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"Pembedahan dapat memicu respons stres metabolik yang dapat menimbulkan hiperglikemia. Mekanisme hiperglikemia pascaoperasi dihubungkan dengan resistensi insulin, peningkatan glukoneogenesis, dan glikogenolisis, serta penurunan glucose transporter-4. Hiperglikemia diduga sebagai respons adaptasi fisiologis “fight or flight” tetapi juga dikaitkan dengan peningkatan morbiditas dan mortalitas pascaoperasi. Risiko hiperglikemia pascaoperasi dan potensi bahaya yang ditimbulkan belum banyak disadari oleh para dokter. Penelitian ini bertujuan untuk mengetahui karakteristik pasien pascaoperasi di Pediatric Intensive Care Unit (PICU) di Rumah Sakit Ciptomangunkusumo, insidens hiperglikemia pada anak pascaoperasi, dan faktor-faktor yang memengaruhi hiperglikemia pascaoperasi. Penelitian ini merupakan suatu studi potong lintang terhadap 199 pasien di RSCM yang dirawat di ruang PICU pascaoperasi sepanjang Januari – Desember 2020. Data demografi serta gula darah pascaoperasi diambil dari rekam medis. Kejadian hiperglikemia pascaoperasi dalam 24 jam pertama adalah 42%. Faktor-faktor yang memengaruhi hiperglikemia pascaoperasi pada penelitian ini adalah usia > 60 bulan (rasio odds 1,92 (95% IK 1,08-3,41) p=0,025) dan median durasi operasi>5 jam (p=0,001)

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Surgery can trigger metabolic stress response that can lead to hyperglycemia. Mechanism of postoperative hyperglycemia is associated with insulin resistance, increased gluconeogenesis, and glycogenolysis, and decreased glucose transporters-4. Hyperglycemia is thought to be a physiological “fight or flight” adaptive response but also associated with increased postoperative morbidity and mortality. The risk of postoperative hyperglycemia and the potential dangers that it causes have not been widely realized by doctors. This study aims to determine the characteristics of postoperative patients at the Pediatric Intensive Care Unit (PICU) at Ciptomangunkusumo Hospital (RSCM), incidence of hyperglycemia in postoperative children, related factors of postoperative hyperglycemia. This study is a cross-sectional study of 199 patients at RSCM who admitted in PICU postoperative during January – December 2020. Demographic data and postoperative blood sugar were taken from medical records. The incidence of postoperative hyperglycemia in the first 24 hours was 42%. Related factors of postoperative hyperglycemia in this study were age > 60 months (Odds ratio 1,92 (95% CI 1,08-3,41); p=0,025 and median operative duration > 5 hours (p=0,001)."

"Latar Belakang: Hiperglikemia akut maupun kronis dapat menyebabkanperubahan patalogis pada lapisan serabut saraf retina RNFL . Pada tahap dinilapisan sel ganglion GCs mengalami apoptosis, yang diregulasi oleh proteinBrn3b. Proses ini diketahui terjadi lebih awal sebelum perubahan histopatologispada RNFL terjadi pada diabetes. Proses apoptosis ditandai dengan, peningkatanstres oksidatif, peningkatan NO, NF-??, TNF-?, dan Caspase 3 pada patogenesisglaukoma primer sudut terbuka GPSTa . Asumsi klinis saat ini bahwa penderitadiabetes melitus dalam jangka waktu lama lebih dari 5 tahun kemungkinan besarberisiko terjadinya glaukoma. Namun kenyataannya dalam pengalaman klinistidak semua pasien diabetes melitus dapat terjadi GPSTa. Berdasarkan temuanklinis tersebut diduga ada peran faktor genetik yang mendasari etiologi dariGPSTa pada pasien diabetes melitus. Tujuan: Mengetahui peran gen Brn3b pada apoptosis di RGCs dan kaitannyadengan perubahan kuantitas NO, Caspase 3, NF-?B, dan TNF-? sebagai prediksiglaukoma dini pada tikus diabetes. Metode: Penelitian ekperimental in vivo menggunakan tikus jantan SpraqueDawleyusia ge; 2 bulan dengan berat 150-200 gram diambil secara random sejakNopember 2015 hingga Juli 2016. Hewan coba dibagi menjadi 2 kelompok yaitu: kelompok perlakuan diinjeksi intraperitoneal STZ 50 mg/kg dalam 0.01M buffersitrat dalam ph 4.5 dan kelompok kontrol tidak ada perlakuan. Glukosa darahpuasa diperiksa 3 hari setelah injeksi STZ, dan dikonfirmasi ge; 250 mg/dL.Jaringan retina dibagi menjadi dua bagian pada kelompok perlakuan maupunkontrol yakni retina kanan untuk IHK Caspase 3 dan TNF-? dan retina kiridibagi dua bagian yaitu untuk pemeriksaan quantitative Real-time PCR RNAdiekstraksi untuk analisis ekspresi gen Brn3b dan pemeriksaan ELISA NO danNF-?B. Hasil: Terjadi penurunan ekpresi gen Brn3b pada tikus perlakuandibandingkan ekspresi gen Brn3b kontrol sebesar 1.2677 kali bulan kedua, 1.1348kali bulan keempat, dan 2.4600 kali bulan keenam. Disisi lain terjadi penurunankuantitas NO dan peningkatan kuantitas Caspase 3, NF-?B, dan TNF-?. Kesimpulan: Ekspresi mRNA Brn3b berbanding terbalik dengan apoptosis padaRGCs. Kuantitas NO, Caspase 3, NF-?B, dan TNF-? dipengaruhi oleh ekspresiBrn3b pada RGCs akibat hiperglikemia pada tikus diabetes.

