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"Panduan resusitasi anak umumnya menganjurkan pemberian cairan dalam jumlah besar. Beberapa penelitian memperlihatkan bahwa penggunaan cairan yang agresif meningkatkan mortalitas. Penelitian pada hewan menunjukkan tekanan vena sentral yang tinggi memicu pelepasan atrial natriuretic peptide ANP , sementara penelitian invitro memperlihatkan ANP meluruhkan glycocalyx endotel vaskular dan meningkatkan permeabilitas endotel. ANP juga memicu vasodilatasi. Hemodilusi berpotensi menurunkan pasokan oksigen tubuh DO2 . Penelitian bertujuan untuk melihat pengaruh resusitasi cairan terhadap kadar ANP serum, peluruhan glycocalyx endotel vaskular, extravascular lung water index ELWI , mean arterial pressure MAP , kadar hemoglobin dan pasokan oksigen. Hewan model renjatan adalah 11 ekor Sus scrofa jantan, usia 6-10 minggu. Renjatan dilakukan dengan metode fixed pressure hemorrhage. Resusitasi pertama dilakukan dengan jumlah cairan sesuai darah yang dikeluarkan resusitasi normovolemik , dilanjutkan dengan 40 mL/kg resusitasi hipervolemik . Pengukuran hemodinamik dilakukan dengan PICCO. Serum ANP dan Syndecan-1, petanda peluruhan glycocalyx, dilakukan dengan teknik ELISA. Hasil penelitian menunjukkan terjadinya peningkatan ANP pasca resusitasi normovolemik p = 0,043 , yang kemudian menurun kembali dalam 30 menit. Peluruhan glycocalyx tidak terjadi. Perbedaan ELWI pada 60 menit pasca resusitasi secara statistik bermakna, dengan perbedaan 0,93 mL/kg 95 IK:0,19 -3,62 . Terdapat korelasi kuat antara SVRI dan CI pasca resusitasi hipervolemik r = -0,587 . Tidak ada perbedaan MAP pasca resusitasi normovolemik dan hipervolemik. Kadar hemoglobin pasca resusitasi hipervolemik lebih rendah daripada pasca resusitasi normovolemik p = 0,009 . Pasokan oksigen tubuh pasca resusitasi hipervolemik lebih tinggi daripada pasca resusitasi normovolemik p = 0,012 . Simpulan: Resusitasi cairan pada renjatan akibat perdarahan tidak mengakibatkan peluruhan glycocalyx endotel vaskular. Peningkatan ELWI amat terbatas. SVRI berkorelasi terbalik dengan CI. Tidak ada perbedaan MAP antara resusitasi normovolemik dan hipervolemik. Resusitasi hipervolemik menyebabkan hemodilusi yang diimbangi dengan peningkatan curah jantung.

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Many pediatric guidelines recommend liberal fluid resuscitation, but recent studies showed that aggressive fluid resuscitation might increase mortality. Animal studies showed that high central venous pressure induced ANP secretion. Invitro studies showed convincing evidence that ANP induced glycocalyx shedding. ANP also induced vasodilatation through cGMP signal transduction pathways. Hemodilution due to a large amount of resuscitation fluid potentially decreasing oxygen delivery.The objectives of this study were investigating the effect of fluid resuscitation, in the animal model, with special concern on serum ANP, glycocalyx shedding indicate by serum Syndecan-1 , changes in extravascular lung water, systemic vascular resirtance and mean arterial pressure, hemoglobin level and oxygen delivery DO2 . The animal models were 11 male domestic pigs, 6 -10 weeks old. The shock was induced with fixed pressure hemorrhage method. Fluid resuscitation was done in 2 phases. On the first attempt, we replaced total numbers of blood that withdrawn normovolemic resuscitation . On the second attempt, we gave 40 mL/kg resuscitation fluids hypervolemic resuscitation . The hemodynamic measurements were done with PICCO. Serum ANP and Syndecan-1 were measure with ELISA method.We found that serum ANP increased after normovolemic resuscitation p = 0.043 and immediately back to base level in 30 minutes. Glycocalyx shedding did not occur. Extravascular lung water index minimally increased. There was a strong correlation between SVRI and CI at hypervolemic resuscitation r = -0.587 . There was no difference in mean arterial pressure between normovolemic and hypervolemic resuscitation. Hemoglobin level after hypervolemic resuscitation was lower than after normovolemic resuscitation p = 0.009 . Oxygen delivery was higher after hypervolemic resuscitation p = 0.012 .Conclusions: Hypervolemic resuscitation in this hemorrhagic shock model did not induce glycocalyx shedding, extravascular lung water index minimally increased. Systemic vascular resistance index negatively correlated to cardiac index. Fluid resuscitation may induce hemodilution, but oxygen delivery can be compensated by increasing cardiac output. "

