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"The management of failure case resulting form mummification treatment Signs of successful treatment folloewing mummification are the absence of clinical complaints, the formation of secondary cement, and no periapical pathosis present. Treatment about amputation the infected pulp, which has been devitalized in the pulp chamber and leaving the necrotic pulp tissues in root canal is no longer in accordance with treatment tenet now a day. The remaining necrotic tissues is a focus of infection capable of disturbing biologic healing of tissues. Three cases of root canal treatment following pulp mummification which has been done causes complaints from discomfort to severe pain and the infections spread to periapical tissue in 2, 10, and 22 years afterwards. The results of the treatment are good and periapical radiolucency shawing signs of diminution and disappearance. Evaluation on each case was done in 3 months, 6 months and 2 years after the root canal treatment."

"Praktik klinik residensi keperawatan medikal bedah pada pasien gangguan sistem kardiovaskular bertujuan untuk mengaplikasikan peran sebagai perawat spesialis yang meliputi pemberi asuhan keperawatan, edukator, peneliti dan inovator. Peran pemberi asuhan keperawatan dilakukan dengan menggunakan pendekatan teori Virginia Henderson pada pasien NSTEMI Non ST-Elevasi Miokard Infark very high risk dan AHF Advance Heart Failure serta 30 pasien lainnya dengan berbagai gangguan sistem kardiovaskular. Peran edukator dilakukan tidak hanya terhadap pasien kelolaan, tetapi juga rekan sejawat di ruangan. Aplikasi peran sebagai peneliti dilakukan melalui penerapan EBN berupa penilaian kualitas tidur pasien gagal jantung dengan instrumen RCSQ Richard Campbell Sleep Questionnaire pada empat puluh responden pasien gagal jantung sebagai bentuk pengkajian awal terhadap kualitas tidur pasien yang dijadikan data untuk perencanaan intervensi keperawatan. Sedangkan peran perawat sebagai inovator diwujudkan dalam pelaksanaan program inovasi pembuatan dan penerapan format discharge planning perencanaan pemulangan pasien yang dapat digunakan sebagai alat bantu bagi perawat dalam memaksimalkan asuhan dan perencanaan pemulangan pasien, terutama pasien dengan kriteria pemulangan kritis.

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Clinical residency practice of medical surgical nursing on cardiovascular system disorders rsquo patients was done to applied the role of nurse specialist as a care giver, educator, researcher and innovator. Nursing role as a care giver have been done with Virginia Henderson theory approach on NSTEMI very high risk and AHF patient, also on thirty different cases on cardiovascular disorders. The role asa an educator not only done on patients, but also give education for nurses. As a researcher, EBN implementation sleep quality assessment of 40 heart failure patient with RCSQ Richard Campbell Sleep Questionnaire instrument, as an initial assessment and can be used to make nursing care plan and administer optimal nursing intervention. Role as an innovator a design and use of discharge planning form assessment that can be used as tools to optimalized nursing care and discharge planning process, especially for critical discharge patients."

"We describe a case report of giant sialolith of Wharton's duct in a 46 years old man. This is an unusual presentation of a salivary calculus and to our knowledge such a huge salivary stone. The clinical symptoms and signs were somewhat typical and included acute supurative cellulites in the floor. This kind of stone is very interesting because of its large size in this case of a surgical intervention by extra-oral extirpation of the presented sialolith."

"Latar belakang: Pada era intervensi koroner perkutan primer (IKKP), angka kematian akibat infark miokard akut dengan elevasi segmen ST (IMA-EST) berhasil ditekan. Peningkatan angka sintasan tersebut berbanding dengan peningkatan insiden gagal jantung. Proses remodeling pascamiokard infark yang belum sepenuhnya dihambat oleh standar terapi saat ini akan berujung pada kondisi gagal jantung. Doksisiklin sebagai anti-matriks metaloproteinase (MMP) menunjukkan hasil yang baik dalam mencegah proses remodeling. Biomarker remodeling merupakan surrogate dini yang baik untuk memprediksi kejadian remodeling. Namun, efek doksisiklin terhadap biomarker remodeling dan luaran klins pasien IMA-EST belum diketahui.Tujuan: Penelitian ini bertujuan untuk mengetahui efek doksisiklin terhadap penurunan kadar biomarker remodeling pascainfark miokard.Metode: Penelitian ini menggunakan desain uji klinis tersamar tripel. Pasien IMA-EST dengan keterlibatan anterior atau Killip 2-3 dengan onset kurang dari 12 jam yang menjalani IKKP terbagi acak kedalam grup yang mendapat doksisiklin 2x100 mg selama 7 hari sebagai tambahan dari standar terapi dan grup dengan standar terapi. Pemeriksaan biomarker (netrofil, hs-Troponin T, hs-CRP, NT-pro BNP) dilakukan saat admisi rumah sakit dan evaluasi intraperawatan. Ekokardiografi dilakuan saat admisi dan hari ke-5 untuk menilai dimensi dan fungsi ventrikel kiri.Hasil: Terdapat 94 subyek yang diikutkan dalam penelitian dan terbagi rata ke dalam kedua grup. Karakteristik demografis dan klinis kedua grup homogen. Grup doksisiklin menujukkan nilai netrofil jam ke-24 yang lebih rendah dibanding grup kontrol (69,1±5,8% vs 71,9±8,0%, p=0,049). Peningkatan hs-Troponin T didapatkan lebih rendah pada kelompok dengan onset lebih dari 6 jam yang mendapatkan doksisiklin, namun tidak pada grup kontrol. Insiden gagal jantung 11,3% lebih rendah pada grup doksisiklin. Perbaikan fraksi ejeksi signifikan didapat pada grup doksisiklin dibanding grup kontrol (4,5±10,4% vs 0,3±10,3%, p=0,05). Peningkatan tersebut lebih besar pada pasien dengan onset lebih dari 6 jam dengan rerata peningkatan 5,9% (95%IK 0,05-11,7%, p=0,048).Kesimpulan: Doksisiklin memiliki efek perbaikan biomarker remodeling ventrikel, terutama netrofil dan hs-troponin T, serta fraksi ejeksi ventrikel kiri. Jumlah insiden gagal jantung lebih rendah pada grup doksisiklin.

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Background: In era of primary percutaneous coronary intervention (PPCI), mortaliry rate was reduced significantly. The increament in survival rate was followed by increament in heart failure cases. Cardiac remodelling after myocardial infarction was not fully anticipated by current therapy hence the patent would suffer for hear failure. Doxycycline as antimatrix metaloproteinase (MMP) inhibitor showed a promising results in modulation cardiac remodelling. Cardiac biomarkers for remodelling are surrogate parameters for early indentifying of remodelling. However, the effect of doxycyline to cardiac remodelling and its clinical implication are unknown.

Objective: To determine the effect of doxycycline on cardiac remodelling biomarkers after myocardial infarction.

Methods: We conducted triple blinded-randomized control trial. Patients with STEMI anterior or with Killip class 2-3 who underwent PPCI were randomly assigned to doxycycline (100 mg b.i.d for 7 days) in addition to standard therapy or to standar care. Cardiac remodelling biomarkers (neutrophils, hs-Troponin T, hs-CRP, NT-proBNP) were obtained on admission and during hospitalization. Echocardiography were assessed on admission and at 5 days to evaluate left ventricle dimmension and function.

Results: There were 94 patients assigned into doxycycline and control group. Baseline demographics and clinical characteristics were comparable between 2 groups. Doxycycline group showed lower percent neutrophils at 12 hours compare to control group (69.1±5.8% vs 71.9±8.0%, p=0.049). hs-Troponin T changes were lower in patients with onset >6 hours who received doxycycline and there were no differences among control group. Heart failure incidence was 11.3% lower in doxycycline group to control group. The improvement of left ventricle ejection fraction was sifnificantly higher in doxycycline group than in control group (4.5±10.4% vs 0.3±10.3%, p=0.05). The imrpovement was even higher in those with onset >6 hours with mean increament of 5.9% (95%CI 0.05-11.7%, p=0.048).

Conclusion: Doxycycline had effect in improving cardiac remodelling biomarkers, ie percent neutrophils and hs-Troponin T and left ventricle ejection fraction. Incidence of heart failure was lowe in doxycycline group."

"Self-care pasien gagal jantung merupakan fokus utama strategi non farmakologi dalam menurunkan angka morbiditas, mortalitas, rehospitalisasi dan meningkatkan kualitas hidup. Kemampuan self-care pasien jantung masih rendah. Penelitian ini bertujuan untuk mengenali faktor yang berhubungan dengan kemampuan self-care pasien gagal jantung. Penelitian ini merupakan penelitian kuantitatif dengan desain deskriptif analitik dengan pendekatan cross sectional yang melibatkan 132 responden. Analisa data menggunakan analisis deskriptid, uji Chi Square dan regresi logistik. Hasil penelitian menunjukkan bahwa sebagian besar responden memiliki kemampuan self-care maintenance yang tidak adekuat, tetapi memiliki kemampuan self-care monitoring dan self-care management yang adekuat. Karakteristik sosisodemografik responden menunjukkan bahwa sebagian besar dewasa akhir yang berumur 46-65 tahun, laki laki, berpendidikan tinggi, penghasilan yang cukup; dan secara karakteristik klinis memiliki derajat gagal jantung kelas fungsional NYHA 2, FEVki > 50 %, lama sakit > 3 tahun dan memiliki ko-morbid ringan. Sebagian besar responden memiliki tingkat pengetahuan baik, efikasi diri adekuat, tidak depresi dan dukungan pelaku rawat di keluarga yang adekuat. Terdapat hubungan yang signifikan antara derajat gagal jantung, lama sakit, ko-morbid dan efikasi diri dengan kemampuan self-care maintenance, dimana derajat gagal jantung adalah faktor yang paling dominan. Terdapat hubungan yang bermakna antara derajat gagal jantung, ko-morbid, pengetahuan dan dukungan pelaku rawat di keluarga dengan kemampuan self-care monitoring, dimana faktor yang paling dominan adalah derajat gagal jantung. Terdapat hubungan yang bermakna antara efikasi diri dan dukungan pelaku rawat di keluarga dengan kemampuan self-care management, dimana efikasi diri adalah faktor yang paling dominan. Perlunya dilakukan intervensi keperawatan spesifik terkait gagal jantung pada pasien untuk meningkatkan kemampuan self-care.

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Self-care of heart failure patients is a main focus of non-pharmacological strategies to decrease morbidity, mortality, rehospitalization, and improve quality of life. Self-care ability of heart failure patients is still low. This study aims to identify factors related to self-care ability of patients with heart failure. This is a quantitative study with a descriptive analytic design using a cross sectional approach involving 132 respondents. Data were analyzed using descriptive analytic, Chi Square and logistic regression test. The results showed that most of the respondents have inadequate self-care maintenance, but have adequate self-care monitoring and self-care management abilities. Sociodemographic characteristics indicated that most of the respondents are late adulthood aged 46-65 years, male, have a fairly high income; and clinically characterized by a degree of heart failure NYHA functional class 2, LVEF > 50%, duration of illness > 3 years and have mild co-morbidities. Most of the respondents have a good level of knowledge, adequate self-efficacy, are not depressed and have adequate support from caregivers in their families. There is a significant relationship between the degree of heart failure, duration, co-morbidities and self-efficacy with self-care maintenance ability, whereas the degree of heart failure is the most dominant factor. There is a significant relationship between the degree of heart failure, co-morbidities, knowledge and support of caregivers in the family with the self-care monitoring ability, meanwhile the most dominant factor is the degree of heart failure. There is a significant relationship between self-efficay and caregiver support in the family with self-care management ability, and self-efficacy is the most dominant factor. Specific nursing interventions related to heart failure need to be carried out to improve self-care abilities."

"Acute decompensated heart failure (ADHF) mengacu pada timbulnya gejala dan/atau tanda-tanda gagal jantung yang cepat atau bertahap. Dispnea saat aktivitas adalah salah satu gejala dominan pada klien dengan gagal jantung yang menyebabkan penurunan kualitas hidup klien dengan mengurangi kemandirian/ kemampuan untuk melakukan aktivitas sehari-hari. Tujuan penulisan ini yaitu memaparkan hasil analisis asuhan keperawatan dengan menggunakan penerapan pursed lip breathing dan posisi semi-fowler untuk mengurangi keluhan sesak, menurunkan laju pernapasan, dan meningkatkan saturasi oksigen pada klien dengan ADHF sehingga kemandirian dalam melakukan aktivitas dapat meningkat. Evaluasi dilakukan menggunakan pulse oximetry, perhitungan laju pernapasan selama satu menit, serta perasaan subjektif pada keluhan sesak yang dirasakan klien. Hasilnya, terdapat penurunan laju pernapasan, penurunan keluhan sesak dan peningkatan saturasi oksigen setelah latihan pursed lip breathing dan posisi semi-fowler diimplementasikan. Kesimpulannya, latihan pursed lip breathing dengan posisi semi-fowler terbukti efektif menurunkan laju pernapasan, meningkatkan saturasi oksigen, dan meredakan keluhan sesak napas pada klien dengan ADHF.

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Acute decompensated heart failure (ADHF) refers to the rapid or gradual onset of symptoms and/or signs of heart failure. Dispnea on exertion is one of the dominant symptoms in patients with heart failure which causes a decrease in the patient's quality of life by reducing independence/ability to perform daily activities. The purpose of this paper is to describe the results of the analysis of nursing care using the application of pursed lip breathing and semi-Fowler's position to reduce complaints of shortness of breath, decrease respiratory rate, and increase oxygen saturation in clients with ADHF so that independence in carrying out activities can increase. Evaluation was carried out using pulse oximetry, calculating the respiratory rate for one minute, as well as subjective feelings of shortness of breath felt by the client. As a result, there is a decrease in respiratory rate, a decrease in complaints of shortness of breath and an increase in oxygen saturation after the pursed lip breathing and semi-Fowler position exercises are implemented. In conclusion, the pursed lip breathing exercise in the semi-Fowler position has been shown to be effective in reducing respiratory rate, increasing oxygen saturation, and relieving shortness of breath in clients with ADHF."

"ADHF (Acute decompensated heart failure) merupakan suatu kondisi gagal jantung dengan perubahan mendadak pada jantung untuk berkontraksi, sehingga mengancam nyawa dan dapat menyebabkan edema paru. Gagal jantung dapat dikategorikan menurut nilai ejeksi fraksi, salah satunya heart failure with reduce ejection fracktion (HFrEF) dengan nilai EF ≤40%. Tanda klinis ADHF salah satunya edema pada tungkai. Hal ini terjadi karena kegagalan LV untuk berkontraksi sehingga menyebabkan aliran balik dengan penumpukan cairan diparu, kemudian kembali ke RV dan keluar melalui atrium kanan ke seluruh tubuh, salah satunya ke tungkai. Intervensi yang dilakukan untuk mengatasi edema tungkai yaitu ankle pumping exercise. Intervensi ini dilakukan selama 3 hari dengan frekuensi 10 kali/jam, kemudian dievaluasi selama 6 jam dengan metode pitting edema. Hasil intervensi menunjukkan terdapat perubahan derajat edema tungkai dari +3/+3 menjadi +1/+2. Hasil karya ilmiah ini diharapkan menjadi salah satu alternatif intervensi untuk mengurangi edema tungkai.

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ADHF (Acute decompensated heart failure) is a condition of heart failure with sudden changes in the heart to contract, so it is life threatening and can cause pulmonary edema. Heart failure can be categorized according to the value of the ejection fraction, one of which is heart failure with reduced ejection fracture (HFrEF) with an EF value of ≤40%. One of the clinical signs of ADHF is edema in the legs. This occurs due to the failure of the LV to contract causing backflow with a buildup of fluid in the lungs, then back into the RV and out through the right atrium to the rest of the body, including the legs. The intervention to treat leg edema is ankle pumping exercise. This intervention was carried out for 3 days with a frequency of 10 times/hour, then evaluated for 6 hours using the pitting edema. The results of the intervention showed that there was a change in the degree of leg edema from +3/+3 to +1/+2. The results of this scientific work are expected to be an alternative intervention to reduce leg edema."