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Abstrak :
Introduction: Mechanical ventilation as the management of acute respiratory distress syndrome (ARDS) in critically ill COVID-19 patient is still controversial, including timing of intubation. The delay of intubation can cause patient self-induced lung injury (P-SILI). However, early intubation which resulted in prolonged mechanical ventilation can cause complications. Therefore, a systematic review is needed to provid information regarding the timing of intubation related to the clinical outcome of the patient. Methods: Database searching from PubMed, The Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest, and Scopus was conducted and penelitianes were selected based on the eligibility criteria. It includes prognostic penelitianes of adult COVID-19 patients with ARDS and mechanically ventilated. The penelitianes were critically appraised for risk of bias using Quality In Prognosis Penelitianes (QUIPS) tool. Result: We included seven penelitianes involving 1395 adult COVID-19 patients with ARDS and mechanically ventilated, with two different methods.. Five of them assessed mortality in two groups of patients, early and late intubation, while two others determined the mean or median of intubation time in survivor and non-survivor group. All of the penelitianes showed no association between timing of intubation and mortality. Most of the penelitianes have low risk of bias for its respective domain, with only three penelitianes showed medium risk of bias due to unclear definition of prognostic factors. Conclusion: Mortality of critically ill COVID-19 adult patient cannot be predicted only with timing of intubation, yet many factors contributed to the prognosis. ......Pendahuluan: Ventilasi mekanik merupakan salah satu manajemen ARDS pada pasien dewasa COVID-19 yang sakit kritis yang masih sering diperdebatkan, salah satunya terkait waktu inisiasi intubasi. Keterlambatan intubasi dapat menyebabkan patient self-induced lung injury (P-SILI). Namun, intubasi yang terlalu dini juga dapat memberikan komplikasi. Oleh karena itu, perlu dilakukan telaah sistematis yang dapat memberikan informasi apakah intubasi dini pada fase awal penyakit memberikan luaran yang lebih baik pada pasien COVID-19 dewasa. Metode: Telaah sistematis dilakukan melalui pencarian penelitian pada basis data PubMed, CENTRAL, ProQuest, dan Scopus, dan dilakukan seleksi penelitian sesuai dengan kriteria eligibilitas. risiko bias dinilai dengan instrument Quality in Prognosis Penelitianes (QUIPS). Hasil: Dilakukan analisis terhadap 7 penelitian dengan total subyek 1395 pasien COVID-19 dewasa berat yang memerlukan ventilasi mekanik, dengan pendekatan penilaian yang berbeda, dimana 5 penelitian menilai mortalitas pada kelompok pasien intubasi dini dan intubasi tunda, dan 2 penelitian lainnya menilai rerata atau median dari waktu inisiasi intubasi pada kelompok yang meninggal dan hidup. Seluruh penelitian menunjukkan tidak adanya hubungan antara waktu intubasi dengan mortalitas. Kebanyakan penelitian memiliki risiko bias yang rendah untuk setiap domain, kecuali tiga penelitian dengan risiko bias menengah karena tidak mendefinisikan faktor prognosis dengan jelas. Kesimpulan: Mortalitas pasien COVID-19 dewasa yang sakit kritis tidak hanya dapat diprediksi dari waktu pemberian intubasi, tetapi banyak faktor lain yang mempengaruhinya.

Abstrak :
Latar belakang : Peresepan antibiotik (AB) yang tidak tepat umum terjadi di seluruh dunia dan berkontribusi pada meningkatnya organisme yang resisten. Diperlukan sistem surveilans untuk memantau penggunaan AB dan resistensi untuk pengambilan keputusan yang tepat. Indonesia belum pernah menerapkan Point prevalence survey (PPS) dalam evaluasi AB dan resistensi. Tujuan: untuk mengetahui profil penggunaan antibiotik dan resistensi mikroorganisme di rumah sakit menggunakan metode PPS Metode : penelitian potong lintang. Dilakukan pengumpulan data demografi, penggunaan antibiotik dan kultur resistensi mikroorganisme menggunakan formulir PPS. Hasil : Pada hari penelitian dilakukan survei terhadap 451 pasien, ditemukan 244 (54,1%) pasien mendapatkan AB dengan diagnosis paling banyak adalah pneumonia (25%). Alasan penggunaan antibiotik adalah untuk tatalaksana infeksi dari komunitas sebanyak 50,8%, infeksi dari fasilitas kesehatan sebanyak 15,5%, penggunaan AB sebagai profilaksis sebanyak 30,7% dan 3% tidak ditemukan alasan indikasi penggunaan AB. Diresepkan 368 AB, di mana hanya 46 (12,5%) AB yang digunakan sebagai terapi definitif. Tiga AB yang paling sering digunakan adalah ceftriaxone (15,5%), levofloxacin 9,2% and ampicillin sulbactam 7,9%. Tanggal evaluasi penggunaan AB hanya tertulis pada 88 (22,3%) AB. Tidak tersedia pedoman tatalaksana lokal sebanyak 83 (22,6%) penggunaan AB dan hanya 214 (58,2%) AB yang diresepkan sesuai dengan pedoman tata laksana lokal. Kami melakukan evaluasi terhadap 244 pasien yang menggunakan AB dan hanya 91 (38%) pasien yang dilakukan pemeriksaan kultur dan tes resistensi. Didapatkan 222 sampel, dimana 81 (36,5%) adalah steril. Tiga mikroorganisme terbanyak adalah Klebsiella pneumoniae 47 (20,7%), Pseudomonas aeruginosa 22 (9,9%) dan Escherichia coli 20 (9%). Jumlah mikroorganisme extended-spectrum β-lactamase (ESBL) didapatkan sebesar 21,4%, resisten terhadap karbapenem 12,5% dan Multiple drug resistance (MDR) sebesar 17,7%. Kesimpulan : lebih dari setengah pasien yang disurvei menggunakan AB dan angka kepatuhan penggunaan antibiotik masih belum baik, evaluasi resistensi kuman terbatas karena jumlah sampel yang diperiksa kurang. Pelaksanaan PPS terbukti efektif dan efisien. ......Background: Inappropriate antibiotic prescribing appears to be common worldwide and is contributing to the selection of resistant organisms. Surveillance systems to monitor antimicrobial use and resistance are needed to improve decision making and assess the effect of interventions. Point prevalence surveys (PPSs) in Indonesian hospitals have not yet been applied. Aim : to evaluate the antibiotic prescribing trends and microorganism resistance using PPS methods Methods: A one day, cross-sectional PPS was performed whereas total of 10 days were taken. Data on demographics, antimicrobial use and culture/resistance test of all adult inpatients were collected using a data collection form. Results: On the day of the study 451 adults patients were surveyed, 244 (54.1%) were received 368 antibiotics and the most common diagnosis was pneumonia (25%). Reasons of using the antibiotics were to treat community acquired infection (CAI) 50.8%, hospital acquired infection (HAI) 15.5%, prophylaxis 30.7% and 3% was unknown. 368 antibiotics prescriptions were issued, of which 46 (12.5%) were used for definitive therapy. The top three antibiotics prescribed were ceftriaxone (15.5%), levofloxacin 9.2% and ampicillin sulbactam 7.9%. Review date of using antibiotics were performed in 88 (22.3%). Local guidelines was not available for 83 (22.6%) of prescribed antibiotics and among prescribed antibiotics with local guidelines available compliance was 214 (58.2%). We evaluate the culture test among those received antibiotics (244), 91 (38%) patients were performed culture and resistance test. From these 222 samples of culture, 81 (36.5%) was sterile. The most three growth microorganisms were Klebsiella pneumoniae 47 (20.7%), Pseudomonas aeruginosa 22 (9.9%) and Escherichia coli 20 (9%). The number of extendedspectrum β-lactamase (ESBL) recorded at 21.4%, Carbapenem Resistanculture ce was 12.5% and Multiple drug resistance was 17.7%. Conclusions: more than half-of-patients surveyed by PPS in an hospital in Indonesia were on antibiotics, has a limitation due to availability of result and sample. Conducting PPS in teaching hospital proved to be effective and efficient.