"Latar belakang : Resusitasi cairan merupakan hal penting dalam penatalaksanaan renjatan hypovolemik pada penderita sakit kritis. Pada umumnya pemberian cairan dalam jumlah besar dan waktu secepatnya sesuai dengan protokol early goal directed therapy EGDT . Pemberian cairan dalam jumlah yang besar dan waktu secepatnya diketahui dapat berkontribusi terhadap terjadinya hypervolemik. Berdasarkan hal tersebut diperlukan suatu pemeriksaan yang dapat mengetahui bahwa resusitasi cairan yang sedang diberikan tidak menyebabkan hipervolemik.Tujuan : 1 Melihat hubungan antara kadar troponin-i dengan resusitasi hipervolemik pada hewan model dan 2 Melihat hubungan antara troponin-i dengan kontraktilitas jantung pada hewan model.Metode Penelitian : Penelitian ini adalah penelitian pre dan post intervention. Penelitian telah dilaksanakan pada 8 ndash; 18 juni 2017 di FKH IPB Bogor. Hewan model renjatan adalah 10 ekor Sus Scrofa jantan usia 6-8 minggu. Renjatan dilakukan dengan metode fixed pressure hemorrhage. Resusitasi pertama dilakukan dengan jumlah cairan sesuai darah yang dikeluarkan resusitasi normovolemik , dilanjutkan dengan 40 ml/kg resusitasi hipervolemik-1 dan 40 ml/kg yang kedua resusitasi hipervolemik-2 . Pengukuran kontraktilitas jantung dengan menggunakan parameter DPmax pada PiCCO dan Kadar troponin-i diukur dengan menggunakan alat iStat dari Abbott.Hasil Penelitian : Terdapat peningkatan kadar troponin-i pasca resusitasi cairan hipervolemik p = 0,005 . Terdapat penurunan kontraktilitas jantung pasca resusitasi hipervolemik. Penurunan kontraktilitas jantung berhubungan dengan peningkatan troponin-i r=0,72; p=0,02Simpulan : Pada hewan model terdapat hubungan antara hipervolemik dengan peningkatan troponin-i. Terdapat hubungan antara penurunan kontraktilitas jantung dengan peningkatan kadar troponin-i.

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Background: Fluid resuscitation is fundamental to the acute shock hypovolemic of critically ill patient. In general, however, early and appropriate goal directed fluid therapy EGDT contributes to a degree of fluid hypervolemic in most if not all patients. Propose that assessment of hypervolemic should be considered as potentially biomarker of critical illness.Objective : 1 To investigating the effect of fluid resuscitation in animal model with special concern on troponin-i value, 2 To investigating the corelation myocard contractility with troponin-i level.Methods : This study is pre and post intervention. Were did at June 2017 8st ndash; 18st at FKH-IPB Bogor. Animal model were 10 male domestic pigs, 6-12 weeks old. The shock was induced with fixed pressure hemorrhage method. Fluid resuscitation was done in 2 phase. On the first attempt we replaced total number of blood that withdrawn normovolemic resuscitation . The second attempt, we gave 40 ml/kg resuscitation fluids hypervolemic resuscitation . Cardiac contractility meassurements were done with DPmax the part of PiCCO parameter.Results: We found that serum troponin-i increase after hypervolemic resuscitation r=0,81;p=0,005 . DPmax decrease significantly after the second resucitation attempt r = 0,72; p=0,02 .Conclusions: Hypervolemic resucitation in this animal model produced significantly troponin-i elevated. There is a corelation between cardiac contractility decrease with troponin-i level elevated."

