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Abstrak :
Pendahuluan: Multi drug resistance (MDR) antibiotik sudah menjadi ancaman kesehatan masyarakat yang berdampak global. Penggunaan antibiotik yang tepat menjadikan upaya preventif dan kuratif sangat penting untuk keberhasilan mengatasi MDR dan intervensi terhadap kompleksitas resistensi, minimal memperlambat laju terjadinya MDR. Tujuan: Mengetahui perbedaan kualitas penggunaan antibiotik dan keberhasilan pengobatan pasien sepsis akibat bakteri MDR gram negatif dengan infeksi bakteri non MDR di rumah sakit tersier. Metode: Jenis penelitian ini merupakan kohort retrospektif dengan menggunakan data sekunder pasien berusia lebih atau sama dengan 18 tahun yang mendapatkan perawatan di Unit Rawat Inap dan ICU RSPAD Gatot Soebroto tahun 2017 – 2019. Hasil: Hubungan kualitas antibiotik pada Bakteri MDR Gram Negatif dan Non MDR Gram Negatif menunjukan perbedaan proporsi yang bermakna pada kelompok MDR gram negatif sebesar 20,6%, dengan kelompok non MDR gram negatif sebesar 13,6% terhadap kualitas antibiotik yang baik dengan RR 1,517, IK 95% 1,1-2,1 dan nilai p=0,015 (p<0,05. Hubungan keberhasilan terapi pada Bakteri MDR Gram Negatif dan Non MDR Gram negatif menunjukan perbedaan proporsi yang bermakna pada kelompok MDR gram negatif sebesar 57,4%, dengan kelompok non MDR gram negatif sebesar 39,1% terhadap keberhasilan terapi (berhasil) dengan RR 1,431, IK 95% 1,0-2,1 dan nilai p=0,02 (p<0,05). Simpulan: (1) Terdapat kualitas yang lebih baik penggunaan antibiotik dengan Index Gyssens pasien akibat infeksi bakteri MDR gram negatif dibandingkan Non MDR di rumah sakit tersier, (2) Terdapat keberhasilan yang lebih baik pengobatan pasien sepsis dengan infeksi bakteri MDR gram negatif dibandingkan dengan Non MDR di rumah sakit tersier ......Introduction: Multi Drug Resistance (MDR) antibiotics have become a global health threat to the community. The use of appropriate antibiotics makes preventive and curative measures very important for the success of overcoming MDR and intervening the complexity of resistance, at least slowing the rate of occurrence of MDR Objective: To know the difference in the quality of antibiotic use and the success in sepsis patients’ treatment due to gram-negative MDR bacteria with non-MDR bacterial infections in tertiary hospitals. Methods: This research design is retrospective cohort. This research was conducted using secondary data from patient with age more or equal than 18 years.The patients was cared in Inpatient Unit and ICU Indonesia Army Central Hospital Gatot Soebroto from 2017-2019 Results: The relationship of antibiotic quality on Gram Negative MDR Bacteria and Non-Gram Negative MDR showed a significant difference in proportion in the gram negative MDR group by 20.6%, with the gram negative non MDR group by 13.6% against good antibiotic quality with RR 1.517, IK 95% from 1.1 to 2.1 and the value of p = 0.015 (p <0.05. The relationship of therapeutic success in Gram Negative MDR Bacteria and Non-Gram negative MDR showed a significant difference in proportion in the gram negative MDR group by 57.4%, with the non-gram negative MDR group by 39.1% for successful therapy (success) with RR 1,431, 95% CI 1.0-2.1 and p = 0.02 (p <0.05). Conclusions: (1) There is a better quality on the utilization of antibiotics with Gyssens Index patients resulted from MDR negative gram bacterial infection in comparison to Non MDR in tertiary hospital, (2) There is a better success in treating the sepsis patient with MDR negative gram bacterial infection in comparison with Non MDR in a tertiary hospital