Abstrak :
ABSTRAK
Hiperglikemia sering terjadi pada pasien sakit kritis dan dapat menimbulkan volume residu lambung tinggi. Penelitian ini bertujuan untuk mengetahui hubungan status hiperglikemia dengan status volume residu lambung tinggi pada pasien dewasa sakit kritis dalam 24 jam I dan II di ICU. Rancangan studi potong lintang, consecutive sampling, pada 96 subjek. Hasil penelitian, terdapat 45,8% subjek mengalami hiperglikemia pada 24 jam I dan 35,4% pada 24 jam II. Terdapat 28,1% subjek mengalami volume residu lambung tinggi pada 24 jam I dan 25% pada 24 jam II. Kesimpulannya, pada penelitian ini tidak didapatkan hubungan yang bermakna antara status hiperglikemia dengan status volume residu lambung tinggi.

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ABSTRAK
Hyperglycemia commonly occurs in critically ill patients and can cause high gastric residual volume. The aim of this study is to determine the relationship between hyperglycemia status and high gastric residual volume status in adult critically ill patients within the first and second 24 hours of admission in ICU. The design was cross sectional with consecutive sampling in 96 subjects. There were 45.8% subjects who had hyperglycemia in the first 24 hours and 35.4% in the second. There were 28.1% subjects who had high gastric residual volume in the first 24 hours and 25% in the second. In conclusion, there was no significant relationship between hyperglycemia status and high gastric residual volume status in this study.

Abstrak :
[ABSTRAK
Latar Belakang: Diare akut adalah masalah umum di negara berkembang seperti Indonesia; penyakit ini banyak ditemukan dalam praktek sehari-hari dengan angka morbiditas dan mortalitas yang cukup tinggi. Pada beberapa Rumah Sakit di Jakarta ditemukan bahwa pasien diare akut dewasa mengalami defisiensi kadar seng sebesar 69.3%. Pemberian seng sudah terbukti bermanfaat untuk pengobatan diare akut pada anak. Tujuan: Mengetahui dampak suplementasi seng sebagai terapi alternatif / adjuvant untuk pengobatan diare akut pada pasien dewasa, dengan membandingkan lama berlangsung dan berat-ringan gejala pada kelompok pasien yang diberikan dan yang tidak diberikan suplementasi seng. Metode: Double blind randomized controlled trial dilakukan pada penelitian ini untuk mengetahui efek suplementasi seng terhadap durasi dan gejala gastrointestinal pada pasien diare akut rawat inap di RS Pusat Pertamina di Jakarta selama periode Januari-Desember 2013. Analisis data dilakukan dengan menggunakan uji chi-square (x2) untuk perbandingan durasi diare dan uji general linear model (GLM) untuk menilai tren perubahan gejala penyerta diare. Hasil: Analisis data dari 84 pasien yang dikelola: 30 pasien pria [seng 19, plasebo 11] dan 54 pasien wanita [seng 23, plasebo 31] ~ (p 0.111) memperlihatkan pemberian suplementasi seng bermakna mengurangi durasi diare akut (p 0.027) dan bermakna mengurangi gejala mual (p 0.032). Selain itu ada tren perbaikan pada sebagian gejala penyerta diare akut, seperti sakit perut, frekuensi b.a.b., konsistensi feses, gejala muntah, kembung, dan gangguan aktivitas sehari-hari. Simpulan: Pemberian suplementasi seng bermakna membuat durasi diare akut lebih singkat dan bermakna mengurangi gejala mual, serta perbaikan pada sebagian gejala gastrointestinal.

