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"Offers practical advice on coping with digestive disorders including a comprehensive range of treatments and complementary remedies. The book gives specific step-by-step advice on how to follow and complete your treatment."

"Latar Belakang: Secara global diperkirakan terdapat 313 juta pembedahan yang dilakukan, dengan angka kematian 30 hari pascaoperasi mencapai 4.2 juta jiwa. Penilaian kondisi pasien preoperatif diperlukan untuk memprediksi morbiditas danmortalitas pasien pascabedah, maka modalitas yang digunakan dalam menilai risiko pembedahan sebaiknya memiliki akurasi dan objektivitas yang baik. Salah satu modalitas yang rutin digunakan di RSUPN Cipto Mangunkusumo (RSUPNCM) adalah skor ASA-PS. Namun skor ini sudah banyak ditinggalkan oleh negara maju dan beralih pada skor P-POSSUM yang dinilai lebih objektif, dan akurat. Studi ini menguji kesahihan skor P-POSSUM dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ICU, yang mencerminkan keparahan morbiditaspascabedah. Tujuan: Studi ini menguji kemampuan kalibrasi dan diskriminasi skor P-POSSUM dalam memprediksi lama perawatan di ICU, dan menganalisis hubungan antar variabel skor P-POSSUM dengan lama perawatan di ICU pada pasien pasabedah digestif mayor. Metode: Studi ini merupakan studi kohort retrospektif di RSUPNCM selama Januari 2017 hingga Desember 2018. Sebanyak 289 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Lama perawatan pascabedah di ICU dan skor P-POSSUM subjek dicatat sesuai dengan data rekam medis. Variabel PPOSSUM yang berpengaruh terhadap lama perawatan subjek dianalisis dengan analisis bivariat dan regresi logistik multivariat. Kesahihan skor dinilai menggunakan uji kalibrasi Hosmer-Lemeshow dan uji diskriminasi dengan melihatnilai Area Under Curve. Hasil: Hasil analisis statistik menghasilkan bahwa skor P-POSSUM memiliki kemampuan kalibrasi yang baik (uji Hosmer-Lemeshow p=0.815) dan kemampuandiskriminasi yang cukup baik (AUC 77.8%, IK 95% 0.717-0.827). Variabel PPOSSUM yang secara statistik berpengaruh signifikan (p<0.05) terhadap lama perawatan di ICU adalah kadar natrium, jumlah perdarahan, laju jantung, dan EKG.Kesimpulan: Skor P-POSSUM sahih dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ruang intensif (ICU).

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Background: It was estimated that there was 313 million surgery underwent worldwide, with the 30-days postoperative mortality rate reaching 4.2 million cases. The evaluation of preoperative patients’ conditions is encouraged to predict

postoperative morbidity and mortality, thus the modality used to assess surgery risk should be accurate and objective. RSUPN Cipto Mangunkusumo (RSUPNCM) routinely uses ASA-PS score to assess patients’ condition. Nonetheless, ASA-PS has

been regarded as subjective. Developed countries has started to replace this score with P-POSSUM score which was considered to be more accurate and objective. This study finds out the validity of P-POSSUM Score in predicting the length of

hospital stay in the ICU in patients who underwent digestive surgery, which reflects the severity of postoperative morbidity. Goals: This study investigated the calibration and discrimination ability of PPOSSUM score in predicting the length of stay in the ICU, and also explored the relationship between variables in P-POSSUM score and the length of stay in the ICU in patients who underwent digestive surgery.

Methods: This retrospective cohort study was conducted in RSUPNCM in January 2017 to December 2018 on 289 subjects who met the inclusion criteria. P-POSSUM score and the length of stay in the ICU unit were recorded, the data was taken from

medical record. Bivariate and multivariate logistic regression was used to investigate the relationship between P-POSSUM variables and the length of stay. The validity of P-POSSUM score was assessed by Hosmer-Lemeshow calibration

test and the measurement of the Area Under Curve (AUC).

Results: Statistical analysis showed that P-POSSUM had a good calibration ability (p=0.815 for Hosmer-Lemeshow test) and moderate discrimination ability (AUC 77.8%, CI 95% 0.717-0.827). Four P-POSSUM variables were found to be significantly associated with length of stay in the ICU (p<0.05), namely natrium level, total blood loss, heart rate and ECG. Conclusion: P-POSSUM score is valid in predicting the length of stay in the ICU in patients who underwent digestive surgery."