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Background: Acute and chronic hyperglycemia may pathologically changeretinal nerve fiber layer RNFL . At early stage, ganglion cells GCs undergoapoptosis, which is regulated by a Brn3b protein. This change is known to occurat earlier time before retinal histological changes can be detected in diabeticpatients. The apoptosis process is marked by an increase in oxidative stress, a risein NO, NF-??, caspase 3, and TNF-? levels in pathogenesis of primary open angleglaucoma POAG . Current clinical assumption proposes that individualssuffering from diabetes mellitus for more than 5 years have greater risk ofglaucoma. Nonetheless, clinical experience shows that not all diabetic patientsdevelop POAG. Based on clinical examinations it is suspected that there is agenetic factor that caused the etiology of POAG in diabetes mellitus patients.

Purpose: To learn the role of Brn3b gene in apoptosis of RGCs and its effect onthe changing of quantity of NO, Caspase 3, NF-?B, and TNF-? as early predictorof glaucoma in diabetic rats.

Methods: Experimental in-vivo study was carried out using male SpraqueDawleyrats with age ge; 2 months, weighing 150-200 grams. The rats wererandomly selected from November 2015 to July 2016. The animals were dividedinto two groups. Group receiving intraperitoneal injection of STZ 50 mg/kg in0.01M citric buffer and pH 4,5; 2 and control group with no treatment. Fastingblood glucose was checked 3 days after injection of STZ and hyperglycemia wasdetermined as fasting blood glucose ge; 250 mg/dL. Retinal tissue was divided intotwo parts both experimental and control groups respectively : a right retina forIHC Caspase 3 and TNF-? ; b left retina was divided into two parts for thepurpose of quantitative Real-Time PCR test RNA extraction for Brn3b geneexpression analysis and ELISA test NO and NF-?B.

Results: Experimental group showed a decrease in Brn3b expression compared tocontrol group 1.2677-fold lower on 2nd month; 1.1348-fold lower on 4th monthand 2.4600-fold lower on 6th month . On the other hand, there was a decrease ofNO and there was increased of Caspase 3, NF-?B and TNF-? quantity.

Conclusion: The expression of mRNA Brn3b is inversely proportional toapoptosis in RGCs. The quantity of NO, Caspase 3, NF-?B and TNF-? isinfluenced by expression of Brn3b in RGCs caused by hyperglycemia in diabeticrats."

"Latar Belakang: Batu ginjal merupakan salah satu bentuk dari batu saluran kemih, yang merupakan masalah yang cukup besar dan bisa menyebabkan morbiditas yang bermakna.Batu ginjal dapat menyebabkan gangguan fungsi ginjal dan dapat berujung pada gagal ginjal, bahkan kematian.Hiperglikemia merupakan salah satu faktor resiko terjadinya batu ginjal. Tujuan: Mengetahui hubungan antara hiperglikemia dengan penurunan fungsi ginjal pada pasien batu ginjal. Metode: Studi potong lintang yang melibatkan 5464 pasien batu ginjal yang berobat di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo pada tahun 2000-2013. Analisis data dilakukan pada 877 orang pasien yang memiliki data gula darah sewaktu dan kreatinin serum, dengan cara mempelajari rekam medis pasien. Sampel penelitian didapatkandengan metodetotal population sampling. Hasil: Rasio subjek laki-laki dan perempuan adalah 2:1. Prevalensi hiperglikemia sebesar 4.79% dan prevalensi fungsi ginjal buruk sebesar 32.39%. Pada uji analisis hubungan hiperglikemia dengan fungsi ginjal didapatkan nilai p = 0.013. Kesimpulan: Hiperglikemia memiliki hubungan yang bermakna dengan fungsi ginjal. Diperlukan tatalaksana serta pencegahan hiperglikemia untuk mencegah perburukan fungsi ginjal pada pasien dengan batu ginjal.

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Background: Kidney stones are one of the forms of urinary tract stones, which is a pretty big problem and can cause significant morbidity. Kidney stones can cause renal dysfunction and can lead to kidney failure, and even mortality. Hyperglycemia can affect the risk of developing kidney stones.

Aim: Knowing the relationship between hyperglycemia and renal function in patients with kidney stones.

Methods: A cross-sectional study involving 5464 patients undergoing treatment for calculous disease at the General National Center Cipto Mangunkusumo Hospital between 2000 and 2013. Analysis was done to 877 patients whoseblood glucose and serum creatinine data were recorded, from patient’s medical record. Samples were obtained by using total population samplingmethod.

Results: Male to female subjects ratio were 2:1. Subjects with hyperglycemia was 4.79%, and there were 32.39% subjects havepoor kidney function.In the analysis of the association between hyperglycemia and kidney function, it is shown that the significance value of p = 0.013.

Conclusion: Hyperglycemia has a significant association with kidney function.Preventions and management of hyperglycemia are necessary to prevent deterioration of kidney function in kidney stone patients."