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ABSTRACT
Background: Acute diarrhea is a common problem in developing countries such as Indonesia; which is found in everyday practice with quite high morbidity and mortality rate. It was revealed in adult acute diarrhea patients in several hospitals in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients. Objective: To discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients by comparing the duration and the severity of signs and symptoms of acute diarrhea between the zinc and placebo group. Methods: A double blind randomized controlled trial is done to find out about the effect of zinc supplementation to the duration, signs and symptoms on acute diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta from January-December 2013. The data is analyzed using chi-square test (x2) for comparing the duration of diarrhea and general linear model (GLM) to assess trend changes accompanying symptoms of diarrhea. Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo] and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation significantly reduced the duration of acute diarrhea (p 0.027) and significantly reduce the symptoms of nausea (p 0.032). In addition there is trend of improvement in some acute diarrhea associated symptoms, such as abdominal pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption of daily activities. Conclusion: Zinc supplementation significantly reduce the duration of diarrhea, significantly reduce the symptoms of nausea; besides, improving some symptoms accompanying acute diarrhea.;Background: Acute diarrhea is a common problem in developing countries such as Indonesia; which is found in everyday practice with quite high morbidity and mortality rate. It was revealed in adult acute diarrhea patients in several hospitals in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients. Objective: To discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients by comparing the duration and the severity of signs and symptoms of acute diarrhea between the zinc and placebo group. Methods: A double blind randomized controlled trial is done to find out about the effect of zinc supplementation to the duration, signs and symptoms on acute diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta from January-December 2013. The data is analyzed using chi-square test (x2) for comparing the duration of diarrhea and general linear model (GLM) to assess trend changes accompanying symptoms of diarrhea. Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo] and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation significantly reduced the duration of acute diarrhea (p 0.027) and significantly reduce the symptoms of nausea (p 0.032). In addition there is trend of improvement in some acute diarrhea associated symptoms, such as abdominal pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption of daily activities. Conclusion: Zinc supplementation significantly reduce the duration of diarrhea, significantly reduce the symptoms of nausea; besides, improving some symptoms accompanying acute diarrhea., Background: Acute diarrhea is a common problem in developing countries such as Indonesia; which is found in everyday practice with quite high morbidity and mortality rate. It was revealed in adult acute diarrhea patients in several hospitals in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients. Objective: To discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients by comparing the duration and the severity of signs and symptoms of acute diarrhea between the zinc and placebo group. Methods: A double blind randomized controlled trial is done to find out about the effect of zinc supplementation to the duration, signs and symptoms on acute diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta from January-December 2013. The data is analyzed using chi-square test (x2) for comparing the duration of diarrhea and general linear model (GLM) to assess trend changes accompanying symptoms of diarrhea. Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo] and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation significantly reduced the duration of acute diarrhea (p 0.027) and significantly reduce the symptoms of nausea (p 0.032). In addition there is trend of improvement in some acute diarrhea associated symptoms, such as abdominal pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption of daily activities. Conclusion: Zinc supplementation significantly reduce the duration of diarrhea, significantly reduce the symptoms of nausea; besides, improving some symptoms accompanying acute diarrhea.]

Abstrak :
Tuberkulosis merupakan salah satu masalah kesehatan global. Terdapat banyak pasien tuberkulosis memiliki status gizi kurang saat awal diagnosis yang berdampak pada penurunan daya tahan tubuh pasien tersebut, sehingga meningkatkan risiko terjadinya kegagala dapn konversi. Penelitian ini bertujuan untuk mengetahui hubungan antara status gizi pasien tuberkulosis pada awal diagnosis dengan keberhasilan konversi sputum. Penelitian ini menggunakan desain kohort retrospektif dengan menggunakan data sekunder yang didapat dari Kartu Pasien TB.01 di UPT Puskesmas Sukmajaya, UPF Puskesmas Villa Pertiwi dan UPF Puskesmas Abadi Jaya n=131. Pada penelitian ini didapatkan 93,2 pasien dengan status gizi kurang BMI0,05 antara status gizi pasien tuberkulosis saat awal diagnosis dengan keberhasilan konversi sputum setelah pengobatan fase intensif dilakukan RR 1,016 ,95 CI,0,932-1,108.

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Tuberculosis is one of global health problem. There is many tuberculosis patients who have low nutritional status in the initial of diagnosis that can lower the immune system of the patients and increase the risk of conversion failure. The aim of this study is to evaluate the correlation between the nutritional status of tuberculosis patient in the initial of diagnosis and the success of sputum conversion after an intensive phase of treatment been performed. This study used a retrospective cohort design using secondary data which obtained from Kartu Pasien TB.01 in UPT Puskesmas Sukmajaya, UPF Puskemas Villa Pertiwi and UPF Puskesmas Abadi Jaya n 131. In this study, 93,2 patients with low nutritional status BMI 0,05 between the nutritional status of tuberculosis patients in the initial of diagnosis and the success of sputum conversion after an intensive phase of treatment been performed RR 1.016, 95 CI, 0.932 to 1.108.