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All Journal Smart Medical Journal Solo Journal of Anesthesi, Pain and Critical Care
Supranoto, Yehuda Tri Nugroho
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Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health

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Potensi Terapi Mesenchymal Stem Cells (MSCs) Untuk Gagal Hati Kronis Eksaserbasi Akut Akibat Infeksi Virus Hepatitis B: Tinjauan Sistematis dan Meta-analisis Terhadap Studi Uji Acak Terkontrol Supranoto, Yehuda Tri Nugroho; Tanuwijaya, Dini Cynthia Dewi
Smart Medical Journal Vol 4, No 3 (2021): Smart Medical Journal
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v4i3.54185

Abstract

Pendahuluan: Gagal hati kronis eksaserbasi akut merupakan dekompensasi penyakit hati kronis yang sering berkaitan dengan infeksi virus hepatitis B (HBV). Terapi Mesenchymal stem cells (MSCs) telah menunjukkan hasil yang menjanjikan untuk meningkatkan fungsi hati secara in vivo. Kajian ini bertujuan untuk menilai potensi MSCs pada pasien dengan gagal hati kronis eksaserbasi akut terkait infeksi HBV.Metode: Meta-analisis ini dibuat berdasarkan pedoman PRISMA. Pencarian literatur dilakukan dengan beberapa database elektronik, yakni PubMed, ScienceDirect, PMC, Google Scholar, dan Cochrane Library. Risk ratio (RR) dan standardized mean difference (SMD) dengan standar deviasi (SD) digunakan untuk membandingkan risiko mortalitas, skor model for end-stage liver disease (MELD), dan total bilirubin (TBIL) dari pemberian MSCs dan standard medical therapy (SMT).Hasil: Kajian ini menunjukkan bahwa risiko mortalitas cenderung lebih tinggi pada kelompok SMT (pooled RR= 0.52, 95%CI (0.40,0,69), p<0.00001, I2=0%). Skor MELD juga cenderung lebih tinggi pada kelompok SMT sampai 12 bulan setelah pengobatan (pooled SMD 0.36, 95%CI (0.07, 0.65), p= 0.00002, I2=65%). Perubahan TBIL lebih besar pada kelompok MSCs sampai dengan 4 minggu (pooled SMD= 0.20, 95%CI (-0.11,0.52), p=0.3, I2=16%) dan perubahan TBIL secara keseluruhan sampai 12 bulan menunjukkan adanya perbedaan antara intervensi MSCs dan SMT (pooled SMD= -0.07, 95%CI (-0.23,0.08), p=0.05, I2= 42%).Kesimpulan: Kajian ini memberikan bukti kuat yang menunjukkan terapi MSCs memiliki potensi yang bermanfaat untuk meningkatkan fungsi hati pada pasien dengan gagal hati kronis eksaserbasi akut terkait infeksi HBV.
Meta-Analysis of Enteral Lactoferrin Supplementation for Reducing the Risk of Preterm Infants Sepsis Supranoto, Yehuda Tri Nugroho; Tanuwijaya, Dini Cynthia Dewi
Smart Medical Journal Vol 5, No 2 (2022): Smart Medical Journal
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v5i2.57007

Abstract

Introduction: Severe COVID-19 in pregnancy is strongly associated with preterm infant late-onset sepsis (LOS), which is a major cause of morbidity and mortality in infants. Recently, Lactoferrin, an iron-binding protein significantly discovered in human colostrum, shows potential effect on reducing the risk of preterm infant LOS and mortality by its immunomodulatory properties. Therefore, this study aimed to evaluate the effect of Lactoferrin on reducing the risk of preterm LOS, necrotizing enterocolitis (NEC), and mortality in preterm infants. Methods: This study followed the guidelines provided by PRISMA. A literature search was conducted with PubMed, Cochrane Library, Google Scholar, and ScienceDirect. The combined effect of LOS, NEC and mortality incidence were presented as risk ratios (RR) with a 95% confidence interval (CI) using a random-effects model (REM) or fixed-effects model (FEM) forest plot. Furthermore, the heterogeneity level was checked by I2 and the p-value of the chi2 test. Results: The incidence of LOS was significantly higher in the control than lactoferrin supplementation group [RR=0.65, 95% CI (0.56,0.77), p
A Meta-Analysis of 80% Fraction of Inspired Oxygen on Surgical Site Infection in Patients Undergoing Surgery Erisadana, Rifaldy Nabiel; Tohari, Achmad Ilham; Supranoto, Yehuda Tri Nugroho; Utami, Wiwien Sugih; Indreswari, Laksmi
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 1 (2023): April 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i1.62251

