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"AKI disebabkan oleh pengaruh gangguan sistemik atau lokal hemodinamik yang menyebabkan terjadinya stres atau kerusakan pada sel tubular yang dapat berlanjut menjadi gagal ginjal kronik. Pasien yang mengalami malnutrisi dengan peningkatan prevalensi kejadian AKI sebanyak 2,25 kali. Skrining pasien malnutrisi dilakukan dalam 24 hingga 48 jam pertama saat pasien masuk ke rumah sakit menggunakan alat skrining, salah satunya adalah NRS-2002. Penelitian menggunakan desain kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di RSUPN dr. CIpto Mangunkusumo dan RSUI. Diperoleh 64 subjek dengan kelompok skor NRS-2002 ≥ 3 sebanyak 36 subjek dan kelompok skor NRS < 3 sebanyak 28 subjek. Jumlah pasien laki-laki sebanyak 40 (62,5%) subjek, dan perempuan sebanyak 24 (37,5%) subjek, dengan usia rerata 50,95 tahun. Berdasarkan indeks massa tubuh, kelompok IMT dengan malnutrisi adalah kelompok terbanyak dengan jumlah 21 (32,8%) subjek. Pasien dengan faktor risiko hipertensi sebanyak 18 (28,1%) subjek. Subjek dengan Skor NRS ≥ 3 didapatkan 36 subjek dengan 10 orang yang mengalami AKI. Subjek dengan skor NRS <3 didapatkan sebanyak 28 orang dengan 1 orang mengalami AKI. Hasil uji statistik menggunakan uji fischer’s exact test diperoleh nilai p 0,017 ( RR 7,78, CI 95% 1,06-57,20). Hal ini menyatakan bahwa didapatkan hubungan bermakna antara skor Nutritional Risk Screening – 2002 dengan kejadian acute kidney injury pada pasien sakit kritis

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AKI is caused by systemic or local hemodynamic disturbances that result in stress or damage to tubular cells, which can progress to chronic kidney failure. Patients experiencing malnutrition have a 2.25 times higher prevalence of AKI. Screening for malnutrition is conducted within the first 24 to 48 hours of hospital admission using screening tools such as the NRS-2002. This study used a prospective cohort design on subjects aged ≥18 years who were treated at RSUPN dr. Cipto Mangunkusumo and RSUI. A total of 64 subjects were obtained, with 36 subjects having an NRS-2002 score ≥ 3 and 28 subjects having an NRS score < 3. There were 40 male subjects (62.5%) and 24 female subjects (37.5%), with an average age of 50.95 years. Based on body mass index, the group with malnutrition was the largest group, with 21 subjects (32.8%). There were 18 subjects (28.1%) with hypertension as a risk factor. Subjects with an NRS score ≥ 3 included 36 subjects, with 10 of them experiencing AKI. Subjects with an NRS score <3 included 28 people, with 1 person experiencing AKI. The results of the statistical test using Fischer's exact test obtained a p-value of 0.017 (RR 7.78, CI 95% 1.06-57.20). This indicates a significant relationship between the Nutritional Risk Screening - 2002 score and the incidence of acute kidney injury in critically ill patients."

"Stroke merupakan penyebab kematian tertinggi kedua di dunia maupun di Indonesia. Terdapat berbagai faktor risiko stroke baik yang dapat dimodifikasi maupun yang tidak. Hipertensi merupakan faktor risiko stroke yang paling penting yang dapat dimodifikasi. Namun demikian, masih belum jelas karakteristik hipertensi seperti apa yang paling berisiko terkena stroke. Penelitian ini bertujuan untuk mendapatkan hubungan antara lamanya hipertensi, tekanan darah sistolik tertinggi yang pernah dicapai, serta kategori hipertensi dengan terjadinya stroke. Penelitian dilakukan menggunakan desain studi kohort retrospektif pada pasien usia lanjut penderita hipertensi di Poliklinik Geriatri RSUPN-Ciptomangunkusumo tahun 2012-2016. Terdapat 207 subjek yang diikutsertakan dalam penelitian ini, dengan 40 di antaranya tercatat menderita stroke. Analisis bivariat menunjukkan hubungan antara lamanya hipertensi dengan stroke p=0.046 , sementara tidak ada hubungan p>0.05 antara tekanan darah sistolik tertinggi yang pernah dicapai maupun kategori hipertensi. Hasil uji multivariat dengan penyesuaian terhadap variabel perancu mendapatkan hubungan antara lamanya hipertensi dan stroke dengan OR 2.019 1.004 ndash; 4.063;IK 95 . Dari hasil tersebut dapat disimpulkan bahwa faktor yang paling berhubungan dengan terjadinya stroke adalah lamanya hipertensi.

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Stroke is the second highest leading cause of death both in the world and in Indonesia. There are various modifiable and non modifiable risk factors of stroke. Among them, hypertension is a well established important stroke risk factor that is modifiable. However, it is unclear which characteristics of hypertension contributes most to the incidence of stroke. This study aimed to determine the association between duration of hypertension, highest systolic blood pressure, and hypertension stages with stroke incidence. A cohort retrospective study was done among elderly hypertensive patients in Geriatric Polyclinic of Ciptomangunkusumo National General Hospital between 2012 and 2016. From 207 subjects, there are 40 stroke incidences. Bivariate analysis showed association between duration of hypertension and incidence of stroke p 0.046 , while there is no association between stroke and either highest systolic blood pressure or hypertension stages. Multivariate analysis with adjustments for confounding variables showed association between duration of hypertension and stroke with OR 2.019 1.004 ndash 4.063 95 CI . From this result, it is concluded that duration of hypertension has the strongest association to stroke."

"Background: Hypokalemia is one of the most common electrolyte disorders in hospitalized patients. If hypokalemia were found, the underlying cause should be identified and treated. The incidence study of hypokalemia in Indonesia hospitalized patients is rarely reported.Objective: To investigate the incidence of hypokalemia in medical patients at the medical wards of department of internal medicine Gatot Soebroto Army Hospital.Method: Patients who required administration of parenteral fluid for various indications, irrespective of diagnosis, length of stay and types of infusion or medications were included in this study. Serum sodium and potassium concentration were checked twice, first at their admission and the second at discharge. The study form contained data record of patient's initials, age, gender, dates of admission and discharge, medical record number, laboratory findings of serum sodium and potassium concentration at admission and discharge.Result: 103 subjects were enrolled with mean age 49 years old (ratio of female: male = 70:30). Serum sodium concentration at admission and discharged were not significantly different. Incidence of hypokalemia was 26%. Furthermore, serum potassium concentration at admission and discharge showed significant reduction from mean concentration of 4.06 mmoUL to 3.83 mmol/L (with P=0.02). The number of patients with hypokalemia increased significantly during hospitalization (from 27 to 45 patients.with p= 0.023). Additional data showed that the types of infusion solutions given to patients are as follows: ringer's lactate (52 patients), normal saline (22 patients), D5W (20 patients) and asering/ringer's acetate (9 patients).Conclusion: The incidence of hypokalemia in medical patients at the medical wards of department of internal medicine Gatot Soebroto Army Hospital was 26%. These patients did not have sodium abnormalities. Number of patients with hypokalemia increased during hospitalization. Most infusion solutions administered contain very low concentration of potassium (ringer's lactate and ringer's acetate 4 mmol/L) or no potassium at all (normal saline, D5W)."

"ABSTRAK Latar Belakang. Pneumonia sering menjadi komplikasi medis yang timbul pada pasien-pasien stroke iskemik akut yang dirawat di rumah sakit, sehingga diperlukan suatu sistem skor yang valid dan mudah diterapkan untuk memprediksi dan menstratifikasi risiko timbulnya pneumonia pada pasien stroke iskemik akut. Tujuan. Menilai performa kalibrasi dan diskriminasi skor A2DS dalam memprediksi insiden pneumonia pada pasien stroke iskemik akut Metode. Penelitian dengan desain kohort retrospektif menggunakan rekam medik pasien stroke iskemik akut di ruang rawat neurologi dan stroke unit gedung A RSCM periode Januari 2014 ndash; Desember 2016 dengan metode total sampling. Usia, ada tidaknya fibrilasi atrium pada EKG, ada tidaknya disfagia, jenis kelamin laki-laki , dan tingkat keparahan stroke dinilai dengan NIHSS , dinilai pada awal perawatan di RSCM. Pasien diikuti hingga 7 hari sejak onset stroke iskemik untuk dilihat outcome-nya pneumonia atau tidak pneumonia . Performa kalibrasi skor A2DS2 dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor A2DS2 dinilai dengan Area Under The Curve AUC . Hasil. Sebanyak 281 subjek diikutsertakan ke dalam penelitian ini, dengan angka kejadian pneumonia dalam 7 hari sejak onset timbulnya stroke iskemik sebanyak 118 subjek 42 . Hosmer-Lemeshow menunjukkan p = 0,222. Plot kalibrasi menunjukkan koefisien korelasi r=0,982 dengan p = 0,000. AUC sebesar 0,885 IK95 0,845 - 0,924 .ABSTRACT Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. Aim. To assess the performance of calibration and discrimination of A2DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital. Methods. This was a retrospective cohort study of adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital. Age, presence or absence of atrial fibrillation, presence or absence of dysphagia, Sex male , and stroke severity rated with NIHSS were obtained at the beginning of admission. The subjects were followed up for up to 7 days after the onset of ischemic stroke to assess the outcome pneumonia or not . Calibration properties of A2DS2 score were assessed by Hosmer Lemeshow test and calibration plot. Discrimination properties of A2DS2 score were assessed by the area under the curve AUC . Results A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients 42 . Hosmer Lemeshow test of A2DS2 score showed p 0,222 and calibration plot showed r 0,982. Discrimination of A2DS2 score was shown by the AUC value of 0,885 95 CI 0,845 0,924 . Conclusion A2DS2 score have a good calibration and discrimination performance in predicting incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital."

"Tetralogy of Fallot (TOF) merupakan salah satu kelainan jantung kongenital sianotik paling umum, dengan insiden sekitar empat dari setiap 10.000 kelahiran hidup. Operasi koreksi TOF dapat diperberat dengan cedera ginjal akut yang berkaitan dengan morbiditas dan mortalitas yang signifikan. Prevalensi cedera ginjal akut pada populasi pasien pascaoperasi koreksi TOF belum banyak diketahui. Penelitian ini menggunakan metode kohort restrospektif. Data diambil secara sekunder dari rekam medis RSPJNHK terhadap semua pasien TOF yang di lakukan koreksi TOF pada tahun 2019 -2023.Terdapat 520 pasien yang dianalisis dalam penelitian ini. Terdapat hubungan bermakna antara kelompok cedera ginjal akut dan kelompok tidak cedera ginjal akut pada variabel lama CPB (p=0.000; MD =-35.78; IK 95% -51.21 - -20.35) dan lama klem silang aorta (p=0.000;MD =-13.68(IK 95% -21.42 - -5.94). Terdapat hubungan bermakna secara antara lesi residual pulmonary regurgitation (p=0.024; RR=1.56; IK 95% 1.07 – 2.28, dan lesi residual pulmonary stenosis dan kejadian cedera ginjal akut (p=0.035; RR =1.49; IK 95% 1.03 – 2.15). Dapat disimpulkan bahwa lama CPB, klem silang aorta dan adanya lesi residual yakni pulmonary regurgitation dan pulmonary stenosis berhubungan dengan kejadian cedera ginjal akut pada pasien yang menjalani koreksi TOF.

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Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart defects, with an incidence of approximately four per 10,000 live births. Corrective surgery for TOF is often complicated by acute kidney injury (AKI), which is associated with significant morbidity and mortality. The prevalence of AKI in patients undergoing postoperative TOF correction is not well established. A retrospective cohort study was conducted using medical records from PJNHK Hospital. Data was collected for TOF patients who underwent corrective surgery between 2019 and 2023. A total of 520 patients were analysed. There was a significant difference between the AKI group and the non-AKI group in terms of cardiopulmonary bypass (CPB) duration (p = 0.000; MD = -35.78; 95% CI: -51.21 to -20.35) and aortic cross-clamp time (p = 0.000; MD = -13.68; 95% CI: -21.42 to -5.94). Residual pulmonary regurgitation lesions were significantly associated with AKI incidence (p = 0.024; RR = 1.56; 95% CI: 1.07–2.28), as were residual pulmonary stenosis lesions (p = 0.035; RR = 1.49; 95% CI: 1.03–2.15). In conclusion, CPB duration, aortic cross-clamp time, and the presence of residual lesions, such as pulmonary regurgitation and pulmonary stenosis, are significantly associated with the incidence of acute kidney injury in patients undergoing TOF corrective surgery."

"Telah dilakukan penelitian retrospektif terhadap pasien infark miokard akut (IMA) yang dirawat di ICCU RSUPN Dr Cipto Mangunkusumo, Jakarta antara Januari 1994 sampai Desember 1999. Dari 513 pasien yang dirawat dengan IMA, 227 pasien adalah usia lanjut, di mana 35,2 % dari mereka adalah wanita. Sebagian besar IMA usia lanjut mengeluh nyeri dada yang khas seperti pada pada kelompok usia muda. Pasien IMA usia lanjut cenderung terlambat datang ke rumah sakit dan lebih banyak menderita IMA gelombang Q. Faktor risiko diabetes melitus dan hipertensi lebih sering dijumpai pada usia lanjut. Prevalensi fibrilasi atrial dan mortalitas lebih tinggi pada usia lanjut. (Med J Indones 2003; 12: 229-35)

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A retrospective study were performed in patients with acute myocardial infarction (AMI) that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2%) were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non-Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients. (Med J Indones 2003; 12: 229-35)"

"Latar belakang: Tingginya insidensi penyakit saluran cerna, bilier, dan pankreas pada pasien usia lanjut membuat kebutuhan endoskopi tinggi. Komplikasi kardiopulmoner intra- dan pascatindakan endoskopi pada pasien usia lanjut lebih tinggi dari kelompok usia lebih muda. Penilaian faktor-faktor risiko komplikasi penting untuk menimbang risiko dan manfaat endoskopi pada pasien usia lanjut. Tujuan: Mengetahui insidensi dan faktor-faktor yang memengaruhi komplikasi kardiopulmoner intra- dan pascatindakan endoskopi pada pasien usia lanjut. Metode: Studi kohort prospektif dilakukan terhadap subjek berusia ≥60 tahun yang menjalani endoskopi di PESC RSUPN-CM sejak Agustus-Oktober 2023. Dilakukan analisis bivariat antara usia, komorbiditas, kelas ASA, status nutrisi, status fungsional, durasi tindakan, jenis sedasi, jenis tindakan, dan tingkat kompleksitas tindakan terhadap komplikasi kardiopulmoner intra- dan pascatindakan endoskopi. Selanjutnya, analisis multivariat dilakukan untuk mengetahui faktor risiko independen. Hasil: Dari 194 subjek, sebanyak 49,52% subjek mengalami komplikasi kardiopulmoner. Komplikasi tersering adalah takikardia (23,20%), hipoksemia (15,03%), dan hipotensi (6,20%). Hasil analisis multivariat menemukan bahwa tingkat kompleksitas tindakan ASGE kelas ≥3 merupakan faktor independen dengan RR 1,505 (IK 95% 1,039 – 2,179), p=0,03; sedangkan sedasi ringan-sedang memiliki RR 0,668 (IK 95% 0,458 – 0,975), p=0,037 terhadap komplikasi kardiopulmoner intra- dan pascatindakan endoskopi pada pasien usia lanjut. Kesimpulan: Insidensi komplikasi kardiopulmoner intra- dan pascatindakan endoskopi pada pasien usia lanjut adalah 49,52%. Tingkat kompleksitas tindakan tinggi menjadi faktor independen, sedangkan sedasi ringan-sedang menurunkan risiko komplikasi kardiopulmoner intra- dan pascatindakan endoskopi. Sementara itu, usia lanjut, komorbiditas banyak, kelas ASA buruk, durasi tindakan lama, status nutrisi buruk, status fungsional buruk, dan jenis tindakan tidak berpengaruh.

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Background/Aims: High incidence of gastrointestinal and pancreaticobiliary diseases in elderly prompts high need of endoscopy. Intra- and post-endoscopy cardiopulmonary complications were higher in elderly compared to younger population. This study aimed to investigate the incidence and affecting factors of intra- and post-endoscopy cardiopulmonary complications in elderly population. Methods: This prospective cohort study was conducted in endoscopy subjects aged ≥60 years at Gastrointestinal Endoscopy Center in Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia from August-October 2023. Results: Among 194 subjects, 49.52% experienced cardiopulmonary complications. The most common complications included tachycardia (23.20%), hypoxemia (15.03%), and hypotension (6.20%). Multivariate analysis revealed that complexity of procedure ASGE level ≥ 3 (RR 1.505 [95% CI 1.039 – 2.179]; p=0.03) and mild-moderate sedation (RR 0.668 [95% CI 0.458 – 0.975]; p=0.037) were significantly related to intra- and post-endoscopy cardiopulmonary complications. Conclusion: The incidence of intra- and post-endoscopy cardiopulmonary complications in elderly in Indonesia is high. Complexity of procedure ASGE level ≥ 3 is an independent factor, whereas mild-moderate sedation reduces the risk of intra- and post-endoscopy cardiopulmonary complications. On the contrary, old age, multicomorbidities, high ASA class, long duration of procedure, poor nutritional status, poor functional status, and type of procedure have no impacts."