"ABSTRAKLatar Belakang:Obesitas merupakan salah satu masalah kesehatan utama yang banyak ditemukandi negara maju maupun negara berkembang. Obesitas menjadi salah satu faktorrisiko timbulnya penyakit kardiovaskular. Diketahui bahwa populasi obesitasmemiliki kadar plasma BNP yang rendah dibanding kelompok normal. BNPadalah suatu hormon yang disintesis oleh miosit atrium yang berperan dalammeregulasi hemodinamik tubuh. Selain itu BNP memiliki efek anti fibrosis dan anti hipertrofi pada jantung. Dipikirkan bahwa adanya gangguan sintesis BNP di miosit jantung sebagai salah satu penyebab. Maka, penelitian ini bertujuan untukmelihat profil ekspresi mRNA BNP, NPR-A dan NPR-C pada populasi obesitas.Metode:Studi potong lintang dilakukan di Rumah Sakit Jantung dan Pembuluh DarahHarapan Kita (RSJPDHK). Jaringan miosit tersimpan yang sudah dilakukanekstraksi RNA dibagi menjadi 2 kelompok berdasarkan IMT, kelompok obesitas(IMT ≥27) dan kelompok normal (IMT <27) dan sesuai kriteria inklusi daneksklusi. RNA kedua kelompok dilakukan sintesis cDNA, ekstraksi protein danReal-Time PCR untuk mendapatkan mean ΔCt. Kemudian dilakukanpenghitungan menggunakan metode Livak untuk mendapatkan nilai ekspresirelatif mRNA. Data kemudian di analisis statistik menggunakan SPSS 20.Hasil Penelitian:Sebanyak 48 pasien diikutsertakan dalam penelitian ini dengan jumlah kelompoknormal 34 orang dan kelompok obesitas 14 orang. Hasil ekspresi mRNA BNP,NPR-A dan NPR-C lebih rendah pada kelompok obesitas dibanding kelompoknormal. Namun, tidak didapatkan perbedaan bermakna ekspresi mRNA BNP (p0,768), NPR-A (p 0,838) dan NPR-C (p 0,768) antara kelompok obesitas dibanding kelompok normal. Kesimpulan:Penelitian ini tidak menemukan perbedaan ekspresi mRNA BNP, NPR-A dan NPR-C yang bermakna antara kelompok obesitas dengan kelompok normal.

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ABSTRACTBackground:Obesity is presenting as a significant health problem across the world. Obesity is arisk factor for cardiovascular diseases. The plasma level of B-type natriureticpeptide (BNP) has been identified to be lower in obese people compare to normal.As we know, BNP is one of the cardiac hormones synthesized by atrial myocytethat plays a role in hemodynamic regulations. In addition, BNP exerts its antifibrotic and anti hypertrophic effects in the heart. It has been hypothesized thatone of the possible mechanism responsible for this inverse relationship is theimpaired synthesize of BNP by cardiomyocytes. Therefore, the aim of our study isto evaluate the mRNA expression profile of BNP, Natriuretic peptide receptortype-A (NPR-A) and Natriuretic peptide receptor type-C (NPR-C) incardiomyocytes of obese population. Method:A cross-sectional study was conducted in Rumah Sakit Jantung dan PembuluhDarah Harapan Kita (RSJPDHK). Cardiomyocytes that have been performed theRNA extraction proses were divided into 2 groups, Obese group (BMI ≥27) andNormal group (BMI <27), according to BMI and inclusion and exclusion criteria.Synthesize cDNA, protein extraction and Real-Time PCR were performed inorder to have the mean of ΔCt. Livak method was used to determine the relativeexpression mRNA value. SPSS 20 for Windows was used for the purpose ofstatistical analyses. Results:48 patients were included in this study that consist of 34 patients in normal groupand 14 patients in obese group. The mRNA expression of BNP, NPR-A and NPRCwerelower in obese group compared to normal group. However, there was nosignificant difference between groups.Conclusion:In conclusion, there is no significant difference of mRNA expression of BNP, NPR-A and NPR-C between obese and normal group.;Background:Obesity is presenting as a significant health problem across the world. Obesity is arisk factor for cardiovascular diseases. The plasma level of B-type natriureticpeptide (BNP) has been identified to be lower in obese people compare to normal.As we know, BNP is one of the cardiac hormones synthesized by atrial myocytethat plays a role in hemodynamic regulations. In addition, BNP exerts its antifibrotic and anti hypertrophic effects in the heart. It has been hypothesized thatone of the possible mechanism responsible for this inverse relationship is theimpaired synthesize of BNP by cardiomyocytes. Therefore, the aim of our study isto evaluate the mRNA expression profile of BNP, Natriuretic peptide receptortype-A (NPR-A) and Natriuretic peptide receptor type-C (NPR-C) incardiomyocytes of obese population. Method:A cross-sectional study was conducted in Rumah Sakit Jantung dan PembuluhDarah Harapan Kita (RSJPDHK). Cardiomyocytes that have been performed theRNA extraction proses were divided into 2 groups, Obese group (BMI ≥27) andNormal group (BMI <27), according to BMI and inclusion and exclusion criteria.Synthesize cDNA, protein extraction and Real-Time PCR were performed inorder to have the mean of ΔCt. Livak method was used to determine the relativeexpression mRNA value. SPSS 20 for Windows was used for the purpose ofstatistical analyses. Results:48 patients were included in this study that consist of 34 patients in normal groupand 14 patients in obese group. The mRNA expression of BNP, NPR-A and NPRCwerelower in obese group compared to normal group. However, there was nosignificant difference between groups.Conclusion:In conclusion, there is no significant difference of mRNA expression of BNP, NPR-A and NPR-C between obese and normal group."