Abstrak :
ABSTRAK
The immune response of dengue fever/dengue hemorrhagic fever is a series of immunopathogenesis processes starting from viral infection to the target on monocytes and macrophages. It may consequently cause a cascade of viremia in the circulation that stimulates the afferent, efferent, and effector mechanism by the interaction of the humoral and complement system. The cascade results in inflammatory substance that will affect capillary permeability and activate coagulation factors leading to further effects on endothelial level. The mechanism involving pathogenesis of DHF/DSS is still vague. So far, a theory of heterologous infection has been developed, which explains that on second infection, there is subneutralization that induce viral replication. The autoimmune mechanism development leads to the better understanding of DHF. It also explains the autoimmune response of the viral infection, which consists of molecular mimicry, bystander activation and viral persistence. The development of the autoimmune pathomechanism is related to the role of autoantibody and endothelial dysfunction that may have role in worsening DHF.

Abstrak :
The endurance of the nation means the concept and strength of maintaining national resilience that covers its existence in the midst of civilization and strategic environmental changes, towards the dynamic conditions of national resilience for maintaining order, stability and the potential for change (the stability idea of changes). The challenges and problems of national resilience are dynamic variants that require comprehensive thinking on systems, policies and the strategy on national behavior (behavior science), which supported by patriotism and the energy of national health security towards the role of the TNI to fill the zones and accumulation of health development that illustrate the performance of national self-sufficiency and national. The struggle of the nation’s health in the perspective of structural and participatory strength starts with the ability to drive leadership, metabolic health community and agent of change that meets the reliability value of High Reliability Organization (HRO). The reliability that is formed will trigger the innovation and out of the box spirit to assemble a network (networking) for change, so that it is manifested as a performance of professional reliability that heightens the potential of the nation’s health and national resilience. Synergy of the National Health System (SKN) and the Defense Health System (Siskeshan) is a web of links to support the effort on the empowerment of the strategic value of national health.This strategy strengthens the national health network (one health) against the global health threats complexity that threaten the national resilience. The existence of Public Health Emergency global challenges in a form of outbreaks which spreads rapidly with unpredictable problematic, that triggers every nation to strengthen the nation struggle for synergizing the health development under the basis of national defense system.

Abstrak :
Daya tahan bangsa bermakna konsep dan kekuatan memelihara ketahanan nasional mencakup eksistensi di tengah peradaban dan perubahan lingkungan strategis, menuju kondisi dinamis ketahanan nasional untuk memelihara keteraturan, stabilitas, dan potensi terjadinya perubahan (the stability idea of changes). Tantangan dan problematika ketahanan nasional merupakan varian dinamik yang memerlukan pemikiran komprehensif terhadap sistem, kebijakan dan strategi perilaku kebangsaan (behaviour science) yang didukung patriotisme dan energi keamanan kesehatan bangsa terhadap peran TNI untuk mengisi zona dan akumulasi pembangunan kesehatan yang menggambarkan performance keswadayaan dan ketahanan nasional. Daya juang kesehatan bangsa dalam perspektif kekuatan struktural dan partisipatif bertitik tolak kepada kemampuan menggerakkan leadership, metabolic health community dan agent of change yang memenuhi nilai keandalan High Reliability Organization (HRO). Keandalan yang terbentuk akan memicu spirit inovasi dan out the box merangkai suatu jejaring (networking) untuk perubahan, sehingga termanifestasikan sebagai performance keandalan profesional yang menjunjung tinggi potensi kesehatan bangsa dan ketahanan nasional. Sinergitas Sistem Kesehatan Nasional (SKN) dan Sistem Kesehatan Pertahanan (Siskeshan) merupakan jaring yang saling bertaut untuk mendukung upaya pemberdayaan nilai strategis kesehatan nasional. Strategi ini menguatkan jejaring ketahanan nasional (one health) terhadap kompleksitas ancaman global kesehatan yang mengancam ketahanan nasional. Tantangan global dengan adanya Public Health Emergency berupa wabah yang sedemikian cepat dengan problematika yang sulit diprediksi, memicu setiap negara memperkuat daya juang bangsa untuk mensinergikan pembangunan kesehatan berasaskan sistem ketahanan nasional.