Factors Associated with Mortality of Intensive Care Unit Patients with Acute Kidney Injury at Cipto Mangunkusumo National Central General Hospital

Background: the incidence of acute kidney injury (AKI) in intensive care units is associated with increased mortality, post AKI morbidity and high treatment costs. Research on factors related to mortality of AKI patients in intensive care units in Indonesia, especially Cipto Mangungkusumo General Hospital has never been done. This study aims to determine the prevalence of AKI, mortality rate of AKI patients, and the factors associated with increased mortality of AKI patients in intensive care units in ICU Cipto Mangunkusumo General Hospital. Methods: this is a retrospective cohort study of all patients diagnosed with AKI in the intensive care unit at Cipto Mangunkusumo General Hospital, January 2015 - December 2016. An analysis of bivariate relationships with multvariate with STATA Statistics 15.0 between age > 60 years, sepsis, use of ventilator, ventilator duration, dialysis, oligoanuria, and APACHE II scores at admission with mortality. Results: the prevalence of AKI patients in the intensive care unit was 12.25% (675 of 5511 subjects) and 220 subjects (32.59%) of the 675 analyzed subjects died in the intensive care unit. Factors related to increased mortality in multivariate analysis were sepsis (OR 6,174; IK95% 3,116-12,233), oligoanuria (OR 4,173; IK95% 2,104-8,274), use of ventilator (OR 3,085; IK95% 1,348-7,057), (scores APACHE II at admission) 1/2 [OR 1,597; IK95% 1.154-2.209], and the duration of the ventilator (OR 1.062; IK95% 1.012-1.114). Conclusion: the prevalence of AKI patients and their mortality rate in the intensive care unit of Cipto Mangunkusumo General Hospital obtained 12.25% and 32.59%. Sepsis, oligoanuria, ventilators (APACHE II score at admission) 1/2, and ventilator duration are factors that are significantly associated with increased mortality of AKI patients in intensive care units

The Influence of Hyperglycemia at Admission on In-hospital Arrhythmia Patients with Acute Coronary Syndrome

Aim: to determine the incidence of in-hospital arrhythmias in patients with acute coronary syndrome (ACS) andto determine the influence of hyperglycemia at admission (HA) on in-hospital arrhythmias complicating ACS. Methods: a retrospective cohort study was conducted using secondary data from medical records of patients with ACS who were admitted to ICCU RSCM, between January 1st-December 31st, 2014. Hyperglycemia at admission was defined when the blood glucose level at admission was >140 mg/dL. The in-hospital arrhythmias encompassed atrial arrhythmia, supraventricular tacchycardia (SVT), high grade AV block (HAVB), and ventricular arrhythmia, during the first seven days of hospitalization. Results: there were 232 subjects in this study. The prevalence of HA was 50.43%. The incidence of in-hospital arrhythmia was 21.55% (95% CI 16.26-26.84). In bivariate analysis, there was significant association between HA and in-hospital arrhythmia (RR 1.75; 95% CI 1.04-2.93). Therewere no association between type of ACS, diabetes mellitus (DM), obesity, and hypertension, with the in-hospital arrhythmias. In multivariate analysis, the adjusted OR of HA was 2.85 (95% CI 1.35-6.02), and DM was the confounding variable. Conclusion: the incidence of in-hospital arrhythmias in patients with ACS was 21.55% (95% CI 16.26-26.84). Hyperglycemia at admission may increase the risk of in-hospital arrhythmia in patients with ACS.Key words: hyperglycemia at admission; in-hospital arrhythmia; acute coronary syndrom

Association of Glucose Variability in the First 72 Hours of ICU Care with ICU Mortality in Critically-III Patients

Introduction. Hyperglycemia during hospitalization is a risk factor that can be managed in order to reduce mortality. Inspite of hyperglycemia, glucose variability also brings negative outcome to cells. Studies about glucose variability effect to mortality had been studied using many variables of glucose variability. Methods. Retrospective cohort study is done to 280 critical ill patient in ICU and HCU in Cipto Mangunkusumo Hospital who admitted to critical care between January 2012-August 2013. MAG change and glucose standard deviation are divided into 4 quartiles. Relationship between MAG change and glucose standard deviation are analyzed using Chi Square test. To control the confounders (MSOFA score, Charlson comorbidities index, hypoglycemia, and hyperglycemia), logistic regression is done. Results. Median of MAG change is 3.3 mg/dL/hour and median of glucose standard deviation is 37.63 mg/dL. Mortality proportion is higher in upper quartile of MAG change and glucose standard deviation compared to lower quartile. OR of upper quartile MAG change to ICU mortality is OR 4.26 (95% CI 1.98-9.15) and OR of upper quartile glucose standard deviation to ICU mortality is OR 2.78 (95% CI 1.35-5.71). These results are adjusted to MSOFA score, hypoglycemia, and hyperglycemia. In logistic regression test, fully adjusted OR are 3.34 (95% CI 1.08-10.31) and 0.90 (95% CI 0.28-2.88) for MAG change and glucose standard deviation, respectively. Conclusions. Mortality proportion of upper quartile of MAG change (>8.1 mg/dL/hour) is higher than lower quartile (59 mg/dL) is higher than lower quartile(<22.7 mg/dL), but the difference is not statistically significant

