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"Saat ini penanganan osteomielitis kronis masih merupakan masalah dalam bidang orthopaedi. Debridemen dan pemberian antibiotika merupakan penatalaksanaan yang dianut. Seringkali antibiotika yang diberikan secara oral maupun parenteral tidak dapat mencapai lokasi infeksi dengan baik. Para ahli mengembangkan pemberian antibiotika lokal dalam bentuk antibiotic beads. Antibiotic beads yang terdapat dipasaran saat ini sangat mahal, sehingga kami mencoba membuat antibiotic beads sendiri dengan menggunakan bahan aktif ceftriakson. Ceftriaxone impregnated beads dibuat dengan mencampur 2 gram bubuk ceftriakson dan 40 gram polimetilmetakrilat secara steril. Ukuran beads 3x5 mm. Digunakan 30 ekor kelinci jantan yang masing-masing dilakukan induksi osteomielitis pada tulang radius kirinya dengan menggunakan kuman Staphylococcus aureus. Pada minggu ke-4 dilakukan pemeriksaan klinis, radiologis, biakan kuman dan histopatologis untuk membuktikan adanya osteomielitis. Selanjutnya dibagi menjadi tiga kelompok dengan jumlah setiap kelompoknya sepuluh kelinci. Kelompok pertama hanya dilakukan debridemen. Kelompok kedua debridemen diikuti pemberian ceftriakson intravena. Kelompok ke-3 debridemen diikuti pemberian ceftriakson intravena dan ceftriaxone impregnated beads. Setelah empat minggu kembali dievaluasi secara klinis, radiologis, biakan kuman dan histopatologis. Pada kelompok pertama, kejadian osteomielitis pada akhir empat minggu terapi adalah 60% (angka keberhasilan 40%). Pada kelompok kedua, angka kejadian osteomielitis setelah pengobatan adalah 20% (angka keberhasilan 80%). Sedangkan kejadian osteomielitis setelah empat minggu pengobatan pada kelompok ketiga adalah 0% (angka keberhasilan 100%). Kesimpulan: kombinasi antibiotik sistemik dengan ceftriaxone impregnated beads lebih efektif dari antibiotik sistemik. (Med J Indones 2005; 14: 157-62).

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Up to now, orthopaedic management of chronic osteomyelitis is still problematic. Debridement and antibiotic administration is still a widely practiced management. However, oral or parenteral antibiotics often cannot reach the infection site well. Some experts have developed a system to administer local antibiotic in the form of antibiotic beads. Antibiotic beads on the market are still very expensive. Therefore, we made efforts to make our own antibiotic beads by using Ceftriaxone as the antibiotic. Ceftriaxone impregnated beads were made by mixing 2 grams of Ceftriaxone powder with 40 grams of polymethyl methacrylate (PMMA) bone cement sterilely. The size of the beads was 3 x 5 mm. Thirty male rabbits that were induced to get osteomyelitis by inoculating Staphylococcus aureus to their left radius bones were used. In the fourth week, clinical, radiological, histological examination and bacterial culture were performed to prove the presence of osteomyelitis. Then, the samples were divided into 3 groups of ten. The first group only underwent debridement. The second group underwent debridement followed by intravenous Ceftriaxone administration. The third group underwent debridement followed by intravenous Ceftriaxone and Ceftriaxone-impregnated beads administration. After four weeks, clinical, radiological, histological examination and bacterial culture were repeated. In the first group, the incidence rate of osteomyelitis at the end of the fourth week of therapy was 60% (success rate 40%). In the second group, after four weeks of therapy the incidence rate of osteomyelitis after treatment was 20% (success rate 80%), whereas that of the third group was 0% (success rate 100%). In conclusion, the efficacy of combination of systemic antibiotic therapy and ceftriaxone impregnated beads in the therapy of chronic osteomyelitis is better than systemic antibiotic therapy. (Med J Indones 2005; 14: 157-62)."

