joined Apolap physical exercise three times a week for 4 weeks. Spirometry, oxygen saturation, and CAT values were recorded pre- and post- intervention. Out of 20 patients, 17 patients completed the study. A statistically insignificant improvement was recorded for spirometry FEV 1 (p = 0,570) and FVC (p = 0,156) meanwhile statistically significant improvement was recorded for oxygen saturation (p=O,032), and CAT value (p = 0,000)."

"Latar Belakang Uji latih jantung beban (ULJB) merupakan modalitas diagnostik PJKO yang telah lama digunakan. Meskipun demikian, perannya semakin semakin tergantikan oleh karena tingginya angka positif palsu, khususnya pada respons iskemik sugestif positif. Tujuan studi ini adalah untuk menyusun sebuah model algoritme prediksi menggunakan kecerdasan buatan untuk mendeteksi PJKO pada populasi respons iskemik sugestif positif.Metode Pasien yang menjalani ULJB dengan hasil respons iskemik sugestif positif dan angiografi koroner invasif dalam rentang 1 tahun pasca ULJB diikutsertakan dalam studi ini. Populasi studi dibagi secara acak menjadi kelompok latihan (80%) dan uji (20%) untuk membuat algoritme prediktif. Total 16 dari 122 fitur yang digunakan, meliputi informasi klinis, faktor risiko dan EKG saat ULJB. Algoritme yang digunakan meliputi support vector machine, logistic regression, random forest, k-nearest neighbor, naive Bayesian, Adaboost, decision tree dan extreme gradient boosting. Hasil Sebanyak 124 dari 513 pasien dengan respons iskemik sugestif positif ikutserta dalam studi ini. Algoritme random forest memiliki nilai akurasi yang paling tinggi 0,75±0,05 dengan indeks Youden 0,37 serta AUC 0,7±0,14. Sebanyak 86(69,35%) populasi terbukti memiliki stenosis signifikan.Kesimpulan ULJB dengan bantuan kecerdasan buatan dapat mendeteksi adanya PJKO pada pasien dengan sindroma koroner kronik dengan respons iskemik sugestif positif.

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Background Treadmill stress testing (TST) used to be an established diagnostic modalities in diagnosing obstructive coronary artery disease (OCAD) among patients with chronic coronary syndrome (CCS). Nevertheless, it has high false positive rate especially especially those with suggestive positive ischemic response (SPIR). We aim to develop an predictive model based on machine learning to detect OCAD among those with SPIR.

Method Patients who underwent TST and coronary angiography (CAG) within 1 year interval were enrolled into the study. They were randomly splitted into training (80%) and testing (20%) dataset for model development. Sixteen out of 122 features were used, including clinical information, risk factor and ECG parameter during TST. Several algorithm were used in model development including support vector machine, logistic regression, random forest, k-nearest neighbor, naive Bayesian, Adaboost, decision tree dan extreme gradient boosting.

Result 124 out of 513 patients with SPIR were enrolled in this study. Random forest algorithm achieved the highest accuracy (0,75±0,05) with Youden index of 0,37 and AUC 0,7±0,14. A total of 86(69,35%) patients had OCAD based on CAG.

Conclusion Machine learning based predictive model can diagnosed OCAD among CCS patients with SPIR."

"Latar Belakang/Tujuan: Pasien ikterus obstruktif maligna stadium lanjut membutuhkandrainase bilier. Sten metal memiliki efektivitas yang lebih baik, namun klinisi perlumempertimbangkan patensi sten dan keterbatasan sumber daya, mengingat kesintasanpasien yang rendah. Oleh karena itu analisis efektivitas biaya pada kasus ini penting untukdilakukan.Metode: Penelitian ini merupakan studi kohort retrospektif yang dilakukan di rumahsakit tersier terhadap pasien ikterus obstruktif maligna yang menjalani pemasangan stenbilier paliatif pada Januari 2015 sampai Desember 2018. Perbedaan kesintasan 180-haridianalisis dengan uji log-rank. Perbedaan durasi patensi dianalisis dengan uji Mann-Whitney U. Efektivitas didefinisikan sebagai patensi sten, biaya dihitung denganperspektif rumah sakit menggunakan model decision tree dan dinyatakan dalamincremental cost effectiveness ratio.Hasil: Sebanyak 81 laki-laki dan 83 perempuan dengan rentang usia 24 -88 tahun ikutdalam penelitian ini. Kesintasan 180-hari kelompok sten plastik 35,9% (median 76, 95%IK 50-102 hari) dan sten metal 33,3% (median 55, 95% IK 32 -78 hari). Rerata (SB)patensi sten plastik 123 (8) hari dan sten metal 149 (13) hari (p=0,489). Pemasangan stenbilier metal dapat menghemat biaya sebesar Rp. 1.217.750 untuk setiap penambahandurasi patensi 26 hari.Simpulan: Tidak didapatkan perbedaan antara kesintasan dan patensi antara keduakelompok. Pemasangan sten bilier metal sebagai tata laksana paliatif pada pasien ikterusobstruktif maligna lebih cost-effective dibandingkan sten plastik.

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Background/Aim: Patients with advanced stage of malignant obstructive jaundice oftenrequire biliary drainage. Metal stent is more effective than plastic stent, but we also oughtto consider of stent patency and resources restraint due to poor patient survival. Hence,cost effectiveness analysis in this case was necessary.Methods: We conducted a retrospective cohort of malignant biliary obstruction patientswho underwent palliative biliary stenting between January 2015 to December 2018 at atertiary hospital. We evaluated the difference of 180-day survival using log-rank test andstent patency duration using Mann-Whitney U test. Effectiveness was defined as stentpatency, cost was calculated using hospital perspective following a decision tree modeland reported as incremental cost effectiveness ratio.Results: A total of 81 men and 83 women aged 24-88 years old were enrolled in thisstudy. 180-day survival was 35.9% (median 76, 95% CI 50 -102 days) and 33.3%(median 55, 95% CI 32 -78 days) for plastic and metal stent group respectively. Mean(SD) of stent patency 123 (8) vs 149 (13) days for plastic and metal stent grouprespectively (p=0.489). Metal stent insertion could save IDR 1,217,750 to get additional26 days of stent patency.Conclusion: There were no differences in survival and patency between the two groups.Metal biliary stent is cost effective than plastic stent for palliation in malignant biliaryobstruction."