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Majalah Kedokteran Bandung
Articles by issue : Vol 46, No 1 (2014)
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Articles
Kesesuaian Hasil Pengukuran Sudut Bilik Mata Depan antara Pentacam dan Ultrasound Biomicroscopy

Zulkarnain, Maulina ( Rumah Sakit Umum Daerah Cibabat Cimahi ) , Enus, Sutarya ( Departemen Ilmu Kesehatan Mata, Fakultas Kedokteran Universitas Padjadjaran-Rumah Sakit Mata Cicendo ) , Prahasta, Andika ( Departemen Ilmu Kesehatan Mata, Fakultas Kedokteran Universitas Padjadjaran-Rumah Sakit Mata Cicendo )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penilaian segmen anterior, khususnya pemeriksaan sudut bilik mata depan memegang peranan penting dalam mendiagnosis dan penatalaksanaan penyakit glaukoma. Pentacam dan ultrasound biomicroscopy (UBM) mampu mengukur sudut bilik mata depan secara kuantitatif dan objektif, namun pemeriksaan UBM lebih invasif sedangkan Pentacam tanpa kontak dengan permukaan bola mata. Tujuan penelitian untuk mencari kesesuaian antara Pentacam dan UBM dalam mengukur sudut bilik mata depan. Penelitian ini merupakan studi analitik deskriptif dengan uji kesesuaian antara dua metode pengukuran, dengan subjek penderita glaukoma dan bukan glaukoma di Rumah Sakit Mata Cicendo Bandung, periode November–Desember 2010, berjumlah 42 mata dari 31 orang. Dilakukan pemeriksaan pada area nasal dan temporal sudut bilik mata depan menggunakan kedua alat tersebut. Uji kesesuaian menggunakan Bland and Altman dan uji hipotesis menggunakan uji-t berpasangan. Secara statistik tidak terdapat perbedaan bermakna pada sudut terbuka, hasil pengukuran sudut bilik mata depan area nasal dan temporal antara Pentacam (37,51; 40,49; p=0,55) dan UBM (38,87; 40,76; p=0,22), namun limit of agreement yang didapatkan menunjukkan rentang yang luas, area nasal (dari 11,94 sampai -18,14) dan area temporal (dari 11,51 sampai -15,31) pada taraf kepercayaan 95%. Pada sudut tertutup terdapat perbedaan bermakna hasil pengukuran sudut bilik mata depan area nasal dan temporal antara Pentacam (27,33; 36,65; p<0,001) dan UBM (31,47; 37,34; p<0,001), sedangkan limit of agreement yang didapatkan menunjukkan rentang pada area nasal (dari 4,51 sampai -16,65) dan area temporal (dari 2,98 sampai -14,73) pada taraf kepercayaan 95%. Simpulan, pengukuran sudut bilik mata depan dengan menggunakan Pentacam memiliki kesesuaian yang tidak baik dibandingkan dengan UBM pada kelompok sudut terbuka, dan tidak memiliki kesesuaian pada kelompok sudut tertutup. [MKB. 2014;46(1):28–33]Kata kunci: Glaukoma, Pentacam, sudut bilik mata depan, ultrasound biomicroscopy Compatibility of the Outcomes in Measurement of the Anterior Chamber Angle between Using Pentacam and Ultrasound BiomicroscopyThe assessment of anterior segment, especially the examination of anterior chamber angle, plays an important role in diagnosing and managing glaucoma. Pentacam and ultrasound biomicroscopy (UBM) were able to measure the anterior chamber angle quantitatively and objectively; however, UBM examination is invasive, where as Pentacam is without contact with eye globe surface. The aim of this study was to seek the conformation between Pentacam and UBM in measuring the anterior chamber angle. The study was analytic descriptive study with the agreement of both measurements in 42 eyes of 31 patients with glaucoma and non-glaucoma Cicendo Eye Hospital Bandung, in period of November to December 2010. The examination used both instruments in nasal and temporal area of anterior chamber angle with equal illumination. The agreement test using Bland and Altman and hypothesis using paired t-test. Statistically, there were no significant differences in anterior chamber open angle of nasal and temporal area between using Pentacam (37.51; 40.49; p=0.55) and UBM (38.87; 40.76; p=0.22), while the limit of agreement indicated wide range in nasal area (11.94 to -18.14) and in temporal area (11.51 to -15.31) in 95% confidence interval. In closed angle of anterior chamber, there was a significant difference at nasal and temporal area between using Pentacam (27.33; 35.65; p<0.001) and using UBM (31.47; 37.34; p<0.001), while the limit of agreement showed (4.01 to -16.65) for nasal area (2.98 to -14.73) for temporal area in 95% confidence interval. In conclusion, the measurement of the anterior chamber in open-angle group using Pentacam indicated poor agreement with using UBM; and there is no agreement in closed angle group. [MKB. 2014;46(1):28–33]Key words: Anterior chamber angle, glaucoma, Pentacam, ultrasound biomicroscopy DOI: 10.15395/mkb.v46n1.224

Faktor Risiko Penderita Prolapsus Organ Panggul terhadap Hiatus Genitalis, Panjang Total Vagina, dan Perineal Body

Purwara, Benny Hasan ( Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Padjadjaran-Rumah Sakit Dr. Hasan Sadikin, Bandung ) , Armawan, Edwin ( Subbagian Uroginekologi dan Rekonstruksi Panggul Perempuan, Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung ) , Sasotya, R. M. Sonny ( Subbagian Uroginekologi dan Rekonstruksi Panggul Perempuan, Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung ) , Achmad, Eppy Darmadi ( Subbagian Uroginekologi dan Rekonstruksi Panggul Perempuan, Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Prolapsus organ panggul (POP) merupakan kondisi yang umum pada perempuan usia lanjut. Keluhannya bersifat prolapsus organ panggul (POP) merupakan kondisi umum bersifat progresif pada perempuan usia lanjut. Saat ini belum ada laporan mengenai hubungan antara komponen faktor risiko dan anatomi. Penelitian ini untuk mengetahui faktor risiko klinis POP serta pengaruhnya pada komponen anatomi penentu tahapan klinis kelainan tersebut. Penelitian dilakukan di Departemen Obstetri dan Ginekologi Fakultas Kedokteran Unpad/Rumah Sakit Dr. Hasan Sadikin Bandung periode Desember 2009–Mei 2010. Limapuluh dua pasien POP dibagi menjadi dua kelompok yaitu 30 subjek POP tingkat III dan 22 POP tingkat I-II. POP berasosiasi signifikan dengan usia, paritas, menopause, serta TSH. Usia ≥50 tahun (OR=0,08; 95% IK=0,018-0,333 versus <50 tahun), paritas ≥3 (OR=5,56; 95% IK=0,02-0,55 versus paritas <3), dan status menopause (OR=5,14; 95% IK=1,18-22,49 versus tidak menopause). Korelasi positif signifikan panjang hiatus genitalis (HG) dengan usia (r=0,656) dan paritas (r=0,539). Ukuran perineal body (PB) korelasi negatif signifikan dengan usia (r= -0,298) dan paritas (r=-0,335). Kelompok menopause menunjukkan peningkatan panjang HG dan penurunan ukuran PB yang signifikan. Panjang PB meningkat signifikan pada kelompok yang menerima TSH. Hubungan yang signifikan antara panjang total vagina (PTV) dan faktor-faktor risiko hanya menemukan pemendekan PTV signifikan pada usia >50 tahun. Simpulan, usia, paritas, dan menopause merupakan faktor risiko kemungkinan POP serta mempunyai korelasi dengan panjang GH dan PB dan progresivitas POP. [MKB. 2014;46(1):57–60]Kata kunci: Hiatus genitalis, panjang total vagina, perineal body, prolapsus organ panggulRisk Factors for Patients with Pelvic Organ Prolapse on Hiatus Genitalis, Total Vaginal Length, and Perineal BodyPelvic organ prolapse (POP) is a common and progressive condition in elderly women. Currently, there are no report regarding the relationship between risk factor and anatomical components. This research was to identify risk factors and its influence on the POP clinical anatomy component determining clinical stages of this disorder. The study was conducted at the Department of Obstetrics and Gynaecology, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung during the period of December 2009–May 2010. Fifty-two POP patients were participated, 30 subjects were in grade III and 22 subjects were in grade I–II. Found a significant association between age, parity, menopause, and hormone replacement therapy (HRT) and the incidence POP. Age >50 years (OR=0.08, 95% CI=0.018 to 0.333 versus <50 years), parity >3 (OR=5.56, 95% C1=0.02 to 0.55 versus parity <3), and menopausal status (OR=5.14, 95% CI=1.18 to 22.59 versus not menopausal). Long hiatus genetalis (HG) had a significant positive correlation to age (r=0.656), while HG had a significant positive correlation to parity (r=0.539). Size of the perineal body (PB) showed a significant negative correlation with age (r=-0.298) and parity (r=-0.335). Menopausal group showed significant increase in HG length and decrease in size of the PB compared to the premenopausal group. The PB length increased significantly in those receiving HRT (p=0.018). Significant relationship between total length of the vagina (PTV) and the risk factors was only found in the form of significant shortening of PTV at aged >50 years. In conclusion, age, parity, and menopause are risk factors for POP probability and has a correlation with HG length, PB and progression of POP. [MKB. 2014;46(1):57–60]Key words: Genital hiatus, pelvic organ prolapse, perinael body, total vaginal length DOI: 10.15395/mkb.v46n1.229

