G3p2a0, 38 Tahun, Gravid 28 Minggu, Janin Tunggal Mati, Intrauterin, Presentasi Bokong, Letak Sungsang, Belum Inpartu Dengan Intrauterine Fetal Death (Iufd)

Latar Belakang. Intrauterine fetal death (IUFD) adalah janin yang mati dalam rahim dengan berat 500 gram atau lebih atau kematian janin dalam rahim pada kehamilan 20 minggu atau lebih. Terdapat beberapa faktor maternal, fetal, dan plasenta yang mempengaruhi risiko IUFD. Dalam kasus ini, diagnosis IUFD ditegakkan berdasarkan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang. Kasus. Seorang pasien, Ny. M, G3P2A0, 38 tahun, gravid 28 minggu datang ke RSUD Jenderal Ahmad Yani Metro dengan keluhan utama Perut terasa kencang sejak 2 hari sebelum masuk rumah sakit dan merasa tidak ada gerakan bayinya sejak satu minggu terakhir. Terdapat faktor resiko berupa faktor maternal, dimana usia ibu > 35 tahun. Tampak sakit sedang, compos mentis, tekanan darah 120/70 mmHg, tinggi fundus uteri 13 cm, letak sungsang, presentasi bokong, tidak ada denyut jantung janin, janin intrauterine, tunggal, mati. Pada pemeriksaan hemoglobin ibu: 12,5 gr/dl, pemeriksaan USG tampak janin tunggal, tidak terdapat gerakan janin, dan terdapat Spalding Sign. Pada pasien ini dilakukan penatalaksanaan berupa terminasi kehamilan. Simpulan. Pasien ini didiagnosis sebagai IUFD. Faktor maternal merupakan kemungkinan terbesar penyabab kematian janin dalam kasus ini. Terminasi kehamilan merupakan tatalaksana dari IUFD. [Medula Unila.2013;1(2):11-18

Sebaran Horizontal Kandungan Klorofil-a Di Perairan Teluk Ujungbatu Jepara

Teluk Ujungbatu merupakan perairan yang disekitarnya terdapat pemukiman, pertambakan, industri wisata, aktifitas nelayan serta muara dari dua sungai, yaitu Sungai Wiso dan Sungai Sampok. Kondisi tersebut memberikan dampak terhadap kesuburan perairan di Perairan Teluk Ujungbatu. Kesuburan perairan yang berubah akan berpengaruh terhadap kandungan klorofil-a. Tujuan penelitian ini adalah mendeskripsikan sebaran klorofil-a secara horizontal pada saat pasang menuju surut. Penelitian ini dilaksanakan pada bulan Oktober-November 2014 di Perairan Teluk Ujung Batu, Jepara menggunakan metode deskriptif. Penentuan lokasi stasiun pengambilan sample menggunakan metode purposive yang terdiri dari 12 stasiun. Data yang diamati adalah kandungan klorofil-a, suhu, DO, salinitas, kecerahan dan pH. Permodelan arus laut menggunakan software SMS 8.1. Pengolahan data menggunakan software ArcGIS 10.0 untuk menganalisis model persebaran. Berdasarkan hasil penelitian didapatkan kandungan klorofil-a di Perairan Teluk Ujungbatu, Jepara sebesar 0,33284l-3,18176 mg/m3 dengan reratanya 1,057 mg/m3. Nilai kandungan klorofil-a relatif lebih tinggi pada stasiun yang berada dekat dengan muara sungai dan semakin kecil pada stasiun yang berada jauh dari muara sungai. Arah persebaran kandungan klorofil-a dominan ke arah barat daya, yang dipengaruhi oleh variabel hidrodinamika yaitu arus pasang surut, dengan kecepatan arus berkisar antara 0,0103 – 0,0973 m/detik

A diet rich in fish oil and Leucine Ameliorates Hypercalcemia in tumour-induced cachectic mice

Background: Dietary supplementation with leucine and fish oil rich in omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) has previously been shown to reduce cachexia-related outcomes in C26 tumour-bearing mice. To further explore associated processes and mechanisms we investigated changes in plasma Ca2+ levels, the involvement of parathyroid hormone related protein (PTHrP), and its possible interactions with cyclooxygenase 2 (COX-2). Methods: CD2F1 mice were subcutaneously inoculated with C26 adenocarcinoma cells or sham treated and divided in: (1) controls, (2) tumour-bearing controls, and (3) tumour-bearing receiving experimental diets. After 20 days, body and organ masses and total plasma Ca2+ levels were determined. Furthermore, effects of DHA, EPA and leucine on production of PTHrP were studied in cultured C26 cells. Results: The combination of leucine and fish oil reduced tumour-associated hypercalcemia. Plasma Ca2+ levels negatively correlated with carcass mass and multiple organ masses. DHA was able to reduce PTHrP production by C26 cells in vitro. Results indicate that this effect occurred independently of COX-2 inhibition. Conclusion: Our results suggest that cancer-related hypercalcemia may be ameliorated by a nutritional intervention rich in leucine and fish oil. The effect of fish oil possibly relates to a DHA-induced reduction of PTHrP excretion by the tumour

