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Perubahan Konsentrasi Amino Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) dan Fraksi Ejeksi Ventrikel Kiri pada Pasien Kemoterapi Doksorubisin Kamelia, Telly; Waspadji, Sarwono; Makmun, Lukman Hakim; Effendi, Shufrie; Ramli, Muchlis; Timan, Ina Susanti
Jurnal Penyakit Dalam Indonesia Vol 4, No 2 (2017)
Publisher : Jurnal Penyakit Dalam Indonesia

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Abstract

Pendahuluan. Pada pasien kanker yang mendapat rejimen kemoterapi mengandung doksorubisin dapat mengalami efek samping kemoterapi pada jantung yang disebut kardiotoksisitas. Pemeriksaan NR-proBNP dapat dipakai sebagai parameter baru untuk mengidentifikasi secara dini dan memantau perkembangan efek samping kemoterapi pada jantung, selain pengukuran fraksi ejeksi ventrikel kiri. Tujuan dari penelitian ini untuk mendapatkan perubahan nilai konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien kanker yang diberi rejimen kemoterapi mengandung Doksorubisisn siklus I-IV.Metode. Studi pre and post test design dilakukan untuk melihat perubahan konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien yang mendapat kemoterapi doksorubisin sebelum dan setelah kemoterapi siklus I sampai siklus IV di Rumah Sakit dr. Ciptomangunkusumo (RSCM), Jakarta. Dilakukan pengambilan sampel darah sebelum kemoterapi dan sesudah kemoterapi siklus I-IV. Analisis statistik dilakukan dengan uji two way Anova dan uji non parametrik Friedman.Hasil. Selama periode bulan Oktober 2007-Juni 2008 terkumpul 29 pasien kemoterapi doksorubisin terdiri dari 16 pasien kemoterapi CHOP (Siklofosfamid, Doksorubisin, Vinkristin, Prednison) dan 13 pasien kemoterapi FAC (5 Fluorourasil, Doksorubsisin, Siklofosfamid). Didapatkan peningkatan nilai median konsentrasi NT-proBNP antara kemoterapi naïve dengan: pasca kemoterapi siklus I 32 pg/mL (12,5-124,6 pg/mL), pasca kemoterapi siklus II 135 pg/mL (44-275,2 pg/mL), pasca kemoterapi siklus III 275,1 pg/mL (97,8-907,2 pg/mL), dan pasca kemoterapi siklus IV 514,6 pg/mL (80,6-6458,2 pg/mL). Dengan uji Friedman, didapat nilai p<0,000. Dengan uji Anova two way, didapatkan penurunan rerata fraksi ejeksi ventrikel kiri dibandingkan fraksi ejeksi ventrikel naïve; pasca kemoterapi siklus I penurunan sebesar 5,1% (p 0,000), pasca kemoterapi siklus II 8,9% (p 0,000), pasca kemoterapi siklus III 11,2% (p 0,000), dan pasca kemoterapi siklus IV sebesar 12,5% (p 0,000).Simpulan. Didapatkan peningkatan nilai median konsentrasi NT-proBNP dan penurunan rerata fraksi ejeksi ventrikel kiri pada pasien yang mendapat rejimen kemoterapi mengandung doksorubisin. Kata Kunci: doksorubisin, fraksi ejeksi, kardiotoksisitas, kemoterapi, NT-proBNP, ventrikel kiri  The Changes of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) Concentration and Left Ventricular Ejection Fraction on Doxorubicin Chemotherapy PatientsIntroduction. Cancer patients who received chemotherapy regimen containing doxorubicin has been known to have serious side effect in heart, called as cardiotoxicity. The measurement of NT-proBNP proposed to be used as a new parameter to identify and evaluate cardiotoxicity in cancer patients earlier before it has been manifested, superior than measurement of left ventricle ejection fraction (LVEF). The aims of this study to examine the changes of NT-proBNP concentration and LVEF on patients with cancer who receive chemotherapy regimen containing doxorubicin.Methods. The study used pre and post test design to observe the changes of NT-proBNP concentration and LVEF on the patients who receive naïve doxorubicin chemotherapy and after chemotherapy-cycle I to cyce IV at the Ciptomangunkusumo hospital, Jakarta. Echocardiography and NT-proBNP were examined on naïve chemotherapy and after chemotherapy each cycle. Statistical analysis was performed by using two way Anova and Friedman nonparametric test. Results. During the period of October 2007 to June 2008, a total of 29 consecutive patiets receiving doxorubicin chemotherapy regimen CHOP (Cyclophosphamide, doxorubicin, Vincristine, Prednisone and FAC-5 Fluorouracil, doxorubicin, Cyclophosphamide) were collected. The increase of median NT-proBNP concentration between naïve chemotherapy and: post chemotherapy cycle I was 32 pg/mL (12,5-124,6 pg/mL), post chemotherapy cycle II was 135 pg/mL (44-275,2 pg/mL), post chemotherapy cycle III was 275,1 pg/mL (97,8-907,2 pg/mL), post chemotherapy cycle IV was 514,6 pg/mL (80,6-6458,2 pg/mL). With Friedman test, p< 0,000. With Anova two way test, it was found the difference between naïve LVEF and LVEF: post chemotherapy cycle I was 5,1% (p 0,000), post chemotherapy cycle II 8,9% (p 0,000), post chemotherapy cycle III 11,2% (p 0,000), post chemotherapy cycle IV 12,5% (p 0,000). Conclusions. Elevated NT-proBNP concentration and LVEF reduction had been observed in doxorubicin chemotherapy patients.  
Perubahan Konsentrasi Amino Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) dan Fraksi Ejeksi Ventrikel Kiri pada Pasien Kemoterapi Doksorubisin Kamelia, Telly; Waspadji, Sarwono; Makmun, Lukman Hakim; Effendi, Shufrie; Ramli, Muchlis; Timan, Ina Susanti
Jurnal Penyakit Dalam Indonesia Vol 4, No 2 (2017)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1290.099 KB) | DOI: 10.7454/jpdi.v4i2.127

Abstract

Pendahuluan. Pada pasien kanker yang mendapat rejimen kemoterapi mengandung doksorubisin dapat mengalami efek samping kemoterapi pada jantung yang disebut kardiotoksisitas. Pemeriksaan NR-proBNP dapat dipakai sebagai parameter baru untuk mengidentifikasi secara dini dan memantau perkembangan efek samping kemoterapi pada jantung, selain pengukuran fraksi ejeksi ventrikel kiri. Tujuan dari penelitian ini untuk mendapatkan perubahan nilai konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien kanker yang diberi rejimen kemoterapi mengandung Doksorubisisn siklus I-IV.Metode. Studi pre and post test design dilakukan untuk melihat perubahan konsentrasi NT-proBNP dan fraksi ejeksi ventrikel kiri pada pasien yang mendapat kemoterapi doksorubisin sebelum dan setelah kemoterapi siklus I sampai siklus IV di Rumah Sakit dr. Ciptomangunkusumo (RSCM), Jakarta. Dilakukan pengambilan sampel darah sebelum kemoterapi dan sesudah kemoterapi siklus I-IV. Analisis statistik dilakukan dengan uji two way Anova dan uji non parametrik Friedman.Hasil. Selama periode bulan Oktober 2007-Juni 2008 terkumpul 29 pasien kemoterapi doksorubisin terdiri dari 16 pasien kemoterapi CHOP (Siklofosfamid, Doksorubisin, Vinkristin, Prednison) dan 13 pasien kemoterapi FAC (5 Fluorourasil, Doksorubsisin, Siklofosfamid). Didapatkan peningkatan nilai median konsentrasi NT-proBNP antara kemoterapi naïve dengan: pasca kemoterapi siklus I 32 pg/mL (12,5-124,6 pg/mL), pasca kemoterapi siklus II 135 pg/mL (44-275,2 pg/mL), pasca kemoterapi siklus III 275,1 pg/mL (97,8-907,2 pg/mL), dan pasca kemoterapi siklus IV 514,6 pg/mL (80,6-6458,2 pg/mL). Dengan uji Friedman, didapat nilai p<0,000. Dengan uji Anova two way, didapatkan penurunan rerata fraksi ejeksi ventrikel kiri dibandingkan fraksi ejeksi ventrikel naïve; pasca kemoterapi siklus I penurunan sebesar 5,1% (p 0,000), pasca kemoterapi siklus II 8,9% (p 0,000), pasca kemoterapi siklus III 11,2% (p 0,000), dan pasca kemoterapi siklus IV sebesar 12,5% (p 0,000).Simpulan. Didapatkan peningkatan nilai median konsentrasi NT-proBNP dan penurunan rerata fraksi ejeksi ventrikel kiri pada pasien yang mendapat rejimen kemoterapi mengandung doksorubisin. Kata Kunci: doksorubisin, fraksi ejeksi, kardiotoksisitas, kemoterapi, NT-proBNP, ventrikel kiri  The Changes of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) Concentration and Left Ventricular Ejection Fraction on Doxorubicin Chemotherapy PatientsIntroduction. Cancer patients who received chemotherapy regimen containing doxorubicin has been known to have serious side effect in heart, called as cardiotoxicity. The measurement of NT-proBNP proposed to be used as a new parameter to identify and evaluate cardiotoxicity in cancer patients earlier before it has been manifested, superior than measurement of left ventricle ejection fraction (LVEF). The aims of this study to examine the changes of NT-proBNP concentration and LVEF on patients with cancer who receive chemotherapy regimen containing doxorubicin.Methods. The study