Dr Moewardi Hospital Research Articles

Non inferiority trial of Channa striata extract on endothelial glycocalyx layer protection in septic patient: a prospective cohort study

Introduction: Sepsis causes significant damage to the endothelial glycocalyx layer, which albumin can protect against. Unfortunately, human albumin is quite expensive, so cheaper substitutes must be found without sacrificing effectiveness. Albumin extract Channa striata is one that is commonly used in Indonesia. Objectives: Conducted a non-inferiority study between human albumin and Channa striata extract in protecting the glycocalyx layer through syndecan-1 levels. Materials and methods: Prospective cohort study of adult patients with early sepsis with hypoalbuminemia (<4 g/dL) treated at ICU Dr Moewardi Hospital between May and October 2021 and got human albumin or Channa striata extract as therapy. The Channa striata group was oberved in two separated groups. The control groups with human albumin 20% 100 ml single dose and the Channa striata group with 15 gram extract of Channa striata in two days, then syndecan-1 levels were compared before treatment and on the third day of the study. Results: We discovered a statistically significant decrease in syndecan-1 levels in both the study (p = 0.013) and control groups (p = 0.027) from the 44 samples we obtained. Conclusion: In both groups, we found a significant decrease in syndecan-1 levels. This demonstrates that Channa striata extract is not inferior to human albumin in terms of glycocalyx layer protection. And it has a higher economic value because the price is lower.

Non-inferiority trial of Channa striata extract on endothelial glycocalyx layer protection in septic patients

Background: Sepsis causes significant damage to the endothelial glycocalyx layer, which albumin can protect against. Unfortunately, human albumin is quite expensive, so cheaper substitutes must be found without sacrificing effectiveness. Albumin extract called snakehead fish extract (SHFE) is one that is commonly used in Indonesia It is also called Channa striata extract. We conducted a non-inferiority study between human albumin and SHFE in protecting the glycocalyx layer through syndecan-1 levels.
 Methodology: It was a prospective cohort study of adult patients with early sepsis, treated at ICU of Dr Moewardi Hospital, between May and October 2021. The study group was divided by giving Channa striata extract 15 mg/day for two days and the control group was given 20 grams of human albumin on the other day, and then syndecan-1 levels were compared before treatment and on the third day of the study.
 Results: We discovered a statistically significant decrease in syndecan-1 levels in both the study (P = 0.013) and control groups (P = 0.027) from the 44 samples we obtained.
 Conclusion: In both groups, there was a significant decrease in syndecan-1 levels, proving that Channa striata extract is not inferior to human albumin in terms of glycocalyx layer protection. And it has a higher economic value because the price is lower.
 Key words: Sepsis; Channa striata; Albumin; Syndecan-1; Glycocalyx
 Citation: Permana SA, Hartono H, Purwanto B, Indarto D. Non-inferiority trial of channa striata extract on endothelial glycocalyx layer protection in septic patients. Anaesth. pain intensive care 2023;27(4):523−527; DOI: 10.35975/apic.v27i4.2278
 Received: May 15, 2023; Reviewed: June 22, 2023; Accepted: June 22, 2023

Effect of Chronic Kidney Disease on the Mortality Rate of Patient with Sepsis

<div><p class="AbstractNormal"><strong>Introduction</strong>: Sepsis is a deathly disease caused by a dysregulation of the body's response to infection. The mortality rate of sepsis has been discovered to be almost equivalent to 20% of the global mortality rate. Comorbidity is one of the non-modifiable risk factors of sepsis. Chronic kidney disease is a comorbid risk factor for sepsis development. Decreasing GFR and albuminuria in chronic kidney disease is strongly associated with an increased mortality rate due to infection. Sepsis with chronic kidney disease shows a higher SOFA score than sepsis without chronic kidney disease. This study aims to determine the effect of chronic kidney disease on the mortality rate of patients with sepsis.</p><p class="AbstractNormal"><strong>Methods:</strong> This study is an observational analytic study with a cross-sectional approach. The data retrieval used purposive sampling, and the sample comprised 90 respondents. Data were taken from medical records of the patients with sepsis hospitalized in Dr Moewardi Hospital from January 2016 to May 2021. Data were analyzed using the Chi-Square test.</p><p class="AbstractNormal"><strong>Results:</strong> Chronic kidney disease significantly affected the sepsis mortality rate with p-value = 0.033 (p < 0.05). The prevalence ratio was 2.531 (95%CI, 1.07 – 5.97).</p><p class="AbstractNormal"><strong>Conclusion:</strong> Chronic kidney disease significantly affects the increasing mortality rate of sepsis patients.</p>Keywords: Chronic kidney disease; Mortality; Sepsis,</div>

Effectiveness of Zingiber officinale to reduce inflammation markers and the length of stay of patients with community-acquired pneumonia: An open-label clinical trial.