"Latar belakang. Acute respiratory distress syndrome (ARDS) merupakan salah satu komplikasi fatal sepsis berat. Penggunaan cairan koloid sebagai cairan resusitasi dapat menurunkan kejadian ARDS lebih banyak karena memiliki berat molekul yang lebih tinggi dibandingkan cairan kristaloid. Peningkatan extravascular lung water (EVLW), kadar interleukin-8 (IL-8) dan vascular cell adhesion molecule-1 (VCAM-1) telah diteliti sebagai indikator penting yang berperan dalam patogenesis ARDS. Penelitian pada hewan coba diharapkan dapat memberikan penjelasan yang lebih baik mengenai patofisiologi ARDS yang kompleks dan sulit dimengerti. Tujuan. Mengungkap pengaruh cairan koloid atau kristaloid terhadap kejadian ARDS pada model hewan coba babi dengan sepsis berat, serta menganalisis pengaruh cairan kristaloid atau koloid terhadap peningkatan EVLW, IL-8, dan VCAM-1. Metode. Penelitian ini merupakan studi eksperimental acak tersamar ganda, dilakukan di Laboratorium Bedah Eksperimental, Fakultas Kedokteran Hewan, Institut Pertanian Bogor, dengan menggunakan babi (Sus scrofa) yang sehat berusia 2-3 bulan, berat badan 8-12 kg. Subjek dialokasikan secara acak menjadi dua kelompok, yaitu yang mendapatkan cairan resusitasi koloid atau kristaloid. Setelah pemberian endotoksin 50 μg/kg, tanda klinis ARDS, EVLW, IL-8, dan VCAM-1 dipantau saat sepsis, sepsis berat, 1 jam, dan 3 jam pasca-resusitasi cairan. Tiga jam pasca-resusitasi, dilakukan eutanasia pada babi, kemudian spesimen jaringan paru diambil untuk pemeriksaan histopatologi. Hasil Utama. ARDS kategori ringan lebih banyak terdapat pada kelompok koloid, sedangkan ARDS kategori sedang lebih banyak pada kelompok kristaloid. Rerata skor cedera paru pada kelompok koloid lebih rendah dibandingkan dengan kristaloid (0,4 vs. 0,7; p=0,001). Peningkatan EVLW lebih sedikit terjadi pada kelompok koloid dibandingkan dengan kristaloid pada 1 jam (1,0 vs. 3,0 mL/kgbb; p=0,030) dan 3 jam pasca-resusitasi (2,7 vs. 6,3 mL/kgbb; p=0,034). Pada kedua kelompok, kadar IL-8 meningkat secara bermakna setelah pemberian endotoksin (103,1 vs. 3854,5 pg/mL; p=0,012 pada kelompok koloid dan 125,0 vs. 4419,3 pg/mL; p=0,003 pada kelompok kristaloid). Nilai kadar IL-8 dan VCAM-1 tidak berbeda bermakna antara kedua kelompok. Simpulan. Penggunaan cairan koloid sebagai cairan resusitasi tidak menurunkan kemungkinan kejadian ARDS dibandingkan kristaloid. Cairan koloid berhubungan dengan peningkatan EVLW dan skor cedera paru yang lebih rendah dibandingkan dengan cairan kristaloid, tetapi tidak pada kadar IL-8 dan VCAM-1.

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Background. Acute respiratory distress syndrome (ARDS) is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW) elevation and levels of interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been studied as indicators playing a role in the pathogenesis of ARDS. The use of animal models may provide a better understanding of the complex and poorly understood pathophysiology of ARDS.

Objectives. To determine the effects of colloid or crystalloid fluid resuscitation on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis.

Methods. This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, Institut Pertanian Bogor, using healthy swine (Sus scrofa) models aged 2 to 3 months with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of 50 μg/kgbw of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Three hours after resuscitation, euthanasia was performed on the animal and the lung tissue specimen was taken for histopathological examination.

Results. Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. Mean lung injury score was lower in colloid compared to crystalloid group (0.4 vs. 0.7; p=0.001). The increase in EVLW was lower in the colloid compared to the crystalloid group both at one hour (1.0 vs. 3.0 mL; p=0.030) and three hours post-resuscitation (2.7 vs. 6.3 mL/kg; p=0.034). In both groups, IL-8 levels were significantly higher after endotoxin administration (103.1 vs. 3854.5 pg/mL; p=0.012 in the colloid group and 125.0 vs. 4419.3 pg/mL; p=0.003 in the crystalloid group). There was no significant difference in IL-8 and VCAM-1 levels between the two groups.

Conclusion. The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI and a lower mean lung injury score, but not with IL-8 or VCAM-1 levels."