Austerity-Driven Labour Market Reforms in Southern Europe: Eroding the Security of Labour Market Insiders

The sovereign debt crisis in the Eurozone and increased pressures for ‘structural reform’ have led to a period of intensive change in labour market policy in Southern Europe. Examining the cases of Greece, Portugal, Spain and Italy, this article focuses on the security of labour market insiders, a key group in labour markets that is highly segmented. Th e security of labour market insiders is conceptualised as consisting of security in employment (protection against dismissals) and security in unemployment (protection against drops in income provided by unemployment insurance and assistance). Using changes in national laws, the article charts and compares labour market change along these two dimensions across these four Southern European countries. Because labour market reform has not been restricted to Southern Europe, the article also compares these developments to broader changes in the countries of the Eurozone, using OECD and MISSOC data. Having demonstrated the degree to which the security of labour market insiders has diminished, the article concludes with an agenda for research on the policy dynamics of Southern European labour market reform in the wake of the fi nancial crisis

Vitamin C and infectious diseases

Non peer reviewe

Effects of Cigarette Smoke on Adipose and Skeletal Muscle Tissue:: In Vivo and In Vitro Studies

Chronic obstructive pulmonary disease (COPD), often caused by smoking, is a chronic lung disease with systemic manifestations including metabolic comorbidities. This study investigates adaptive and pathological alterations in adipose and skeletal muscle tissue following cigarette smoke exposure using in vivo and in vitro models. Mice were exposed to cigarette smoke or air for 72 days and the pre-adipose cell line 3T3-L1 was utilized as an in vitro model. Cigarette smoke exposure decreased body weight, and the proportional loss in fat mass was more pronounced than the lean mass loss. Cigarette smoke exposure reduced adipocyte size and increased adipocyte numbers. Adipose macrophage numbers and associated cytokine levels, including interleukin-1β, interleukine-6 and tumor necrosis factor-α were elevated in smoke-exposed mice. Muscle strength and protein synthesis signaling were decreased after smoke exposure; however, muscle mass was not changed. In vitro studies demonstrated that lipolysis and fatty acid oxidation were upregulated in cigarette smoke-exposed pre-adipocytes. In conclusion, cigarette smoke exposure induces a loss of whole-body fat mass and adipose atrophy, which is likely due to enhanced lipolysis

Effects of a nutritional intervention on impaired behavior and cognitive function in an emphysematous murine model of COPD with endotoxin-induced lung inflammation

One cluster of the extrapulmonary manifestations in chronic obstructive pulmonary disease (COPD) is related to the brain, which includes anxiety, depression and cognitive impairment. Brain-related comorbidities are related to worsening of symptoms and increased mortality in COPD patients. In this study, a murine model of COPD was used to examine the effects of emphysema and repetitive pulmonary inflammatory events on systemic inflammatory outcomes and brain function. In addition, the effect of a dietary intervention on brain-related parameters was assessed. Adult male C57Bl/6J mice were exposed to elastase or vehicle intratracheally (i.t.) once a week on three consecutive weeks. Two weeks after the final administration, mice were i.t. exposed to lipopolysaccharide (LPS) or vehicle for three times with a 10 day interval. A dietary intervention enriched with omega-3 PUFAs, prebiotic fibers, tryptophan and vitamin D was administered from the first LPS exposure onward. Behavior and cognitive function, the degree of emphysema and both pulmonary and systemic inflammation as well as blood-brain barrier (BBB) integrity and neuroinflammation in the brain were assessed. A lower score in the cognitive test was observed in elastase-exposed mice. Mice exposed to elastase plus LPS showed less locomotion in the behavior test. The enriched diet seemed to reduce anxiety-like behavior over time and cognitive impairments associated with the presented COPD model, without affecting locomotion. In addition, the enriched diet restored the disbalance in splenic T-helper 1 (Th1) and Th2 cells. There was a trend toward recovering elastase plus LPS-induced decreased expression of occludin in brain microvessels, a measure of BBB integrity, as well as improving expression levels of kynurenine pathway markers in the brain by the enriched diet. The findings of this study demonstrate brain-associated comorbidities - including cognitive and behavioral impairments - in this murine model for COPD. Although no changes in lung parameters were observed, exposure to the specific enriched diet in this model appeared to improve systemic immune disbalance, BBB integrity and derailed kynurenine pathway which may lead to reduction of anxiety-like behavior and improved cognition

From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions

Human resources for health policies: a critical component in health policies

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: • the central role of the workforce in the health sector; • the various challenges thrown up by health system reforms; • the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs. Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH): • to move beyond the traditional approach of personnel administration to a more global concept of HRM; • to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy; • to foster a more proactive attitude among human resources (HR) policy-makers and managers; • to promote the full commitment of all professionals and sectors in all phases of the process. The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms