AbstrakDefek septum ventrikel (ventricular septal defect VSD) merupakan penyakit jantung bawaan yang paling sering ditemukan pada bayi dan anak. Penutupan defek ini masih memberikan tantangan tersendiri. Penanganan VSD dengan metode minimally invasive transthoracic merupakan perkembangan inovatif penutupan defek ventrikel. Laporan kasus ini bertujuan memperkenalkan metode terbaru dalam penanganan kasus VSD yang dilakukan di RSUP Dr. Mohammad Hoesin Palembang. Kami melaporkan serial kasus penutupan VSD menggunakan metode minimally invasive transthoracic dengan panduan transesophageal echocardiography (TEE). Transesophageal Echocardiography digunakan selama prosedur sebagai panduan penempatan alat dan mengevaluasi hasil operasi. Empat pasien pada periode November 2015 menjalani prosedur penutupan defek, dua pasien laki-laki dan dua perempuan, usia 2 tahun sampai 4 tahun dengan berat badan 12-22 kg, dengan diameter VSD berdasar atas pemeriksaan ekokardiografi 4-7 mm. Penutupan VSD menggunakan metode minimally invasive transthoracic dengan panduan TEE melalui mini sternotomi menunjukkan prosedur yang aman dan efektif. Penggunaan TEE memberikan informasi yang sangat berguna selama periode intraoperatif. Kata kunci: Defek septum ventrikel, minimal invasif, transesophageal echocardiography Minimally Invasive Transthoracic Ventricular Septal Defect ClosureUsing Transesophageal Echocardiography (TEE) Guidance AbstractVentricular septal defect (VSD) is the most common congenital heart disease found in infants and children. Until currently, the management of VSD closure remains as a challenge for clinicians. Ventricular septal defect closure with minimally invasive transthoracic method is an innovative development of ventricular defect closure. This case report aimed to introduce the minimally invasive transthoracic VSD closure method which is the latest method in VSD management, in Dr. Mohammad Hoesin General Hospital Palembang. A series of VSD closure cases using minimally invasive transthoracic method with transesophageal echocardiography (TEE) guidance were described. Transesophageal echocardiography is used during the procedure to guide the placement of device and to evaluate the results of the surgery. Four patients were seen in November 2015, two girls and two boys aged 2 years to 4 years old weighing 12-22 kg, with a diameter of VSD based on echocardiography examination of between 4-7 mm. The closure of VSD using minimally invasive transthoracic under TEE guiding through mini-sternotomy is shown as a safe and effective procedure as it provides very useful information during the intraoperative period.

Background : Incidence of AKI in intensive care unit patients reach 60-70%, and the mortality rate is about 60%.  IL-18 is a pro-inflammatory cytokine which increased in endogenous inflammation process. Studies in human showed that IL-18 concentration increased prior to AKI. Objective : The aims of this research is to determine the sensitivity and specificity of Interleukin-18 urine examination as an early biomarker for acute kidney injury. Methods : There’re total of 66 subjects who met the inclusion criteria. All the subject were checked for the IL-18 urine level with Cloud Clone kit and creatinine serum were also checked 48 hours after admission. Results :The results showed in the cut-off point of 411.25 Pg/mL , urine IL-18 has a sensitivity of 54.3 % and specificity 83.9%, positive predictive value 79.17%, negative predictive value 61.9% and accuracy of 68.18% Conclusions : Our result suggest that IL-18 urine holds a promise as an early biomarker of AKI and more sensitive and specific as an early biomarker for AKI compared to creatinine serum. Key words : Acute Kidney Injury, Interleukin-18, sensitivity, spesificity

Background: Ultrasound-guided arterial cannulation has the potential to increase the total success rate and first attempt and reduce complications compared to conventional landmark palpation methods. This study aims to compare the success rate of radial artery cannula with palpation techniques and ultrasound guidance in patients undergoing major surgery under general anesthesia. Methods: This study is a randomized controlled trial singly. The inclusion criteria for this study were patients who underwent both emergency and elective surgery under general anesthesia, aged >18 years, with ASA I and II physical status. The study sample (60 people) was randomized by computer and divided into two groups (ultrasound guidance and palpation technique). The study will assess the success of the first insertion of the radial artery cannula in both groups. Data analysis was performed with SPSS 25 univariate and bivariate. Results: There is a significant relationship with the success of the first attempt at an ultrasound-guided cannula trial with a p-value of 0.045 with an odds ratio of 3.33 with a 95% confidence interval (0.998 – 11.139). Conclusion: Ultrasound-guided arterial cannulation has a better success rate and fewer complications than conventional palpation techniques.

Background: Bone Marrow Puncture (BMP) is an invasive procedure associated with pain and anxiety. The ketamine-midazolam and the ketamine-propofol is an effectivecombination with minimal side effects. This study of the study aims to compare the effect of the combination of ketamine-midazolam and ketamine- propofol on sedation depth based on BIS in pediatric leukemia patients undergoing BMP. Methods: This study was a randomized controlled trial that was done single-blinded. The population was all pediatric patients diagnosed with leukemia who underwent BMP at RSMH and performed sedation. The research sample is the population that fulfill the inclusion and exclusion criteria. The sample size for each group was 25, with 50 Subjects in total. Sampling was done by block randomization. Results: This study found no differences in sex, age, and body weight between the two groups ([p=1.000], [p=0.845], and [p=0.147], respectively). In this study, there was no difference in mean MAP (p=0.592), oxygen saturation (p=0.164), heart rate (p=0.098), and respiratory rate (p=0.252) before intervention between the two groups. BIS value of the two groups had significant difference before and after the intervention where the two groups could reduce BIS to reach the optimal value of sedation <60 (p <0.05) There was no difference in BIS before intervention in the two groups (p=0.385). In this study, it was found that hypersalivation occurred more frequently in the ketamine-midazolam combination group. Conclusion: The combination of ketamine-midazolam and ketamine-propofol was equally good for sedation as indicated by a decrease in the mean BIS in patients undergoing BMP.

Introduction. Sepsis is a syndrome that describes physiological dysfunction, pathological, and biochemistry caused by infection. Fluid balance is an indicator that can monitor input and output. This study was aimed to evaluate the relationship between positive cumulative fluid balance and the mortality rate of sepsis patients treated in the intensive care unit. Method: This study design is a retrospective study. The inclusion criteria consist of patients diagnosed with sepsis written in the medical record, 18-65 years old, and patients admitted in intensive care unit dr Moh. Hoesin General Hospital. Data were analyzed using SPSS 22.0 with the normality of data distribution, independent sample t-test, Mann-Whitney analysis, chi-square, Fisher’s Exact to measure the relationship, and using Medcalc version 14 application to measure cut-off value, ROC curve AUC, cross-sectional point, sensitivity, and specificity. Result. The result showed that characteristic between age (p=0,491), gender (p=0,703) did not differ significantly between survived and non-survived patient. Length of stay (p=0,002), balance (p=0,000), and ward unit (p=0,014) has a significant different between survived and non survived patient. In chi square analysis, p value=0,000with odds ratio 7,083. Cut-off value of ROC curve is -97 mL with AUC 0,844, sensitivity 76,1% and specificity 79,3%. Conclusion. Cumulative positive balance patient in the sepsis patient correlates with increased mortality in a sepsis patient in Dr. Mohammad Hoesin General Hospital Palembang.