Abstract

Background: WHO recommended the use of 80% FiO2 in patients undergoing general anesthesia with endotracheal intubation (ETI) to prevent surgical site infection (SSI). However, the ongoing debate regarding efficacy and safety raises because further trials have been published. We conducted a review based on recommendations in terms of SSI as the primary outcome and adverse events as the secondary outcome in both patients with or without ETI.Method: A literature search was carried out by PubMed, ScienceDirect, and Google Scholar for RCTs in all-type surgical patients who administrated 80% FiO2 compared with 30–35% FiO2. Pooled relative risks with a 95% confidence interval were conducted for meta-analysis. Result: Based on 23 RCTs included in the analysis, there were no significant differences in terms of SSI (RR,0.85; 95%CI, 0.72 to 1.01; p=0.07), sepsis (RR,1.47; 95%CI, 0.78 to 2.76; p=0.23), postoperative hospitalization days (PHD) (RR,0.16; 95%CI, -0.67 to 0.98; p=0.71), ICU admission (RR,0.94; 95%CI, 0.78 to 1.13; p=0.50), reoperation required (RR,0.78; 95%CI, 0.30 to 2.06; p=0.62), and 30-days mortality (RR,1.18; 95%CI, 0.76 to 1.84; p=0.45). In contrast, even though the subgroup analysis showed association that PHD longer in high FiO2 group for colorectal surgery (RR,0.80; 95%CI, 0.24 to 1.35; p=0.005), the high FiO2 significantly reduced SSI and anastomotic leakage in abdominal surgery (RR,0.78; 95%CI, 0.62 to 0.99; p=0.04 and RR,0.55; 95%CI, 0.36 to 0.85; p=0.008).Conclusion: This meta-analysis provides evidence that administration of 80% FiO2 even though association with longer of PHD in colorectal surgery, it is associated with a reduction in SSI and anastomotic leakage in patients who underwent abdominal surgery. It contrasts for sepsis, ICU admission, reoperation required, 30-day mortality, SSI, and PHD in all-type surgery. 
Meta-Analysis of Higher PEEP Strategies' Effects on Mortality Rates and Inflammatory Mediators in Patients with ARDS: A Perspective Review on Patients with Severe COVID-19-Associated ARDS Supranoto, Yehuda Tri Nugroho; Negara, I Made Putra Wira
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.62253

Abstract

Background: Different strategies of positive end-expiratory pressure (PEEP) in mechanical ventilation are crucial for patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). PEEP acts as a “double-edged sword” for ARDS patients. PEEP could recover pulmonary atelectasis but can induce alveolar hyperinflation.Objective: This review aimed to evaluate the effect of higher PEEP in patients with severe COVID-19-associated ARDS.Method: This meta-analysis included randomized controlled trial (RCT) studies to assess the mortality rates, barotrauma events, and inflammatory mediators modulation due to higher PEEP strategies. The pooled effect of the mortality rates and barotrauma events were presented as risk ratios (RR) with 95% confidence of interval (CI) using random-effects model (REM) or fixed-effects model (FEM).Results: We identified twelve RCTs comparing higher versus lower PEEP in ARDS patients. There was unsignificant result in overall mortality rates group [RR=0.94,95%CI(85,1.03),p=0.21] but not in mortality after positive response of oxygenation group [RR=0.88,95%CI(0.81,0.95),p=0.002] in higher PEEP group. In terms of patients without positive response of oxygenation, higher PEEP group had significantly higher mortality rates [RR=1.07,95%CI(1.00,1.15),p=0.06]. Higher PEEP significantly reduced the mortality rates in ARDS patients with PaO2/FiO2<150 mmHg [RR=0.867,95%CI(0.74,1.00),p=0.04] instead of patients with moderate ARDS (PaO2/FiO2 ≥150 mmHg) [RR=1.12, 95%CI(0.85,1.47), p=0.44]. There were no differences in overall barotrauma events [RR=1.03,95%CI(0.78,1.36),p=0.85] between higher and lower PEEP group. The use of higher and lower PEEP also contribute to the modulation of inflammatory mediators including TNF-α, IL-6, IL-1RA, and IL-8.Conclusion: Higher PEEP could reduce the mortality of patients with ARDS who responded to the oxygenation. Higher PEEP does not increase the risk of overall barotrauma events. Higher PEEP can modulate the inflammatory mediators.
Co-Authors Erisadana, Rifaldy Nabiel Laksmi Indreswari Negara, I Made Putra Wira Tanuwijaya, Dini Cynthia Dewi Tohari, Achmad Ilham Wiwien Sugih Utami