Examination of the interleukin 6 (IL-6) and procalcitonin levels, and neutrophil-lymphocyte ratio (NLR) might could help to diagnosis and predict the duration of therapy and prognosis of pneumonia cases. Zingiber officinale var rubrum could be used as an adjunct therapy in infectious diseases as it has anti-inflammatory activity. The aim of study was to assess the effect of Z. officinale on levels of IL-6 dan procalcitonin, NLR, and the length of hospitalization of patients with community-acquired pneumonia (CAP). An open-label clinical trial was conducted among CAP cases regardless of the etiology at Dr Moewardi Hospital and Universitas Sebelas Maret Hospital, Surakarta, Indonesia from July to September 2022. A total of 30 inpatient CAP cases were recruited and were randomly divided into two groups: (1) received Z. officinale capsule 300 mg daily for five days in addition to CAP standard therapy; and (2) received CAP standard therapy only, as control group. The data were compared using a paired Student t-test, Chi-squared test, Mann-Whitney test and Wilcoxon signed-rank test as appropriate. In Z. officinale group, the mean difference between post-and pre-treatment as follow: IL-6 level was 9.93 pg/mL, procalcitonin level -471.31 ng/mL, and NLR value -4.01. In control group, the difference was 18.94 pg/mL for IL-6, 339.39 ng/mL for procalcitonin, and 1.56 for NLR. The change of IL-6 was not statistically significant between treatment and control groups with p=0.917. The changes of procalcitonin level and NLR were significant between treatment and control group with p=0.024 and p=0.007, respectively, of which the treatment had better improvement. In addition, our data indicated that the length of stay was not statistically significant between the treatment and control groups (4.13 vs 4.47 days, p=0.361). In conclusion, Z. officinale could reduce serum inflammatory markers such as procalcitonin and NLR but it has little impact in reducing IL-16 level and the length of hospitalization of CAP patients.

Literature Review : Kelengkapan Kode Topography dan Morphology pada Kasus Neoplasma

In the Medical Record for determining the cancer diagnosis code (Neoplasm), there are 2 codes, namely the topographic code and the morphology code. These two codes are very important because the topographic code is a code that shows the location of the tumor, while the morphology code is a code that shows the nature of the tumor. If the two codes are not included, it will not determine the level of malignancy of the tumor. The aim of the study was to identify the completeness of the topographic and morphological codes in neoplasm cases. Literature study conducted on 7 journals uploaded online in the span of 2011-2021. Search journals in this study using the keywords "completeness", "Topography and Morphology code" obtained through Google Scholar. The results of the literature review show that the completeness of topographic and morphological codes in neoplasm cases has not yet reached 100%. The highest completeness of topographic codes is 98% at Aisyiyah Hospital Malang in 2018. While the lowest percentage is 0% at MRCCC Siloam Semanggi Hospital in 2020 and Karanganyar District Hospital in 2011. The highest completeness of morphology codes is 82.4% at Santa Elisabeth Hospital Medan while The lowest percentage was 0% at MRCCC Siloam Semanggi Hospital in 2020, Bhayangkara Hospital, Aisyiyah Hospital, Dr Moewardi Hospital, and Karanganyar District Hospital. The incompleteness is due to 2 factors Man: Coder inaccuracy in coding, officers have not implemented coding procedures in neoplasm cases. Method: there is no SOP for coding neoplasms, there is no PA result sheet, and the doctor's writing is not clear and complete. In assigning codes to neoplasm cases, officers should code according to the SOP, so that the resulting code is complete and accurate.

