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Background: Stroke is a syndrome characterized by loss of focal and function of the rapidly developing CNS. Furthermore, hypertension is a known risk factor that occurs approximately 70% of the time, and lowering systolic BP from 1 to 3 mmHg effectively reduces the risk of stroke by 20 to 30%. Methods: An observational analytic design, using a retrospective medical record data collection in Malang City Hospital. A total of 113 patients met the inclusion criteria. In addition, the inclusion criteria include hospitalized patients with a primary diagnosis of stroke, ischemia or bleeding as evidenced by a head CT scan, having comorbid hypertension, and having received antihypertensive therapy. Meanwhile, the exclusion criteria were the BP data of the patient measured only once. Results: The results showed the ability of antihypertensive monotherapy and combinations to lower systolic BP by 33.62 ± 30.15 mmHg and 30.50 ± 29.47 mmHg (p = 0.744) in ischemic patients. In comparison, diastolic BP decreased by 6.86 ± 13.18 mmHg and 11.50 ± 16.26 mmHg (0.291), respectively. Moreover, the administration in bleeding stroke patients resulted in a decrease to 16.95 ± 17.89 mmHg and 22.82 ± 23.91 mmHg, (p = 0.029) for systolic, and 8.63 ± 14.63 mmHg and 8.71 ± 17.17 mmHg (p = 0.647) for diastolic BP, respectively. Furthermore, a combination of 4 antihypertensives drugs showed a better decrease in systolic BP in both patients (44.50 ± 21.63) compared to monotherapy, and a mixture of 2 as well as three drugs, by 27.02±27.05, 25.65 ± 29.97, and 25.37 ± 25.08 (p = 0.027), respectively. Conclusions: Combination therapy is recommended in stroke patients because BP can be better controlled.

Objective: This study aims to compare the effectiveness of hyperkalemia drug combinations in reducing potassium levels in chronic kidney disease (CKD) patients. Methods: This is an observational study on medical records of CKD patients with hyperkalemia at Dr. Saiful Anwar and Lavalette Hospitals, Malang, Indonesia. From 2017 to 2019, 78 hyperkalemia correction data were obtained from 47 patients’ medical records. The hypothesis test used in this study was the one-way ANOVA test. Results: Drug combinations of calcium gluconate, Actrapid® HM, and D40% (∆p = 0.62 mmol/L); calcium gluconate, Actrapid® HM, D40%, and Ventolin® Nebules (∆p = 0.72 mmol/L); and calcium gluconate, NovoRapid®, and D40%® (∆p = 1.03 mmol/L) were able to significantly reduce serum potassium levels (p < 0.05). A drug combination of calcium gluconate, Humulin® R, and D40% (∆p = 0.84 mmol/L) was also able to reduce serum potassium levels but not statistically significant (p > 0.05). The comparison test results of the four groups of drug combinations showed that no combination of drugs was superior to others in lowering potassium levels (p > 0.05). Conclusions: The four groups of hyperkalemia drug combinations can reduce the patient’s serum potassium level and have the same effectiveness.

Caring merupakan “heart” profesi dari keperawatan, fenomena di Rumah Sakit mengindikasikanadanya kecenderungan perawat tidak caring dalam memberikan asuhan keperawatan kepada pasien.Keadaan ini berdampak pada kualitas asuhan keperawatan yang pada akhirnya mempengaruhikepuasan pasien terhadap pelayanan keperawatan khususnya dan pelayanan kesehatan padaumumnya. Penelitian ini bertujuan untuk mengetahui hubungan perilaku caring perawat dengankepuasan pasien di ruang perawatan umum penyakit dalam RSUD Palembang BARI Tahun 2016. Jenispenelitian ini deskriptif analitik dengan pendekatan cross sectional, tehnik pengambilan sampel dengankuota sampling berjumlah 78 responden. Penelitian ini dilakukan pada tanggal 23 April sampai 06 Mei2016. Hasil penelitian menunjukan bahwa 51,3% pasien menyatakan perilaku caring perawat baik,56,4% pasien menyatakan puas dengan perilaku caring perawat dan didapatkan ada hubungan yangbermakna antara perilaku caring perawat dengan kepuasan pasien di ruang rawat inap dengan nilai pvalue 0,000. Disarankan bagi RSUD Palembang BARI penelitian ini diharapkan dapat dijadikan sebagaibahan masukan dan evaluasi untuk meningkatkan pelayanan asuhan keperawatan terutama tentangcaring perawat.

Hiperurisemia adalah kondisi ketika kadar asam urat dalam darah melebihi nilai normal. Terdapat banyak faktor yang memengaruhi peningkatan kadar asam urat, seperti obesitas, konsumsi tinggi purin, dan pengobatan. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara obesitas, konsumsi tinggi purin, dan pengobatan terhadap kadar asam urat dengan penggunaan allopurinol pada pasien hiperurisemia. Data diperoleh melalui rekam medis dan kuesioner dari RSUD Dr. Saiful Anwar, Malang, dan dengan studi potong melintang. Pengambilan sampel dilakukan selama satu bulan (April–Mei 2014). Data dianalisis secara deskriptif dan diuji hipotesis. Sampel penelitian ini adalah 45 pasien hiperurisemia yang memperoleh allopurinol sebagai terapinya selama satu bulan dan pasien dipilih dengan metode pengambilan sampel konsekutif. Hasil dari penelitian ini menunjukkan bahwa tidak terdapat hubungan komparasi yang bermakna secara statistik antara kadar asam urat terhadap obesitas (0,193), konsumsi tinggi purin yaitu makanan laut (0,420), daging (0,469), jerohan (0,054), dan polong-polongan (0,398) juga pengobatan yaitu furosemid (0,631), aspirin dosis rendah (0,773), hidroklorotiazid (0,216), dan spironolakton (0,246). Selain itu, tidak pula terdapat korelasi yang bermakna secara statistik antara kadar asam urat terhadap obesitas (0,197), konsumsi tinggi purin yaitu makanan laut (0,426), daging (0,476), jerohan (0,053), dan polong-polongan (0,404) juga pengobatan yaitu furosemid (0,637), aspirin dosis rendah (0,776), hidroklorotiazid (0,220), dan spironolakton (0,250). Kata kunci: Allopurinol, asam urat, penghambat xantin oksidase Associations between Obesity, High Purine Consumptions, and Medications on Uric Acid Level with the Use of Allopurinol in Hyperuricemia Patients Hyperuricemia is a condition when the blood uric acid level exceeds the normal amount. There are many factors that can increase the uric acid level, such as obesity, high purine consumptions, and medications. The aim of this study was to determine the associations between obesity, high purine consumptions, and medications on uric acid level with the use of allopurinol in hyperuricemia patients. Data were collected through medical records and questionnaires from General Hospital of Dr. Saiful Anwar, Malang, and delivered within a cross-sectional study. Sampling was conducted for one month (April–May 2014). Data were analyzed descriptively and tested hypothetically. The samples of this study were 45 hyperuricemia patients who had gotten allopurinol as their therapy for a month and they were choosen by the consecutive sampling method. The results of this study showed that there were no statistically significant comparative association between uric acid level on obesity (0.193), high purine consumptions i.e. seafoods (0.420), meats (0.469), organ meats (0.054), and pods (0.398) also medications i.e. furosemide (0.631), low dose aspirin (0.773), hydrochlorotiazide (0.216), and spironolactone (0.246). In particular, there were no statistically significant correlations between uric acid level on obesity (0.197), high purine consumptions i.e. seafoods (0.426), meats (0.476), organ meats (0.053), and pods (0.404) also medicines i.e. furosemide (0.637), low dose aspirin (0.776), hydrochlorotiazide (0.220), and spironolactone (0.250). Keywords: Allopurinol, uric acid, xanthin oxidase inhibitor