"[ABSTRAKPendahuluan: Sel punca mesenkimal (SPM) sebagai salah satu alternatif terapi kasus sulit dapat diperoleh dari jaringan adiposa. Kemampuan SPM dalam rekayasa jaringan membutuhkan prosedur implantasi SPM yang aman dan bebas kontaminasi. Tindakan minimal invasive pada kasus cedera medulla spinalis dengan terapi implantasi SPM dapat menyebabkan sel tersebut terpajan radiasi sinar-x c-arm. Viabilitas dan waktu penggandaan populasi (WPP) merupakan salah satu komponen utama keberhasilan prosedur implantasi tersebut. Penelitian ini bertujuan mengetahui efek pajanan sinar-x c-arm terhadap viabilitas dan WPP SPM.Metode: Penelitian ini adalah penelitian eksperimental SPM jaringan adiposa pasca cryopreservation. Sel punca pasca thaw dan propagasi kemudian dilakukan pajanan radiasi sinar-x dengan c-arm. Sel punca kemudian di kultur untuk menilai viabilitas dan waktu penggandaan populasi. Uji Generalized Linear Model untuk menilai perbedaan viabilitas antara besar dosis radiasi. Uji Spearman menilai korelasi perbedaan viabilitas kelompok pasca-radiasi, dan pasca radiasi dan kultur. Uji Kruskall-Wallis menilai WPP kelompok pasca-radiasi antara masing-masing besar dosis. Uji Wilcoxon menilai WPP antara kelompok pre-radiasi dengan kelompok pasca-radiasi.Hasil: Waktu konfluensi kultur sel pasca radiasi rata-rata 4.33 hari. Rerata perbedaan viabilitas antara besar dosis radiasi tidak terdapat perbedaan yang bermakna secara statistik (p>0.05). Didapatkan korelasi positif viabilitas pasca radiasi dengan besar dosis radiasi namun tidak bermakna secara statistik (p>0.05) namun didapatkan korelasi negatif viabilitas pasca radiasi dan kultur dengan besar dosis radiasi dan bermakna secara statistik. Tidak didapatkan perbedaan bermakna median WPP antara kelompok pre-radiasi dan pasca-radiasi (p>0.05) dan perbedaan WPP diantara kelompok pasca radiasi (p>0.05).Kesimpulan: Tidak terdapat perbedaan secara statistic viabilitas dan WPP SPM jaringan adiposa pasca pajanan radiasi sinar-x c-arm sampai sampai dosis radiasi 32.34 mSv.

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ABSTRACTIntroduction. The use of adipose tissue derived mesenchymal stem cells (MSCs)in tissue engineering require implantation procedure that is safe and free of contamination. Minimally invasive procedure in the case of spinal cord injury using a c-arm device for MSC implantation causes x-ray exposure to the implanted cells. Viability and population doubling time (PDT) is a major component of the success of the implantation procedure. This study aims to determine the effect of c-arm x-ray exposure on MSC viability and PDT.Methods. This was an experimental study that used cryopreserved adipose tissue derived MSCs. Cells were thawed, propagated, and exposed to varying doses of c-arm x-ray radiation. Stem cell viability was measured, and then the cells were cultured to assess their PDT. Generalized linear models test was used to compare cell viability between post-thaw, post-propagation, post-radiation, post-culture post-radiation, and control and between radiation dose groups. Kruskal-Wallis test assessed PDT between various radiation doses in post-radiation groups. Wilcoxon test assessed PDT between pre-radiation and post-radiation groups.Results. Mean confluence period of adipose MSCs post radiation was 4.33 days. There was no statistically significant difference in MSC mean viability after exposure to x-ray radiation between each group and control (p>0.05). There was no significant positive correlation between post radiation viability and radiation dose (p > 0.05), however, there was significant negative correlation between post radiation post culture viability and radiation dose. There were no significant differences in PDT between pre- and post-culture post radiation groups and between various radiation doses in post-radiation groups (p>0.05).Conclusion. No statistical differences in MSC viability and PDT after x-ray radiation exposure of c-arm up to 32.34 mSv;Introduction. The use of adipose tissue derived mesenchymal stem cells (MSCs)in tissue engineering require implantation procedure that is safe and free of contamination. Minimally invasive procedure in the case of spinal cord injury using a c-arm device for MSC implantation causes x-ray exposure to the implanted cells. Viability and population doubling time (PDT) is a major component of the success of the implantation procedure. This study aims to determine the effect of c-arm x-ray exposure on MSC viability and PDT.Methods. This was an experimental study that used cryopreserved adipose tissue derived MSCs. Cells were thawed, propagated, and exposed to varying doses of c-arm x-ray radiation. Stem cell viability was measured, and then the cells were cultured to assess their PDT. Generalized linear models test was used to compare cell viability between post-thaw, post-propagation, post-radiation, post-culture post-radiation, and control and between radiation dose groups. Kruskal-Wallis test assessed PDT between various radiation doses in post-radiation groups. Wilcoxon test assessed PDT between pre-radiation and post-radiation groups.Results. Mean confluence period of adipose MSCs post radiation was 4.33 days. There was no statistically significant difference in MSC mean viability after exposure to x-ray radiation between each group and control (p>0.05). There was no significant positive correlation between post radiation viability and radiation dose (p > 0.05), however, there was significant negative correlation between post radiation post culture viability and radiation dose. There were no significant differences in PDT between pre- and post-culture post radiation groups and between various radiation doses in post-radiation groups (p>0.05).Conclusion. No statistical differences in MSC viability and PDT after x-ray radiation exposure of c-arm up to 32.34 mSv, Introduction. The use of adipose tissue derived mesenchymal stem cells (MSCs)in tissue engineering require implantation procedure that is safe and free of contamination. Minimally invasive procedure in the case of spinal cord injury using a c-arm device for MSC implantation causes x-ray exposure to the implanted cells. Viability and population doubling time (PDT) is a major component of the success of the implantation procedure. This study aims to determine the effect of c-arm x-ray exposure on MSC viability and PDT.Methods. This was an experimental study that used cryopreserved adipose tissue derived MSCs. Cells were thawed, propagated, and exposed to varying doses of c-arm x-ray radiation. Stem cell viability was measured, and then the cells were cultured to assess their PDT. Generalized linear models test was used to compare cell viability between post-thaw, post-propagation, post-radiation, post-culture post-radiation, and control and between radiation dose groups. Kruskal-Wallis test assessed PDT between various radiation doses in post-radiation groups. Wilcoxon test assessed PDT between pre-radiation and post-radiation groups.Results. Mean confluence period of adipose MSCs post radiation was 4.33 days. There was no statistically significant difference in MSC mean viability after exposure to x-ray radiation between each group and control (p>0.05). There was no significant positive correlation between post radiation viability and radiation dose (p > 0.05), however, there was significant negative correlation between post radiation post culture viability and radiation dose. There were no significant differences in PDT between pre- and post-culture post radiation groups and between various radiation doses in post-radiation groups (p>0.05).Conclusion. No statistical differences in MSC viability and PDT after x-ray radiation exposure of c-arm up to 32.34 mSv]"

"[ABSTRAKPendahuluan: Tatalaksana osteomielitis dengan debridement, guttering, pemberian antibiotika sistemik sering tidak mencapai hasil yang memuaskan dikarenakan antibiotik tidak dapat mencapai lokasi infeksi dengan baik. Cara lain dengan pemberian antibiotik lokal untuk mencapai lokasi infeksi dalam bentuk beads dinilai tidak efektif karena memerlukan 2 kali operasi. Kombinasi antibiotik lokal dengan scaffolding berupa hidroxyapatite (HA) porous yang dapat diserap dan pembawa antibiotik belum pernah diteliti.Metode penelitian: Dilakukan uji pre test post test kelompok kontrol pada model kelinci osteomielitis. Sepuluh ekor kelinci New Zealand digunakan dengan berat 2.500-3500 gr yang dibagi kedalam 2 kelompok yaitu kelompok kontrol dan kelompok perlakuan (n=5). Dilakukan penyuntikan bakteripada tulang tibia kelinci, setelah terbentuk model osteomielitis kemudian dilakukan perlakuan. Untuk kelompok kontrol dilakukan debridement dan diberikan injeksi antibiotik ceftriaxon selama 4 minggu dan kelompok perlakuan dilakukan debridement, diberikan kombinasi HA dan Gentamisin serta injeksi antibiotik ceftriaxon selama 4 minggu. Setelahnya dilakukan penilaian klinis, x- ray, kultur dan histopatologis.Temuan dan Diskusi: Secara radiologis ditemukan perbaikan skor penebalan kortek tibia pada kelompok perlakuan dibanding kelompok kontrol (p=0.48), begitu juga pada Histopatological osteomyelitis evaluation score (p=0,009). Secara klinis terdapat perbaikan skor pembengkakan pada semua (n=5) kelompok perlakuan dibanding dengan kelompok kontrol, namun secara statistik tidak bermakna (p=0,053). Sementara pada penilaian kultur tidak ditemukan perbedaan bermakna antar kedua kelompok (p=1,00)Kesimpulan: Kombinasi Hydroxyapaptite porous dan gentamisin sebagai antibiotik lokal pada pengobatan model osteomielitis tibia kelinci memberikan perbaikan skor radiologis, histopatologis dan perbaikan klinis dibanding dengan prosedur standar pengobatan oseomielitis kronis yang sudah ada.

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ABSTRACTIntroduction. Treatment of osteomyelitis with debridement, guttering, systemic antibiotics often do not achieve satisfactory results due to the antibiotic can not reach the infection site. Another way of local antibiotic delivery to reach the site of infection in the form of beads is considered ineffective because it requires two separate surgeries. Local antibiotic combined with scaffold in the form of porous hidroxyapatite that can be absorbed and antibiotics cariere have not been studied.Methods. We conducted pretest and posttest control group in a rabbit model of osteomyelitis. Ten rabbits divided in control group and the treatment group (n=5). We injected Staphylococcus aureus in the rabbit tibia, forming the osteomyelitis model, and then performed treatment for osteomyelitis. In the control group, we performed debridement and gave ceftriaxone injection for 4 weeks. Whereas in the treatment group, we add the combination of porous hidroxyapatite and Gentamicin. Afterwards, we did clinical assessment, x-ray, culture, and histopathology.Results and discussion. Radiologically, tibia cortical thickening scores improved in the treatment group compared to the control group (p=0.48) as well as histopatological osteomyelitis evaluation score (p=0,009). Clinically, there were improvements in the swelling scores (n=5) of the treatment group compared to control group, but no significant statistically (p=0.053). In culture, there were no significant difference between the two groups (p=1.00).Conclusion. Combination of porous hydroxyapaptite and gentamycin as a local treatment of osteomyelitis of the rabbit tibial osteomyelitis models improved radiological and histopathological scores and also clinically compared to existing standard treatment procedures for chronic osteomyelitis., Introduction. Treatment of osteomyelitis with debridement, guttering, systemic antibiotics often do not achieve satisfactory results due to the antibiotic can not reach the infection site. Another way of local antibiotic delivery to reach the site of infection in the form of beads is considered ineffective because it requires two separate surgeries. Local antibiotic combined with scaffold in the form of porous hidroxyapatite that can be absorbed and antibiotics cariere have not been studied.Methods. We conducted pretest and posttest control group in a rabbit model of osteomyelitis. Ten rabbits divided in control group and the treatment group (n=5). We injected Staphylococcus aureus in the rabbit tibia, forming the osteomyelitis model, and then performed treatment for osteomyelitis. In the control group, we performed debridement and gave ceftriaxone injection for 4 weeks. Whereas in the treatment group, we add the combination of porous hidroxyapatite and Gentamicin. Afterwards, we did clinical assessment, x-ray, culture, and histopathology.Results and discussion. Radiologically, tibia cortical thickening scores improved in the treatment group compared to the control group (p=0.48) as well as histopatological osteomyelitis evaluation score (p=0,009). Clinically, there were improvements in the swelling scores (n=5) of the treatment group compared to control group, but no significant statistically (p=0.053). In culture, there were no significant difference between the two groups (p=1.00).Conclusion. Combination of porous hydroxyapaptite and gentamycin as a local treatment of osteomyelitis of the rabbit tibial osteomyelitis models improved radiological and histopathological scores and also clinically compared to existing standard treatment procedures for chronic osteomyelitis.]"

"Hingga saat ini Angka Kesakitan dan Angka Kematian di Indnonesia yang disebabkan oleh Pneumonia masih tinggi terutama pada usia balita. Pneumonia termasuk sepuluh penyakit terbanyak di Rawat inap RSU Kabupaten Tangerang yang membutuhkan antibiotika untuk infeksinya menggunakan Ceftriaxone atau Cefotaxime. Efektifitas biaya penggunaan obat tersebut perlu diteliti untuk mengetahui antibiotika yang lebih efektif biaya. Penelitian menggunakan data sekunder, diambil secara cross sectional selama Januari - Desember 2010 di Rawat Inap RSU Kabupaten Tangerang. Analisa biaya Investasi disetahunkan (Annual Investment Cost), menggunakan metoda ABC (Activity Based Costing) untuk analisis biaya. Hasil Penelitian didapat bahwa komponen biaya terbesar pada pengobatan Pneumonia Balita adalah Biaya Operasional, yaitu sekitar 99 % dari Biaya Total, diikuti biaya Pemeliharaan 0,02 % dan kemudian biaya Investasi 0,01 %. Biaya Obat dan Bahan Habis Pakai merupakan komponen terbesar dari biaya operasional. Pada Ceftriaxone biaya operasional Rp 39.053.526,- dan pada Cefotaxime sebesar Rp. 124.228.339,-. Efektifitas pada Ceftriaxone 29 pasien dan Cefotaxime 85 pasien dengan CER Cefotaxime lebih kecil dari Ceftriaxone berdasarkan hilangnya sesak, frekuensi nafas dan leukosit normal, hilangnya demam dan hari rawat maka disimpulkan bahwa Cefotaxime lebih cost effective dari Ceftriaxone. Disarankan x Universitas Indonesia pengobatan Pneumonia Balita menggunakan Cefotaxime yang bertujuan untuk efektifitas, efesiensi dan pengendalian biaya dapat terwujud.

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Until now the Morbidity Rate and Mortality Rate due to pneumonia in Indonesia would remain high, especially under 5 years old. Pneumonia disease into ten largest in Hospitalizations RSU Tangerang Regency, they need antibiotics to cure infections, such as Ceftriaxone or cefotaxime. Cost effectiveness of theme need to be investigated to find out and determine the effective and efficience. Research conducted using secondary data in crosssectional taken during January to December 2010 in the Tangerang Regency Hospital Inpatient. Annualized investment cost analysis, methods of analysis using the method of the cost calculation ABC (Activity Based Costing).

Research results indicate that the largest cost component in the treatment of Pneumonia Toddlers are Operating Costs, which is about 99% of the total cost, followed by a maintenance cost of 0.02% and then 0.01% of the investment cost. Cost of Drugs and consumables is the largest component of operating costs. At the operational costs of Rp 39.053.526,- Ceftriaxone, - and on cefotaxime at Rp 124.228.339,-. Effectiveness on Ceftriaxone was 29 patients and 85 patients on cefotaxime. CER Ceftriaxone smaller than Cefotaxime values obtained by the loss of tightness, breathing frequency and leukocyte return to normal values, fever and loss of day care is also concluded that the use of Cefotaxime more cost effective than Ceftriaxone. Thus in the treatment of Pneumocystis Toddlers xii Universitas Indonesia are expected to use cefotaxime aiming for effectiveness, efficiency and cost control can be realized."

"ABSTRAKNama : Echa AisyahProgram Studi : Ilmu Kesehatan MasyarakatJudul : Evaluasi Ekonomi Penggunaan Antibiotika Profilaksis CefotaximeDan Ceftriaxone Pada Pasien Operasi Seksio Sesarea Di RumahSakit X Tahun 2017Pemberian antibiotik profilaksis pada operasi seksio sesarea sangat dianjurkan.Menurut pedoman umum penggunaan antibiotik obat dipilih atas dasar keamanan danefektivitas biaya. Evaluasi ekonomi ini menggunakan metode alongside observationalstudy, data dikumpulkan selama bulan April ndash;Mei 2017 secara prospektif mencakup 60pasien dengan operasi seksio sesarea yang mendapatkan antibiotik profilaksis,membandingkan efektivitas biaya antara Cefotaxime dan Ceftriaxone. Hasil ujistatistik menunjukkan bahwa tidak ada perbedaan karakteristik pada 60 pasien tersebut.Analisis menggunakan perspektif rumah sakit, dilaksanakan di rumah sakit milikPemerintah di Jawa Barat. Hasil Systematic Review menunjukkan bahwa tidak adaperbedaan efikasi pada penggunaan kedua obat tersebut. Hasil penelitian inimenkonfirmasi bahwa tidak ada perbedaan outcome klinis berupa infeksi luka operasibaik pada pasien yang mendapatkan antibiotik profilaksis Ceftriaxone maupunCefotaxime. Komponen biaya terbesar adalah biaya operasional 84,79 , diikutibiaya alokasi dari unit penunjang 13,68 , lalu biaya investasi 1,2 dan biayapemeliharaan 0,32 . Analisis memberikan hasil biaya inkremental sebesar Rp.342.535,00 pada satu episode rawat inap. Rumah sakit memiliki potensi untukmenghemat sebesar Rp. 317.529.945,00 setahun dengan memilih antibiotik profilaksisCefotaxime pada pasien operasi seksio sesarea.Kata Kunci : Antibiotik Profilaksis; Operasi Seksio Sesarea; Efektivitas Biaya.

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ABSTRACTName Echa AisyahProgram of Study Public HealthTitle Economic Evaluation on The Use of Prophylaxis AntibioticCefotaxime and Ceftriaxone in Caesarean Section SurgeryPatients at X Hospital in The Year 2017.Prophylactic antibiotic for patients with caesarean section surgery is highlyrecommended in the clinical guideline. The use of antibiotics is selected by usingcriteria safety and cost effectiveness. This economic evaluation was using alongsideobservational study method, prospective data was collected from April to May 2017covering 60 patients with cesarean section surgery who received prophylaxisantibiotics, comparing cost effectiveness between Cefotaxime and Ceftriaxone. Thestatistical test showed that there was no differences of characteristics in the 60 patients.The analysis based on hospital perspective, carried out in a public hospital in WestJava. The Systematic Review showed that there were no difference in the efficacy ofthe drugs. This study confirmed that there was no difference in clinical outcome onsurgical wound infections either in patient who received Ceftriaxone prophylaxis orCefotaxime. The greatest component of the cost was the operational cost 84,79 ,followed by the indirect cost 13,68 , investment cost 1,2 , and maintenance cost 0,32 . The analysis suggested the incremental cost was IDR 342.535 in one episodeof treatment. Hospital would save cost of IDR 317.529.945 a year by choosingCefotaxime prophylactic antibiotics for patients with cesarean section surgery.Keywords Prophylaxis Antibiotic Cesarean Section Surgery Cost Effectiveness"

"The chief complain of chronic peripheral arterial occlusion disease is intermittent clodication, or calf pain during exercise that is relieved by resting. As the disease advances, pain occurs even during resting. The main cause for this disease is atherosclerosis.Clinical evaluation of patients comprise of questionnaire, exploration of atherosclerosis risk factors such as smoking, hyperlipidemia, diabetes mellitus, hypertension, etc. Pulse examination, ankle-brachial pressure index (ABPl) measurements and leg segmenta! blood pressure assessments are integral examinations in such patients. Another important test is functional assessments using the treadmill, or other tests to cause hyperemia.The chief management is to prevent common morbidity and mortality due to atherosclersosis such as coronary heart disease and its complications, as well as cerebrovascular disease and its complications. Management is also targeted towards preventing the progress of peripheral arterial occlusion disease.Specific management for peripheral arterial occlusion disease that is clearly beneficial to improve symptoms is physical exercise. Drugs such as pentoxyphylline, naftidrofuryl, buflomedil, and cilostazol are of little benefit only. Aspirin is useful to prevent cardiovascular, but is useless to improve symptoms.Prior to offering interventional procedures (angiopfasty and for stent insertion) or surgery, the following issues should be contemplated: I) the patient does not respond to physical exercise and risk factor modification, b) there is severe disability, c) there is no longer other disease that limits activity, and d) the morphology of the lesion is in line with the intervention, with a low risk and high probability for initial and long-term success"