Hubungan Gaya Hidup Dengan Kejadian Stroke Di Rumah Sakit

Stroke is a neurological disorder associated with vascular injury of the central nervous system. This disease is the second leading cause of death and the leading cause of disability worldwide. The prevalence of stroke in Indonesia increases with age. The highest stroke cases were aged 75 years and over (50.2%) and the lowest was 15-20 years (0.6%). Based on gender, male (11.0%) was more than female (10.9%). Stroke can be done by controlling lifestyle such as smoking, alcohol consumption, light physical activity, unhealthy eating patterns. The population in this study was to find stroke patients at Moewardi Hospital. Samples were outpatients at Anggrek 2 and inpatients at instalasi rehabilitasi medik totaling 30 patients. The method used is analytic observational with cross sectional design. Collecting data through direct interview techniques to the patient or the patient's guardian. The statistical test used to analyze the data in this study was the chi square test. The results of data analysis showed a relationship between diet (p=0.025 <0.05) and physical activity (p=0.010 <0.05) with the incidence of stroke at Dr Moerwardi Hospital, and there was no significant relationship between smoking (p=0.459 > 0.05) and alcohol (p = 0.309 > 0.05) with the incidence of stroke in Dr Moewardi Hospital.

The Efficacy of Albumin Channa Striata Extract Administration in Stabilizing PAI-1 and Platelet Levels in Septic Patients: A Randomized Control Trial Study

BACKGROUND: Recently, sepsis has become a serious problem worldwide. There are many studies trying to find the etiologies of morbidity and mortality of sepsis. One of them is the damage of endothelial glycocalyx layer, which can lead to an increase in plasminogen activator inhibitor-1 (PAI-1) level and a decrease in platelets. This damage can be prevented by administering albumin; unfortunately, it is costly. Therefore, an alternative albumin is required. Channa striata extract albumin has been found to be relatively effective in increasing serum albumin levels. However, studies on its effectiveness are still limited. Hence, we analyzed this channa striata extract albumin in stabilizing PAI-1 and platelet levels of septic patients. AIM: This study analyzed channa striata extract albumin in stabilizing PAI-1 and platelet levels of septic patients. METHODS: We conducted a randomized control experimental study in patients with sepsis hospitalized at Dr Moewardi Hospital, Surakarta, Indonesia. The samples were taken by consecutive sampling technique. These patients were allocated into two groups, the albumin extract of channa striata, and human albumin 20% (the control) groups. We examined the PAI-1 and platelet levels on the 1st and 3rd days. We used Mann–Whitney test for statistical analysis with p < 0.05 was considered significant. RESULTS: There were 21 subjects in each group of channa striata (study) and human albumin (control). The increase of PAI-1 level in the study group (0.36 ng/ml) was lower than that of in control group (0.72 ng/ml). More subjects in study group experienced decreased PAI-1 level (n = 5) than those in control group (n = 3), the decrease more profound in control group (p = 0.004) than study group (p = 0.054). The decrease of platelet level was also greater in study group (22 × 103/mcl) than that of in control group (1 × 103.md) despite insignificant difference (p = 0.364 and p = 0.468). CONCLUSION: The administration of channa striata extract effective in stabilizing PAI-1 level in sepsis patient and also had potential benefit as human albumin in stabilizing platelet levels of septic patients.

Prenatal Diagnosis and Management of Advanced Abdominal Pregnancy in Dr. Moewardi Hospital Surakarta: A Case Series

Background: The abdominal pregnancy is a pregnancy anywhere in the abdominal cavity other than the tube, ovary, and broad ligament. Abdominal pregnancy has 7.7 times greater risk than tubal pregnancy and 90 times greater than intrauterine pregnancy. This study aims to reveal the diagnosis and treatment of abdominal pregnancy in Dr. Moewardi Hospital Surakarta. Subjects and Method: This was a case series study conducted at Dr. Moewardi Hospital Surakarta. This study report three cases of advanced abdominal pregnancy at Dr Moewardi Hospital (2019 – 2020), that consisted of two cases of advanced abdominal pregnancy to term, and one advanced abdominal pregnancy with acute abdomen. Case presentation: Case 1 (it was found abdominal pregnancy at 30 weeks), the condition of the mother and the fetus was good, the pregnancy was continued until the gestational age was term. The patient was given corticosteroids for lung maturation and magnesium sulfate for neuro­protection. Case 2 (an abdominal pregnancy was found at term), it was decided to immediately terminate it with good preoperative preparation. Both patients in case 1 and case 2 had good result in both the mother and the fetus. The placenta was left in situ in both cases to prevent massive bleeding and injury to the gastrointestinal organs. Case 3 (advanced abdominal pregnancy with acute abdominal symptoms) decided to undergo an emergency laparotomy and removal of the placenta. Conclusion: Abdominal pregnancy must be diagnosed and managed properly to reduce maternal mortality and morbidity. In advanced abdominal pregnancy, it could be considered to continue the pregnancy until the term. The placenta management of in situ without methotrexate might be considered in cases of abdominal pregnancy.

Age as an Independent Factor in the Permanent Chemotherapy-Induced Amenorrhea Incidence in Breast Cancer Patients at Dr. Moewardi Hospital, Surakarta, Indonesia

Background: Chemotherapy Induced Amenorrhea (CIA) is one common side effect of chemotherapy in breast cancer patients. Some who have CIA may experience menstruation return while others experience permanent CIA.
 Aim: to examines the factors that contribute to the incidence of persistent CIA in breast cancer patients.
 Methods: The population of this retrospective study was new breast cancer patients with premenopausal status when they started receiving chemotherapy at dr Moewardi Hospital Surakarta, Indonesia, from January 2019 to July 2021. To determine the relationship, the chi-square/Fisher’s exact test was performed. Risk factor analysis on the incidence of permanent CIA was carried out by using a bivariate logistic regression test, followed by multivariate analysis.
 Results: A number of 105 premenopausal breast cancer patients who received chemotherapy were found. Of these patients, 97 (93.38%) patients experienced CIA and 8 patients (6.62%) continued to menstruate. Of all the subjects having CIA, 49 patients (46.67%) menstruated again while the other 48 (45.71%) had persistent CIA. Age factor has a significant relationship with the incidence of permanent CIA (p =< 0.001), where patients aged > 45 years tend to have permanent CIA incidence with a proportion of 42 patients (87.5%) (p < 0.05). The multivariate analysis showed that age > 45 years (OR = 75.117; 95% CI = 12.671-445.311; p = < 0.001) was the most dominant risk factor associated with the incidence of permanent CIA, while other variables as risk factors for permanent CIA based on multivariate analysis were Stage III (R = 6.677; 95% CI = 1.370-32,545; p = 0.019) compared to stages I and II, and BMI in the normal category (OR = 5.485; 95% CI = 1.083-27.786; p = 0.040) compared to excess BMI. The other variables were not found to be associated with the incidence of permanent CIA.
 Conclusion: Age is a major factor associated with permanent CIA incidence. Other factors related to this study are staging and BMI.
 
 Keywords: Age, Permanent, Chemotherapy Induced Amenorrhea, Breast Cancer

A 38 Years Old Man with ANCA Negative Wegener’s Granulomatosis Vasculitis with Type 2 Diabetes Mellitus and Electrolyte Imbalance: A Case Report

A B S T R A C TBackground: Wegener's granulomatosis is a very rare long-term systemicdisorder, in which granuloma formation occurs and inflammation of bloodvessels (vasculitis). The cause of disorder is not yet known, but geneticfactors are thought to play an important role. Clinical symptoms are oftensimilar to other disorders, making diagnosis difficult. However, earlydiagnosis is very important in order to provide effective management.Objective: Diagnosis and management in a rare case of Wegener’sgranulomatosis vasculitis, especially it was found with other comorbidities.Methods: This case report showed a-38-years-old-man that came to theemergency room of Dr Moewardi Hospital with complaints of swellingaccompanied by redness and stiff on the face, hands and feet that worseningsince 7 days ago. He also complained of fever fluctuating, nasal congestionaccompanied by clear discharge and sometimes hearing loss in the rightear. Since the last 3 months, he was often experience similar complaints.History of diabetes was recognized by the patient for 5 years, but he did notregularly take medication. Results: In this case, examination of vital signswithin normal limits. Physical examination revealed a saddle nose with cleardischarge, swelling and redness around the face, hands and feet. Laboratorytests showed hemoglobin 12.9 g/dl, HbA1c 8.4%, sodium level 128 mmol/L,potassium level 3.1 mmol/L, calcium level 1.12 mmol/L. The Anti -Neutrophil Cytoplasmic Antibodies (ANCAs) and Anti Nuclear Antibody(ANA) Indirect Immunofluorescence (IF) method were negative.Electrocardiogram and chest x-ray examination within normal limits.Histopathological examination revealed epidermal atrophy and multiplegranulomas of the dermis. The patient underwent treatment for 10 dayswith tappering-off dose steroid, immunosuppressants, insulin, calcium,and potassium preparations therapy. Conclusions: Wegener’sgranulomatosis vasculitis is a rare case. Prompt and accurate diagnosis andmanagement will prevent poor progression of them, especially it was foundwith other comorbidities.