"Prediabetes adalah kondisi dimana kadar gula darah seseorang diatas batas normal tetapi belum mencapai kriteria diagnosis diabetes melitus. Hiperglikemia pada penderita prediabetes dapat meningkatkan penanda inflamasi kronik dan pembentukan spesies oksigen reaktif, yang akan meningkatkan stres oksidatif. Kadar GSH (glutation tereduksi), GSSG (glutation teroksidasi), dan rasio GSH/GSSG dapat diukur untuk melihat tingkat stres oksidatif. Dilakukan pengukuran GSH dan GSSG pada ginjal tikus Wistar dengan metode kolorimetri. Tikus dibedakan menjadi tikus sehat sebagai kontrol negatif dan prediabetes. Induksi prediabetes dilakukan dengan diet tinggi lemak dan glukosa ditambah injeksi streptozotocin. Tikus prediabetes terbagi menjadi tiga kelompok intervensi, yaitu tanpa suplementasi vitamin D3 dan suplementasi vitamin D3 dengan dosis 100 dan 1000 IU/kgBB/hari. Pemberian vitamin D3 pada tikus model prediabetes tidak memberikan efek yang signifikan secara statistik pada kadar GSH (p=0,077) dan GSSG (p=0,509) ginjal tikus. Pemberian vitamin D3 dosis rendah (100 IU/kgBB/hari) meningkatkan rasio GSH/GSSG ginjal tikus model prediabetes (2,59 ± 0,32) dibandingkan dengan ginjal tikus model prediabetes tanpa pemberian vitamin D3 (1,68 ± 0,80) dan signifikan secara statistik (p = 0,026). Suplementasi vitamin D 100 IU/kgBB/hari pada ginjal tikus prediabetes dapat meningkatkan rasio GSH/GSSG secara signifikan.

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Hyperglycemia in prediabetic patients can increase the formation of reactive oxygen species, which will increase oxidative stress. GSH (reduced glutathione), GSSG (oxidized glutathione), and the GSH/GSSG ratio can be measured to see the level of oxidative stress. GSH and GSSG were measured in the kidneys of Wistar rats using the colorimetric method. Mice were differentiated into healthy mice as negative controls and prediabetes. Prediabetes was induced with a diet high in fat and glucose plus injection of streptozotocin. Prediabetic rats were divided into three intervention groups, namely without vitamin D3 supplementation and vitamin D3 supplementation at doses of 100 and 1000 IU/kgBW/day. Administration of vitamin D3 to prediabetic rats did not have a statistically significant effect on rat kidney GSH (p=0.077) and GSSG (p=0.509) levels. Administration of low-dose vitamin D3 (100 IU/kgBW/day) increased the ratio of GSH/GSSG in the kidneys of prediabetic rat models (2.59 ± 0.32) compared to the kidneys of prediabetic rats without administration of vitamin D3 (1.68 ± 0.80) and statistically significant (p = 0.026). Supplementation of vitamin D 100 IU/kgBB/day in the kidneys of prediabetic rats can significantly increase the ratio of GSH/GSSG."

"Diabetes mellitus tipe II adalah penyakit gangguan metabolik yang gejalanya adalah hiperglikemia atau tingkat glukosa darah yang meningkat, yang disebabkan oleh rusaknya fungsi insulin baik dalam sekresi, kerja, atau keduanya. Penyakit ini adalah penyakit menahun yang bisa menyebabkan berbagai komplikasi. Salah satu pendekatan untuk mengobati penyakit diabetes mellitus tipe II adalah dengan memperlambat penyerapan glukosa melalui penghambatan α-glukosidase. Enzim α-glukosidase akan mengkatalisasi hidrolisis gula kompleks, termasuk karbohidrat, menjadi glukosa yang bisa diserap dalam usus. Dengan demikian penghambatan α-glukosidase akan menghambat pembentukan glukosa yang bisa diserap usus, yang kemudian akan memperlambat kenaikan tingkat glukosa darah. Banyaknya penderita diabetes mellitus tipe II mendorong usaha untuk mencari senyawa aktif penghambat α-glukosidase baru dari bahan alam, yang diharapkan mempunyai efikasi yang lebih baik atau lebih mudah diekstrak atau disintesis daripada yang ada sekarang. Penelitian ini bertujuan untuk mencari senyawa aktif penghambat α-glukosidase dari bahan alam yang ada di Indonesia, khususnya dari tanaman Artabotrys sp. Ada 4 jenis tanaman Artabotrys sp. yang diteliti keaktifan ekstrak etanolnya terhadap penghambatan α-glukosidase: Artabotrys hexapetalus (daun dan kulit batang), Artabotrys suaveolens (daun dan kulit batang), Artabotrys blumei (batang dan ranting), dan Artabotrys sumatranus (daun dan ranting). Hasil pengetesan menggunakan bioassay menunjukkan bahwa ekstrak etanol yang memiliki aktivitas penghambatan α-glukosidase terkuat adalah dari daun A. sumatranus, disusul berturut-turut oleh ranting A. sumatranus, daun A. suaveolens, kulit batang A. hexapetalus, kulit batang A. suaveolens, batang A. blumei, ranting A. blumei, dan terakhir daun A. hexapetalus. Skrining juga dilakukan dengan pengetesan bioassay DPPH (2,2-diphenyl-1-picrylhydrazyl) dan FRAP (ferric ion reducing antioxidant power) untuk mengetahui aktivitas antioksidan ekstrak etanol Artabotrys sp. yang ada, dan didapatkan bahwa secara umum aktivitas penghambatan α-glukosidase mempunyai relasi positif dengan aktivitas antioksidan. Analisis tes total fenolik, total flavonoid, tes aktivitas antioksidan (DPPH dan FRAP), dan tes aktivitas penghambatan α-glukosidase; serta relasi antara tes-tes tersebut, menghasilkan prediksi golongan senyawa aktif penghambat α-glukosidase pada ekstrak Artabotrys sp. dan relasinya terhadap aktivitas antioksidan. Prediksi tahap skrining ini secara umum dikonfirmasi oleh hasil penambatan molekuler pada senyawa-senyawa yang terindentifikasi dari analisis LC-MS/MS (liquid chromatography – tandem mass spectrometry) pada ekstrak yang ada. Penelitian lalu difokuskan pada ekstrak daun A. sumatranus yang memiliki potensi yang paling tinggi dalam penghambatan α-glukosidase dan memiliki aktivitas antioksidan yang terkuat dibandingkan ekstrak Artabotrys sp. yang lain. Perbandingan antara hasil tes aktivitas antioksidan dan penghambatan α-glukosidase, serta tes total fenolik dan total flavonoid, memberikan indikasi bahwa kebanyakan senyawa penghambat α-glukosidase pada daun A. sumatranus memiliki aktivitas antioksidan, dan berasal dari golongan fenolik dan flavonoid. Teknik metabolomik tak bertarget berbasis LC-MSn dengan menggunakan analisis statistik multivariat dan machine learning lalu dipakai untuk memprediksi senyawa aktif penghambat α-glukosidase yang juga memiliki aktivitas antioksidan pada daun A. sumatranus. Data input adalah data dari 30 sampel ekstrak daun A. sumatranus dengan berbagai kombinasi pelarut etanol dan air, serta pengulangannya, dengan 80 variabel independen (fitur) berupa nilai m/z dari senyawa yang terdeteksi pada ekstrak tersebut. Variabel output (target) adalah aktivitas penghambatan α-glukosidase (target utama) dan aktivitas antioksidan (dalam bentuk penghambatan DPPH, target sampingan) yang dinyatakan dengan nilai IC50 dan 1/IC50. Pendekatan analisis statistik multivariat dilakukan dengan berbagai metode yaitu PCA (Principal Component Analysis), PLS (Partial Least Square), OPLS (Orthogonal Partial Least Square), PLS-DA (Partial Least Square – Discriminant Analysis), dan OPLS – DA (Orthogonal Partial Least Square – Discriminant Analysis). Pendekatan machine learning dilakukan secara bertingkat, dengan yang pertama membuat model prediksi keaktifan ekstrak terhadap penghambatan α-glukosidase (dilakukan dengan metode random forest yang memiliki performansi paling baik dibandingkan metode lain), yang lalu dilanjutkan dengan analisis fitur (senyawa) yang paling berpengaruh pada model prediksi keaktifan ekstrak tersebut dengan metode permutasi acak dan SHAP (Shapley additive explanations). Penggabungan hasil metode statistik multivariat dan machine learning menghasilkan prediksi sembilan senyawa aktif penghambat α-glukosidase dari daun A. sumatranus. Diantara kesembilan senyawa aktif tersebut hanya enam yang dapat teridentifikasi yaitu mangiferin, neomangiferin, norisocorydine, lirioferin, apigenin-7-O-galaktopyranosida, dan 15,16-dihydrotanshinone. Hasil penambatan molekuler menggunakan α-glukosidase dari Saccharomyces cerevisiae menunjukkan hanya mangiferin, apigenin-7-O-galaktopyranosida, dan lirioferin yang memiliki energi bebas pengikatan yang lebih negatif (lebih aktif) dibanding acarbose yang digunakan sebagai pembanding. Sedangkan penambatan molekuler menggunakan sebagian dari α-glukosidase pada usus manusia mendapatkan hanya norisocorydine saja yang lebih lemah keaktifannya dibandingkan acarbose. Analisis korelasi menunjukkan bahwa senyawa yang diprediksi aktif, termasuk yang belum teridentifikasi, mempunyai aktivitas antioksidan dan terindikasi berasal dari beberapa biosynthesis pathway. Selanjutnya isolasi senyawa aktif penghambat α-glukosidase dilakukan dengan metode fraksinasi yang dipandu dengan bioassay, diikuti dengan elusidasi strukturnya. Senyawa aktif yang didapat adalah mangiferin, yang merupakan salah satu senyawa yang diprediksi aktif dari analisis metabolomik, dengan IC50 83,72 µg/ml terhadap α-glukosidase dari Saccharomyces cerevisiae. Kontribusi dari penelitian ini adalah memperkaya wawasan kegunaan dan literatur akan A. sumatranus yang belum pernah ada publikasinya. Selain itu, penelitian ini berhasil menemukan beberapa senyawa potensial penghambat α-glukosidase yang belum pernah dipublikasikan sebelumnya, seperti apigenin-7-O-galactopyranoside, lirioferine, and norisocorydine; selain yang belum teridentifikasi. Hasil penelitian ini dapat dikembangkan selanjutnya menjadi sediaan herbal.