Predictor Factors Affecting Seroconversion Post-Influenza Vaccination in the Elderly

Introduction. The influenza vaccine as the most effective method for preventing influenza virus infection currently has lower efficacy in the elderly than younger adults due to change of immune response as well as other risk factors. This study aims to identify predictor factors affecting seroconversion post-influenza vaccination in elderly. Methods. retrospective cohort study in the elderly population in East Jakarta Posyandu who got the influenza vaccine. A total of 277 subjects with antibody titre pre and one month post-vaccination influenza were examined. Risk factors such as age, gender, exercise status, smoking status, type 2 diabetes, pulmonary, and cardiovascular disease, nutritional status of MNA (Mini Nutritional Assessment), GDS (Geriatric Depression Scale), and pre-vaccination antibodi titre were assessed in each subject. Results. The proportion of elderly people who seroconverted (fourfold rise or more in antibody titer post-vaccination) was 50.9% (141/277). On multivariate analysis, the predictor factors that affect seroconversion of one month post- influenza vaccination in the elderly on the community is a no depression state (p = 0.048, OR = 2.1, CI = 1.01 to 4.30), exercise status ≥5 times per week minimal 30 minutes (p = 0.013, OR 4.0, CI 1.34 to 11.76), and not seroprotective pre-vaccination (p=0.000, OR 6.4, CI 3.40 to 11.99). Conclusion. Predictor factors affecting seroconversion post-influenza vaccination in the elderly on the community is depression status, exercise status and pre-vaccination antibody titre

『維摩経玄疏』訳注 ⑷

Buku ini secara sistematis membahas penyakit - penyakit berdasarkan organ atau pun cabang ilmu yang ad

Effects of the COVID-19 pandemic on the management of ST-Segment elevation myocardial infarction in Indonesia: a cohort study [version 1; peer review: 2 approved]

Background: ST-segment elevation myocardial infarction (STEMI) is a form of acute coronary syndrome with high mortality rate. Management of STEMI should be performed as soon as possible to prevent further damage. With the emergence of coronavirus disease 2019 (COVID-19), it may face obstacles. To overcome those problems, some changes in policy focusing on fibrinolytic therapy in STEMI patients have been applied. This study aimed to identify the effects of COVID-19 in management of STEMI patients in Indonesia. Methods: This retrospective study was conducted in Dr. Cipto Mangunkusumo Hospital (CMH), the national referral center in Indonesia. We compared data between 2018 to 2019 and 2020 to 2021 as before and during COVID-19 pandemic period, respectively. We analyzed the effects of COVID-19 on STEMI patients' visits to hospital i.e., monthly hospital admission and symptoms-to-hospital, management of STEMI i.e., the strategies and time of reperfusion, and clinical outcomes of STEMI patients i.e., major adverse coronary event and mortality. Results: There was a significant statistically reduced mean of monthly hospital admissions from 11 to 7 (p = 0.002) and prolonged duration of symptoms-to-hospital during COVID-19 from 8 to 12 hours (p = 0.005). There was also a decrease in primary percutaneous coronary intervention (PPCI) procedures during COVID-19 (65.2% vs. 27.8%, p<0.001), which was accompanied by an increased number of fibrinolytic (1.5% vs. 9.5%, p<0.001) and conservative therapy (28.5% vs. 55.6%, p <0.01). Moreover, there was also a prolonged duration of diagnosis-to-wire-crossing time (160 vs. 186 minutes, p = 0.005), meanwhile, percentage of urgent PCI, door-to-needle time, and clinical outcomes were not statistically significant. Conclusions: During COVID-19 pandemic, the number STEMI patients declined in monthly hospital admission, delays in symptoms-to-hospital time, changes in type of reperfusion strategy, and delays in PPCI procedures in CMH. Meanwhile, fibrinolytic time and clinical outcomes were not affected

Kapita Selekta Kedokteran

xxxii, 738 hal. : il. ; 15 x 23,5 cm

Kapita selekta kedokteran

738 hlm.; 23 hlm

Kapita Selekta Kedokteran

x, 701 hlm

Kapita Selekta Kedokteran

xxxii; 738 hlm; ilus; 15 x 23,5 c