The Effectiveness of Letrozole Adjuvant Therapy - Electro Acupuncture in Reducing the Number of Follicles and Body Weight and Increasing Endometrial Thickness in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Acupuncture can improve menstrual cycle recovery and decrease body mass index (BMI) in women with PCOS. The effect of acupuncture can be enhanced by giving letrozol. Researchers are interested in knowing the comparison between letrozol therapy with letrozol + electroacupuncture on body weight, follicle count, and endometrial thickness in women with polycystic ovary syn­drome. This study aims to determine the diffe­rences in weight loss, follicle number, and endometrial thickness in PCOS patients receiving letrozol treatment compared to letrozol + electroacupuncture. Subjects and Method: An observational ana­lytic study using a case-control approach and fixed disease sampling technique was carried out at the Gynecology Polyclinic and Sekar Clinic at Dr Moewardi Hospital, Sura­karta. Group 1 consisted of 15 infertile SOPK women who received letrozol and group 2 consisted of 15 infertile SOPK women who received electro­acupuncture + letrozol. Body weight, follicle count, and endometrial thick­ness were measured in both groups. Data were analyzed univariate, bivariate and multivariate using the IBM-SPSS version 22 and STATA version 13 statistical applications. Results: There was a significant difference in the thickness of the endometrium (p= 0.008), the number of follicles on day 6 (p= 0.039), the number of follicles on day 8 (p= 0.033), the number of follicles on day 10 (p= 0.041), the number of follicles on day 12 (p= 0.041) ) with letrozol therapy with letrozol + electroacupunc­ture. There was no significant difference in body weight between groups Conclusion: There were significant diffe­ren­ces between the letrozol group compared to the letrozol + electroacupuncture group in endo­metrial thickness and on the number of follicles on days 6, 8, 10, 12 in infertile PCOS women. However, there was no significant difference in body weight between groups. Keywords: number of follicles, endometrial thickness, PCOS, letrozol, electroacupuncture Correspondence: Todung Antony Wesliaprilius. Department of Obstetrics and Gynecology, Faculty of Medi­cine, Universitas Sebelas Maret/ Dr. Moewardi hospital, Surakarta. Mobile: 08222181626 Email: todungtobing@gmail.com. Journal of Maternal and Child Health (2021), 06(02): 219-228 https://doi.org/10.26911/thejmch.2021.06.02.09

Efektivitas Latihan Rhytmic Stabilitation dan Combination Of Isotonic Terhadap Penurunan Nyeri pada Nyeri Punggung Bawah

Background: Low back pain is a complaint that is often encountered and very disturbing in carrying out daily activities. Myogenic pain is the most common complaint, around 49%.Physiotherapy modalities that can be given are Proprioceptive Neuromuscular Facilitation (rhythmic stabilization and combination of isotonic). Purpose this study to analyze effectivity rhythmic stabilitation exercise and combination of isotonic to decreased pain for myogenic pain. Methods: this research is two groups pre and post test design. Subjects: 30 subject diagnosed with myogenic pain in Dr Moewardi Hospital during the period between 2019 June –Augs. Results: The result of test toward pain effect between pre and post in group one after 3 weeks (6 times of therapy) is p = 0.009 with Wilcoxon test. The result of test toward pain between pre and post in group two is p = 0.001 and the test of pain between group one and group two shows p = 0.051. Conclusion: there is no difference in effect between the group one and group two toward the reduction of pain of patients with myogenic pain so that the results cannot be seen which is more effective.

Difference of Calcium Levels in Infants with Low Birth Weight

Background: Hypocalcemia is a condition that can cause serious disorders, especially in new­borns. The occurrence of hypocalcemia is an event that often occurs in babies born that can be caused due to late parathyroid hormone function in calcium metabolism in the baby's body. Hypo­calcemia is often associated with hypotension and disorders of the heart rhythm, symptoms that are often seen are apnea, tachycardia, lethar­gy, vomiting, and gastrointestinal disor­ders. This study aimed to analyze differences in calcium level between low birth weight infants. Subjects and Method: A cross sectional study was conducted at Dr Moewardi Hospital, Sura­kar­ta, Central Java, from December 2016 to April 2017. A sample of 158 LBW children was selected using consecutive sampling. The dependent va­ria­­ble is a decrease in calcium levels. The inde­pen­dent variable is low birth weight babies. Data collected by medical records. Data were analyzed using multiple logistic regression. Results: Calcium level ≥1.13 mmol/L (OR= 0.30; 95% CI= 0.15 to 0.57; p <0.001), no seizures (OR= 0.20; 95% CI= 0.06 to 0.64; p = 0.004), and QoTC (OR= 0.20; 95% CI= 0.07 to 0.572; p= 0.003) decreased the risk of low birth weight. Conclusion: Calcium level ≥1.13, no seizures, and QoTC decrease the risk of low birth weight. Keyword s : low birth weight, hypo­calcemia Correspondence: Sandi Nugraha. Department of Pediatrics, Uni­ver­sitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta. Phone/Fax.0271-633348. Email:sssa­n­di­nugraha@gmail.com Indonesian Journal of Medicine (2020), 05(02): 131-136 https://doi.org/10.26911/theijmed.2020.05.02.06

Pengaruh Phonophoresis Untuk Menurunkan Nyeri Pasien Osteoarthritis Lutut

Background: In everyday life activities human beings need prime conditions to create functional motion. One factor that interferes with functional motion is pain. The goal of physiotherapy for people with pain is to relieve pain. Many of the physiotherapy modalities recommended for reducing pain include phonophoresis. But the phonophoresis modality has not been widely implemented in Indonesia. Objective: To determine the effect of phonophoresis on reducing knee pain in patients with knee osteoarthritis. Methods: This study was a pure experiment with a pre-test and post-test with control group design. The study subjects were patients with knee osteoarthritis who met the inclusion and exclusion criteria. From the number of patients who came to the physiotherapy polyclinic of Dr Moewardi Hospital Surakarta, they would be randomized to the experimental group and the control group. The experimental group will get standard therapy at Dr Moewardi Hospital Surakarta plus phonophoresis, while the control group only gets standard therapy from the hospital. The independent variable is the administration of phonophoresis and the dependent variable is a decrease in knee pain. Statistical analysis using t-test. Results: Of Phonophoresis and standard therapy can reduce knee pain. More pain occurs in phonophoresis. Conclusion: Phonophoresis can be selected as a therapy to reduce pain in people with osteoarthritis

DEVELOPMENT STRATEGY OF PHARMACY DEPARTEMENT BASED ACCREDITATION EVALUATION IN RSUD Dr MOEWARDI SURAKARTA BY HANLON METHOD

Getting excellent service is the dream of all society, especially recipients of health services in the hospital including in pharmacy departement. Many problems obtained by the patient, because services do not meet the standards. To meet the needs of the patient, pharmacy departement must be accredited. The purpose this study was to determine the suitability of pharmacy departement service to accreditation standards in RSUD Dr Moewardi Hospital Surakarta and development strategy based on Hanlon method. The research was a non experimental research plan. The data collected by using a self-assessment questionnaire of pharmacy care standards. The respondents consisted of key informant was the Hospital Director, Sub Division Head of Human Resources and Training, Head of Organization and Personnel, and the pharmacist in charge, and key informants that pharmacists and pharmaceutical technical employee in pharmacy installation hospital, and the main informant were all pharmacists and pharmacy technical staff of pharmacy installation hospital in Dr Moewardi Hospital Surakarta. From the results count of respondent of pharmacy installation officers, equalled with observation result. The processing of research data conducted with Hanlon method. The results showed that was difference in accreditation standard assessment between self-assessment of pharmacy installation hospital staff (97,5%) with the observation results (93,75%). From this result, the pharmacy installation of Dr Moewardi Surakarta had to meet KARS accreditation standards but still need to be maximized again to lead to JCI accreditation standard. Therefore, it was needed the commitment of Director, Accreditation Committee, Stakeholders and pharmacy installation hospital staffs in improving services in accordance with standards. Strategy and plan development efforts could be done through the addition of pharmacy staff, provision of space/place which meet the standards, complete SOP, optimal pharmaceutical care and evaluated and followed up

PENGARUH N-ASETIL SISTEIN ORAL TERHADAP PENURUNAN HsCRP PADA PASIEN PENYAKIT GINJAL KRONIS STADIUM V YANG MENJALANI CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)

Inflammation and oxidative stress are risk factors of cardiovascular diseases among chronic kidney disease patients. There is increasing of HsCRP level in stage V CKD patients wih CAPD. N-Acetyl Cysteine(NAC) is a compounds containing thiol with antioxidant and anti-inflammatory effects. This research obejectives was to examine the effect of oral NAC in the decline of HsCRP level in stage V CKD patients with CAPD. This is an experimental research with Randomized Double Blind Control Trial, involving 30 patients CKD with CAPD Dr Moewardi Hospital and complete inclusion and exclusion criteria, divided 15 patients as a control group (placebo) and 15 patients as a treatment group of oral NAC. Examination of data research variables have been performed before and after 8 weeks treatment. The results were the level of HsCRP in control group before treatment and after treatment (15,76±42,79 vs 16,50±30,63). Level of HsCRP in treatment group before treatment and after treatment (29,53±76,52 vs 4,56±12,85) was decrease statistically significant with p< 0,05. The N-Acetyl Cysteine orally can decreased the level of HsCRP in stage V CKD patients with CAPD. Keywords : N-Acetyl Cysteine , CAPD, HsCRP

Oral N-Acetyl Cysteine Lowered IL 6 Level Among Stage V Chronic Kidney Disease Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

Background. IL 6 level is increased in stage V CKD patients on CAPD. N-Acetyl Cysteine is a compound containing thiol with antioxidant and anti-inflammatory effects. Objective. To examine the effect of oral NAC on IL 6 level in stage V CKD patients on CAPD. Method. An experimental research with Randomized Double Blind Control Trial, involving 30 CKD patients on CAPD in Dr Moewardi Hospital. They were divided into control group/placebo (15 patients) and oral NAS treatment group (15 patients). IL 6 level was measured before and after 8 weeks of treatment. Result. Level of IL 6 before and after treatment in control group were (8.13 + 7.62 vs 11.16 + 8.32 , p= 0,001), significantly (p<0,001). Level of IL 6 before and after treatment in treatment group were (9.72 + 7.29 vs 6.09 + 3.82, p = 0,002); lowered significantly (p<0,05). Conclusion. Oral NAC lowered the level of IL 6 in stage V CKD patients on CAPD.

Faktor Yang Mempengaruhi Kejadian BBLR (Berat Badan Lahir Rendah) Di Ruang Perawatan Intensif Neonatus RSUD DR Moewardi Di Surakarta

Abstract: Low Birth Weight, Age, Hypertension. Weight is one health indicator of the newborn. In basic, infants with low birth weight of less than 2500 grams have a greater risk of health problems which cause by many factor like hypertension, anemia, asthma, a history of low birth weight, birth spacing, parity, antepartum haemorrhage, rupture prematures, and placenta previa. The purpose of this study to determine the factors that influence the incidence of low birth weight in neonatal intensive care units of DR Moewardi Hospital. This study design was retrospective descriptive analytic approach in low birth weight infants in the neonatal intensive care unit of DR Moewardi Hospital in January to March 2016. The sampling technique using total sampling. The inclusion criteria low birth weight infants in the neonatal intensive care DR. Moewardi Hospital, mothers who gave birth low birth weight in DR Moewardi Hospital, low birth weight babies referrals from outside hospitals DR Moewardi accompanied by her mother who participated to DR Moewardi Hospital. Exclusion criteria mothers with low birth weight babies and low birth weight infants who died. Analysis data with frequency distribution and bivariate using Chi Square test. The age (p=0.021), hypertension (p=0.049), parity (p=0.024), antepartum haemorrhage (p=0.049), eclampsia (p=0,049), rupture prematures (p=0.031) was associated with low birth weight. Anemia (p=0.737) bronchial asthma (p=0.362), a history of low birth weight (p=0.554), birth spacing (p=0.680), placenta previa (p=0.258) was not associated with low birth weight. Age, hypertension, parity, antepartum haemorrhage, eclampsia and rupture prematures associated with low birth weight