used pre and post test design to observe the changes of NT-proBNP concentration and LVEF on the patients who receive naïve doxorubicin chemotherapy and after chemotherapy-cycle I to cyce IV at the Ciptomangunkusumo hospital, Jakarta. Echocardiography and NT-proBNP were examined on naïve chemotherapy and after chemotherapy each cycle. Statistical analysis was performed by using two way Anova and Friedman nonparametric test. Results. During the period of October 2007 to June 2008, a total of 29 consecutive patiets receiving doxorubicin chemotherapy regimen CHOP (Cyclophosphamide, doxorubicin, Vincristine, Prednisone and FAC-5 Fluorouracil, doxorubicin, Cyclophosphamide) were collected. The increase of median NT-proBNP concentration between naïve chemotherapy and: post chemotherapy cycle I was 32 pg/mL (12,5-124,6 pg/mL), post chemotherapy cycle II was 135 pg/mL (44-275,2 pg/mL), post chemotherapy cycle III was 275,1 pg/mL (97,8-907,2 pg/mL), post chemotherapy cycle IV was 514,6 pg/mL (80,6-6458,2 pg/mL). With Friedman test, p< 0,000. With Anova two way test, it was found the difference between naïve LVEF and LVEF: post chemotherapy cycle I was 5,1% (p 0,000), post chemotherapy cycle II 8,9% (p 0,000), post chemotherapy cycle III 11,2% (p 0,000), post chemotherapy cycle IV 12,5% (p 0,000). Conclusions. Elevated NT-proBNP concentration and LVEF reduction had been observed in doxorubicin chemotherapy patients.  
Gender and Learning Duration in Changing of Understanding Score After Integrated Learning on Culturally Competence on Antenatal Care in Medical Education Vidiawati, Dhanasari; Makmun, Lukman Hakim; Basuki, Bastaman; Mansyur, Muchtaruddin
JOURNAL OF THE INDONESIAN MEDICAL ASSOCIATION Majalah Kedokteran Indonesia Vol 64, No 4 (2014): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA

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Abstract

Introduction:?Learning culturally competent on antenatal care (ANC) should be integrated and structured in medical program. The purpose of the study is to identify dominant factors that influence the increasing score of understanding culture competence after integrated learning of cultural competence on antenatal care in medical education.Methods:?The integrated learning model conducted in 2010-2011 on year class?1st, 3rd and 5th, with vary on learning duration of each class. Change of understanding score assessed by using before and after test.Result:?A total of 464 students showed 54.5% get increase change score. Before learning, the average score was 23.08 (SD 2.99) and after learning was 24.13 (SD 3.25). Year 5 students compared to year 1, 21% less likely to increase the score on understanding cultural competence (RRA 0.79, p=0.030). Female students had 28% more to get the possibility of changes in understanding score increase, (RRA 1.28,p=0.006).Conclusions:?Gender and learning duration has effect on the increase of understanding culture competence score.Keyword:?Antenatal care, cultural competence, integrated learnig, medicla education