NTA (Nekrosis Tubular Akut) merupakan sindrom GGA (Gagal Ginjal Akut) intrinsik karena kondisi iskemia atau paparan agen nefrotoksik. Hal tersebut menyebabkan banyak sel tubulus mengalami kematian dan menurunkan fungsi tubulus sehingga berakibat GGA. Proses peroksidasi lipid dapat menyebabkan NTA dan dihasilkan radikal bebas malondialdehida (MDA) yang dapat merusak fungsi sel. Minyak kelapa sawit dengan kandungan senyawa antioksidan mampu memperbaiki kondisi NTA dengan menghambat proses peroksidasi lipid sehingga kadar MDA menurun. Minyak kelapa sawit dengan pembawa kitosan dalam bentuk mikrosfer memungkinkan peningkatan bioavaibilitas minyak kelapa sawit sehingga dapat menembus ginjal. Studi experimental post-test only controlled group design dilakukan pada 24 Mus musculus yang terbagi dalam 6 kelompok yaitu kontrol positif (KP), kontrol negatif (KN), kelompok mikrosfer kitosan minyak kelapa sawit dosis 0,072 mg/gBB (P1) dan dosis 0,107 mg/gBB (P2), serta kelompok minyak kelapa sawit dosis 0,14 mg/gBB (P3) dan dosis 0,21 mg/gBB (P4). Variabel yang diukur adalah kadar MDA menggunakan metode spektrofotometri (Na-TBA). Hasil menunjukkan kadar MDA dari yang tertinggi sampai yang terendah berturut-turut adalah KP, P1, P2, P3, P4, dan KN. Kelompok KN, P2, P3, dan P4 memiliki perbedaan yang signifikan dengan KP (p < 0,001) sementara kelompok KP, P1, P2, P3, dan P4 memiliki perbedaan yang signifikan dengan KN (p < 0,001). Penelitian ini menunjukkan bahwa mikrosfer kitosan minyak kelapa sawit dapat menurunkan kadar MDA Mus musculus yang mengalami NTA pada dosis mikrosfer minyak kelapa sawit sebesar 0,107 mg/gBB. Kata kunci : LMWC, Malondialdehida, Mikrosfer, Minyak Kelapa Sawit, Nekrosis Tubular Akut, Peroksidasi Lipid

Diabetes melitus (DM) dengan glukosa darah yang tidak terkontrol dapat memicu pembentukan radikal bebas yaitu produk malondialdehida (MDA) di hepar. Radikal bebas tersebut dapat diturunkan menggunakan senyawa antioksidan (timokuinon). Timokuinon terkandung dalam biji Nigella sativa . Produk herbal sering mengalami kegagalan efikasi akibat rendahnya bioavailabilitas. Oleh karena itu, dilakukan terobosan baru yaitu formulasi ekstrak biji Nigella sativa dengan sistem penghantaran nanopartikel PLGA. Penelitian ini dillakukan untuk mengetahui pengaruh nanopartikel PLGA dalam memperbaiki efektivitas ekstrak biji jintan hitam dalam menurunkan produk radikal bebas berupa malondialdehida (MDA) di hepar tikus model DM tipe 2. Desain penelitian adalah true experimental posttest-only controlled design. Sebanyak 24 tikus yang diinduksi DM tipe 2 menggunakan streptozocin, kemudian dibagi menjadi empat kelompok yaitu kelompok yang diberi akuades dan pakan normal tanpa terapi (P n ), glibenklamid 0,45 mg/kgBB (P p ), non-nanopartikel ekstrak biji Nigella sativa 48 mg/kgBB/hari (P 1 ), dan nanopartikel PLGA ekstrak biji Nigella sativa 48 mg/kgBB/hari (P 2 ) selama 26 hari. Data dianalisis menggunakan uji hipotesis Kruskal Wallis. Untuk mengetahui kadar MDA digunakan metode asam tiobarbiturat. Rerata kadar MDA dari yang terendah adalah P 2 (0,3652±0,0363 ng/mL), P 1 (0,3749±0,0242 ng/mL), P n (0,4084±0,0719 ng/mL), dan P p (0,4329±0,0588 ng/mL). Terdapat perbedaan kadar MDA hepar tikus model DM tipe 2 yang tidak berbeda bermakna pada semua kelompok perlakuan (Kruskal Wallis, p = 0,199). Hasil penelitian ini masih belum dapat menunjukkan kemampuan nanopartikel PLGA Nigella sativa dalam menurunkan radikal bebas MDA di hepar. Kata kunci: malondialdehida hepar, nanopartikel PLGA, Nigella sativa .

Diabetes Melitus (DM) merupakan masalah yang banyak terjadi di negara berkembang, salah satunya adalah di Indonesia.DM tipe 2 ditandai dengan keadaan resistensi insulin yang dapat terjadi karena penurunan sintesis dan translokasi GLUT-4 ke permukaan sel, hal tersebut disebabkan oleh hambatan aktivitas AMPK di jaringan otot karena produksi TNF-α yang berlebihan. Biji jintan hitam mengandung thymoquinone yang memiliki aktivitas sebagai antiinflamasi. Penelitian ini bertujuan untuk mengetahui efek ekstrak biji jintan hitam terhadap konsentrasi GLUT-4 di jaringan otot. Desain penelitian ini adalah true experimentaldengan sampel 25 ekor tikus putih jantan strain Wistar model DM tipe 2 yang dibagi ke dalam 5 kelompok yaitu kontrol negatif (10% tween 80), kontrol positif (metformin 75 mg/kgBB), 3 kelompok mendapat ekstrak biji jintan hitam dengan dosis yang berbeda (24 mg/kgBB, 48 mg/kgBB, dan 96 mg/kgBB). Induksi DM tipe 2 dilakukan selama 2 bulan dengan menggunakan pakan tinggi kalori yang mengandung 10% lemak babi dan 20% sukrosa serta injeksi STZ 30 mg/kgBB, lalu dilakukan terapi selama 1 bulan. Konsentrasi GLUT-4 diukur dengan menggunakan ELISA, hasilnya tidak terdapat perbedaan konsentrasi GLUT-4 yang signifikan antar kelompok (ANOVA, p > 0,05).

The obesity prevalence in the world continues to increase yearly, which further cause clinical problems related to metabolic syndrome and lipid peroxidation. This study aims to determine the effect of ß-glucan extract from oyster mushrooms on lipid peroxidation markers, namely serum MDA levels in rats. Therefore, Sprague dawley rats were divided into four groups, namely the KN group, which was fed with AIN-93M standard diet, the KP group was given the AIN-93M modified HFHF diet, the PI group was fed with AIN-93M modified HFHF + ß-glucan diet 125 mg/kgBW, and the P2 group was given the AIN-93M modified HFHF + ß-glucan diet 375 mg/kgBW. The ß-glucan detection test in oyster mushroom extract used an FTIR spectrophotometer, while the content analysis used the Mega-Calc™ from Megazyme, and also, the MDA levels were determined through the TBARS method. Furthermore, based on FTIR spectrum results, it was proven that oyster mushroom extract contained ß-glucan. The provision of HFHF diet for 14 weeks caused the rats to be pre-obese, resulting in lipid peroxidation due to the free radicals induction. The average Fee index rats at the end of treatment were 294.00 + 6.40 (KN), 292.78 + 6.37 (KP), 291.85 + 9.60 (PI), and 286.88 + 10.60 (P2), with a p value of 0.687. Meanwhile, the average serum MDA level (ng/mF) obtained were 507.833 + 35.95 (KN), 504.184 + 29.17 (KP), 540.397 + 29.80 (PI), and 553.996 + 86.78 (P2), with a p value of 0.001. The values of serum MDA levels that were statistically significant were KN vs P2, KP vs P1, KP vs P2, and P1 vs P2. These results showed that the dose and duration of ß-glucan administered were not sufficient to prevent the lipid peroxidation process.

Low-dose aspirin (75-100 mg/day) is a long-term platelet antiaggregation therapy for certain coronary heart disease (CHD) patients. This study aims to evaluate the long-term use of aspirin on kidney function by examining the changes in the levels of serum creatinine, blood urea nitrogen (BUN), and creatinine clearance of CHD patients. The research method used was a prospective observational cohort analysis. The number of study subjects was 37 CHD patients who took 80 mg/day of aspirin and never experienced kidney disease. Serum creatinine and BUN levels were examined in the 1st and 3rd month of the study. Patient creatinine clearance values were calculated using the Cockcroft-Gault equation. The results of the study showed that the mean levels of serum creatinine, BUN, and creatinine clearance on the 1st and 3rd month were 1.03 ± 0.27 mg/dL and 1.03 ± 0.29 mg/dL; 13.05 ± 4.10 mg/dL and 14.65 ± 4.44 mg/dL; 73.16 ± 18.14 mL/min and 72.92 ± 19.76 mL/min, respectively. The paired t-test results showed that the differences in the mean of creatinine serum, BUN, and creatinine clearance on the 1st and 3rd month were not statistically significant (p > 0.05). The One Way ANOVA test results on the effect of the duration of aspirin use on kidney function were also not statistically significant (p > 0.05) however there is a tendency to decrease creatinine clearance and increase in serum creatinine and BUN. Long-term use of low-dose aspirin has the potential to cause a decrease in kidney function that is seen from a decrease in creatinine clearance as well as an increase in serum creatinine and BUN.

Aspirin adalah terapi antiplatelet standar untuk penyakit jantung dan pembuluh darah. Aspirin dapat memberikan efek antiplatelet melalui asetilasi siklooksigenase di platelet sehingga menimbulkan hambatan pembentukan platelet yang permanen. Namun, aktivitas antiplatelet pada setiap individu dapat bervariasi. Penelitian di luar Indonesia memperkirakan sekitar 5 sampai 45% dari populasi tidak memperoleh efek antiplatelet yang adekuat dari aspirin. Penelitian tentang resistensi aspirin belum pernah dilakukan di RS Indonesia. Penelitian ini dilakukan untuk melihat prevalensi resistensi aspirin dan mengetahui faktor-faktor yang dapat memengaruhi resistensi aspirin pada pasien penyakit jantung koroner dengan komorbid hipertensi menggunakan metode agregasi platelet optik. Penelitian ini menggunakan studi potong lintang dengan melibatkan 43 pasien di Rumah Sakit Dr. Soetomo Surabaya selama bulan Juni 2012. Hasil penelitian menunjukkan tidak diperoleh pasien dengan resistensi aspirin dan hanya dua (4,7%) pasien termasuk aspirin semirespon. Respon pasien penyakit jantung coroner (PJK) dengan komorbid hipertensi terhadap aspirin sebagai antiplatelet masih bagus. Diperlukan penelitian serupa dengan sampel yang lebih besar pada pasien PJK disertai dua atau lebih komorbid. Selain itu, diperlukan penelitian lanjutan untuk mengetahui genotipe diantara pasien yang memberikan respon bagus dan pasien yang memberikan respon kurang terhadap aspirin. Kata kunci: Agregasi platelet, hipertensi, penyakit jantung koroner, resistensi aspirin Aspirin Resistance in Coronary Artery Disease with Hypertensive Patients Aspirin is gold standard for antiplatelet therapy in cardiovascular treatment today. It exerts its antiplatelet effect by acetylation of the platelet cyclooxygenase, resulting in an irreversible inhibition of plateletdependent thromboxane formation. However, aspirin has been shown to have variable antiplatelet activity in individual patients. Previous studies estimated that 5% to 45% of population do not achieve an adequate antiplatelet effect from aspirin. Studies about aspirin resistance have never been done in Indonesian hospitals. This study was initiated to investigate the prevalence of aspirin resistance and influencing factors of aspirin resistance in coronary artery disease with hypertensive patients by using an established method of optical platelet aggregation. Fourty three patients were involved in this study. The sampling of this cross sectional study was conducted at Dr. Soetomo Hospital Surabaya in June 2012. Of the patients studied, there were no aspirin resistant and only 2 (4.7%) were aspirin semiresponders. It can be concluded that coronary artery disease patients with hypertension to aspirin as antiplatelet agent were good. Similar research is needed to be conducted with more sample sizes in coronary artery disease patients with two or more comorbid. In addition, further research is needed to determine genotyping between good or poor patient’s respond to aspirin. Keywords: Aspirin resistance, coronary artery disease, hypertensive, platelet aggregation

Chemotherapy has immunosuppressive side effects, one of which is neutropenia. In neutropenia, fever often occurs as a manifestation of infection. Antibiotics are given in neutropenia condition to prevent complication of infection. The aim of this study was to investigate the role of different prophylactic antibiotics on the increase of Absolute Neutrophil Count (ANC), duration of fever, and degree of improvement in ANC values in cancer patients with fever neutropenia. This study was an observational with quantitative descriptive analyses. Data were taken from medical records for the period January 2015 to December 2016. The sample size that met the inclusion criteria was 45 patients including 15 using ceftriaxone-gentamicin, 8 using ceftriaxone, 16 using ceftazidime-ciprofloxacin, and 6 using ceftazidime. The results showed a significant difference in the increase ANC values for different antibiotics (p = 0.001). However, the administration of different antibiotics did not provide a significant difference in the mean duration of fever (p = 0.341). Administration of different antibiotics was known to give a degree of improvement in the same ANC value (p = 0.711). The conclusion of this study was that the administration of different antibiotics in post-chemotherapy neutropenia fever patients has a significant influence on the ANC value where the type of antibiotic that has the highest influence is a combination of ceftazidime-ciprofloxacin.