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"Latar belakang: Frailty merupakan sindrom biologis yang dapat menyebabkan kerentanan terhadap hasil yang lebih buruk terhadap pasien. Penilaian frailty saat ini berkembang pada populasi penyakit lainnya antara lain pada populasi pasien sirosis hati. Modalitas yang dikembangkan dan sudah divalidasi untuk menilai frailty pada populasi sirosis hati adalah dengan Liver Frailty Index (LFI). Prevalensi pasien sirosis hati yang mengalami frail ternyata cukup tinggi. Dipikirkan pasien yang mengalami frail akan meningkatkan mortalitas pada pasien sirosis hati. Tujuan: Menilai apakah frailty berdasarkan Liver Frailty Index dapat menjadi prediktor mortalitas pada pasien sirosis hati Metode: Penelusuran literatur dilakukan melalui basis data daring: PubMed/ MEDLINE, EMBASE, ProQuest, dan EBSCOhost dengan menggunakan kata kunci “sirosis hati” dan “liver frailty index” dalam Bahasa Inggris dan Indonesia. Pencarian manual dilakukan melalui portal data nasional, e-library fakultas kedokteran, dan snowballing. Studi yang dimasukkan ke dalam penelitian adalah studi kohort prospektif dan retrospektif yang mengikutsertakan pasien sirosis hati tanpa keganasan hati dan melaporkan mortalitas pasien berdasarkan status frailty. Hasil: Sebanyak 7 artikel diikutsertakan dalam telaah sistematis ini, 3 diantaranya diikutkan dalam meta-analisis untuk menilai hubungan dengan mortalitas dan 2 studi menilai hubungan dengan kejadian dekompensasi. Risiko mortalitas lebih tinggi pada pasien sirosis dengan frailty (HR 1,68; IK 95% 1,36-2,08; p<0,00001). Frailty berhubungan dengan kejadian asites (OR 1,84 IK 95% 1,41-2,40; p<0,00001). Tidak didapatkan adanya hubungan antara frailty dengan kejadian EH pada pasien sirosis hati (OR 1,57 IK 95% 0,65-3,80; p=0,31). Kesimpulan: Frailty merupakan prediktor mortalitas pada pasien sirosis hati. Pasien sirosis hati dengan frailty memiliki risiko kematian lebih besar dibandingkan pasien sirosis hati tanpa frailty.

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Background: Frailty is a biologic syndrome that can lead to susceptibility to poorer outcomes for patients. Frailty assessment is currently developing in other disease populations, including the population of patients with liver cirrhosis. The developed and validated modality to assess frailty in the liver cirrhosis population is the Liver Frailty Index (LFI). The prevalence of liver cirrhosis patients who experience frail is quite high. It is thought that patients who experience frail will increase mortality in patients with liver cirrhosis.

Objective: Assessing whether frailty based on the Liver Frailty Index can be a predictor of mortality in patients with liver cirrhosis.

Methods: Literature search was conducted through online databases: PubMed/MEDLINE, EMBASE, ProQuest, and EBSCOhost using the keywords “cirrhosis of the liver” and “liver frailty index” in English and Indonesian. Manual searches were carried out through national data portals, medical faculty e-libraries, and snowballing. The studies included in the study were prospective and retrospective cohort studies that included patients with liver cirrhosis without liver malignancy and reported patient mortality based on frailty status.

Results: A total of 7 articles were included in this systematic review, 3 of which were included in a meta-analysis to assess the association with mortality and 2 studies assessed the association with the incidence of decompensation. There was a higher risk of mortality in cirrhotic patients with frailty (HR 1.68; 95% CI 1.36-2.08; p<0.00001). Frailty was found to be associated with the incidence of ascites (OR 1.84 95% CI 1.41-2.40; p<0.00001). There was no association between frailty and the incidence of HE in patients with liver cirrhosis (OR 1.57 95% CI 0.65-3.80; p=0.31).

Conclusion: Frailty is a predictor of mortality in patients with liver cirrhosis. Liver cirrhosis patients with frailty have a greater risk of death than patients with liver cirrhosis without frailty."

