Abstrak: Tujuan: Mediastinitis pascabedah BPAK adalah komplikasi yang jarang namunmematikan. Tujuan penelitian ini adalah mengetahui determinan dan sistem skoringmediastinitis pascabedah BPAK.Metode: Studi kohort retrospektif yang melibatkan 706 pasien operasi BPAK di RSUPNDr. Cipto Mangunkusumo dari Januari 2011 hingga Desember 2017. Definisimediastinitis disesuaikan dengan definisi CDC infeksi kasus spesifik, yangmelatarbelakangi resternotomi debridement. Terdapat delapan faktor risiko yangberpotensi mediastinitis dalam analisa univariate.Hasil: Dari 706 pasien BPAK, terjadi insiden mediastinitis sebanyak 35 pasien. Lima daridelapan variable tersebut bertahan dalam analisa multivariate yaitu diabetes mellitusdengan OR sebesar 4.46 (IK95% = 2,01-9,89), IMT ≥ 26,5 kg/m2 dengan OR 3,34(IK95% =1,61-6,97) dan lama operasi ≥ 300 menit dengan OR 3,43 (IK95=1,67-7,04), usia≥60 tahun dengan OR 2,01 (IK 95%=0,97-4,19), dan pemedahan ulang karena perdarahandengan OR sebesar 3,10 (IK 95%= 0,94-10,27).Kesimpulan: Determinan utama yaitu diabetes mellitus, obesitas, usia, lama operasi danpembedahan ulang karena perdarahan.Kata kunci: bedah pintas arteri koroner; determinan mediastinitis.

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Abstrak: Berdasarkan laporan WHO 2013, kasus TB ekstra paru di Indonesia mengalami peningkatan dari 14.054 tahun 2012 menjadi 15.697 tahun 2013. Salah satu rumah sakit yang mencatat adanya peningkatan kasus TB ekstra paru adalah RSUPN Dr. Cipto Mangunkusumo Jakarta sehingga, penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang berhubungan dengan TB ekstra paru pada pasien rawat inap TB di RSUPN Dr. Cipto Mangunkusumo Jakarta tahun 2011-2013.Penelitian ini menggunakan rekam medis dengan desain studi kasus kontrol. Sampel penelitian ini meliputi kasus yaitu, pasien rawat inap TB ekstra paru tahun 2011-2013 serta kontrol yaitu, pasien rawat inap TB paru tahun 2011-2013 dengan rekam medis yang tercatat lengkap.Hasil penelitian menunjukkan proporsi kasus TB ekstra paru tertinggi berdasarkan organ terjangkit adalah TB tulang dan sendi sebesar 60%. Setelah TB ekstra paru dihubungan dengan beberapa variabel, umur < 25 tahun (OR: 19,36; 95% CI: 4,90-76,44) dan 25-50 tahun (OR: 4,40; 95% CI: 1,42-13,62), riwayat DM (OR: 0,08; 95% CI: 0,02-0,37) dan riwayat hipertensi (OR: 0,17; 95% CI: 0,03-0,81) secara statistik memiliki hubungan bermakna dengan TB ekstra paru, tetapi riwayat DM dan riwayat hipertensi menjadi faktor proteksi terhadap TB ekstra paru.Oleh karena itu, perlu dilakukan penelitian lanjutan terkait faktor-faktor yang berperan terhadap TB ekstra paru, memberikan perhatian khusus kepada pasien yang lebih berisiko dalam diagnosis, serta promosi kesehatan kepada masyarakat agar lebih menyadari bahwa TB dapat menyerang organ lain selain paru-paru yang akan berdampak serius jika tidak ditangani segera, khususnya mereka yang termasuk kelompok berisiko.

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Based on the WHO report 2013, extra-pulmonary TB cases in Indonesia have increased from 14.054 in 2012 to 15.697 in 2013. One of hospitals which get an increase of extra-pulmonary TB cases is National Center General Hospital Dr. Cipto Mangunkusumo Jakarta, so, this study ultimately aims to identify risk factors that associated with extra-pulmonary TB to TB hospitalized patients in National Center General Hospital Dr. Cipto Mangunkusumo Jakarta 2011-2013.This study is using medical records with the design of case-control study. Samples of this study include the case is extra-pulmonary TB hospitalized patients 2011-2013 while control is pulmonary TB hospitalized patients in 2011-2013. Both case and control must have complete medical records.The results showed that the highest proportion of extrapulmonary TB cases by an affected organ is tuberculosis of bones and joints by 60%. After connecting extra-pulmonary TB with several variables, age < 25 years (OR: 19,36; 95% CI: 4,90-76,44) and 25-50 years (OR: 4,40; 95% CI: 1,42-13,62), history of diabetes (OR: 0,08; 95% CI: 0,02-0,37) and history of hypertension (OR: 0,17; 95% CI: 0,03-0,81), they statistically had significant association with extra-pulmonary TB, but a history of diabetes mellitus and a history of hypertension be protective factors against extra-pulmonary TB.Therefore, it is advisable to do further research related to the factors that contribute to extra-pulmonary TB, giving special attention to patients who are more at risk in making the diagnosis, and doing health promotion to the public to be more aware that TB can affect other organs beside the lungs that would have a serious impact if it is not treated promptly, especially for the risky ones

Abstrak: Hasil. Median kesintasan lama rawat intensif 43 jam. Nilai skor EuroSCORE tidak memenuhi asumsi hazard proporsional. Model baru telah dibuat dari 7 variabel EuroSCORE yang secara substansi berhubungan dengan lama rawat intensif (AUC 0,67). Kesimpulan. Model baru dari tujuh faktor EuroSCORE cukup dapat memprediksi lama rawat intensif 48 jam. Kata Kunci: Model prediksi, lama rawat intensif, bedah jantung, regresi Cox

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Abstrak: HIV/AIDS berdampak kepada peningkatan kerentanan terkena infeksi penyakitlain yang berujung kepada kematian. Menurut UNAIDS, Indonesia termasuk kedalam daftar negara dengan kematian akibat AIDS tidak mengalami penurunan ataulaju penurunannya kurang dari 25%. Penelitian ini merupakan penelitian observasional, dengan desain cross sectional yang bertujuan untuk mengetahui gambaran kejadian dan faktor atau determinan utama yang berhubungan dengan kematian berkaitan AIDS pada pasien HIV/AIDS di unit rawat inap Rumah SakitCipto Mangunkusumo pada tahun 2008-2012. Sampel penelitian ini sebanyak 207pasien. Data pasien diambil dengan memanfaatkan data rekam medis pasien untukmelihat variabel independen yang terdiri dari jenis kelamin, umur, pekerjaan, kadarCD4, faktor risiko penularan, jumlah penyakit yang diderita, status gizi, riwayatgangguan syaraf pusat, riwayat konsumsi obat ARV, dan kondisi psikologis untuknantinya dihubungkan dengan status kematian pasien HIV/AIDS. Analisis datadilakukan hingga analisis multivariat dengan model prediksi. Hasil penelitianmenunjukkan bahwa kematian AIDS sebesar 28,5%. Dari hasil analisis multivariatdidapatkan 4 variabel yang berhubungan dengan kematian AIDS, yaitu status gizikurang dari normal (OR=4,75) dengan 95% CI (2,278-9,917), riwayat gangguansyaraf pusat (OR=1,82) dengan 95%CI (1,025-3,251), jumlah penyakit yang dideritalebih dari 5 penyakit (OR=4,09) dengan 95%CI (1,854-9,043), dan kadar CD4. KadarCD4 menjadi faktor paling berpengaruh terhadap kematian AIDS dengan nilai ORsebesar 5,9 dengan 95%CI 2,096-17,106. Dari hasil penelitian ini dapat direkomendasikan upaya peningkatan awarenessakan pentingnya kontrol kadar CD4 darah untuk pasien HIV/AIDS dan upaya pendukung lainnya untuk mencegah kematian AIDS seperti peningkatan kualitas gizi pasien AIDS, skrining dan deteksidini gangguan syaraf pusat, dan pencegahan komplikasi penyakit. Kata kunci: HIV/AIDS, Kematian, kadar CD4, determinan utama

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HIV/AIDS impact to increased susceptibility to other diseases infections whichlead to death. The death of AIDS is also a problem, especially in Indonesia.According to UNAIDS, Indonesia is included in the list of countries where deathsfrom AIDS do not decline or rate of less than 25% of his descent. This research isobservational research, design with cross sectional. This research aims to know thedescription and the main factors which related to mortality of AIDS HIV/AIDS ininpatient unit RSUPN Dr Cipto Mangunkusumo in 2008-2012. The sample of thisresearch are 207 patients. Data collected by utilizing the patient's medical record datato see the independent variables consisted of gender, age, job, CD4 levels, risk factorsof transmission, the amount of illness suffered, nutritional status, history of centralnervous disorders, drug consumption history ARV consumption, and psychologicalconditions to be linked with the status of a patient's death related with HIV/AIDS.The data analysis done to multivariate analysis with prediction model. The resultsshowed that the AIDS death prevalence reach up to 28.5%. The results ofMultivariate analysis obtained 4 variables related to the death of AIDS, poornutritional status (OR=4,75) with 95% CI (2,278-9,917), central nervous disorderhistory (OR=1,82) with 95% CI (1,025-3,251), the number of illnesses suffered morethan 5 disease (OR=4,09) with 95% CI (1,854-9,043), and CD4 levels. CD4 levelsbecame the most influential factors towards AIDS deaths with a value of 5, 9 OR and95% CI (2,096-17,106). From the results can be recommended the efforts toincreased awareness toward control CD4 blood levels for HIV/AIDS patients andother supporting efforts to prevent deaths of AIDS such as improved quality ofnutrition AIDS patients, screening and early detection of central nervous disorders,and prevention of complications of the disease.Keywords: HIV/AIDS, Death, CD4 level, main determinant

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Hospital admissions and mortality due to pneumonia increased during the COVID-19 pandemic, both due to COVID-19 and other pathogens, Thus, risk factors need to be identified. The research was conducted to simultaneously analyze the relationship between various biological, lifestyle, environmental and health service determinants on the survival rate of pneumonia patients during the COVID-19 pandemic. This research uses mixed methods design. First, a quantitative retrospective cohort study was performed using cox regression analysis, interaction analysis was carried out using stratification and multiplication methods. Simple random sampling was done from medical records list of pneumonia patients who were treated during the COVID-19 pandemic in May 2020December 2021 at Dr. Cipto Mangunkusumo Hospital, Jakarta. Second, a sequential explanatory qualitative study was performed with a case study design. Information was collected through in-depth interviews of six informants to explain the dynamics of health determinants and inpatient survival from a hospital resilience perspective. There were 1945 subjects, the incidence of mortality during hospitalization was 34.1%. Biological determinants associated with an increased risk of mortality were initial conditions of severe pneumonia (HR 1,8; CI95% 1,38-2,43), CCI score ≥2 (HR 1,5; CI95% 1,16-2,08), complications ≥2 (HR 5,9; 95%CI 2,9-11,9), the trend of inpatient mortality increases with increasing age. The risk of death was lower in subjects with primary infection of organs other than the lungs (HR 0,4; 95% CI 0,35-0,51). Determinants of health care that are associated with an increased risk of death are intubation (HR 1,6; 95% CI 1,27-2,05) and waiting time in the ER ≥8 hours (HR 1,4; 95% CI 1,12-1,63), mortality risk was lower in subjects who received intensive care (HR 0,3;95%CI 0,25-0,41), anticoagulant therapy (HR 0,3;95%CI 0,27-0,44) and steroid therapy in severe non-COVID-19 pneumonia (0,7; 95%CI 0,5-0,9). In COVID-19 pneumonia subjects, the risk of death during hospitalization was lower if they received empiric antibiotics (HR 0,4; 95%CI 0,26-0,58), anticoagulant therapy (HR 0,3; 95%CI 0,23-0,4), and antiviral therapy (HR 0,4;95% CI 0,3-0,5). Steroids (HR 0,4; CI95% 0,3-0,6), convalescent plasma therapy (HR 0,2; CI95% 0,08-0,57), and anti-interleukin-6 therapy (HR 0,7; IK95% 0,46-1,03) reduces the risk of inpatient death in severe COVID-19 pneumonia. Hospital resilience is maintained by having zoning policies, implementing risk mitigation principles, and modulating services according to the principle of proportionality. Hospital networks help reduce financial burdens through providing donations or grants. Hospital vulnerabilities include the fragility of infrastructure, slower process of return to regular services, fearness among health workers and pre-hospital triage not adequately performed. There was no interaction between the pneumonia etiology variable and the surge phase of cases, and there was no interaction between the pneumonia etiology variable and the length of stay in the ER. Biological, environmental and health service determinants are associated to the inpatient survival rate of pneumonia during the COVID-19 pandemic. Hospital resilience needs to be assessed by looking at the impact of the pandemic on mortality from COVID-19 pneumonia and non-COVID-19 pneumonia. Management of the surge capacity due to the COVID-19 pandemic needs to consider zoning principles, proportional service modulation, psychological readiness of health workers, financial condition of hospitals, and infrastructure readiness. Prehospital triage is an external factor that helps improve hospital resilience. Keywords : Pneumonia; COVID-19; Pandemic; survival; hospital resilience