"Pengobatan pada pasien lansia sangat kompleks karena biasanya bersifat multipatologi sehingga menyebabkan peningkatan jumlah obat yang digunakan (polifarmasi) untuk kondisi klinis yang berbeda-beda. Terdapatnya hipertensi, diabetes dan/atau dislipidemia menyebabkan pengobatan yang berpotensi menimbulkan Reaksi Obat yang Tidak Dikehendaki (ROTD), karena umumnya pengobatan pada pasien dengan hipertensi, diabetes dan/atau dislipidemia bersifat jangka panjang dengan menggunakan beberapa jenis obat. Penelitian ini bertujuan untuk menilai pengaruh umur lansia terhadap kejadian reaksi obat yang tidak dikehendaki pada pasien dengan hipertensi, diabetes dan/atau dislipidemia di Puskesmas Pancoran Mas, Puskesmas Tanah Baru, dan Puskesmas Beji kota Depok. Penelitian menggunakan rancangan kohort prospektif. Sampel penelitian terdiri dari 62 pasien lansia sebagai kelompok kohort dan 62 pasien non lansia sebagai kelompok kontrol. Pengambilan sampel dilakukan selama Januari-Juni 2014. Sampel dimonitoring keadaannya setiap minggu selama satu bulan. Manifestasi klinik ROTD merupakan hasil evaluasi terhadap keluhan-keluhan yang dialami pasien yang dievaluasi menggunakan skala Naranjo. Manifestasi klinik ROTD yang didapat pada kedua kelompok dianalisis menggunakan uji kaikuadrat dan uji regresi logistik. Pasien dengan hipertensi, diabetes dan/atau dislipidemia yang mengalami kejadian ROTD 30,6% dengan frekuensi kejadian 39 kali, presentase terbesar adalah batuk kering karena kaptopril (56,3%), dan tingkat keparahan manifestasi klinik ROTD yang terjadi pada mayoritas (53,8%) pasien tersebut adalah level 2 (mild/sedang). Risiko umur lansia 3,577 kali lebih besar untuk terjadinya ROTD.

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Treatment in elderly patients is very complex, because it is usually multiphatology thus causing an increase in number of drugs used (polypharmacy) for every clinical conditions. The presence of hypertension, diabetes and/or dyslipidemia will increase the risk of cause Adverse Drug Reaction (ADR) because of polypharmacy and long term of treatment. This study aimed to assess the effect of elderly age on the incidence of ADR in patients with hypertension, diabetes and/or dyslipidemia at Puskesmas Pancoran Mas, Beji, and Tanah Baru Depok. The design of the study is cohort study. The Sampling was conducted at January- June 2014. 62 elderly patients was collected as a risk factor group and 62 non- elderly patients as a control group. Sample was monitored every weeks in a month. Clinical Manifestation of ADR event was an evaluation result of the recording complaints experienced by the sampel using Naranjo scale. Clinical manifestation of ADR events obtained in the both group were analyzed using Chi- Square and Logistic Regression test. Patient with hypertension, diabetes and/or dyslipidemia experienced ADR event 30,6% with a frequency of accurrence was 39 times. Dry cough because of captopril (56,3%) was the most common clinical manifestation found, while severity level clinical manifestation ADR which occured in most of patient (53,8%) was at level 2 (mild). The risk of elderly age was 3,577 times greater for ADR event."

"Proses penuaan dan masalah kesehatan perkotaan dapat menyebabkan penurunan fungsi kognitif pada lansia. Karya ilmiah ini bertujuan untuk menganalisis asuhan keperawatan pada lansia dengan masalah konfusi kronik melalui orientasi realita dan terapi seni di Panti Sosial Trena Werdha Budi Mulia 1 Cipayung. Intervensi orientasi realita diadakan tiga puluh menit setiap hari selama empat minggu, sedangkan terapi seni dilakukan dua kali per minggu dengan durasi enam puluh menit pada setiap sesinya selama lima minggu. Hasil karya ilmiah ini menunjukkan bahwa rata-rata peningkatan skor total Mini Mental State Examination 4,3 poin setelah intervensi. Pemberi pelayanan di panti dapat menerapkan intervensi orientasi realita dan terapi seni sebagai upaya dalam mengatasi penurunan fungsi kognitif pada lansia.

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The process of aging and urban health problems cause the decline of the cognitive function in elderly. This study aims to analyze nursing care in elderly with chronic confusion through reality orientation and art therapy at Panti Sosial Tresna Werdha Budi Mulia 1 Cipayung. The reality orientation intervention was held for thirty minutes once per day during the four weeks, while art therapy was conducted during the five weeks in twice weekly one hour sessions. The results of this paper show that the average increase in total score of Mini Mental State Examination 4,3 points after intervention. Service providers in nursing home can apply reality orientation and art therapy as a program to overcome the decline of the cognitive function in elderly."