"Latar Belakang. Prediksi mortalitas pada kelompok lanjut usia yang semakin meningkat jumlahnya akan memberikan banyak manfaat bagi kesehatan. Cystatin C ditunjukkan memiliki kemampuan sebagai prediktor mortalitas pada beberapa studi. Studi-studi mengenai kemampuan prediksi cystatin c masih sangatlah beragam dan belum ada telaah sistematis untuk menilai kemampuannya dalam memprediksi mortalitas jangka panjang pada kelompok lansia.Tujuan. Penelitian ini bertujuan untuk menilai kemampuan cystatin c sebagai prediktor mortalitas semua sebab dan mortalitas kardiovaskular jangka panjang pada kelompok lanjut usia.Metode. Studi ini merupakan telaah sistematis dan meta-analisis dari studi kohort prospektif observasional. Pencarian studi dilakukan di PubMed, Cochrane, Scopus, EBSCOHost, dan Proquest serta pencarian menual. Kriteria inklusi berupa lansia minimal berusia 65 tahun dengan data cystatin c serum tercantum, kematian semua sebab sebagai luaran. Waktu follow up minimal 5 tahun. Seleksi studi dilakukan berdasarkan alur dari PRISMA. Penilaian kualitas studi dan risiko bias dinilai menggunakan Newcastle Ottawa Scale untuk studi kohort. Hasil studi ditampilkan dalam bentuk deskriptif serta Forest plot.Hasil. Dari 609 studi hasil pencarian, didapatkan 12 studi yang memenuhi kriteria: 5 studi menilai kematian semua sebab, 3 studi menilai kematian kardiovaskular saja, dan 4 studi menilai keduanya. Sebanyak 6 studi dengan kualitas baik dan 6 studi kualitas sedang setelah dilakukan penilaian. Hasil meta-analisis menunjukkan kadar Cystatin C yang tinggi meningkatkan risiko mortalitas jangka panjang akibat semua sebab [HR: 1,74 (95% CI: 1,48 – 2,04); p < 0,00001)] dan mortalitas jangka panjang kardiovaskular [(HR: 2,01 (95% CI: 1,63 – 2,47); p < 0,00001)] pada lansia. Kemampuan prognostik cystatin c tergolong moderat [AUC 0,70 (95% CI: 0,68-0,72); p = 0,02)].

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Background. Prediction of mortality in growing aged-population will offer several benefits for health sector. Cystatin C, which has long been known as biomarker to more accurately evaluate glomerular filtration rate in elderly, has also been shown to predict mortality from several studies. Studies regarding its predictive ability were vastly varied and there has not been systematic review to examine its ability in predicting long-term mortality in elderly population.

Objectives. This study aimed to evaluate Cystatin C performance as predictor for all-cause and cardiovascular mortality among elderly population.

Methods. A systematic review of prospective cohort studies was performed. Literature searching was done in major databases such as PubMed, Cochrane, Scopus, EBSCOhost, and Proquest. Manual searching was also performed. Inclusion criteria were studies involving elderly age 65 or older, cystatin c serum levels available, all-cause mortality as outcome, and 5-years minimum of follow-up. Study selection was performed according to PRISMA algorithm. Newcastle Ottawa Scale for cohort study was used to assess primary studies’ quality and risk of bias. Study results were presented in descriptive tables and Forest plot.

Results. Initial searching revealed 609 hits with 12 studies eligible for the review: five studies evaluated all-cause mortality, three studies evaluated cardiovascular mortality, and four studies evaluated both. Meta-analysis showed that high cystatin c levels increasing risk of long-term all-cause mortality [(HR: 1.74 (95% CI: 1.48 – 2.04); p < 0.0001)] and cardiovascular mortality [HR: 2.01 (95% CI: 1,63 – 2,47); p < 0,0001)]. The prognostic ability of cystatin c was considerably moderate [AUC 0.70 (95% CI: 0.68-0,72); p = 0.02].

Conclusion. Cystatin C was able to predict long-term mortality in elderly population."

"Latar belakang: Deteksi dini dengue berat dapat mengurangi mortalitas akibat infeksi dengue. Saat ini, observasi harian terhadap keadaan klinis dan laboratorium pasien merupakan cara yang paling lazim dipakai dalam mendeteksi kejadian dengue berat. Namun demikian, cara ini biasanya terlambat mendeteksi kebocoran plasma berat. Laktat serum adalah salah satu penanda yang lazim dipakai dalam menilai hipoksia atau hipoperfusi jaringan akibat penyakit sistemik sehingga dipikirkan dapat dipakai sebagai prediktor kejadian dengue berat. Tujuan: Menilai kemampuan laktat darah sebagai prediktor kejadian dengue berat. Metode: Telaah sistematis ini disusun berdasarkan standar PRISMA. Pencarian primer dilakukan melalui penulusuran artikel secara daring di PubMed/Medline®, Cochrane Library, Embase, dan Scopus®. Penelusuran sekunder dilakukan secara daring menggunakan Google Scholar® dan portal lokal di Indonesia serta secara manual dengan korespondensi dengan peneliti atau Institusi yang berhubungan. Artikel dicari dengan kata kunci “dengue” dan “laktat” dalam bahasa Inggris dan Indonesia. Artikel yang diambil dan mencakup studi observasi prospektif dan retrospektif pada pasien dewasa (> 15 tahun) dengan infeksi dengue yang melaporkan hasil pemeriksaan laktat. Pencarian dilakukan tanpa membatasi waktu penelitian dan bahasa. Data dianalisis dengan RevMan dan Medcalc untuk mencari effect measure kemampuan laktat darah dalam prediksi kejadian dengue berat.Hasil: Sebanyak enam artikel diinklusi ke dalam telaah sistematis ini dan lima diantara artikel tersebut diikutsertakan ke dalam meta-analisis. Dari analisis yang dilakukan, diketahui bahwa laktat darah merupakan prediktor kejadian dengue berat yang cukup baik dengan pooled OR 8,38 (95%CI: 2,13 – 32,93); I2 87%, p <0,00001 dan pooled AUC 0,749 (95%CI 0,687-0,81); I2 48,98%, p = 0,1176. Lebih jauh, laktat darah terutama lebih baik dalam prediksi kejadian renjatan dengue/gagal organ (pooled OR 21,27 (95%CI 11,05 – 40,91); I2 44%, p = 0,17) dibandingkan terhadap kejadian kebocoran plasma tanpa gagal organ/renjatan dengue (pooled OR 1,6 (95%CI 0,77 – 3,32); I2 0%, p = 0,33). Beberapa hal yang diketahui dapat mempengaruhi kemampuan prediksi laktat terhadap kejadian dengue berat antara lain, waktu pengambilan laktat darah, luaran yang dinilai, dan nilai ambang batas laktat yang dipakai. Kesimpulan: Laktat darah merupakan prediktor kejadian dengue berat yang cukup baik, terutama terhadap kejadian renjatan dengue/gagal organ.

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Background: Early detection of severe dengue may decrease mortality caused by dengue infection. Currently, daily observation of patient’s clinical and laboratorium parameter is the most common way to detect severe dengue. However, this common practice is lacking in punctuality to detect severe dengue. Serum lactate is one of common biomarkers to detect hypoxia or hypoperfusion due to systemic disease. Accordingly, serum lactate may be a valuable predictor of severe dengue.

Objective: Evaluate the value of blood lactate as a predictor of severe dengue.

Methods: This systematic review is conducted by following the PRISMA standard. PubMed/Medline®, Cochrane Library, Embase, and Scopus® were systematically searched for studies evaluating the value of blood lactate to predict severe dengue. Moreover, manual searching by searching Google Scholar® and local Indonesia journal database and by corresponding to some researchers or any institution that may have conducted research about the topic. “Dengue” and “lactate” in English and Bahasa were used as keywords. Prospective and retrospective cohort studies with samples of adult (> 15 y.o) with dengue infection and reported the blood lactate result of any language and publication years are included. Data analysiswas conducted by using RevMan and Medcalc to synthesis the pooled effect measure of blood lactate as a predictor of severe dengue.

Results: This systematic review included six articles. However, only five articles were included in the meta-analysis. The analysis showed that blood lactate was a fairly good predictor of severe dengue with a pooled OR: 8.38 (95% CI: 2.13 - 32.93); I2 87%, p <0.00001 and pooled AUC: 0.749 (95% CI 0.687-0.81); I2 48.98%, p = 0.1176. Furthermore, blood lactate was particularly better at predicting dengue shock/organ failure (pooled OR: 21.27 (95% CI 11.05 - 40.91); I2 44%, p = 0.17) compared to predict plasma leakage without organ failure/dengue shock (pooled OR 1.6 (95% CI 0.77 - 3.32); I2 0%, p = 0.33). Several things that are known to affect the ability of blood lactate to predict the incidence of severe dengue including the time of blood lactate examination, the outcome measured, and the value of lactate’s cut-off.

Conclusions: Blood lactate is a fairly good predictor of severe dengue, particularly good predictor to predict the incidence of dengue shock/organ failure."

"Latar Belakang: Pendekatan indeks frailty 40 item (FI-40) dianggap sebagai alat terbaik untuk evaluasi mortalitas dan hospitalisasi sindrom frailty, tetapi sulit diterapkan dalam praktik klinis sehari-hari. Pendekatan dengan sistem skor CHS, SOF, dan FI-CGA lebih mudah diterapkan dalam praktik klinis sehari-hari, namun hingga saat ini belum ada data validasi di Indonesia. Tujuan: Mendapatkan rekomendasi mengenai alat ukur sindrom frailty yang mudah diterapkan dalam praktik klinis sehari-hari di Indonesia. Metode: Penelitian ini merupakan studi potong lintang dengan pendekatan uji diagnostik yang dilakukan pada pasien di poliklinik Geriatri Rumah Sakit Cipto Mangunkusumo, dengan usia ≥60 tahun, pada periode Mei-Juni 2013. Setiap subjek dinilai menggunakan sistem skor CHS, SOF, FI-CGA, dan FI-40. Dilakukan penilaian sensitivitas, spesifisitas, nilai prediksi positif (NPP), nilai prediksi negatif (NPN), rasio kemungkinan positif (RK+), dan rasio kemungkinan negatif (RK-) untuk masing-masing sistem skor CHS, SOF, dan FI-CGA dibandingkan dengan FI-40. Hasil: Proporsi individu yang termasuk dalam kategori frail, pre-frail, dan fit berdasarkan indeks frailty 40 item berturut-turut adalah 25,3%, 71%, dan 3,7%. Untuk membedakan individu frail dengan tidak frail, skor CHS memiliki sensitivitas 41,2%, spesifisitas 95%, NPP 73,7%, NPN 82,7%, RK+ 8,41 dan RK- 0,62. Skor SOF memiliki sensitivitas 17,6%, spesifisitas 99,5%, NPP 92,3%, NPN 78,1%, RK+ 35,2 dan RK- 0,83. Sedangkan skor FI-CGA memiliki sensitivitas 8,8%, spesifisitas 100%, NPP 100%, NPN 76,4%, RK+ tak terbatas, dan RK- 0,91. Kesimpulan: Tidak ada sistem skor yang dapat digunakan sebagai alat skrining yang baik untuk sindrom frailty, namun masing-masing sistem skor dapat digunakan sebagai alat diagnostik yang baik untuk sindrom frailty.

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Background: The Frailty Index 40-item (FI-40) approach is considered the best tool for evaluating mortality and hospitalization outcomes related to frailty syndrome, although it is challenging to implement in daily clinical practice. The CHS, SOF, and FI-CGA scoring systems are easier to use in daily practice, but there is no validation data available in Indonesia.

Aim: To obtain recommendations for a frailty syndrome diagnostic tool that is easy to implement in daily clinical practice in Indonesia.

Methods: This was a cross-sectional study with a diagnostic test approach conducted on patients aged ≥60 years at the Geriatric Outpatient Clinic of Cipto Mangunkusumo Hospital from May to June 2013. Each subject was assessed using the CHS, SOF, FI-CGA, and FI-40 scoring systems. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated for each scoring system compared to FI-40.

Results: The proportions of frail, pre-frail, and robust individuals based on the 40-item frailty index were 25.3%, 71%, and 3.7%, respectively. To differentiate between frail and non-frail individuals, the CHS score showed a sensitivity of 41.2%, specificity of 95%, PPV of 73.7%, NPV of 82.7%, LR+ of 8.41, and LR- of 0.62. The SOF score showed a sensitivity of 17.6%, specificity of 99.5%, PPV of 92.3%, NPV of 78.1%, LR+ of 35.2, and LR- of 0.83. The FI-CGA score showed a sensitivity of 8.8%, specificity of 100%, PPV of 100%, NPV of 76.4%, LR+ infinite, and LR- of 0.91.

Conclusion: No scoring system was found to be suitable as a screening tool for frailty syndrome; however, all scoring systems can be used as effective diagnostic tools for frailty with good predictive ability."

"Latar Belakang: Aktivasi komplemen dapat menyebabkan respon imun berlebihan dan merupakan salah satu faktor yang berpengaruh terhadap morbiditas serta mortalitas pasien COVID-19. Beberapa penghambat aktivasi komplemen saat ini sedang dipelajari untuk menghambat aktivasi sistem komplemen yang berlebihan pada pasien COVID-19. Resiko, keuntungan, waktu pemberian dan bagian dari sistem yang akan ditargetkan perlu dipertimbangkan pada saat akan menggunakan penghambat komplemen, oleh karena itu telaah sistematis ini dibuat untuk mengambil kesimpulan apakah pemberian terapi penghambat sistem komplemen dapat menurunkan mortalitas pasien COVID-19 yang dirawat di Rumah Sakit berdasarkan penelitian-penelitian yang tersedia.Tujuan: Mengetahui efek pemberian terapi penghambat sistem komplemen terhadap mortalitas pasien COVID-19 yang dirawat di Rumah Sakit.Metode: Dengan menggunakan kata kunci spesifik, dilakukan pencarian artikel potensial secara komprehensif pada PubMed, Embase, Cochrane, dan Scopus database dengan pembatasan waktu 2019 sampai dengan sampai 31 Desember 2022. Protokol studi ini telah diregistrasi di PROSPERO (CRD42022306632). Semua penelitian pemberian terapi penghambat komplemen pada pasien COVID-19 dimasukkan. Analisis statistik dilakukan dengan menggunakan perangkat lunak Review Manager 5.4.Hasil: 5 penelitian memenuhi kriteria dan dimasukkan dalam telaah sistematis serta meta-analisis dengan total 739 pasien COVID-19. Hasil analisis Forest plot menunjukan bahwa pemberian terapi penghambat sistem komplemen menurunkan mortalitas sebesar 28% pada pasien COVID-19 yang dirawat di Rumah Sakit (RR 0,72; 95% CI: 0,46 – 1,14, I2 = 61%, P-value = 0.16).Kesimpulan: Pemberian terapi penghambat sistem komplemen secara statistik tidak signifikan menurunkan mortalitas pada pasien COVID-19 yang dirawat di Rumah Sakit

