EFEKTIVITAS MODEL PEMBELAJARAN KOOPERATIF TIPE JIGSAW DITINJAU DARI KEMAMPUAN PEMECAHAN MASALAH MATEMATIS SISWA

This quasi-experimental research aims to find out the effectiveness of Jigsaw cooperative learning model considered by student’s mathematical problem solving ability. The population of this research is eighth grade students in second semester of Junior High School State 13 Bandar Lampung in 2012/2013 academic years and as the samples are VIII.A and VIII.C, that are selected from eleven classes by using purposive sampling technique. Based on the analysis of the student’s mathematical problem solving ability, it is known that the ability of student’s mathematical problem solving with Jigsaw cooperative learning model is better than the ability of student’s mathematical problem solving with conventional learning, and also 65% or more students who are taught by Jigsaw cooperative learning model have achieved KKM. The conclusion from this research is Jigsaw cooperative learning model effective considered by student’s mathematical problem solving ability in eighth grade students of even semester Junior High School State 13 Bandar Lampung in 2012/2013 academic years. Keywords: Jigsaw, Problem Solvin

Salmonella enteritidis meningitis in a first time diagnosed AIDS patient: Case report

We describe a patient with salmonella enteritidis meningitis and unknown HIV infection

Effect of intravenous clarithromycin in patients with sepsis, respiratory and multiple organ dysfunction syndrome: a randomized clinical trial.

Clarithromycin may act as immune-regulating treatment in sepsis and acute respiratory dysfunction syndrome. However, clinical evidence remains inconclusive. We aimed to evaluate whether clarithromycin improves 28-day mortality among patients with sepsis, respiratory and multiple organ dysfunction syndrome. We conducted a multicenter, randomized, clinical trial in patients with sepsis. Participants with ratio of partial oxygen pressure to fraction of inspired oxygen less than 200 and more than 3 SOFA points from systems other than the respiratory function were enrolled between December 2017 and September 2019. Patients were randomized to receive 1 gr of clarithromycin or placebo intravenously once daily for 4 consecutive days. The primary endpoint was 28-day all-cause mortality. Secondary outcomes were 90-day mortality; sepsis response (defined as at least 25% decrease in SOFA score by day 7); sepsis recurrence; and differences in peripheral blood cell populations and leukocyte transcriptomics. Fifty-five patients were allocated to each arm. By day 28, 27 (49.1%) patients in the clarithromycin and 25 (45.5%) in the placebo group died (risk difference 3.6% [95% confidence interval (CI) - 15.7 to 22.7]; P = 0.703, adjusted OR 1.03 [95%CI 0.35-3.06]; P = 0.959). There were no statistical differences in 90-day mortality and sepsis response. Clarithromycin was associated with lower incidence of sepsis recurrence (OR 0.21 [95%CI 0.06-0.68]; P = 0.012); significant increase in monocyte HLA-DR expression; expansion of non-classical monocytes; and upregulation of genes involved in cholesterol homeostasis. Serious and non-serious adverse events were equally distributed. Clarithromycin did not reduce mortality among patients with sepsis with respiratory and multiple organ dysfunction. Clarithromycin was associated with lower sepsis recurrence, possibly through a mechanism of immune restoration. Clinical trial registration clinicaltrials.gov identifier NCT03345992 registered 17 November 2017; EudraCT 2017-001056-55

Soluble urokinase plasminogen activator receptor informs on the progression course after multiple injuries

Purpose: The purpose of this study is to study the use of soluble urokinase plasminogen activator receptor (suPAR) for the prognosis of multiple organ dysfunction (MOF) after multiple traumas. Methods: Serum suPAR was measured within the first 24 h after multiple injuries in 85 patients. Measurements were repeated after 4 d or at sepsis onset. Results: Odds ratio for trauma-associated MOF was 4.09 (p: 0.026) with admission suPAR greater than 8 ng/ml. More than 40% increases of suPAR were associated with odds ratio 9.33 (p: 0.047) for severe sepsis. Conclusions: suPAR is a useful surrogate biomarker for development of MOF and severe sepsis after multiple traumas. © 2016 Informa UK Limited, trading as Taylor & Francis Group

Early changes of the kinetics of monocyte trem-1 reflect final outcome in human sepsis

