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"Pendahuluan: Kembar siam adalah gangguan kongenital yang langka dengan insiden 1/50.000 hingga 1/500.000 kelahiran di seluruh dunia.1 Operasi pemisahan adalah pengobatan utama yang memiliki tingkat kematian tinggi hingga 60%. Penelitian sebelumnya menunjukkan bahwa kembar siam memiliki tingkat kejadian penyakit jantung kongenital hingga 66%, dengan kejadian tertinggi terlihat pada kembar siam thorakopagus.2 Penelitian ini bertujuan untuk mengevaluasi hubungan antara penyakit jantung kongenital (PJK) dan mortalitas kembar siam setelah operasi pemisahan. Metode: Kami melakukan studi retrospektif, pada semua pasien kembar siam yang menjalani operasi pemisahan di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) dari tahun 2009 hingga 2022. Dua puluh enam subjek ditemukan telah memenuhi kriteria inklusi dan eksklusi kami. Kompleksitas penyakit jantung kongenital didefinisikan oleh klasifikasi kompleksitas penyakit Bethesda. Hubungan antara kompleksitas PJK dan mortalitas dalam satu tahun pada pasien kembar siam yang menjalani operasi pemisahan dianalisis menggunakan uji Fisher. Hasil: Penyakit jantung kongenital terjadi pada kembar omfalopagus di RSCM. Tingkat kematian kembar siam dengan PJK yang menjalani operasi pemisahan di pusat kami adalah 40%, menunjukkan tidak adanya korelasi signifikan antara PJK dan mortalitas setelah operasi pemisahan, (p= 0,369). Kesimpulan: Kembar siam dengan PJK tidak menunjukkan korelasi dengan tingkat mortalitas setelah operasi pemisahan dalam studi awal ini. Penelitian lebih lanjut diperlukan dengan lebih banyak subjek untuk mendapatkan hasil yang lebih konklusif.

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Introduction: Conjoined twins are a rare congenital disorder with an incidence of 1/50.000 up to 1/500.000 births around the world.1 Separation surgery is the mainstay treatment which yields a high mortality rate of up to 60%. Previous studies show conjoined twins have a high incidence of congenital heart disease up to 66%, with the highest incidence evident in thoracopagus conjoined twins.2 This study aimed to evaluate the relationship between congenital heart disease (CHD) and conjoined twins mortality after separation surgery.

Methods: We performed a retrospective study, on all conjoined twin patients who underwent separation surgery in Dr. Cipto Mangunkusumo Hospital (CMH) from 2009 until 2022. Twenty-six subjects were found to have fulfilled our inclusion and exclusion criteria. Congenital heart disease complexity was defined by Bethesda disease complexity classification. The relationship between CHD complexity within one-year mortality in conjoined twins patients who underwent separation surgery was analysed using Fischer’s exact test.

Results: Congenital heart disease occurs in omphalopagus twins in CMH. The mortality rate of conjoined twins with CHD who underwent separation surgery in our centre was 40%, showing no significant correlation between CHD and mortality after separation surgery, (p= 0,369).

Conclusion: Conjoined twins with CHD showed no correlation to mortality rates following separation surgery in this preliminary study. Further research is needed with more subjects to make more conclusive results."

"Kelahiran prematur menghadapi konsekuensi risiko morbiditas dan mortalitas perinatal yang lebih tinggi. Dukungan nutrisi yang tepat dimasa awal periode kritis menjadi salah satu upaya menurunkan risiko tersebut. Masalah nutrisi menjadi salah satu aspek perawatan yang penting untuk diatasi. Tujuan penulisan ini adalah memberikan gambaran asuhan keperawatan bayi kembar prematur dengan risiko defisit nutrisi. Studi ini menggunakan desain studi kasus terhadap empat bayi kembar prematur yang mengalami masalah defisit nutrisi, baik aktual maupun risiko. Hasil studi menunjukkan bahwa Model Konservasi Levine dapat digunakan dalam asuhan keperawatan bayi kembar prematur. Integrasi Model ini dapat diimplementasikan kedalam proses keperawatan dapat meningkatkan kualitas asuhan keperawatan yang bersifat holistik.

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Preterm birth faces the consequence of a higher risk of perinatal morbidity and mortality. Proper nutritional support in the early critical period is one of the efforts to reduce this risk. Nutrition problems is one of the urgent aspects of treatment to be overcome. This study aims to provide an overview of nursing care for premature twins with a risk of nutritional deficit. This study was designed as a case study of four premature twins who experienced nutritional deficit problems, both actual and risk. The results of the study indicate that the Conservation Model Levine’s can be used in the nursing care of premature twins. The integration of this model can be implemented into the nursing process to improve the quality of holistic nursing care.

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"Scott Richardson gives us a finely detailed experiential account of how gender and teaching are woven together in public schools. Through his own memories and the narrativized experiences of his research subjects, Richardson demonstrates both the institutional benefits associated with being male and the fragility of masculinity. Membership in the “Boys’ Club” of hypermasculinity requires constant checking, surveillance, and choices that fit within the narrow range of dominant masculinity (so well detailed by R. W. Connell). Richardson’s causal style parallels the ease with which men in leadership and teaching positions articulate their allegiance to gender norms and one another, and in effect, set critique of such gender norms. "

"Book Two in the critically acclaimed The Fire Sermon trilogy--The Hunger Games meets Cormac McCarthy's The Road in this richly imagined post-apocalyptic series by award-winning poet Francesca Haig. Four hundred years in the future, the Earth has turned primitive following a nuclear fire that has laid waste to civilization and nature. Though the radiation fallout has ended, for some unknowable reason every person is born with a twin. Of each pair, one is an Alpha--physically perfect in every way; and the other an Omega--burdened with deformity, small or large. With the Council ruling an apartheid-like society, Omegas are branded and ostracized while the Alphas have gathered the world's sparse resources for themselves. Though proclaiming their superiority, for all their effort, Alphas cannot escape one harsh fact: whenever one twin dies, so does the other. Cass is a rare Omega, one burdened with psychic foresight. While her twin, Zach, gains power on the Alpha Council, she dares to dream the most dangerous dream of all: equality. For daring to envision a world in which Alphas and Omegas live side-by-side as equals, both the Council and the Resistance have her in their sights.Book Two in the critically acclaimed The Fire Sermon trilogy--The Hunger Games meets Cormac McCarthy's The Road in this richly imagined post-apocalyptic series by award-winning poet Francesca Haig. Four hundred years in the future, the Earth has turned primitive following a nuclear fire that has laid waste to civilisation and nature. Though the radiation fallout has ended, for some unknowable reason every person is born with a twin. Of each pair, one is an Alpha--physically perfect in every way; and the other an Omega--burdened with deformity, small or large. With the Council ruling an apartheid-like society, Omegas are branded and ostracised while the Alphas have gathered the world's sparse resources for themselves. Though proclaiming their superiority, for all their effort, Alphas cannot escape one harsh fact: whenever one twin dies, so does the other. Cass is a rare Omega, one burdened with psychic foresight. While her twin, Zach, gains power on the Alpha Council, she dares to dream the most dangerous dream of all: equality. For daring to envision a world in which Alphas and Omegas live side-by-side as equals, both the Council and the Resistance have her in their sights."

"Although everone experiences unexpected challenges with the arrival of a new baby, the parents of twins face their own unique sets of joys and frustrations. As the parent of three children under the age of six, including three-year-old fraternal twins, Dagmara Scalise knows firsthand just how daunting that all-important first year can be. Now, in TWIN SENSE, she offer real-world advice on dealing with the many issue that arise when caring for newborn twins."