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Background: Complement activation can cause an exaggerated immune response and is one of the factors that influence the morbidity and mortality of COVID-19 patients. Several complement activation inhibitors are currently being studied to inhibit excessive complement activation in COVID-19 patients. The risks, benefits, time of administration and the part of the system to be targeted need to be considered when using complement inhibition, therefore this systematic review was made to conclude whether the administration of complement system inhibition therapy can reduce the mortality of COVID-19 patients who are hospitalized based on available studies.

Objective: To determine the effect of complement system inhibitory therapy on the mortality of hospitalized COVID-19 patients

Methods: Using specific keywords, we comprehensively searched the PubMed, Embase, Cochrane, and Scopus databases for potential articles from 2019 to December 31, 2022. The research protocol was registered with PROSPERO (CRD42022306632). All studies administering complement inhibitory therapy to COVID-19 patients were processed. Statistical analysis was performed using Review Manager 5.4 software.

Result: 5 studies met the criteria and were included in a systematic review and meta-analysis of a total of 739 COVID-19 patients. The results of the Forest plot analysis showed that administration of complement system inhibitor therapy reduced mortality by 28% in hospitalized COVID-19 patients (RR 0.72; 95% CI: 0.46 – 1.14, I2 = 61%, P -value = 0.16).

Conclusion: Providing complement system inhibitor therapy did not statistically significantly reduce mortality in hospitalized COVID-19 patients"

"Latar Belakang: Janus Kinase (JAK)-inhibitors telah digunakan untuk terapi beberapa penyakit inflamasi dan autoimun karena kemampuannya untuk mengendalikan respon imun dan cytokine release syndrome. Saat ini penggunaan baru dari Janus Kinase (JAK)-inhibitors diperuntukan untuk terapi coronavirus disease 2019 (Covid-19), namun bukti mengenai kegunaannya masih belum jelas. Penelitian ini dilakukan untuk menganalisa efikasi dari Janus Kinase (JAK)-inhibitors untuk mengurangi mortalitas pasien Covid-19.Tujuan: Mengetahui efek pemberian terapi Janus Kinase (JAK)-inhibitors terhadap mortalitas pasien Covid-19.Metode: Dengan menggunakan kata kunci spesifik, dilakukan pencarian artikel potensial secara komprehensif pada PubMed, Europe PMC, and ClinicalTrials.gov database dengan pembatasan waktu sampai 2 Juni 2021. Semua penelitian tentang Covid-19 dan JAK-inhibitors dimasukan. Analisa statistik dilakukan denganReview Manager 5.4 software.Hasil: 13 penelitian dengan 4339 pasien Covid-19 dimasukan dalam meta-analisis. Data kami menyimpulkan bahwa terapi JAK-inhibitors berhubungan dengan menurunnya mortalitas pasien Covid-19 (RR 0.52; 95%CI: 0.36-0.76, p=0.0006, I2 = 33%, random-effect modelling).Kesimpulan: Penelitian ini menyimpulkan terapi JAK-inhibitors berhubungan dengan menurunnya mortalitas pasien Covid-19. Namun dibutuhkan randomized clinical trials yang lebih banyak untuk mengkonfirmasi hasil penelitian ini.

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Background: : Janus Kinase (JAK)-inhibitors have been used for treating several inflammatory and autoimmune disease because of its ability to restrains immune systems and cytokine release syndrome. Currently, JAK-inhibitors are repurposed for the treatment of coronavirus disease 2019 (Covid-19), however the evidence regarding their benefit are still unclear. This study sought to analyze the efficacy of JAK-inhibitors in improving the mortality outcomes of Covid-19 patients.

Objective: To determine the effect of JAK-inhibitors as therapy in Covid-19 patients related to mortality.

Methods: Using specific keywords, we comprehensively searched the potential articles on PubMed, Europe PMC, and ClinicalTrials.gov database until June 2nd, 2021. All published studies on Covid-19 and JAK-inhibitors were retrieved. Statistical analysis was conducted using Review Manager 5.4 software.

Results: A total of 13 studies with 4,339 Covid-19 patients were included in the meta-analysis. Our data suggested that JAK-inhibitors was associated with reduction of mortality from Covid-19 (RR 0.52; 95%CI: 0.36 – 0.76, p=0.0006, I2 = 33%, random-effect modelling).

Conclusion: Our study suggests that JAK-inhibitors may offer beneficial effects on Covid-19 mortality. However, more randomized clinical trials warrant to confirm the findings of our study."

"Tujuan: Melakukan telaah sistematis untuk membandingkan terapi hidrokortison dan hidrokortison, asam askorbat, dan tiamin (HAT) sebagai ajuvan pada tingkat mortalitas pasien syok septik. Metode: Pencarian komprehensif dilakukan menggunakan empat pangkalan data (PubMed, EMBASE, Scopus, and Cochrane) menggunakan kata kunci spesifik hingga tanggal 18 Mei 2022. Semua studi yang dipublikasikan mengenai penggunaan terapi HAT pada pasien syok septik dikumpulkan dan ditelaah. Hasil: Dua studi uji acak terkendali, satu studi kontrol kasus, dan satu studi kohort yang melibatkan 635 pasien. Terapi HAT ditemukan tidak signifikan dalam menurunkan angka kematian di ICU (RR 0.89 95% CI [0.60 sampai 1.32], p=0.56), angka kematian di rumah sakit (RR 1.2 95% CI [0 ,90 sampai 1.59], p= 0,21), dan mortalitas 28 hari (RR 0,95, 95% CI [0,56 hingga 1,58], p=0,83) Kesimpulan: Tidak ditemukan perbedaan signifikan dalam mortalitas pada kelompok yang menggunakan HAT bila dibandingkan dengan terapi hidrokortison. Registrasi: ID pendaftaran PROSPERO untuk penelitian ini adalah CRD42022296055 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296055).

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Objective: We systematically reviewed the comparison between hydrocortisone and hydrocortisone-ascorbic acid-thiamine combined therapy (HAT) as adjuvant in the mortality rate of septic shock patients. Method: Four databases (PubMed, EMBASE, Scopus, and Cochrane) are comprehensively searched using specific keywords up to 18th May 2022. All published studies on the use of HAT on septic shock patients were collected and reviewed Results: Two randomized controlled trials, one case control study and one cohort study enrolling 635 patients were included. HAT therapy was found to be not significant in reducing the ICU mortality rate (RR 0,89 95% CI [0,60 to 1,32], p=0,56), hospital mortality rate (RR 1.2 95% CI [0,90 to 1,59], p=0,21), and 28 days mortality (RR 0,95, 95% CI [0,56 to 1,58], p=0,83). Conclusion: No significant difference in mortality was found in the HAT group when compared with hydrocortisone therapy. Trial registration: PROSPERO registration ID for this study is CRD42022296055 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296055)."

"Tesis ini disusun untuk mengetahui manfaat dari penambahan terapi latihan berfokus skapula pada pasien dengan gangguan rotator cuff dengan luaran primer berupa perbaikan keluhan nyeri dan kemampuan fungsional. Penelitian ini adalah penelitian telaah sistematis dan meta-analisis. Studi dijaring dari database MEDLINE, Embase, CENTRAL, dan PEDro disertai pencarian tambahan melalui registry studi klinis dan referensi dari penelitian-penelitian topik serupa. Kriteria eligibilitas penelitian ini meliputi studi uji klinis acak terkendali tanpa batasan waktu publikasi, partisipan dewasa yang memiliki spektrum kelainan rotator cuff, dan membandingkan terapi latihan berfokus skapula dibandingkan terapi konvensional non-bedah lain atau tanpa terapi. Gangguan rotator cuff akibat cedera traumatik akut, sekunder akibat kelainan neurologis dan/atau keganasan, kelainan struktur skeletal pada bahu, serta yang memiliki riwayat tindakan pembedahan pada kompleks bahu dieksklusikan. Dua peneliti secara independen melakukan seleksi studi dan mengevaluasi risiko bias masing-masing studi menggunakan skala PEDro. Total didapatkan delapan studi dengan total 422 partisipan diinklusikan di penelitian ini dengan risiko bias “fair” hingga “good” berdasarkan skala PEDro. Dari meta-analisis didapatkan latihan berfokus skapula memberikan luaran perbaikan nyeri dan kemampuan fungsional yang lebih baik dibandingkan kontrol (MD -0,84 p<0,001 dan SMD -0,58 p<0,001) khususnya jika diberikan selama lebih dari delapan minggu. Secara kesimpulan, terapi latihan berfokus skapula memberikan perbaikan terhadap keluhan nyeri dan kemampuan fungsional pasien dengan gangguan rotator cuff.

