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Faktor-faktor yang Mempengaruhi Rendahnya Cakupan K4 di Desa Sukarame Kecamatan Sukanagara Kabupaten Cianjur Tahun 2005-2006 Kasim, Felix; Rahardjo, Theresia Monica
Jurnal Kedokteran Maranatha Vol 6, No 2 (2007)
Publisher : Universitas Kristen Maranatha

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Abstract

Pelayanan Antenatal merupakan salah satu manifestasi program Assesment Safe Motherhood dengan bantuan WHO, UNICEF dan UNDP, sejak tahun 1990-1991, sebagai upaya untuk menurunkan Angka Kematian Ibu (AKI) Indonesia yang masih tinggi yaitu 307 per 100.000 kelahiran hidup. Salah satu indikator pelayanan antenatal yang terpenting adalah K4 yaitu kunjungan ke 4 ibu hamil pada trimester terakhir kehamilannya, yang menentukan kualitas pelayanan antenatal di suatu daerah. Kabupaten Cianjur, yang terletak di Jawa Barat, memiliki cakupan K4 63,88% pada tahun 2004 dan menempati peringkat ke 3 terendah setelah Kabupaten Indramayu sebesar 57,05% dan Kabupaten Tasikmalaya sebesar 62,99%. Desa Sukarame, yang merupakan salah satu desa dari 10 desa di wilayah Kecamatan Sukanagara, Kabupaten Cianjur, memiliki angka cakupan K4 terendah sepanjang tahun 2005 bila dibandingkan dengan desa-desa lainnya. Angka cakupan K4 Desa Sukarame berkisar antara 2,27% sampai 25,5%, jauh di bawah target Puskesmas sebesar 75% dan target nasional sebesar 90%. Penelitian ini bertujuan untuk mengetahui dan menganalisis faktor-faktor yang mempengaruhi rendahnya cakupan K4 di Desa Sukarame, Kecamatan Sukanagara, Kabupaten Cianjur, tahun 2005-2006. Metode yang digunakan dalam penelitian adalah deskriptif – analitik dengan desain cross sectional dilakukan ter-hadap seluruh ibu bersalin di Desa Sukarame yang berjumlah 117 orang. Pengambilan data dilakukan dengan wawancara langsung menggunakan kuesioner dan data dianalisis dengan menggunakan Chi-square test. Hasil yang didapat setelah diuji menggunakan Chi-square test, ternyata faktor kehamilan, pendidikan, ekonomi, informasi dan rumor memiliki hubungan yang kuat (p<0.05) dengan rendahnya cakupan K4 di Desa Sukarame.  Dari penelitian ini dapat disimpulkan bahwa terdapat hubungan yang kuat antara kehamilan, pendidikan, ekonomi, informasi dan rumor dengan rendahnya cakupan K4 di Desa Sukarame, Kecamatan Sukanagara, Kabupaten Cianjur pada tahun 2005-2006 (p<0.05).
The Role of Free Radicals and Antioxidant in Abortion Suryawan, Aloysius; Rahardjo, Theresia Monica
The Indonesian Biomedical Journal Vol 5, No 1 (2013)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v5i1.47

Abstract

BACKGROUND: Free radicals and antioxidant exist in balance under normal condition. In prooxidant condition, excessive free radicals can initiate a state of oxidative stress (OS) followed by capillary endothelial cell damage, a process involved in the pathophysiology of abortion.CONTENT: Abortion is a common complication of pregnancy and occurs in 25% of women. Many factors can cause abortion including fetal factor, implantation process and hormonal status. Combination those factors with OS influence the entire reproductive life of a woman. Antioxidant can neutralize free radicals and used to reduce OS especially in recurrent abortion.SUMMARY: Antioxidant therapy is a very interesting field in abortion especially used as prevention approach mainly caused by the high cost of infertility treatment methods.KEYWORDS: free radical, antioxidant, abortion
Propofol Effect on Stress Response and Free Radicals in Patient during Surgery and Sedation Procedure Rahardjo, Theresia Monica
The Indonesian Biomedical Journal Vol 7, No 3 (2015)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v7i3.183

Abstract

BACKGROUND: Propofol is an intravenous anesthetic used worldwide as an anesthesia induction and maintenance agent. Propofol also used as sedation agent in Intensive Care Unit (ICU). Despite it’s usual anesthesia properties, propofol has an unique pharmacologic characteristic, especially as antioxidant and stress response reduction. These advantages suggested propofol has positive effects when used as an anesthesia agent in surgery or sedation in ICU in conditions when high stress and free radical level are released.CONTENT:Stress response and free radical can be elevated in various conditions including surgery or during care in ICU, especially critical ill patient. Cortisol is a major stress hormone that influences metabolism, cardiovascular and central nervous system, either in acute or chronic phase. Oxidative stress was marked by free radical elevation called Radical Oxygen Species (ROS). Combination of both elements (cortisol and ROS) can worsen patient condition. Propofol with anti-stress and antioxidant properties could be used to reduce stress response and attenuate free radical level in order to improve patient condition.SUMMARY: The anti-stress and antioxidant properties of Propofol are interesting, because these benefits can be added as adjunctive therapy when propofol was used as an anesthetic agent in surgery and a sedation in ICU.KEYWORDS: propofol, stress response, antioxidant
Penatalaksanaan Anestesia pada Pasien Cretin dengan Hipopituitarisme Sekunder Akibat Kraniofaringioma Rahardjo, Theresia Monica; Fuadi, Iwan; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Abstract

Kraniofaringioma adalah tumor sela dan parasela, yang merupakan 6-10% tumor otak pada anak-anak. Gejala umum merupakan tanda peningkatan tekanan intrakranial, seperti sakit kepala, muntah dan gangguan penglihatan. Disfungsi endokrin yang nyata merupakan gambaran umum kraniofaringioma akibat lokasi tumor terhadap kelenjar hipotalamus dan pituitari. Fisik pendek ditemukan pada 50-86% pasien dengan laju pertumbuhan subnormal dan pubertas yang terlambat. Seorang laki-laki, umur 20 tahun, pasien kretin dengan hipopituitarisme sekunder menjalani craniotomy tumor removal dan penempatan omaya shunt. Dia memiliki riwayat sakit kepala sejak 13 tahun yang lalu disertai dengan gangguan penglihatan yang dimulai dari mata kiri dan saat ini dia buta. Dia juga menderita kegagalan pertumbuhan dan pubertas yang terhambat, memiliki fisik seorang anak laki-laki, dengan tinggi badan 140 cm dan berat badan 40 kg. Dia memiliki TSHs yang meningkat dengan T3 dan fT4 yang normal, LH dan FSH yang menurun, prolaktin yang normal, hormon pertumbuhan yang normal rendah dan kortisol yang menurun. Teknik anestesia yang digunakan adalah anestesia umum. Induksi dengan fentanyl, pentotal, lidocaine dan vecuronium dengan kombinasi N2O/O2 dan isoflurane. Rumatan anestesi dengan isoflurane dan kombinasi O2/udara. Pernapasan pasien dikontrol dengan dosis inkremental vecuronium untuk mempertahankan relaksasi. Mannitol dan furosemide diberikan untuk menurunkan tekanan intrakranial. Operasi berlangsung selama 5 jam. Setelah 5 hari di ICU, pasien dapat kembali keruangannya di Kemuning. Masalah pasien ini adalah peningkatan tekanan intrakranial, disfungsi endokrin dan kemungkinan kesulitan jalan napas akibat bentuk tubuh yang kecil. Kortikosteroid sebagai terapi penggantian hormonal diberikan sebelum operasi. Dosis obat anestesi disesuaikan dengan berat badan. Intubasi menggunakan laryngoscope blade dan endotracheal tube dengan ukuran lebih kecil. Selama operasi dihindari pemakaian nitrous oxide, digunakan konsentrasi rendah anestesi inhalasi dan penggunaan dominan anestesi intravena. Pemantauan post operatif dilakukan di ICU dengan memperhatikan kemungkinan komplikasi hormonal seperti diabetes insipidus dan hiponatremia selain pengelolaan nyeri post operatif. Pasien dengan penyakit pituitari, dalam kasus ini kraniofaringioma, disertai dengan disfungsi endokrin dan pertumbuhan abnormal, membutuhkan penatalaksanaan preoperatif, intraoperatif dan postoperatif yang sangat teliti. Kerjasama yang baik antara bagian anestesi, bedah dan endokrinologi dapat menurunkan morbiditas dan mortalitas pada penyakit ini.  Anesthesia Management In Cretin Patient With Hypopitutarism Secondary Of CraniopharyngiomaCraniopharyngioma is a sellar and parasellar tumor, which accounts to 6-10% of childhood brain tumors. Common symptoms are signs of increase intracranial pressure, like headache, vomiting and visual dysfunction. A significant endocrine dysfunction is an usual feature of craniopharyngioma due to the proximity of the tumor to hypothalamus and pituitary gland. Short statue found in 50-86% patient with subnormal growth rates and delayed puberty. A male, 20 yrs cretin patient with hypopituitarism secondary of craniopharyngioma had a craniotomy tumor removal and placement of omaya shunt. He had a history of headache since 13 yrs ago accompanied by visual disturbance, started from his left eye, now he is totally blind. He also suffered from growth failure and delayed puberty, has a physic of a boy regardless his age as 20 yrs old adult, with height 140 cm and weight 40 kg. He has an elevated TSHs but normal T3 and fT4, a decreased LH and FSH, a normal prolactin, a normal but low growth hormon and a decreased cortisol. Anesthetic technique used was general anesthesia. Induction was done with fentanyl, pentotal, lidocaine and vecuronium with a mixture of N2O/O2 and isoflurane. Anesthesia was maintained with isoflurane and a mixture of O2/air. Patient was in controlled breathing with an incremental dose of vecuronium to maintaine the relaxation. Mannitol and furosemide were given to reduce intracranial pressure. The procedure took about 5 hours. After 5 days ICU stayed, the patient was referred back to his room at Kemuning. The problems in this patient are a raised of intracranial pressure, an endocrine dysfunction and a possibility of airway difficulty related to his short statue. Corticosteroid as hormone replacement therapy was given before the operation. Based on his short statue, induction dose of anesthetic agents were adjusted and smaller laryngoscope blade and endotracheal tube were used for intubation. Avoidance of nitrous oxide, low concentration of volatile agent and dominant used of intravenous anesthetic agent were applied during the operation. Post operative monitoring was done in ICU with specific concern of hormone complications like diabetes insipidus and hyponatremia beside post operative pain control. Patient with pituitary disease, in this case craniopharyngioma, accompanied by endocrine dysfunction and abnormal growth, need a very careful treatment from preoperative, intraoperative to postoperative period. A good management and cooperation between anesthesiologist, surgeon and endocrinologist can reduce the morbidity and mortality in this kind of disease.   
Blood Rheology and It’s Effect in Various Clinical Conditio Rahardjo, Theresia Monica; Wargahadibrata, Himendra
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Abstract

Blood ia a heterogen fluid consists of a suspension of blood cells, erythrocyte, leucocyte, thrombocyte, in a liquid plasma which contains water, proteins, mineral ions, hormones and glucose. Blood rheology is well known has an important rule in circulation. Blood viscosity depend on shear forces and determined by hematocrit, plasma viscocity, blood cells distribution and mechanical properties. Blood rheology can be altered in various pathology proccess like diorder of hematocrit, erytrocute deformability and aggregation. Hematocrit alteration contributed significantly to hemorheology variation and extreme physiologist conditions. Erytrocyte deformability sensitive to local and general homeostasis caused by endogen or exogen factors. Erythrocyte aggregation is determined by plasma protein composition and erythrocyte surface properties like acute phase of inflammation, other factors are in vivo aging, free radical and proteolitic enzymes. Rheology alteration will cause impairment of blood fluidity which is significantly affect tissue perfusion and result in organ function deteriorations, especially if disease processes also disturb vascular properties. This review will reveal blood rheology effect on various pathological conditions, like sepsis, hypertension and diabetes mellitus.