Background: TREM-1 (triggering receptor expressed on myeloid cells), a receptor expressed on neutrophils and monocytes, is upregulated in sepsis and seems to tune the inflammatory response. We explored the expression of TREM-1 at the gene level and on cell membranes of monocytes and association with clinical outcome. Methods: Peripheral venous blood was sampled from 75 septic patients (39 patients with sepsis, 25 with severe sepsis and 11 with septic shock) on sepsis days 1, 3 and 7. TREM-1 on monocytes was measured by flow cytometry; gene expression of in circulating mononuclear cells was assessed by real-time PCR. sTREM-1 was measured in serum by an enzyme immunoassay. Results: Although surface TREM-1, sTREM-1 and gene expression did not differ between sepsis, severe sepsis and septic shock on day 1, survivors had greater expression of surface TREM-1 on days 3 and 7 compared to non-survivors. sTREM-1 on non-survivors decreased on day 3 compared to baseline. Patients with increase of monocyte gene expression of from day 1 to day 3 had prolonged survival compared to patients with decrease of gene expression of from day 1 to day 3 (p: 0.031). Conclusions: Early decrease of gene expression of in monocytes is associated with poor outcome. A reciprocal decrease of the pro-inflammatory surface receptor TREM-1 linked with sepsis-induced immunosuppression may be part of the explanation. © Marioli et al

Early changes of the kinetics of monocyte trem-1 reflect final outcome in human sepsis

Background: TREM-1 (triggering receptor expressed on myeloid cells), a receptor expressed on neutrophils and monocytes, is upregulated in sepsis and seems to tune the inflammatory response. We explored the expression of TREM-1 at the gene level and on cell membranes of monocytes and association with clinical outcome. Methods: Peripheral venous blood was sampled from 75 septic patients (39 patients with sepsis, 25 with severe sepsis and 11 with septic shock) on sepsis days 1, 3 and 7. TREM-1 on monocytes was measured by flow cytometry; gene expression of in circulating mononuclear cells was assessed by real-time PCR. sTREM-1 was measured in serum by an enzyme immunoassay. Results: Although surface TREM-1, sTREM-1 and gene expression did not differ between sepsis, severe sepsis and septic shock on day 1, survivors had greater expression of surface TREM-1 on days 3 and 7 compared to non-survivors. sTREM-1 on non-survivors decreased on day 3 compared to baseline. Patients with increase of monocyte gene expression of from day 1 to day 3 had prolonged survival compared to patients with decrease of gene expression of from day 1 to day 3 (p: 0.031). Conclusions: Early decrease of gene expression of in monocytes is associated with poor outcome. A reciprocal decrease of the pro-inflammatory surface receptor TREM-1 linked with sepsis-induced immunosuppression may be part of the explanation. © Marioli et al

Linear and nonlinear analysis of pressure and flow during mechanical ventilation

Objective: Linear modeling as a method of exploring respiratory mechanics during mechanical ventilation, was compared to nonlinear modeling for now dependence of resistance in three distinct groups of patients, those with: (a) normal respiratory function (NRF), (b) chronic obstructive pulmonary disease (COPD), or (c) adult respiratory distress syndrome (ARDS). Design and patients: Airways opening pressure (Pao), flow (V’), and volume (V) signals were recorded in 32 ICU mechanically ventilated patients, under sedation and muscle relaxation (10 NRF, 11 COPD, 11 ARDS). All patients were ventilated with controlled mandatory ventilation mode at three levels of end-expiratory pressure (PEEPe): 0, 5, and 10 hPa. Data were analyzed according to: (a) Pao = PE + Ers V + Rrs V’ and (b) Pao = PE + Ers V + k(1)V’ + k(2)’’: where Ers and Rrs represent the intubated respiratory system (RS) elastance and resistance, k(1) and k(2) the linear and the nonlinear RS resistive coefficients, and PE the end-expiratory pressure. The model’s goodness of fit to the data was evaluated by the root mean square difference of predicted minus measured Pao values. Results: NRF data fit both models well at all PEEPe levels. ARDS and particularly COPD data fit the nonlinear model better. Values of k(2) were often negative in COPD and ARDS groups, and they increased in parallel with PEEPe. A gradual increase in PEEPe resulted in better fit of ARDS and COPD data to both models. Conclusions: The model of V’ dependence of resistance is more suitable for the ARDS and particularly the COPD groups. PEEP tends to diminish the V’ dependence of respiratory resistance during the respiratory cycle, particularly in the COPD group, probably through an indirect effect of the increased lung volume