Background: Increased blood pressure that occurs in chronic kidney disease (CKD) is influenced by the occurrence of thickening of blood vessels. This study evaluates the utilization of propolis which acts as an anti-inflammatory and vitamin D3 which plays a role in calcium-phosphate metabolism, that when combined are expected to prevent atherosclerosis. Methods: This experimental research used a post-test only group design with a total of 24 male rats divided into 3 groups. Subjects were induced to develop CKD with unilateral ureteral obstruction. A combination of 50mg/kgBW of propolis and 0.126mcg/kgBW of vitamin D3 was given orally every morning in the intervention group. Hemodynamics and atherosclerosis status were observed using sonography until week 4. Inflammatory markers with vascular cell adhesion molecule 1 (VCAM-1) and Caspase-3 were evaluated weekly via plasma and target organ samples were immunohistochemically examined at the study’s end. Results: Propolis and vitamin D3 significantly reduced blood pressure from 156 mmHg at the beginning of the study to 117mmHg at week 4 (p=0.000). Thickening of the aorta occurred in the control and intervention groups but the thickening in the control group (0.90mm) was statistically significantly (p=0.000) higher than the intervention group (0.30mm). There were decreased VCAM-1 and Caspase-3 levels in the intervention group compared to the control group, both in plasma and target organ levels Conclusion: Utilization of propolis and vitamin D3 combined has a good effect on lowering inflammation, improving hemodynamics and preventing atherosclerosis in chronic kidney disease rat models.

<p class="Abstract"><strong><em> ABSTRACT</em></strong></p><p class="TextAbstract"><strong><em>Introduction:</em></strong><em> Diaphragmatic rupture is a major challenge for the radiologist to be confirmed as an emergency diagnosis. The prevalence of the injury is 5% of abdominal blunt force trauma cases. Left-sided injury is more common with left-to-right ratio 3:1. Chest X-Ray is a conventional modality as an early assessment of abdominal trauma and computed tomography is a standard reference to confirm this diagnosis.</em></p><p class="TextAbstract"><strong><em>Case Report:</em></strong><em> A 70 yo man complained about chest pain after falling from 4 meter-height tree. Chest X-Ray revealed bowel gas appearance in the left thorax cavity with no appearance of left diaphragm. Contrasted abdominal CT showed gaster and intestine in the left thorax cavity. The patient underwent left diaphragm thoracotomy confirming the existence of gaster, ileum, and spleen in the pleural cavity. Those organs were returned to the abdomen and the left diaphragm repaired. Following-up after discharge obtained remarkable outcomes.</em></p><p class="TextAbstract"><strong><em>Discussion:</em></strong><em> Confirming the diagnosis of diaphragmatic rupture is a challenge for the radiologist because it can be asymptomatic until life-threatening complications manifest such as respiratory disorders and visceral incarceration.</em></p><p class="TextAbstract"><strong><em>Conclusion</em></strong><em>: With the improvement of imaging technology, the radiologist is able to confirm a diaphragmatic rupture to get a better prognosis. </em></p><p class="TextAbstract"><em> </em></p><p class="TextAbstract"><strong><em>Key words: </em></strong><strong><em>diaphragmatic rupture</em></strong><strong><em>; trauma</em></strong><strong><em>; </em></strong><strong><em>chest X-</em></strong><strong><em>ray</em></strong><strong><em>; computed tomography</em></strong></p><p class="TextAbstract"><strong> </strong></p><p class="TextAbstract" align="center"><strong>ABSTRAK</strong></p><p class="TextAbstract" align="center"><strong> </strong></p><p class="TextAbstract"><strong>Pendahuluan</strong> : Konfirmasi diagnosis emergensi ruptur diafragma masih menjadi tantangan bagi spesialis radiologi. Prevalensi ruptur diafragma sebesar 5% dari kasus trauma tumpul abdomen dan perlukaan diafragma pada sisi kiri lebih umum terjadi dibandingkan sisi kanan dengan rasio 3:1. Foto X-Ray dada merupakan modalitas konvensional sebagai penilaian awal trauma abdomen dan <em>computed tomography scanning</em> (CT scan) merupakan standar pemeriksaan untuk mendiagnosis kasus tersebut.</p><p class="TextAbstract"><strong>Laporan Kasus </strong>: Seorang laki-laki berusia 70 tahun mengeluhkan nyeri dada setelah jatuh dari pohon setinggi 4 meter. X-ray dada menunjukkan gambaran gas usus di sebelah kiri rongga thorax dan tidak tampak gambaran diafragma kiri. CT scan abdomen dengan kontras menunjukkan gambaran lambung dan usus di sebelah kiri rongga thorax. Pasien tersebut kemudian ditatalaksana dengan thorakotomi diafragma kiri untuk mengkonfirmasi adanya lambung, ileum dan lien pada rongga pleura. Organ-organ tersebut kemudian dikembalikan ke dalam abdomen dan diafragma kiri direparasi. Kondisi klinis pasien setelah penatalaksanaan tersebut menunjukkan perbaikan.</p><p class="TextAbstract"><strong>Diskusi</strong> : Konfirmasi diagnosis ruptur diafragma merupakan tantangan bagi spesialis radiologi karena kasus tersebut bisa tidak bergejala sampai timbulnya komplikasi yang mengancam jiwa seperti gangguan respirasi dan perlekatan organ visceral.</p><p class="TextAbstract"><strong>Kesimpulan : </strong>Dengan adanya perkembangan teknologi<strong> </strong>pencitraan, spesialis radiologi dapat mengkonfirmasi ruptur diafragma sehingga memberikan prognosis yang lebih baik.</p><p class="TextAbstract"> </p><p class="TextAbstract"><strong>Kata Kunci : ruptur diafragma</strong><strong><em>; </em></strong><strong>trauma;<em> </em></strong><strong><em>chest X-ray, computed tomography</em></strong></p>

Introduction: Placenta previa and morbidly adherent placenta cause significant maternal morbidity and mortality from postpartum hemorrhage. Intra-aortic balloon occlusion has been shown to reduce intraoperative hemorrhage effectively. Cases Presentation We reported four cases of women who underwent cesarean section and hysterectomy with IABO. All four were multigravida, gestational age range was 37-39 weeks, MAP score range 6-8. Ultrasound examination showed placenta accreta. After the cesarean section and hysterectomy procedure with IABO, the bleeding was 600-800 cc. Conclusions Intra-Aortic Ballooning Occlusion is an effective method to reduce bleeding complications during and after cesarean section in pregnancies with placenta accreta.

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