"Latar Belakang: Kurkumin diketahui sebagai antiinflamasi, antioksidan, antiproliferatif, dan antiangiogenik, sehingga menjadi salah satu alternatif terapi diabetes tipe 2 dengan menghambat progresifitasnya. Dengan sediaan nanopartikel availibilitasnya semakin meningkat. Penelitian ini dilakukan untuk melihat adanya efek nanokurkumin terhadap komplikasi diabetes melitus khususnya kardiomiopati yang dinilai dengan ekspresi mRNA B-type natriuretic peptide BNP pada jaringan jantung. Metode: Penelitian ini menggunakan jaringan tersimpan dari penelitian yang telah dilakukan sebelumnya. Jaringan kemudian dibuat menjadi cDNA dari sintesis isolasi RNA jaringan jantung tikus. Diabetes tipe 2 pada tikus dibuat dengan menginjeksikan streptozotocin dan nicotinamide. Nanokurkumin diberikan dalam dosis 100mg/kgBB/hari selama 30 hari. Tingkat ekspresi mRNA BNP-45 diukur dengan qRT-PCR dan dihitung dengan metode Livak. Hasil: Terdapat peningkatan ekspresi mRNA BNP-45 pada kelompok DM terhadap kelompok normal. Pemberian nanokurkumin sebanyak 100mg/KgBB selama 30 hari pada kelompok DM NK menghasilkan rasio ekspresi mRNA BNP-45 lebih rendah secara statistik terhadap kelompok DM. Kesimpulan: Nanokurkumin dapat menekan ekspresi mRNA BNP-45 pada jantung tikus yang diinduksi streptozotocin dan nicotinamide pada tingkat dosis 100mg/kgBB/hari selama 30 hari.

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Background: Curcumin is known as anti inflammatory, antioxidant, antiproliferative, and antiangiogenic. Therefore it is promising to become alternative treatment of type 2 diabetic by inhibiting its progressiveness. From previous study, it was reported that bioavailability of curcumin increases in form of nanoparticles. This study was conducted to see the effect of nanacurcumin on cardiomyopathy assessed by the expression of B type natriuretic peptide BNP mRNA in heart tissue.

Method: This experimental study used stored tissue from previous research. Then the tissue changed to cDNA from RNA isolation synthesis of rats heart tissue. The type 2 diabetic in rat was induced by streptozotocin and nicotinamide. Nanocurcumin was given orally at the dose 100mg kgBW day for 30 days. The expression level of BNP 45 mRNA was measured by qRT PCR and calculated by the Livak method.

Result: There was an increased ratio of expression of BNP 45 mRNA in the DM group against the normal group. Nanocurcumin 100mg KgBB administered orally for 30 days in the DM NK group resulted in a statistically lower ration of BNP 45 mRNA expression than the DM Group.

Conclusion: Nanocurcumin may suppress expression of BNP 45 mRNA in the heart of rats induced streptozotocin and nicotinamide at a dose level of 100 mg kgBW day for 30 days."

"Latar Belakang: Duktus arteriosus persisten (patent ductus arteiosus, PDA) merupakan penyakit jantung bawaan yang sering ditemukan pada bayi, terutama bayi prematur. Ekokardiografi menjadi baku emas untuk mendiagnosis PDA dengan gangguan hemodinamik signifikan (hs-PDA) pada bayi prematur. Beberapa penelitian telah membuktikan bahwa, pemeriksaan biomarker darah Amino-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) bermanfaat untuk diagnosis dan penatalaksanaan hs-PDA. Namun, di Indonesia penelitian seperti ini belum pernah dilakukan; padahal akurasi diagnostik NT-proBNP untuk hs-PDA sangat dipengaruhi oleh karakteristik assay (assay kit dan nilai ambangnya), serta karakteristik pasien (gestational dan usia kronologis).Tujuan: Untuk mengetahui hubungan antara nilai NT-proBNP dan hs-PDAMetode: Penelitian potong lintang dilakukan di RSCM dari bulan Desember 2015? Febuari 2016 terhadap 49 neonatus prematur dengan usia gestasi <37 minggu dan berat lahir di bawah 2000 gram. Diagnosis PDA dipastikan dengan menggunakan ekokardiografi. Pasien dikelompokkan menjadi kelompok tanpa PDA, non hs-PDA dan hs-PDA. Pemeriksaan NT-proBNP dikerjakan pada neonatus dengan PDA, kemudian dibandingkan nilai NT-proBNP pada kelompok non hs-PDA dan hs-PDA.Hasil: Pada 49 subyek yang diteliti, terdapat 33 neonatus dengan PDA, 16 diantaranya dengan hs-PDA. Terdapat korelasi bermakna antara nilai NT-proBNP dengan hs-PDA (p<0,0001).Kesimpulan: Peningkatan NT-proBNP berkorelasi dengan PDA hemodinamik signifikan.