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This thesis aims to determine the effect of adding scapular-based therapeutic exercise for patient with rotator cuff pathology with the primary outcome being improvement in pain and functional ability. The research design is systematic review and meta-analysis. Studies were searched from MEDLINE, Embase, CENTRAL and PEDro database in addition to clinical registry search and references searching from affiliated studies. Eligibility criteria of this research include randomized clinical trial with no time restriction, adult participant with rotator cuff pathology and study comparing effect of scapular-based therapeutic exercise versus other non-surgery intervention or no intervention. Rotator cuff pathology due to traumatic injury, neurological and/or malignancy disease, structural abnormalities of shoulder and history of shoulder surgery were excluded. Two reviewers independently select the study and did risk of bias evaluation using PEDro scale. In total, eight studies with 422 participants were included with risk of bias “fair” to “good” based on PEDro scale. From meta-analysis, scapular-based therapeutic exercise resulted in better improvement in pain and functional ability compared to control (MD -0,84 p<0,01 and SMD -0,58 p<0,01) especially if given as intervention for at least eight weeks. In conclusion, scapular-based therapeutic exercise is shown to be be more effective in improving shoulder pain and functional ability for patient with rotator cuff pathology."

"Latar belakang: Asma merupakan penyakit ditandai peradangan saluran napas kronik. Satu dari tiga kasus tidak memberikan respon adekuat. Modalitas alternatif terapi  asma adalah magnesium inhalasi. Inhalasi magnesium memiliki efek samping sistemik minimal. Oleh karena itu, peran magnesium inhalasi perlu diteliti lebih lanTujuan: Penelitian bertujuan untuk mengetahui efektivitas dan keamanan pemberian magnesium inhalasi pada pasien dewasa mengalami  asma akut.Metode: Penelusuran literatur dilakukan dua peneliti independen melalui: PubMed/ MEDLINE, Google Scholar, ProQuest, dan Cochrane dengan kata kunci “magnesium inhalasi” dan “serangan asma” dalam bahasa Inggris dan Indonesia. Pencarian manual dan snowballing dilakukan di portal data nasional. Studi yang dimasukkan adalah uji acak terkontrol mengenai perbandingan magnesium inhalasi dengan terapi standar pada serangan asma akut. Penilaian efektivitas berdasarkan parameter readmisi, tanda vital, perbaikan klinis, serta fungsi paru, sedangkan keamanan berdasarkan parameter efek samping. Protokol telaah sistematis didaftarkan pada PROSPERO.Hasil: Lima artikel diikutsertakan dalam telaah sistematis. Dua artikel diikut-sertakan menilai aspek  readmisi. Tiga studi  menilai hubungan magnesium terhadap tanda vital pasien. Dua studi menilai tingkat keparahan penyakit dan perbaikan klinis. Studi menunjukkan tidak terdapat hubungan bermakna pemberian magnesium inhalasi pada aspek readmisi pasien (RR 1; IK 95% 0.92 - 1,08; p= 0,96), dan saturasi oksigen (MD  1,82; IK 95%: -0.89 - 4.53; p= 0.19). Ada penurunan bermakna laju napas pasien  (MD -1,72; IK 95% -3,1 -0.35; p= 0.01), dan perbaikan gejala pada pasien  (RR 0.29; IK95% 0.18 - 0.47; p <0.001). Ada peningkatan bermakna efek samping pasien magnesium inhalasi (HR 1.56; IK 95% 1.05 – 2.32; p= 0.32). Efek samping relatif ringan  berupa hipotensi dan rasa mual. Kesimpulan: Magnesium inhalasi memperbaiki  klinis pasien asma terutama gejala, laju napas, dan fungsi paru.  Magnesium inhalasi dikatakan aman jika diberikan pada pasien, namun hati-hati penggunaan pada pasien hipotensi.

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Background:  Asthma is a disease characterized by chronic airway inflammation. Asthma occurs to many people worldwide. One third of asthmatic case did not respond adequately to standard therapy (Short Acting Beta Agonist, Anticholinergic, Corticosteroid). One of alternative treatment of asthma is inhaled magnesium.  Theoretically, inhaled magnesium is thought to have less systemic side effect and could act directly to respiratory tract. However, the role of inhaled magnesium therapy is not established yet.

Objective: This review is made to evaluate the effectiveness and safety of nebulized magnesium in adult with acute asthma attack.

Methods: Literature search was conducted by two independent investigators through online databases: PubMed/MEDLINE, Cochrane, ProQuest, and Google scholar using the keywords “inhaled magnesium” and “asthma” in English and Indonesian. Manual searches and snowballing were carried out through national data portals and medical faculty e-libraries. Journal articles included in this study are randomized controlled trials that observed inhaled magnesium in adult with acute asthma attack. All the protocol of this systematic review has been registered in PROSPERO.

Result: There are five articles included in this review. Two of them evaluate the effect of magnesium in term of readmission, three of the studies measures effect of magnesium in vital sign, and two of them evaluate the effect of magnesium in term of severity of asthma There is no significant difference in readmission rate and oxygen saturation in magnesium group compared to control (RR 1; 95% CI 0.92 to 1,08; p= 0,96 and MD 1,82; 95% CI -0.89 to 4.53; p= 0.19, respectively). There is significant reduction of respiratory rate and clinical severity in magnesium (MD -1,72; 95% CI   -3,1 to 0.35; p= 0.01, RR 0.29; 95% CI 0.18 to 0.47; p <0.001, respectively). There was a higher risk of side effect in magnesium group (HR 1.56; 95%CI 1.05 to 2.32; p= 0.03). However, the side effect is relatively mild such as hypotension and nausea.

Conclusion: Inhaled magnesium improves clinical outcome for patient with asthma attack especially lung function, improvement of clinical outcome, and lung function. Moreover, Inhaled magnesium is considered safe to be given to asthmatic patient. However, the inhaled magnesium is given with caution in patient with hypotension."

"Latar Belakang. Walaupun pasien HIV mendapat terapi antiretroviral yang efektif, penurunan fungsi fisik sering ditemukan lebih awal dan menimbulkan masalah baru berupa penuaan dan frailty.Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan prefrail dan frail pada pasien HIV dalam terapi antiretroviral.Metode. Desain studi potong lintang pada pasien HIV usia ≥30 tahun dalam terapi ARV minimal 6 bulan. Pasien yang memenuhi inklusi dilakukan pencatatan demografis, penyakit komorbid, faktor terkait HIV seperti lama terdiagnosis, lama ARV, dan CD4, pengukuran antropometri seperti indeks massa tubuh, penilaian depresi dengan Indo BDI-II, dan penilaian frailty dengan kriteria Fried. Pasien dengan riwayat infeksi otak, kanker, dan oportunistik aktif dieksklusi. Analisis bivariat dan multivariat dilakukan pada faktor-faktor tersebut.Hasil. Terdapat 164 pasien yang dianalisis. Proporsi prefrail sebanyak 51,2% (84 pasien) dan frail 3,7% (6 pasien), dengan komponen dominan pada kelemahan genggam. Pasien laki-laki sebanyak 72% dengan median usia (IQR) 40,5 (36-47) tahun, dan median CD4 nadir (IQR) 53 (21-147) sel/mm3, median CD4 awal (IQR) 77 (32 - 206) sel/mm3. Hepatitis C menjadi faktor komorbid terbanyak. Depresi berhubungan dengan prefrail dan frail dengan OR 2,14 (IK95%: 1,034-4,439) dan p = 0,036. Tidak terdapat hubungan faktor usia ≥50 tahun, ≥2 penyakit komorbid, lama terdiagnosis HIV ≥5 tahun, lama ARV ≥5 tahun, CD4 <200 sel/mm3, indeks massa tubuh ≥25 kg/m2, dan pendapatan rendah dengan prefrail dan frail.Kesimpulan. Terdapat proporsi prefrail sebanyak 51,2% dan frail 3,7%. Depresi merupakan salah satu faktor yang terbukti berhubungan terhadap prefrail dan frail pada pasien HIV dalam terapi ARV.

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Background. Although HIV patients receive effective antiretroviral therapy, decrease in physical function is often found earlier and creates new problems in the form of aging and frailty

Aim. to determine the proportion and factors associated with prefrail and frail in HIV patients on antiretroviral therapy.

Method. A cross-sectional study design in HIV patients aged ≥30 years who were on ARV therapy for at least 6 months. Patients who fulfilled the inclusion were recorded demographically, comorbid diseases, HIV-related factors such as length of diagnosis, duration of ARV, CD4, anthropometric measurements such as body mass index, depression assessment with Indo BDI-II, and frailty assessment with Fried criteria. Patients with a history of brain infection, cancer, and active opportunists were excluded. Bivariate and multivariate analysis was carried out on these factors.

Results. There were 164 patients analyzed. The proportions of prefrail and frail were 51.2% and 3.7% respectively, with the dominant component in muscle weakness. Male patients were 72% with median age (IQR) 40.5 (36-47) years, median baseline CD4 (IQR) 77 (32 - 206) cell/mm3, and median nadir CD4 (IQR) 53 (21-147) cells/mm3. Hepatitis C is the most comorbid factor. Depression is related to prefrail and frail with OR 2.14 (95%CI: 1,034-4,439) and p = 0,036. There was no correlation between factors such as age ≥50 years, ≥2 comorbid diseases, length of diagnosis of HIV ≥5 years, duration of ARV ≥5 years, CD4 cell count <200 cells/mm3, body mass index ≥25 kg/m2, and low income with prefrail and frail.

Conclusion. The proportions of prefrail and frail are 51.2% and 3.7% respectively. Depression is one of the factors that is proven to be related to prefrail and frail in HIV patients in ARV therapy."