Pengaruh Pendidikan Kesehatan Terhadap Upaya Pencegahan Hipoglikemia Pada Pasien Diabetes Mellitus Di Ruang Intensive RSUD DR. Moewardi Surakarta Tahun 2016

Abstract: Hypoglycemia, Health Education, Knowledge, Patient. Hypoglycemia is one of the complications faced by people with diabetes mellitus, ie blood glucose levels fall below 50 to 60 mg / dl. Hypoglycemia may occur acutely, suddenly and can be life-threatening. Management of diabetes mellitus one of them is health education, especially about complications, namely Hypoglycemia. The objectives of this study were 1) to identify the level of knowledge of diabetes mellitus patients about prevention of hypoglycemia prior to health education 2) to identify the knowledge level of diabetes mellitus patients about hypoglycemia prevention after health education 3) to analyze knowledge change about prevention of hypoglycemia in patients with diabetes mellitus before and after the provision of health education in the intensive space of Dr Moewardi Hospital in 2016. This research type is experimental with pre-experimental design, variable approach using pre and post test designs method and data analysis used is Paired T-Test. The result of this research is there is influence of health education toward prevention effort of hypoglycemia in patient of diabetes mellitus in intensive room of Dr Moewardi Hospital 2016. This is proved by Paired T-Test test analysis on the value of knowledge before and after given health education obtained t count = -19,090, whereas t table value 2,042 so value -t arithmetic &lt;-t table (-19,090 &lt;-2,042) and sig. 0.000 (&lt;0.05) then Ho is rejected and Ha accepted, meaning there is a significant difference between the value of knowledge before and after being given health education about hypoglycemia. There is an influence of health education on prevention of hypoglycemia in people with diabetes mellitus in intensive space Dr Moewardi Hospital in 2016.

The Effect of Self-Efficacy, Family Support, and Socio-Economic Factors on the Quality of Life of Patients with Breast Cancer at Dr. Moewardi Hospital, Surakarta

Background :Breast cancer is the highest cancer among women in the world. Patients with breast cancer experience various changes, including physical, psychological and social changes. This changes affect their quality of life. This study aimed to determine the effect of self-efficacy, family support, and socio-economic factors on health-related quality of life of patients with breast cancer. Subjects and Method : This was an analytic observational study with cross sectional design. The study was conducted at Dr Moewardi Hospital, Surakarta. A total of 63 patients with breast cancer diagnosis were selected for this study by purposive sampling. The dependent variable was health-related quality life, consisting of global health status, physical function, role function, emotional function, social function, fatigue, pain, body image, financial hardship, and future perspective. The independent variables were self-efficacy, family support, education, and family income. The data were collected by questionnaire and medical record, and then were analyzed by multiple logistic regression. Results : Average age (and standard deviation) of the breast cancer patients under study was 50.21±7.67 years. Average score of quality of life in the global health status dimension was  73.81±10.97. Multiple logistic regression analysis showed positive effect of self-efficacy (OR=3.45;95% CI=0.98 to 12.12; p=0.053), family support (OR=2.67; 95%CI=0.84 to 8.46; p=0.096), education (OR=3.99; 95%CI=1.15 to 13.79; p=0.028), and family income (OR=1.51; 95%CI=0.43 to 5.26; p=0.518) on global health status. Conclusion :Self-efficacy, family support, education, and family income have positive and significant effects on global health status. Keywords : self-efficacy, family support, social economy, quality of life, breast cancer Correspondence: Lusiatun. Masters of Public Health, Sebelas Maret University, Surakarta. Email: lusiatun12@gmail.com. Mobile: 085743778941 Journal of Epidemiology and Public Health 2016, 1(3): 182-194 https://doi.org/10.26911/jepublichealth.2016.01.03.05