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Background: Persistent ductus arteriosus is one of the most frequently congenital heart disease found in infant mainly in preterm infant. Echocardiography is the gold standard for the diagnosis of hemodinamically significant patent ductus arteriosus (hs-PDA) in preterm neonates. There are few studies demonstrate that the examination of simple blood assay such as N Terminal-proBrain Natriuretic Peptide (NT- proBNP) may be useful in determining the diagnosis and management of hs-PDA. However in Indonesia there are no studies have been done before even though the level of NT-proBNP accuracy in determining hs-PDA is influenced by the assay kit, and the characteristic of the patient (gestational age and chronological age).Objective: To determine the association between NT-proBNP level and the prevalence of hs-PDA.Methods: Across sectional study was conducted at Dr. Cipto Mangunkusumo Hospital from Desember 2015 to February 2016. Forty-nine preterm neonates with gestational age less than 37 weeks and birthweight of less than 2000 gram were performed echocardiography to determine PDA, subsequently these patients were divided into three groups: non PDA, non hs-PDA, and hs-PDA. Further, in the non hs-PDA and hs-PDA groups, blood NT pro-BNP was examined. We then compared the level of NT pro-BNP between these groups.Results: Among 49 neonates, there were 33 patients with PDA, of those 16 patients were hs-PDA. There was an association between the level of NT pro-BNP and hs-PDA (p<0,0001).Conclusion: This study found a significant association between the NT-proBNP level and hs-PDA"

"Latar belakang: Sepsis merupakan penyebab kematian dan kesakitan utama di unit perawatan intensif anak. Pemberian bolus cairan masih menjadi pilihan utama dalam mengatasi renjatan sepsis dan digunakan pada panduan tata laksana internasional. Terapi bolus cairan bertujuan memperbaiki pasokan oksigen dengan meningkatkan curah jantung. Bukti yang mendukung panduan tersebut sangat terbatas sehingga menimbulkan kontroversi.Tujuan: Menilai perubahan pasokan oksigen, indeks curah jantung dan hemoglobin pada anak renjatan sepsis yang mendapat bolus cairan saat resusitasi.Metode: Penelitian observasional terhadap 35 subyek dari Februari-Mei 2019 di unit perawatan intensif anak Rumah Sakit Cipto Mangunkusumo (RSCM), Rumah Sakit Umum Daerah (RSUD) Tarakan dan Pasar Rebo Jakarta. Subyek dipilih secara consecutive sampling dan ditata laksana sampai selesai sesuai prosedur yang berlaku.Hasil: Terdapat 23 dari 35 subyek yang mendapat  cairan bolus sampai 40 mL/kg dan 12 subyek hanya mendapat 20 mL/kg. Tidak terdapat perubahan indeks curah jantung dan pasokan oksigen sebelum dan sesudah pemberian cairan bolus (p= 0,235 dan p=0,340). Terdapat perubahan kadar Hb setelah pemberian cairan bolus (p=0,002).Simpulan: Penurunan kadar hemoglobin terjadi setelah pemberian cairan bolus tetapi tidak terbukti menyebabkan perubahan indeks curah jantung dan pasokan oksigen pada penelitian ini.

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Background: Sepsis is a leading cause of morbidity and mortality in children with a worldwide prevalence in pediatric intensive care units. Fluid bolus (FB) is a first line therapy for resuscitation of septic shock and has been recommended in international guidelines. FB aimed to increase delivery oxygen with increasing cardiac output. The supporting evidence based are still limited and controversy.

Objective: To evaluate the changing of delivery oxygen (DO₂), cardiac index (CI) and hemoglobin (Hb) in pediatric septic shock after fluid bolus in resuscitation.

Methods: An observational study of 35 subject that conducted from February till May 2019 in Pediatric Intensive Care Unit (PICU) Rumah Sakit Cipto Mangunkusumo (RSCM), Rumah Sakit Umum Daerah (RSUD) Tarakan and Pasar Rebo Jakarta. The selection of subject with inclusion criteria through consecutive sampling and managed according to standard operating procedure.

Result: There were 23 from 35 subject got 40 mL/kg and 12 subject got 20 mL/kg fluid bolus only. There were no changing of DO₂ and CI after FB (p=0.235;p=0.340) then there was changing of hemoglobin after FB (p=0.002).

Conclusion: Hemoglobin decreases after FB without change of CI and DO₂ can be proved in this study."

"Perkembangan teknologi menyebabkan praktik pencampuran produk makanan menggunakan substansi non-halal. Dokumen (International Standardization Organization/ Technical Specification) ISO/TS 20224-3: 2020 digunakan sebagai prosedur standar uji deteksi kehalalan berbasis Deoxyribonucleic Acid (DNA) memanfaatkan metode Quantitative Polymerase Chain Reaction (qPCR) yang berlaku secara internasional melalui gen Beta actin (ACTB) sebagai gen target. Namun, kemampuan gen ACTB sebagai gen target belum banyak teruji langsung melalui reaksi PCR sehingga dibutuhkan evaluasi potensi gen target alternatif lain melalui optimasi primer seperti gen Cytochrome b (Cytb) untuk mendeteksi kandungan babi domestik (Sus scrofa domesticus) dan babi hutan (Sus scrofa). Metode yang digunakan terdiri atas desain primer dan probe, optimasi suhu annealing primer dan probe, uji spesifisitas in silico, uji sensitivitas in vitro, serta pengolahan dan analisis data. Adapun sampel yang digunakan untuk uji sensitivitas in vitro adalah pig genomic DNA. Berdasarkan pengujian yang dilakukan, primer dan probe gen Cytb memiliki suhu annealing optimal pada suhu 55°C. Uji spesifisitas in silico membuktikan bahwa sekuens primer dan probe gen Cytb memiliki kemampuan deteksi pada sekuens babi domestik dan babi hutan. Uji sensitivitas menggunakan qPCR pada gen ACTB membentuk kurva standar dengan nilai y=-3,6541x +38,385 dan R2=0,9967, serta LoD sebesar 5 pg/uL. Nilai linearitas (0,9967) dan efisiensi (87,78%) yang dihasilkan masuk ke dalam rentang standar sesuai literatur karena berada ≥0,98 untuk linearitas dan rentang 80%—120% untuk efisiensi. Sementara itu, uji sensitivitas menggunakan qPCR pada gen Cytb membentuk kurva standar dengan nilai y=-2,7222x + 32,196 dan R2= 0,9867, serta LoD sebesar 1 pg/uL. Nilai linearitas (0,9867) yang dimiliki masuk ke dalam rentang standar, tetapi nilai efisiensi (132,99%) melebihi rentang persentase yang baik akibat kemungkinan konsentrasi serial dilusi yang kurang sesuai dan protokol yang belum optimal. Gen Cytb memiliki jangkauan sensitivitas yang lebih baik dibandingkan gen ACTB. Keseluruhan grafik hasil membentuk kurva sigmoid yang valid sebagai hasil uji qPCR. Oleh karena itu, berdasarkan uji spesifisitas in silico dan sensitivitas in vitro yang dilakukan dapat disimpulkan bahwa gen Cytb berpotensi dijadikan gen target altenatif sebagai pengembangan halal kit.

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Technological developments have led to the practice of mixing food products using non-halal substances. Document (International Standardization Organization/Technical Specification) ISO/TS 20224-3: 2020 is used as a standard procedure for Deoxyribonucleic Acid (DNA)-based halal detection test that is internationally applicable through the Beta actin gene (ACTB) as the target gene. However, the ability of the ACTB gene as a target gene has not been tested directly through PCR reactions, so it is required to evaluate the potential of other alternative target genes through primer optimization such as the Cytochrome b (Cytb) gene to detect domestic pig (Sus scrofa domesticus) and wild boar (Sus scrofa) containment. The method used was comprised of primer and probe design, primer and probe annealing temperature optimization, in silico specificity test, in vitro sensitivity test, and data processing and analysis. The sample used for the in vitro sensitivity test is pig genomic DNA. Based on the tests conducted, primers and probes of the Cytb gene have an optimal annealing temperature at 55°C. The in silico specificity test proved that the primer sequences and Cytb gene probes have the ability to detect domestic pig and wild boar sequences. The sensitivity test using qPCR on the ACTB gene forming a standard curve with a value of y=-3.6541x +38.385 and R2=0.9967, and LoD of 5 pg/uL. The linearity (0.9967) and efficiency (87.78%) values generated are in the standard range according to the literature because they are ≥0.98 for linearity and 80%—120% range for efficiency. Meanwhile, the sensitivity test using qPCR on the Cytb gene is forming a standard curve with a value of y= -2.7222x + 32.196 and R2= 0.9867, and LoD of 1 pg/uL. The linearity value (0.9867) is within the standard range, but the efficiency value (132.99%) exceeds the good percentage range as a result of the possibility of inappropriate serial dilution concentrations and an unoptimal protocol. The Cytb gene has a better sensitivity range than the ACTB gene. The overall result graph forms a sigmoid curve which is valid as a qPCR test result. Therefore, based on the in silico specificity and in vitro sensitivity tests, it can be concluded that the Cytb gene has the potential to be used as an alternative target gene as a halal kit development."

