Characteristics of Mediastinal Tumor Patients in Cipto Mangunkusumo National Hospital Jakarta

Tumor mediastinum mewakili keragaman penyakit di berbagai negara. Di Indonesia, khususnya di Rumah Sakit Nasional Cipto Mangunkusumo, masih kekurangan karakteristik epidemiologi, klinis, radiologi, dan karakteristik histopatologi dari tumor mediastinal.Tujuan: untuk menentukan karakteristik kasus-kasus tumor mediastinum berbasis rekam medis. Metode: penelitian retrospektif ini didasarkan pada data yang telah dilaporkan dalamChest meetingsyang diselenggarakan oleh Divisi Pulmonologi Penyakit Dalam Rumah Sakit Cipto Mangunkusumo dari Januari 2007 sampai Desember 2008. Saat penelitian, terdapat 27 kasus tumor mediastinum.Hasil: kebanyakan pasien didiagnosis tumor mediastinum pada usia di atas 40 tahun (56%) dan lebih dari separuh pasien berjenis kelamin laki-laki (67%). Dari 13 pasien (52%) telah dipastikan bahwa 9 dari mereka memiliki riwayat merokok. Tiga gejala yang paling umum ditemukan di antaranya batuk, terengah-engah, dan terjadinya penurunan berat badan. Jenis histologis yang paling umum dari tumor adalah thymoma (33%). Tujuh belas pasien (63%) di antaranya pernah menjalani pembedahan. Radioterapi oleh 44% pasien dan kemoterapi oleh 26% pasien.Kesimpulan: peneliti menangani 27 kasus tumor mediastinum dari Januari 2007 hingga Desember 2008. Lebih dari separuh kasus terjadi pada usia di atas 40 tahun dan thymoma adalah temuan histopatologis yang paling umum

Demographic, Clinic, Radiologic, and Histopathologic Pattern of Patient with Mediastinal Mass Who Died During Treatment at Cipto Mangunkusumo Hospital Jakarta

Banyak penyakit dapat timbul atau melibatkan mediastinum. Penyakit-penyakit tersebut adalah tumor primer, metastase, kista, dan infeksi akut atau kronis. Mendiagnosis massa mediastinum seringkali menjadi tantangan mengingat diperlukan standar diagnosis dan rencana perawatan. Meningkatkan risiko pasien dan memutuskan kapan harus melakukan perawatan agresif akan memberikan hasil akhir yang lebih baik dalam menurunkan angka kesakitan dan kematian. Saat ini, pola demografi, klinik, radiologi, dan histopatologi pasien dengan massa mediastinum yang meninggal selama perawatan di RS Cipto Mangunkusumo belum dilaporkan.Tujuan: mendapatkan pola demografi, klinik, radiologi, dan histopatologi pasien dengan massa mediastinum yang meninggal selama perawatan di RS Cipto Mangunkusumo dalam kurun waktu sepuluh tahun terakhir.Metode: penelitian ini merupakan studi cross-sectional deskriptif. Penelitian dilakukan antara April 2010 sampai Juli 2010 dengan mengumpulkan dan mempelajari catatan medis pasien dengan massa mediastinum yang didiagnosis selama Januari 2000 sampai Desember 2009 di RS Cipto Mangunkusumo, kemudian diproses dengan program SPSS versi 16.0.Hasil: terdapat 201 pasien yang didiagnosis memiliki massa mediastinum di RS Cipto Mangunkusumo selama sepuluh tahun terakhir. Delapan puluh delapan catatan medis tidak ditemukan sehingga hanya ada 113 sampel yang diteliti. Empat puluh lima sampel (39,8%) dari 113 sampel meninggal selama perawatan di rumah sakit.Kesimpulan: ada sedikit perbedaan dalam pola demografi, klinik, radiologi, dan histopatologi pasien dengan massa mediastinum yang meninggal selama pengobatan di RS Cipto Mangunkusumo dibandingkan dengan penelitian lain. Tingkat kematian selama pengobatan tinggi. Diagnosis yang tepat pada stadium dini sangat diperlukan untuk menurunkan angka kesakitan serta angka kematian dan pasien memperoleh hasil akhir yang lebih baik