"According to the National Institutes of Health, more than 90 million Americans suffer from digestive disorders. Drawing on the expertise of 25 practitioners, Optimal Digestive Health explores the symptoms, possible causes, medical testing, and effective treatments for 30 digestive disorders, from candida and colitis to ulcers. In addition, the authors explain the role digestion plays in many other health conditions, such as arthritis, fibromyalgia, headaches, mood swings, immune function, and skin problems. They provide clear information on detoxification, food allergies, and environmental factors, as well as meditation, qigong, and yoga. A step-by-step diet is offered to help readers moderate their carbohydrate intake and balance their blood sugar--keys to health and weight loss. Optimal Digestive Health demystifies the use of herbal therapies, acupuncture, biofeedback, and Ayurveda in the treatment of digestive disorders, pairing the best of mainstream medicine and complementary therapies with intelligent self-care for an integrated patient-centered approach to healing."

"Penelitian penapisan beberapa Lactobacillus plantarum dan optimasi produksi protease serupa tripsin (PST) dilanjutkan dengan pemekatan dan karakterisasi parsial telah dilakukan. Tripsin memiliki peran penting dalam pencernaan protein di usus kecil namun produksi tripsin komersial saat ini masih terbatas oleh masalah sertifikasi halal dan risiko penularan penyakit yang bersumber dari babi atau sapi. Penelitian bertujuan menyeleksi koleksi isolat L. plantarum yang menghasilkan aktivitas PST tertinggi dan menentukan kondisi optimum dalam produksi PST dari L. plantarum terpilih menggunakan Response Surface Methodology (RSM) diikuti dengan pemurnian dan karakterisasi parsialnya. Tujuh isolat L. plantarum yang diperoleh dari makanan tradisional Indonesia diseleksi secara kualitatif dan kuantitatif. Semua isolat L. plantarum menunjukkan aktivitas proteolitik, terlihat adanya zona bening di sekitar koloni. Zona bening menunjukkan adanya potensi L. plantarum sebagai sumber PST secara kualitatif. Hasil pengujian kuantitatif menunjukkan bahwa isolat dengan kode B6 (L. plantarum WBM-4) menghasilkan PST dengan aktivitas tripsin tertinggi sebesar 0,16 mU/mL. Lactobacillus plantarum WBM-4 diisolasi dari buah Menteng Banjarmasin paling berpotensi untuk menghasilkan PST. Selanjutnya, L. plantarum WBM-4 dioptimalisasi produksi menggunakan Respon Surface Methodology (RSM) dan karakterisasi PST. Kondisi optimal ditentukan pada komposisi medium dengan 1,96% glukosa, 0,39% yeast extract, 1,97% skim milk, dan pH 6,62, menghasilkan aktivitas PST sebesar 0,303 mU/mL. Pemekatan enzim kasar di bawah kondisi optimum menggunakan viva spin 5000 MWCO meningkatkan kemurnian hingga 11,08 kali lipat, dengan aktivitas sebesar 2,47 mU/mL. Karakterisasi parsial menunjukkan berat molekul PST sekitar ~19 kDa dan ~29 kDa, stabilitas dalam rentang suhu 30 - 40°C, dan aktivitas optimal pada pH 7,0 - 8,0. Penambahan ion logam EDTA, Ca2+, dan Zn2+ memengaruhi aktivitas PST. Penyimpanan PST selama 30 hari pada suhu 4°C aktivitas tersisa PST masih 65% sedang pada suhu 24-28°C aktivitas hanya tersisa 15%. Hasil penelitian ini memberikan gambaran tentang potensi PST yang berasal dari L. plantarum untuk aplikasi suplemen pencernaan dan memberikan alternatif sumber tripsin yang halal dan aman.

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Research on screening of several Lactobacillus plantarum and optimization of trypsin-like protease production (TLP) followed by concentration and partial characterization has been carried out. Trypsin has an important role in protein digestion in the small intestine, but commercial trypsin production is currently limited by halal certification issues and the risk of transmission of diseases sourced from pigs or cattle. The study aimed to select a collection of Lactobacillus plantarum isolates that produced the highest TLP activity and determine the optimum conditions in TLP production from selected L. plantarum using Response Surface Methodology (RSM) followed by purification and partial characterization. Seven isolates of L. plantarum obtained from traditional Indonesian food were selected qualitatively and quantitatively. All L. plantarum isolates exhibited proteolytic activity, with clear zones around the colony. The clear zone shows the potential of L. plantarum as a qualitative source of TLP. The results of quantitative testing showed that isolates with code B6 (L. plantarum WBM-4) produced TLP with the highest trypsin activity value 0.16 mU/mL. L. plantarum WBM-4 isolated from Banjarmasin Menteng fruit has the most potential to produce TLP. Furthermore, L. plantarum WBM-4 optimized production using Response Surface Methodology (RSM) and TLP characterization. Optimal conditions were determined in the composition of the medium with 1.96% glucose, 0.39% yeast extract, 1.97% skim milk, and pH 6.62, resulting in TLP activity of 0.303 mU/mL. Crude enzyme concentration under optimum conditions using viva spin 5000 MWCO increases purity up to 11.08-fold, with an activity of 2.47 mU/mL. Partial characterization shows TLP molecular weights of approximately ~29 kDa and ~19 kDa, stability in the temperature range of 30 - 40 °C, and optimal activity at pH 7.0 - 8.0. The addition of EDTA, Ca2+, and Zn2+ metal ions affect TLP activity. TLP storage for 30 days at 4°C the remaining activity of PST is still 65% while at 24-28°C the activity is only 15%. The results of this study provide an overview of the potential of PST derived from L. plantarum for digestive supplement applications and provide an alternative source of trypsin that is halal and safe."

"Gangguan keseimbangan mikrobiota pada saluran pencernaan dapat menyebabkan dampak pada kesehatan. Upaya untuk menggunakan mikrobiota sebagai pengobatan dapat dilakukan salah satunya dengan memanfaatkan flora normal saluran pencernaan, sehingga meminimalkan kemungkinan gangguan yang tidak diharapkan. Penelitian sebelumnya telah berhasil mengisolasi beberapa bakteri dari mekonium neonatus, di antaranya Staphylococcus hominis, Bacillus subtilis, dan Enterococcus hirae. Penelitian ini bertujuan untuk mengeksplorasi potensi koktail ketiga bakteri untuk microbial therapeutic, dengan cara menguji daya saing koktail dengan tiga bakteri patogen saluran pencernaan, yaitu Salmonella typhi, Escherichia coli, dan Streptococcus mutans. Koktail bakteri dibuat dengan perbandingan Staphylococcus hominis : Bacillus subtilis :Enterococcus hirae 0,5 : 1 : 0,75 berdasarkan penelitian sebelumnya. Analisis daya saing dilakukan dengan Deferred Growth Inhibition Assay dan uji metode sumuran, agar kedua uji dapat saling mengkonfirmasi hasil analisis. Hasil uji DGIA dan metode sumuran menunjukkan adanya kemampuan koktail bakteri untuk bersaing dengan bakteri patogen berupa tidak terbentuknya zona penghambatan pertumbuhan satu dengan yang lain. Hasil metode sumuran terutama menunjukkan kemampuan koktail untuk bersaing yang tidak teramati pada bakteri individual berupa lingkaran jernih berbentuk cincin di sekitar sumuran.Hal ini menunjukkan potensi pengembangan lebih lanjut sebagai produk microbial therapeutic.

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Changesof the microbiota balance of the digestive system could impact health. One way to use microbial therapy is to use the commensal flora of the digestive system, minimalizing the chance of unwanted interactions. The previous study has isolatedseveral bacteria from neonatal meconium, i.e., Staphylococcus hominis, Bacillus subtilis, andEnterococcus hirae.This study explores the potential of the coktail of the three bacteria to be developed as a microbial therapeutic on the digestive systemby conducting an inhibition assay with three indicator bacteria of the pathogenic digestive system, i.e.,Salmonella typhi, Escherichia coli, andStreptococcus mutans.The cocktail was made based on a previous study with the composition ofStaphylococcus hominis : Bacillus subtilis :Enterococcus hirae,i.e.,0,5: 1: 0,75, respectively. The inhibition analysis was carried out by performing a Deferred Growth Inhibition Assay (DGIA)and well diffusion method assay so that both assays can confirm the results of each other. The results of DGIA and well method assayshow the ability of the cocktail to inhibit the pathogenic bacteria by the inhibition zone not being formed. The well method assay in particular shows the cocktail having inhibition ability not observed by individual bacteria by the clear ring zone around the wells. Thisshows further development potential of the cocktail as a microbial therapeutic product."

"ABSTRAKAnesthesi spinal pada bedah digestif merupakan tindakan pembedahan yang dapatmempengaruhi keadaan hemodinamik.Pemberian Latihan mobilisasi rom dinidiharapkan mampu membantu menstabilkan keadaan hemodinamik.Tujuanpenelitian ini adalah mengetahui perbedaan mobilisasi 2 jam dan 6 jam pascaoperasi digestif dengan anestesi spinal. Desain penelitian ini adalah quasieksperimen dengan pre-post test non equivalen dengan jumlah 60 responden.Penilaian dilakukan dengan pengukuran tanda vital pada ketiga kelompok,pengukuran pertama yaitu 2 jam post operasi sebelum dilakukan intervensi,pengukuran kedua dilakukan setelah 2 DAFTAR GRAFIKjam setelah diberilatihan mobilisasi dan pengukuran ketiga 6 jam post operasi setelah diberi latihan.Hasil uji anova-post-hoc diperoleh perbedaan nilai p < 0.05, pada kelompokintervensi 2, khusus nilai diastolik dan MAP. Rekomendasi penelitian ini adalahbahwa dapat dipertimbangkan pemberian mobilisasi ROM dini baik 2 jam dan 6jam post operasi bisa dilakukan mobilisasi secara bertahap khususnya pada pasiendengan anestesi spinal pada pembedahan digestif ini.

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ABSTRACTSpinal anesthesia on post digestive surgery patient can influence hemodynamics’patient. The early mobilization: ROM is expected to stabilize hemodynamicpatient post-surgery. The purpose of this study is to determine the difference onhemodynamic status patient who have early mobilization 2 hours and 6 hours postsurgerywith spinal anesthesia. Quasi experiment was used with pre-posttestnonequivalent method which is recruited 60 respondents. Hemodynamic statuses weredocumented by measuring vital signs on 3 different groups. The first measurement wasdocumented on 2 hours post-surgery before intervention. The second measurements wereconducted 2 hours after early mobilization was given and third measurements wereconducted 6 hours post-surgery after mobilization. The result from ANOVA test showssignificant different (p<0.05) between second group who received ROM 2 hours postsurgery,especially on diastolic and MAP score. It is recommended that earlymobilization 2 and 6 hours post-surgery should be given gradually, especially patient withdigestive surgery who received spinal anesthesia"

"L’écho-endoscopie digestive est une technique exigeante et son apprentissage demeure, année après année, toujours aussi long et difficile. Cet ouvrage est le fruit de la collaboration des membres du Club francophone d’écho-endoscopie (CFE), tous leaders reconnus de la technique en France comme à l’étranger.Conçu comme un traité pratique permettant avant tout l’apprentissage et le perfectionnement de la méthode, c’est également un ouvrage de référence qui positionne l’écho-endoscopie à chaque étape de la réflexion diagnostique et thérapeutique grâce à des algorithmes décisionnels qui reprennent les données de la littérature et les recommandations de pratique clinique en vigueur.Les débutants y trouveront des descriptions très précises sur la manière de réaliser un examen écho-endoscopique, organe par organe, en technologie radiale et en technologie linéaire, notamment pour l’examen de la sphère bilio-pancréatique. Les écho-endoscopistes aguerris y trouveront de multiples trucs et astuces visant à simplifier et à optimiser l’examen. Par souci didactique les auteurs ont sélectionné une quinzaine de séquences audio-vidéos réunies dans un DVD. Toutes sont extraites de la base de données du Club francophone d’écho-endoscopie.L’écho-endoscopie est en pleine mutation depuis l’apparition des nouvelles consoles d’échographies. Celles-ci proposent des images d’une résolution exceptionnelle qui permettent l’utilisation des technologies échographiques les plus modernes, comme l’élastographie et l’écho-endoscopie de contraste.Il y a donc un futur très excitant pour cette technique d’imagerie endoscopique désormais arrivée à maturité. Cet ouvrage devrait participer à son développement en France comme dans les pays francophones."