"Tingginya angka mortalitas syok anak dapat dicegah dengan deteksi dini dan terapi adekuat. Parameter hemodinamik digunakan sebagai dasar tatalaksana syok. Tujuan penelitian ini adalah mengetahui perubahan parameter hemodinamik pada pasien syok anak pasca resusitasi cairan dan obat-obatan vasoaktif. Penelitian deskriptif ini dilakukan di instalasi gawat darurat dan rawat intensif RSUPN dr. Cipto Mangunkusumo Jakarta, Januari 2013-September 2014, pada seluruh anak yang mengalami syok. Pengukuran hemodinamik dengan USCOM dilakukan pada jam I dan VI. Sebagian besar pasien mengalami syok hipodinamik dan refrakter cairan pasca resusitasi. Pasca pemberian obat-obatan vasoaktif, terjadi peningkatan inotropy pada sebagian besar kasus, namun diikuti oleh peningkatan afterload.

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The high mortality rate in pediatric shock can be prevented by early detection and adequate management. Hemodynamic parameters is useful for guiding shock management. The aim of study was describing hemodynamic parameters in pediatric shock after fluid resuscitation and vasoactive drugs therapy. This descriptive study was conducted at emergency room and intensive care unit, Cipto Mangunkusumo Hospital, Jakarta, in January 2013 ? September 2014, including all shock children. The hemodynamic was measured by USCOM in 1st and 6th hour. Most patients suffered from hypodynamic and fluid-refractory shock after fluid resuscitation. Post-administration of vasoactive drugs, inotropy and afterload increased in most cases."

"Defisiensi kobalamin dapat menyebabkan berkurangnya donor metil yang berpotensi menggangu metabolisme jantung. Defisiensi kobalamin dapat terjadi pada pasien dengan malnutrisi, ulkus peptikum, diabetes melitus, dan alkoholisme. Berbagai studi pada defisiensi vitamin B12 masih berfokus pada aterogenesis dan stress oksidatif. Penelitian ini bertujuan mengetahui korelasi defisiensi vitamin B12 dengan penurunan fungsi jantung melalui gambaran EKG, ekspresi protein PGC-1α dan protein BNP. Empat belas tikus Sprague-Dawley jantan usia 24-28 minggu dibagi dalam 2 kelompok (kontrol dan perlakuan). Kelompok kontrol diberikan pakan standar dengan nutrisi lengkap, sementara kelompok perlakuan diberikan pakan AIN-93M termodifikasi defisien vitamin B12. Kedua kelompok diberikan pakan dalam periode yang sama yakni selama 16 minggu. Pada akhir minggu ke-16 dilakukan pemeriksaan EKG, pemeriksaan ELISA vitamin B12 plasma, Hcy plasma, ekspresi PGC-1α dan kadar BNP-45 plasma. Hasil penelitian pada kelompok perlakuan menunjukkan terdapat penurunan kadar vitamin B12 plasma, peningkatan kadar Hcy plasma disertai dengan penurunan ekspresi protein PGC-1α dan peningkatan kadar BNP-45 plasma. Pada kelompok perlakuan didapatkan hasil tebal miokardium lebih besar dari kelompok kontrol. Pada kelompok perlakuan juga didapatkan aritmia pada rekam EKG 2 dari 7 tikus. Terdapat korelasi negatif dengan kekuatan sedang antara penurunan ekspresi PGC-1α dengan peningkatan BNP-45 plasma. Defisiensi kobalamin terbukti menyebabkan gangguan metabolisme energi kardiomiosit yang ditandai dengan penurunan ekspresi protein PGC-1α dan berujung pada aritmia serta hipertrofi/pembesaran ventrikel kiri yang ditandai dengan peningkatan tebal miokardium dan peningkatan kadar BNP-45 plasma.

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Cobalamin deficiency may cause lack of dietary methyl donors which alter heart metabolism. Cobalamin deficiency are common in patients with malnutrition, gastrics ulcers, diabetes mellitus, and alcoholism. Most studies on cobalamin deficiencies are focused on its relationship with oxidative stress and atherogenesis. Therefore, this study aims to find the corelation between cobalamin deficiency and heart function deterioration through analysis of ECG pattern, expression of PGC-1α protein, and plasma BNP-45 level. Fourteen male Sprague-Dawley rats (age 24-28 weeks) were divided into 2 groups: control group and treatment group. The control group was given standard diet while the treatment group received a modified diet type AIN-93M. Both groups are fed with the same 16-weeks period. ECG and ELISA was performed to evaluate plasma vitamin B12, Hcy levels, expression of PGC-1α protein and plasma BNP-45 levels in each group at the end of the treatment period. At the end of study period, higher Hcy level was observed in the treatment group with lower plasma cobalamin followed by two rats has developed arrythmias and decreased expression of PGC-1α protein and also increased in plasma BNP-45 levels. There is a relatively strong correlation between deterioration of PGC-1α protein with the increased in plasma BNP-45 levels. Cobalamin deficiency has proven to alter cardiomyocites energy metabolism which resulted in arrythmia and tendency to developed left ventricular hypertrophy."