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Diabetes mellitus type II is a metabolic disease whose symptom is hyperglycemia or elevated blood glucose level, caused by insulin malfunctions, either in its secretion, action, or both. This disease is a chronic disease that can cause many complications. One of the diabetes mellitus treatments is delaying glucose absorption using α-glucosidase inhibition. The α-glucosidase enzyme will catalyze the hydrolysis of complex sugar, including carbohydrate, into glucose that can be absorbed in the intestine. Therefore, inhibiting α-glucosidase will inhibit the production of glucose that can be absorbed in the intestine, which will then slow down the increase of blood glucose. The large number of diabetes mellitus type II patients drives the efforts to find new active α-glucosidase inhibitor compounds from natural products, which are hoped to have better efficacies or can be more easily extracted or synthesized compared to the existing ones. This research goal was to find active α-glucosidase inhibitor compounds from natural compounds which are available in Indonesia, especially from Artabotrys sp. plants. There are 4 kinds of Artabotrys sp. plants whose ethanol extract’s activity in α-glucosidase inhibition was investigated: Artabotrys hexapetalus (leaf and stem bark), Artabotrys suaveolens (leaf and stem bark), Artabotrys blumei (stem and twig), and Artabotrys sumatranus (leaf and twig). Bioassay test results showed that ethanol extract that had the strongest α-glucosidase inhibition activity was the leaf of A. sumatranus, followed in succession by twig of A. sumatranus, leaf of A. suaveolens, stem bark of A. hexapetalus, stem bark of A. suaveolens, stem of A. blumei, twig of A. blumei, and lastly leaf of A. hexapetalus. Screening was also done by doing bioassay tests of DPPH (2,2-diphenyl-1-picrylhydrazyl) and FRAP (ferric ion reducing antioxidant power) to know about the antioxidant activities of the ethanol extracts of the available Artabotrys sp., and it was found out that in general α-glucosidase inhibition activity had positive relation to antioxidant activity. Analyses of total phenolic test, total flavonoid test, antioxidant activity tests (DPPH and FRAP), and α-glucosidase inhibition activity test; as well as the relation between those tests, lead to predictions of the groups of the active α-glucosidase inhibitor compounds in the extract of Artabotrys sp. and their relations to antioxidant activity. These predictions in the screening stage were in general confirmed by the results of molecular docking of the identified compounds from LC-MS/MS (liquid chromatography – tandem mass spectrometry) analyses on the available extracts. The research was then focused on the leaf extract of A. sumatranus which had the highest potency in α-glucosidase inhibition and had the strongest antioxidant activity compared to other extracts of Artabotrys sp. Comparisons between test results of antioxidant and α-glucosidase activities, as well as total phenolic and total flavonoid, indicated that most of the α-glucosidase inhibitor compounds in the leaf of A. sumatranus had antioxidant activities, and belonged to phenolic and flavonoid groups. Untargeted metabolomic techniques based on LC-MSn by using multivariate statistical analysis and machine learning were then used to predict the active α-glucosidase inhibitor compounds which also had antioxidant activities. The input data was data from 30 samples of leaf extracts of A. sumatranus with various solvent combinations of ethanol and water, and their duplications, with 80 independent variables (features) consisting of m/z values of detected compounds in those extracts. The output variables (targets) were α-glucosidase inhibition activity (main target) and antioxidant activity (in the form DPPH inhibition, secondary target), which were represented by the value of nilai IC50 dan 1/IC50. The multivariate statiscal analysis approach was done with several methods, which were PCA (Principal Component Analysis), PLS (Partial Least Square), OPLS (Orthogonal Partial Least Square), PLS-DA (Partial Least Square – Discriminant Analysis), and OPLS – DA (Orthogonal Partial Least Square – Discriminant Analysis). The machine learning approach was done in stages, with the first one was making a prediction model of the α-glucosidase inhibition activity of the extracts (done with random forest method which had the best performance compared to other methods), and then followed by analysis of the most important features (compounds) in the extract’s activity prediction model using random permutation and SHAP (Shapley additive explanations) methods. Combining the results of multivariate statistical methods and machine learning produced a prediction of nine active α-glucosidase inhibitor compounds from the leaf of A. sumatranus. From these nine active compounds, only six could be identified which were mangiferin, neomangiferin, norisocorydine, lirioferin, apigenin-7-O-galaktopyranosida, and 15,16-dihydrotanshinone. Molecular docking using α-glucosidase from Saccharomyces cerevisiae showed only mangiferin, apigenin-7-O-galactopyranoside, and lirioferine had more negative free energy binding (more active) than acarbose, which was used as comparison. On the other hand, molecular docking using a part of α-glucosidase from humans showed only norisocorydine had weaker activity than acarbose. The correlation analyses showed that the predicted active compounds, including the unidentified ones, had antioxidant activities and were indicated to come from several biosynthesis pathways. Next, the isolation active compound as α-glucosidase inhibitor was done by using bioassay-guided fractionation, continued by structure elucidation. The isolated active compound turned out to be mangiferin, which was one the predicted compound from metabolomic analysis, with IC50 83,72 µg/ml with respect to α-glucosidase from Saccharomyces cerevisiae. The contribution of this research is to enrich and broaden the knowledge about the usefulness and literature on A. sumatranus, which had no publications before. Moreover, this research succeeded in discovering potential α-glucosidase inhibitors which were not yet published before, such as apigenin-7-O-galactopyranoside, lirioferine, and norisocorydine; besides the unidentified ones. The results of this research can be developed later on to become herbal medicine."

"Latar Belakang: Obstruksi usus strangulata merupakan masalah kegawatdaruratan yang sering ditemui, mencakup 20% dari total pasien di unit gawat darurat. Obstruksi usus strangulata memiliki morbiditas dan mortalitas yang tinggi. Terdapat banyak faktor yang memengaruhi luaran pascaoperasi obstruksi usus strangulata, dan sebgaian besar berhubungan dengan komplikasi respirasi, infeksi daerah operasi, dan acute kidney injury (AKI). Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang memengaruhi morbiditas dan mortalitas pascaoperasi pada pasien dengan obstruksi usus strangulata.Metode: Studi kohort retrospektif dengan menggunakan total sampling dari registrasi Divisi Bedah Digestif dari tahun 2015-2019. Analasis bivariat digunakan dengan menggunakan studi Chi Square, Fisher, Mann Whitney, dan Spearman. Total 133 pasien tercakup di dalam analisis studi.Hasil: Angka mortalitas obstruksi usus strangulata di RS Cipto Mangunkusumo sebesar 7,5%. Angka kejadian acute kidney injury (AKI) pascaoperasi sebesar 30,1%. Terdapat beberapa faktor yang berhubungan dengan luaran morbiditas dan mortalitas, seperti usia pasien, onset strangulata, kondisi sepsis, dan kadar asam laktat serum.Kesimpulan: Faktor-faktor seperti usia pasien, onset strangulata, kondisi sepsis, dan kadar asam laktat serum berpengaruh terhadap morbiditas dan mortalitas pascaoperasi pada pasien dengan obstruksi usus strangulata. Beberapa faktor lain juga berhubungan dengan luaran mortalitas

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Background: Strangulated bowel obstruction is common emergency problem, included 20% of total patients registered to emergency department. Strangulated bowel obstruction is serious medical conditioin with high morbidity and mortality. There are many factors influencing postoperative outcome of strangulated bowel obstruction, and most related to respiratory complications, surgical site infection, and acute kidney injury. The objective of this study is to find out which factors contributing to postoperative morbidity and mortality in patients with strangulated bowel obstruction.Method: A cohort retrospective with total sampling is used from Digestive Surgery Division registry by the year 2015-2019. Bivariate analysis has been done using Chi Square, Fisher, Mann Whitney, and Spearman study. Total of 133 patients were included in the analysisResult: Mortality rate of strangulated bowel obstruction was 7,5% in Cipto Mangunkusumo Hospital. The acute kidney injury morbidity rate was 30,1%. There are some factors related to the postoperative morbidity and mortality outcome, such as age, strangulation onset, sepsis condition, and lactate acid serum level.Conclusion: Factors such as age, strangulation onset, sepsis condition, and lactate acid serum level are contributing to postoperative morbidity and mortality outcome in patients with strangulated bowel obstruction. Some of these factors also related to mortality outcome."

"[ABSTRAKLatar belakang: Hiponatremia pasca tindakan operasi mayor pada populasi anak merupakan gangguan elektrolit yang sering terjadi. Penggunaan cairan yang belum tepat sering menimbulkan peningkatan kejadian hiponatremia yang berhubungan erat dengan meningkatnya berbagai komplikasi seperti edema otak, kejang, bahkan kematian. Populasi anak merupakan risiko tinggi karena perbandingan jaringan otak dan tulang tengkorak yang lebih besar sehingga ruang yang tersedia saat terjadi edema otak lebih sempit.Tujuan: Mengetahui insidens hiponatremia pada anak pasca tindakan operasi mayor.Metode: Studi retrospektif potong lintang dilakukan terhadap anak usia 1 bulan hingga 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif. Penelusuran status medik sesuai kriteria inklusi dilakukan sampai jumlah sampel terpenuhi. Pencatatan terhadap subjek yang meliputi data praoperasi, intraoperasi, serta pemantauan pascaoperasi dilakukan. Subjek yang memenuhi definisi hiponatremia (<135 mEq/L) diklasifikasikan sesuai derajat hiponatremia dan dilakukan pencarian lebih lanjut terhadap komplikasi.Hasil : Studi dilakukan terhadap 90 subjek yang terdiri dari 56,7% lelaki, dengan 51,1% memiliki rentang usia 1 bulan hingga 4 tahun. Sebanyak 47,8% subjek menjalani tindakan laparatomi dengan berbagai indikasi. Hampir semua subjek (93,3%) mendapat cairan hipotonik pascaoperasi. Insidens hiponatremia pascaoperasi sebesar 28,9% dengan 11,1% diantaranya merupakan hiponatremia sedang-berat. Rerata kadar natrium pascaoperasi adalah 130,1 ± 4,1 mEq/L dengan rerata total cairan 79,8 ± 27,4 ml/kg. Sebesar 30,9% subjek yang mendapatkan cairan hipotonik pascaoperasi mengalami kejadian hiponatremia dengan rerata lama rawat 5,6 ± 4 hari. Terdapat 1/26 subjek yang mengalami komplikasi berupa kejang dan edema otak.Simpulan: Insidens hiponatremia pasca tindakan operasi mayor di ruang perawatan intensif hampir mencapai 30% dan sebagian besar mendapat cairan hipotonik pascaoperasi. Penelitian lebih lanjut perlu dilakukan untuk mengevaluasi pemberian cairan pascaoperasi yang tepat untuk mencegah hiponatremia.

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ABSTRACTBackground: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space.Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower.Objective: To describe the incidence of hyponatremia in children after major surgery.Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications.Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema.Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia, Background: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space.Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower.Objective: To describe the incidence of hyponatremia in children after major surgery.Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications.Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema.Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia]"

"Malnutrisi pada anak sakit kritis dalam perawatan intensif menjadi masalah dalam beberapa dekade terakhir dan berhubungan erat dengan morbiditas dan mortalitas. Hingga kini, Rumah Sakit Cipto Mangunkusumo (RSCM) belum memiliki panduan baku mengenai dukungan nutrisi anak sakit kritis. Penelitian bertujuan untuk mengetahui profil pemberian nutrisi enteral (NE) dan waktu pencapaian resting energy expenditure (REE) di Pediatric Intensive Care Unit (PICU) RSCM dan faktor-faktor yang memengaruhi. Penelitian dilakukan secara retrospektif dengan menggunakan data rekam medis anak sakit kritis yang dirawat di PICU RSCM pada tahun 2017-2018. Waktu inisiasi pemberian NE dan pencapaian REE serta faktor-faktor yang memengaruhi pemberian tersebut dicatat dan dilakukan analisis multivariat untuk mencari faktor risiko yang bermakna. Terdapat 203 pasien yang memenuhi kriteria inklusi. Terdapat 120 subyek berjenis kelamin lelaki (59,1%), dengan median usia adalah 35 bulan (rentang usia 1-209 bulan). Kasus bedah terdapat pada 125 subyek (61,6%) dan status gizi normal terdapat pada 87 subyek (42,9%). Prevalensi pemberian NE dini adalah 63,1%, dan pencapaian kalori REE ≤72 jam adalah 67,5%, dengan median 48 jam. Faktor risiko yang menghambat pemberian NE dini adalah pasca-bedah abdomen, penggunaan inotropik, penggunaan ventilator, gejala gastrointestinal sebelum inisiasi, dan status gizi tidak normal dengan odds ratio (OR) 10,89 (IK 95% 4,31-27,50; p=0,009), 4,60 (IK 95% 1,78-11,90; p=0,002), 4,18 (IK 95% 1,56-11,17; p=0,004), 3,40 (IK 95% 1,59-7,29; p=0,002), 2,49 (IK 95% 1,09-5,72; p=0,031). Faktor risiko yang menghambat pencapaian kalori REE ≤72 jam adalah pemberian NE lambat, intoleransi pemberian enteral berupa gejala gastrointestinal dan skor PELOD-2 ≥7 dengan OR 20,62 (IK 95% 6,48-65,65; p=0,000), 14,77 (IK 95% 4,40-49,60; p=0,000), 3,98 (IK 95% 1,01-15,66; p=0,048). Prevalensi pemberian NE dini pada anak sakit kritis di PICU RSCM cukup baik dengan waktu pencapaian REE sesuai dengan target. Faktor terbanyak penghambat pemberian NE dini adalah kondisi pasca-bedah abdomen, sedangkan faktor penghambat pencapaian REE ≤ 72 jam terbanyak adalah pemberian NE lambat.

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Malnutrition of critically ill children remains a major problem that is closely related to high morbidity and mortality in pediatric intensive care unit (PICU) during the last decades. The protocol of nutritional support for critically ill children in Cipto Mangunkusumo Hospital (CMH) has not yet been developed. The study is aimed to evaluate the enteral nutrition (EN) profile, the duration to achieve resting energy expenditure (REE) and number of influencing factors associated with the late EN administration and late REE achievement. The data were collected retrospectively from medical records during the year 2017 to 2018 in PICU CMH. We assessed the timing of EN given and the duration of REE achieved from EN. We performed multivariate analysis to determined significant factors associated with late EN and late REE achievement. Two hundred three subjects were included. One hundred twenty subjects (59%) were boys, with median age of 35 (1-209) months old. One hundred twenty five subjects (61.6%) were post-surgical period and 87 subjects (42.9%) were in good nutritional status. The prevalence of early EN was 63.1%, and REE ≤72 hours was achieved in 67.5% subjects, with the median time was 48 hours. Significant factors inhibit early EN administration were post-abdominal surgery, ventilator use, inotropic use, gastrointestinal symptoms before initiation, and abnormal nutritional status; with OR 10.89 (95% CI 4.31 to 27.50; p=0.009), 4.60 (95% CI 1.78 to 11.90; p=0.002), 4.18 (95% CI 1.56 to 11.17; p=0.004), 3.40 (95% CI 1.59 to 7.29; p=0.002), 2.49, 95% CI 1.09 to 5.72; p=0.031), respectively. While factors inhibit the achievement of REE ≤72 hours were the late EN initiation, enteral intolerance, and PELOD-2 score ≥7 with OR 20.62 (95% CI 6.48 to 65.65; p=0.000), 14.77 (95% CI 4.40 to 49.60; p=0.000), 3.98 (95% CI 1.01 to 15.66; p=0.048), respectively. The prevalence of early EN administration with the duration to achieve REE among critically ill children in the PICU CMH was quite satisfying. The most influencing factor inhibit early EN administration was post-abdominal surgery, while the most significant factor inhibit the achievement of REE ≤72 hours was the late NE administration."