Obstructive Sleep Apnea and Atherosclerosis

Obstructive sleep apnea (OSA) is a sleep respiratory disorder characterized by recurrent episodes of complete or partial airway obstruction, resulting in apneas or hypopneas. OSA could contribute to atherosclerosis through direct and indirect mechanisms.Endothelial dysfunction, sympathetic stimulation, and proinflammatory cytokine modulation caused by OSA play significant role to an atherosclesrotic event. Other risk factors of atherosclerosis like hypertension and diabetes mellitus also associated with OSA. Animal and clinical studies recently showed promising data to prove association between OSA, atherosclerosis, and its risk factors. However, provided data has not showed consistent result. In the future, demand of further research both basic and clinical sciences need to be fulfilled

The Association of Gastropods and Seagrass in Coastal Waters of Beruk Island of North Rupat of Riau Province

This study was conducted in July 2013 in the coastal waters of Beruk Island, Riau. This study was aimed to describe the species composition, distribution, density of seagrass and gastropods, its was also directed to know the distribution of gastropods based on the distribution of seagrass. The survey methods was used in this study. The results showed that there were 279 individuals of gastropod. Those consisted of six species, i.e. Strombus urceus, Ellobium sp, Nerita costata, Conus nobilis, Littorina sp, and Gibbula ardens. There were two seagrass species used as habitat by gastropod, i.e. Enhalus acoroides and Halophila ovalis. Distribution patterns of gastropods in Beruk Island were generally uniform, and varied at each station. The analysis showed that C. nobilis found at all stations, this indicated that these waters were suitable for the survival of C. nobilis, as well as the seagrass species of E. acoroides was also found in all stations

Profil Pasien Tb-hiv dan Non Tb-hiv di Rscm

Tuberculosis (TB) is the most common opportunistic infection and cause of death in patients with Human Immunodeficiency Virus (HIV) in developing countries. TB-HIV cases showed an increase in recent years. There has been no report on TB-HIV patient profiles in RSCM. The purpose of this study was to obtain data an demographic, clinical, laboratory, and radiological TB-HIV patients. This study was a descriptive cross-sectional study design to document medical records of HIV-TB patients who came for treatment to the Pokdisus RSCM between July 2008-December 2010. A number of 522 patients consisted of 424 males (81.2%) and 98 females (18.8%), with a mean age of 31.92 years, the majority in the age group 18-40 years (90.8), 53.1% married, tribal Betawi 28.4%, and 64.2% graduated from high school. The proportion of injecting drug transmission (56.5%). Concomitant infection is hepatitis C infection (42.9%) and oral candidiasis (26.4%). Chronic cough is the most clinical manifestation (67.5%), followed by prolonged fever (57.5%) and weight loss (50.4%). Patients with sputum smear-negative (36.2%), CD4 <200 (78.0%) and chest X-ray finding of TB (32.8%).Keywords : tuberculosis, hiv.AbstrakTuberkulosis (TB) merupakan infeksi oportunistik terbanyak dan penyebab kematian utama pada pasien Human Immunodeficiency Virus (HIV) di negara berkembang. Kasus TB-HIV menunjukkan kenaikan dalam beberapa tahun terakhir. Belum ada laporan mengenai profil pasien TB-HIV di RSCM. Tujuan penelitian ini adalah untuk mendapatkan data demografi, klinis, laboratoris, dan radiologis pasien TB-HIV. Penelitian ini merupakan rancangan studi potong lintang deskriptif dengan menelusuri rekam medik pasien TB-HIV yang datang berobat ke Kelompok Studi Khusus (Pokdisus) RSCM antara bulan Juli 2008-Desember 2010. Sejumlah 522 penderita yang terdiri dari 424 laki-laki (81,2%) dan 98 wanita (18,8%), dengan usia rerata 31,92 tahun, mayoritas pada kelompok usia 18-40 tahun (90.8), sudah kawin 53.1%, suku Betawi 28,4%, dan tamat SMA 64,2%. Proporsi transmisi narkoba suntik (56,5%). Infeksi penyerta adalah infeksi hepatitis C (42,9%) dan kandidiasis oral (26,4%). Batuk kronik merupakan manifestasi klinik terbanyak (67,5%), diikuti dengan demam lama (57,5%) dan berat badan turun (50,4%). Pasien dengan sputum BTA negatif (36,2%), CD4 <200 (78,0%) dan gambaran TB pada foto toraks (32,8%).Kata kunci : tuberculosis, hiv

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe