Analisis Syndecan-1 Laktat dan Profil Lipid Sebagai Faktor Risiko Keparahan dan Mortalitas Sepsis

Pada sepsis, endothelial glycocalyx (EG), dapat rusak dan luruh melepaskan syndecan-1 ke dalam plasma. Kerusakan EG akan mengganggu mikrosirkulasi, menimbulkan hipoperfusi jaringan, dan meningkatkan kadar laktat. Gangguan profil lipid pada sepsis terjadi karena gangguan metabolisme dan kerusakan langsung hepatosit akibat meluruhnya EG. Penelitian ini bermaksud menganalisis syndecan-1, laktat, dan profil lipid sebagai faktor risiko keparahan dan mortalitas pada pasien sepsis. Penelitian ini adalah penelitian analitik observasional pada 39 pasien dewasa yang memenuhi kritera sepsis-3. Keparahan sepsis diklasifikasikan menjadi sepsis dan syok septik dan ditentukan dalam 6 jam setelah time zero berdasarkan penggunaan vasopresor, kecukupan resusitasi cairan, dan nilai laktat ulangan. Kematian 7 hari dihitung sejak time zero sepsis. Syndecan-1, laktat, dan profil lipid diambil dalam jam pertama setelah time zero dianalisis sebagai faktor risiko keparahan dan mortalitas 7 hari. Analisis data dilakukan dengan uji logistik regresi bivariat dan multivariat. Pada penelitian ini didapatkan 20 pasien dengan sepsis, 19 pasien dengan syok septik. Berdasar atas mortalitas 7 hari, 10 pasien meninggal dan 29 pasien bertahan hidup. Laktat dan syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan variabel yang lebih superior dibanding dengan syndecan-1 sebagai prediktor keparahan sepsis. Laktat merupakan prediktor untuk mortalitas 7 hari pada pasien sepsis. Simpulan penelitian ini adalah laktat dan syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan prediktor kematian 7 hari pada sepsis. Syndecan-1 Lactate and Lipid Profiles as Risk Factors for Severity and Mortality in SepsisIn sepsis, endothelial glycocalyx (EG) may experience damages and decay, releasing syndecan-1 into plasma. EG damages will disrupt microcirculation, causing tissue hypoperfusion and increasing lactate levels. Disorders of the lipid profile in sepsis occur due to metabolic disorders and direct hepatocyte damages due to EG shedding. This study intended to analyze the Syndecan-1, lactate, and lipid profiles as risk factors for severity and mortality in septic patients. This was an observational analytic study on 39 adult patients who met the criteria for sepsis-3. Sepsis severity was classified into sepsis and septic shock and was determined within 6 hours after time zero based on the vasopressor use, adequacy of fluid resuscitation, and repeat lactate values. The 7-day mortality was counted from time zero sepsis. Syndecan-1, Lactate, and Lipid Profiles were assessed within the first hour after time zero and analyzed as risk factors for severity and 7-day mortality. Data analysis was performed using bivariate and multivariate logistic regression tests. In this study, there were 20 patients with sepsis, 19 patients with septic shock. Based on the 7-day mortality, 10 patients died and 29 patients survived. Lactate and Syndecan-1 are predictors of severity in sepsis. Lactate is superior than Syndecan-1 as a predictor of sepsis severity and is a predictor of 7-day mortality in septic patients. Nonetheless, both lactate and Syndecan-1 are predictors of severity in sepsis.Pada sepsis, endothelial glycocalyx (EG), akan rusak dan luruh, melepaskan syndecan-1 ke dalam plasma. Kerusakan EG akan mengganggu mikrosirkulasi, menimbulkan hipoperfusi jaringan dan meningkatkan kadar laktat. Gangguan profil lipid pada sepsis terjadi karena gangguan metabolism dan kerusakan langsung hepatosit akibat meluruhnya EG. Tujuan: Menganalisis Syndecan-1, Laktat dan Profil Lipid sebagai faktor risiko keparahan dan mortalitas pada pasien sepsis. Metode: Penelitian ini adalah penelitian analitik observasional pada 39 pasien dewasa yang memenuhi kritera sepsis-3. Keparahan sepsis diklasifikasikan menjadi sepsis dan syok septik dan ditentukan dalam 6 jam setelah time zero berdasarkan penggunaan vasopressor, kecukupan resusitasi cairan dan nilai laktat ulangan. Kematian 7 hari dihitung sejak time zero sepsis. Syndecan-1, Laktat dan Profil Lipid diambil dalam jam pertama setelah time zero dianalisis sebagai faktor risiko keparahan dan mortalitas 7 hari. Digunakan analisis normalitas data, uji logistik regresi bivariat dan multivariat. Hasil: Pada penelitian ini didapatkan 20 pasien dengan sepsis, 19 pasien dengan syok septik. Berdasarkan mortalitas 7 hari, 10 pasien meninggal dan 29 pasien bertahan hidup. Laktat dan Syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat (RR 3,597 CI 95% 1,373 – 9,421 p 0,009) merupakan variabel yang lebih superior dibandingkan Syndecan-1 (RR 1,009 CI 95% 1,002 – 1,016 p 0,018) sebagai prediktor keparahan sepsis. Laktat (RR 2,369 CI 95% 1,021 – 5,495 p 0,045) merupakan prediktor untuk mortalitas 7 hari pada pasien sepsis. Simpulan: Laktat dan Syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan prediktor kematian 7 hari pada sepsis

Analisis Faktor Risiko Oxygenation Index, Oxygen Saturation Index, dan Rasio Pao2/Fio2 sebagai Prediktor Mortalitas Pasien Pneumonia COVID-19 dengan ARDS di Ruang Perawatan Intensif Isolasi Khusus RSUD Dr Soetomo

Pada kasus berat, pneumonia COVID-19 terjadi perburukan secara cepat dan progresif yang menyebabkan ARDS. Pengukuran parameter oksigenasi seperti oxygenation index (OI) dan oxygen saturation index (OSI) pada beberapa penelitian menunjukkan superioritas dibanding dengan rasio PaO2/FiO2 dalam menilai status oksigenasi dan derajat keparahan ARDS. Penelitian ini bertujuan melakukan analisis faktor risiko OI, OSI, dan Rasio PaO2/FiO2 terhadap mortalitas pasien pneumonia COVID-19 dengan ARDS. Penelitian ini adalah penelitian analitik observaional dengan desain cohort-prospective terhadap pasien dewasa pneumonia COVID-19 dengan ARDS berdasar atas kriteria Berlin. Data perhitungan OI, OSI, dan rasio PaO2/FiO2 diambil pada 30 menit pertama pascapemasangan ventilator mekanik. Analisis regresi logistik digunakan untuk menganalisis faktor risiko OI, OSI, dan rasio PaO2/FiO2 terhadap mortalitas 28 hari pasien pneumonia COVID-19 dengan ARDS. Hasil penelitian didapatkan pada 77 pasien yang memenuhi kriteria inklusi dan tidak termasuk eksklusi, hanya variabel OI yang terbukti signifikan sebagai prediktor independen mortalitas dengan nilai p 0,043, sementara OSI dan rasio PaO2/FiO2 tidak signifikan. Dari ketiga variabel, OI mempunyai AUC tertinggi, yakni 0,935 dibanding dengan variabel OSI dan rasio PaO2/FiO2. Simpulan, OI terbukti sebagai prediktor independen mortalitas pada pasien pneumonia COVID-19 dengan ARDS.Oxygen Index, Oxygenation Saturation Index, and Pao2/Fio2 Ratio as Predictors of Mortality in Pneumonia Covid-19 with ARDS Patients Treated in Intensive Isolated Care Unit In severe COVID-19 cases, worsening of pneumonia occurs rapidly and leads to ARDS. Oxygenation parameters such as oxygenation index (OI) and oxygen saturation index (OSI) has been shown to be superior when compared to the PaO2/FiO2 ratio in assessing the oxygenation status and ARDS severity in some studies. Currently, there are limited studies that explore the prognostic values of these parameters in pneumonia COVID-19 with ARDS. This study aimed to analyze the OI, OSI, and PaO2/FiO2 Ratio as predictors of mortality in pneumonia COVID-19 with ARDS in patients treated in the intensive isolated care room. This was an observational analytic study conducted at dr. Soetomo Hospital, Indonesia, on adult patients who met the criteria for pneumonia COVID-19 with ARDS based on Berlin criteria. Data on OI, OSI, and PaO2/FiO2 were collected based on the results of measurements 30 minutes post-intubation and mechanical ventilation in these patients. Logistic regression analysis was used to analyze the OI, OSI, and PaO2/FiO2 as risk factors for 28 days mortality of pneumonia COVID-19 patients with ARDS. In a total of 77 patients eligible for the analyses, it was observed that OI was independently associated with hospital mortality (p 0.043) while OSI and PaO2/FiO2 ratio were not statistically significant. From these three variables, the AUC for mortality prediction was the greatest for OI (AUC 0.935, p<0.05). In conclusion, OI is the only one that is proven to be the independent predictor mortality with the highest sensitivity and specificity compared to the OSI and PaO2/FiO2 ratio for patients with pneumonia covid-19 with ARDS.Pada kasus berat, pneumonia COVID-19 terjadi perburukan secara cepat dan progresif yang  menyebabkan ARDS. Pengukuran parameter oksigenasi seperti oxygenation index (OI) dan oxygen saturation index (OSI) pada beberapa penelitian menunjukkan superioritas dibanding dengan rasio PaO2/FiO2 dalam menilai status oksigenasi dan derajat keparahan ARDS. Penelitian ini bertujuan melakukan analisis faktor risiko OI, OSI, dan Rasio PaO2/FiO2 terhadap mortalitas pasien pneumonia COVID-19 dengan ARDS. Penelitian ini adalah penelitian analitik observaional dengan desain cohort-prospective terhadap pasien dewasa pneumonia COVID-19 dengan ARDS berdasar atas kriteria Berlin. Data perhitungan OI, OSI, dan rasio PaO2/FiO2 diambil pada 30 menit pertama pascapemasangan ventilator mekanik. Analisis regresi logistik digunakan untuk menganalisis faktor risiko OI, OSI, dan rasio PaO2/FiO2 terhadap mortalitas 28 hari pasien pneumonia COVID-19 dengan ARDS. Hasil penelitian didapatkan pada 77 pasien yang memenuhi kriteria inklusi dan tidak termasuk eksklusi, hanya variabel OI yang terbukti signifikan sebagai prediktor independen mortalitas dengan nilai p 0,043, sementara OSI dan rasio PaO2/FiO2 tidak signifikan.  Dari ketiga variabel, OI mempunyai AUC tertinggi, yakni 0,935 dibanding dengan variabel OSI dan rasio PaO2/FiO2. Simpulan, OI terbukti sebagai prediktor independen mortalitas pada pasien pneumonia COVID-19 dengan ARDS

Comparison of central vein pressure between distal, medial, and proximal lumens with water manometer method

ABSTRACT Catheter Vein Pressure in ward-cared patients is rarely measured and considered invalid. The two catheter vein pressure postulates contradict, making confusion among health workers. Dr Russo said the distal-medial-proximal Catheter Vein Pressure has no difference but were denied by Susan S. Scott. Proof of postulate is needed as a solution to inward care. Therefore, this study aimed to compare the central vein pressure between distal, medial, and proximal lumens with the water manometer method. Forty-nine samples retrospective study were taken from the distal - medial - proximal Catheter Vein Pressure of the "zero" until fifth days. The differences are analyzed with Statistical Paired t Test with p-Value < 0.05 from SPSS ver. 26 to prove the right postulate. 49 samples were concluded to represent of population. Catheter Vein Pressure from day "zero" becomes zero difference, the fifth day 91.8% are no difference while the rest have difference of 0.2 - 1.0 cm H2O and the conclusion are no significant difference with 95% CI. The correlation scale of 0.998 and 0.999 proves that the three lumens tend to produce no differences. In conclusion, the distal - medial - proximal Catheter Vein Pressure values in this study have no significant differences and consistent from "zero" until fifth days. This is formulated as P distal = P medial = P proximal (cm H2O).Keywords      : Central Vein Pressure, Pressure, distal - medial - proximal, no differences, ward patient.Correspondence    : [email protected]

Retention of basic life support in medical students of Airlangga University

Background: Cardiac arrest is one of the leading cause of death in the world with steadily increasing number over the years. Basic life support has been proven to lower the risks of tissue damage and further complication. Several study shows that BLS skill are lacking in some doctors and nurses. Objective: Therefore, the purpose of this study is knowing the retention of basic life support in medical student of Airlangga University. Methods: This descriptive study used cross sectional design. Subjects were students at faculty of medicine in Airlangga University who trained one year ago and completed their study of Basic Life Support. Fifty two subject were asked to practice their BLS techniques then scored based on modified American Hearth Assosiation (AHA)’s Basic life support skill checklist. Results: Based on the data, the percentage of students who did the retest correctly: response checked by shouting 92.31% students, response checked by tapping 69.23% students, call for help 44.23% students, airway checked 48.08% students, breathing checked 46.15% students, correct hand placement 100% students, compression rate 78.85% students, compression ratio 75% students, position 94.23% students, and compression depth 78.85% students.  Conclusion: One year post training and test, 14 from 52 students could complete all the steps in basic life support skill. Less than a half of the students successfully done 3 out of 10 points that were being tested. Meanwhile, many aspects in circulation point show higher results all above 75%

BACTERIAL AND SENSITIVITY PATTERN OF PATHOGENS CAUSING VENTILATOR-ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

Highlight: 1. Antimicrobial resistance bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. 2. Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to the non-VAP group. 3. The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. Cefoperazone-sulbactam, meropenem and amikacin were more than 70% sensitive against these bacteria. Abstract: Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit (ICU). Antimicrobial resistant bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. Objective: This study aimed to analyze the pattern and sensitivity among pathogens that caused VAP in ICU. Materials and Methods: The study was conducted retrospectively by extracting the data of bacterial isolates from sputum specimens in the Laboratory of Clinical Microbiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia and confirming the clinical data on patients suffering from VAP in ICU ward. The study started from January until December 2017. Results: The total 148 pathogens were isolated, 18 of them were diagnosed as VAP, and 130 were not VAP. The most predominant isolates in the VAP group were Acinetobacter baumannii as many as 38 (9%) followed by Pseudomonas aeruginosa 22 (2%), E. coli 16 (7%), and Klebsiella pneumoniae 11 (1%). The pathogens showed a sensitivity rate above 70% to cefoperazone-sulbactam (SCF), meropenem (MEM) and amikacin (AK). Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to non-VAP group. Conclusion: The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. The pathogens had sensitivity rate above 70% to cefoperazone-sulbactam, meropenem, and amikacin

Efektivitas Body Surface Area dibanding Predicted Body Weight dalam Menentukan Volume Semenit untuk Mencapai Target PaCO2 pada Operasi Tumor Otak

Latar Belakang dan Tujuan: Manajemen neuroanestesi pada operasi tumor otak bertujuan untuk mencegah terjadinya cedera otak sekunder dan memberikan lapangan operasi yang baik. Hal ini dapat dicapai melalui brain relaxation therapy. Penelitian ini bertujuan menganalisis efektifitas Body Surface Area (BSA) dan Predicted Body Weigh (PBW) untuk menentukan volume semenit dalam mencapai target PaCO2 pada pasien yange menjalani operasi tumor otak. Subjek dan Metode: Penelitian analitik observasional dengan desain cross-sectional melibatkan 31 pasien yang menjalani operasi tumor otak di RSUD Dr Soetomo Surabaya. Pasien yang memenuhi kriteria, dilakukan pengukuran tinggi badan dan berat badan, kemudian dibagi dalam 2 kelompok BSA dan PBW. Kelompok BSA mendapat volume semenit 4xBSA (laki-laki) dan 3.5xBSA (perempuan). Kelompok PBW mendapat volume semenit 100mL/kgBB. Tiga puluh menit setelah pengaturan ventilasi mekanik, dilakukan pemeriksaan analisa gas darah untuk menilai PaCO2. Hasil: Penentuan volume semenit menggunakan BSA menghasilkan volume yang lebih besar dibanding PBW pada pasien normal hingga obesitas.Penggunaan BSA dibanding PBW secara signifikan memiliki PaCO2 lebih rendah (33.55±3.43: 39.29±3.32 mmHg) dengan nilai p=0.0001. Simpulan: Penggunaan BSA dalam menentukan volume semenit efektif dalam mencapai target PaCO2 pada pasien yang menjalani operasi tumor otak

The Influence of Mass Basic Life Support Training on The Skills and Attitude in Undertaking Life Support Using the Method of the Faculty of Medicine, Universitas Airlangga

The quality of bBasic lLife sSupport training given by medical students to the public, using methods from the Ffaculty of Mmedicine, Airlangga University, appears to be effective. There is hope that it will affect the success rates of resuscitation by non-medical personnel. This study uses a quasi-experimental design, with total subjects of 1,378 persons. We compared the level of attitudes using a pre-post test, then linked this to the skill level in performing bBasic lLife sSupport after training. The correlation test results show a significant relationship between attitude and skill. Basic lLife sSupport training for non-medical personnel, using methods from the Ffaculty of Mmedicine at Airlangga University, enhances the level of attitude and skill of all participants

Post-Serial Earthquakes Health Problems in Lombok, Indonesia: Experience of 'Ksatria Airlangga' Floating Hospital (Profil Masalah Kesehatan Pasca Gempa Serial di Lombok, Indonesia: Pengalaman Rumah Sakit Terapung Ksatria Airlangga)

Predictions regarding damaged land access by a serial earthquake in Lombok, West Nusa Tenggara in 2018, was the background of the Rumah Sakit Terapung Ksatria Airlangga (RSTKA), being sent. RSTKA is phinisi ship with an operating theatre and other healthcare facilities. The earthquake was not accompanied by a tsunami, so the dock was suitable to be used for leaning. The study analyzes patient data in RSTKA, and as an evaluation of field hospitals. This study used observational descriptive design. Obtained 1601 patients with disease distribution classified as trauma and non-trauma. A number of patients who came to RSTKA were volatile. The number of cases recorded was more than the number of patients because some patients had more than one health problem. Trauma cases recorded 121 cases (6.7%) while non-trauma 1679 cases (93.3%). Non-trauma cases have increased rapidly since the fourth day. The trauma case was dominated by soft tissue injury 57.02%. Non-trauma cases were dominated by non-infectious diseases with 919 cases (54.8%) and 760 cases of infection (45.2%). Infectious diseases were dominated by respiratory infections (437 cases) followed by gastrointestinal infections (239 cases). Humanity mission of RSTKA has succeeded in making meaningful contributions to disaster-affected communities in Lombok, especially in North Lombok District

Pengantar Antropologi Ekonomi

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