"Malnutrisi pada anak sakit kritis dalam perawatan intensif menjadi masalah dalam beberapa dekade terakhir dan berhubungan erat dengan morbiditas dan mortalitas. Hingga kini, Rumah Sakit Cipto Mangunkusumo (RSCM) belum memiliki panduan baku mengenai dukungan nutrisi anak sakit kritis. Penelitian bertujuan untuk mengetahui profil pemberian nutrisi enteral (NE) dan waktu pencapaian resting energy expenditure (REE) di Pediatric Intensive Care Unit (PICU) RSCM dan faktor-faktor yang memengaruhi. Penelitian dilakukan secara retrospektif dengan menggunakan data rekam medis anak sakit kritis yang dirawat di PICU RSCM pada tahun 2017-2018. Waktu inisiasi pemberian NE dan pencapaian REE serta faktor-faktor yang memengaruhi pemberian tersebut dicatat dan dilakukan analisis multivariat untuk mencari faktor risiko yang bermakna. Terdapat 203 pasien yang memenuhi kriteria inklusi. Terdapat 120 subyek berjenis kelamin lelaki (59,1%), dengan median usia adalah 35 bulan (rentang usia 1-209 bulan). Kasus bedah terdapat pada 125 subyek (61,6%) dan status gizi normal terdapat pada 87 subyek (42,9%). Prevalensi pemberian NE dini adalah 63,1%, dan pencapaian kalori REE ≤72 jam adalah 67,5%, dengan median 48 jam. Faktor risiko yang menghambat pemberian NE dini adalah pasca-bedah abdomen, penggunaan inotropik, penggunaan ventilator, gejala gastrointestinal sebelum inisiasi, dan status gizi tidak normal dengan odds ratio (OR) 10,89 (IK 95% 4,31-27,50; p=0,009), 4,60 (IK 95% 1,78-11,90; p=0,002), 4,18 (IK 95% 1,56-11,17; p=0,004), 3,40 (IK 95% 1,59-7,29; p=0,002), 2,49 (IK 95% 1,09-5,72; p=0,031). Faktor risiko yang menghambat pencapaian kalori REE ≤72 jam adalah pemberian NE lambat, intoleransi pemberian enteral berupa gejala gastrointestinal dan skor PELOD-2 ≥7 dengan OR 20,62 (IK 95% 6,48-65,65; p=0,000), 14,77 (IK 95% 4,40-49,60; p=0,000), 3,98 (IK 95% 1,01-15,66; p=0,048). Prevalensi pemberian NE dini pada anak sakit kritis di PICU RSCM cukup baik dengan waktu pencapaian REE sesuai dengan target. Faktor terbanyak penghambat pemberian NE dini adalah kondisi pasca-bedah abdomen, sedangkan faktor penghambat pencapaian REE ≤ 72 jam terbanyak adalah pemberian NE lambat.

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Malnutrition of critically ill children remains a major problem that is closely related to high morbidity and mortality in pediatric intensive care unit (PICU) during the last decades. The protocol of nutritional support for critically ill children in Cipto Mangunkusumo Hospital (CMH) has not yet been developed. The study is aimed to evaluate the enteral nutrition (EN) profile, the duration to achieve resting energy expenditure (REE) and number of influencing factors associated with the late EN administration and late REE achievement. The data were collected retrospectively from medical records during the year 2017 to 2018 in PICU CMH. We assessed the timing of EN given and the duration of REE achieved from EN. We performed multivariate analysis to determined significant factors associated with late EN and late REE achievement. Two hundred three subjects were included. One hundred twenty subjects (59%) were boys, with median age of 35 (1-209) months old. One hundred twenty five subjects (61.6%) were post-surgical period and 87 subjects (42.9%) were in good nutritional status. The prevalence of early EN was 63.1%, and REE ≤72 hours was achieved in 67.5% subjects, with the median time was 48 hours. Significant factors inhibit early EN administration were post-abdominal surgery, ventilator use, inotropic use, gastrointestinal symptoms before initiation, and abnormal nutritional status; with OR 10.89 (95% CI 4.31 to 27.50; p=0.009), 4.60 (95% CI 1.78 to 11.90; p=0.002), 4.18 (95% CI 1.56 to 11.17; p=0.004), 3.40 (95% CI 1.59 to 7.29; p=0.002), 2.49, 95% CI 1.09 to 5.72; p=0.031), respectively. While factors inhibit the achievement of REE ≤72 hours were the late EN initiation, enteral intolerance, and PELOD-2 score ≥7 with OR 20.62 (95% CI 6.48 to 65.65; p=0.000), 14.77 (95% CI 4.40 to 49.60; p=0.000), 3.98 (95% CI 1.01 to 15.66; p=0.048), respectively. The prevalence of early EN administration with the duration to achieve REE among critically ill children in the PICU CMH was quite satisfying. The most influencing factor inhibit early EN administration was post-abdominal surgery, while the most significant factor inhibit the achievement of REE ≤72 hours was the late NE administration."