Efek Olive Oil dan Virgin Coconut Oil terhadap Striae Gravidarum

Pratami, Evi ( Program Studi Kebidanan Sutomo Jurusan Kebidanan Politeknik Kesehatan Kemenkes Surabaya ) , Permadi, Wiryawan ( Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung ) , Gondodiputro, Sharon ( Departemen Ilmu Kesehatan Masyarakat Fakultas Kedokteran Universitas Padjadjaran )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Prevalensi striae gravidarum (SG) pada ibu hamil berkisar 50% sampai 90%. Efek SG menyebabkan rasa gatal, panas, dan kering serta gangguan emosional sehingga menimbulkan masalah kosmetik pada sebagian besar ibu. Saat ini banyak ibu hamil menggunakan olive oil untuk mencegah SG, namun minyak ini relatif sukar didapat dan harganya mahal. Di Indonesia dikenal minyak lain yaitu virgin coconut oil (VCO) yang memiliki kandungan efektif untuk menjaga elastisitas kulit, minyak ini mudah didapat dan murah. Penelitian ini bertujuan menganalisis perbedaan dan korelasi efek olive oil dan VCO terhadap SG. Penelitian ini dilaksanakan pada bulan Maret−Juli 2012. Rancangan penelitian ini merupakan penelitian klinis melalui pendekatan eksperimental. Subjek penelitian adalah 80 ibu hamil di wilayah Dinas Kesehatan Kota Surabaya dan dikelompokkan menjadi 2 kelompok dengan menggunakan random permuted blocks. Hasil penelitian menunjukkan tidak terdapat perbedaan SG berdasarkan jumlah garis dan tingkat eritema antara kelompok yang menggunakan olive oil dan VCO (p=0,156 dan 1,00). Selanjutnya terdapat korelasi kuat antara kelompok olive oil dan VCO dengan jumlah garis (r=-0,576 dan -0,560) dan tingkat eritema (r=-0,699 dan -0,586). Simpulan, tidak ada perbedaan efek olive oil dengan VCO terhadap SG. [MKB. 2014;46(1):1–5]Kata kunci: Olive oil, striae gravidarum, virgin coconut oilEffects of Olive Oil and Virgin Coconut Oil against Striae GravidarumThe prevalence of striae gravidarum (SG) in pregnant women ranges from 50% to 90%. Effects of SG include itchy and hot feeling as well as dry skin. This situation also causes emotional disturbances that poses a cosmetic problem for most pregnant women. Nowadays, many pregnant women use olive oil to prevent SG, but it is relatively difficult to find and costly. In Indonesia, a similar oil, virgin coconut oil (VCO), has been used by many pregnant women for the same reason. The aim of this study was to analyze the differences and correlation between effects of olive oil and VCO against SG. The study was conducted in March−July 2012. An experimental study was performed on 80 pregnant women in Surabaya Municipality and they were divided into 2 groups using random permuted blocks. The results of this study showed that there was no difference in SG appearance based on the number of lines and levels of erythema between groups (p=0.156 and 1.00). Furthermore, there was a strong negative correlation between the effect of olive oil or VCO on the number of lines (r=-0.576 and -0.560) and the level of erythema (r=-0.699 and -0.586). In conclusion, there is no difference in the effect of olive oil and VCO against SG. [MKB. 2014;46(1):1–5]Key words: Olive oil, striae gravidarum, virgin coconut oil DOI: 10.15395/mkb.v46n1.220

Erupsi Gigi Sulung pada Anak dengan Riwayat Lahir Prematur, Berat Badan Lahir Rendah

Soewondo, Willyanti Syarif ( Bagian Kedokteran Gigi Anak, Fakultas Kedokteran Gigi Universitas Padjadjaran ) , Effendi, Sjarif Hidajat ( Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjadjaran Rumah Sakit Dr. Hasan Sadikin Bandung )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pertumbuhan dan perkembangan gigi merupakan bagian pertumbuhan dan perkembangan tubuh secara umum dan dipengaruhi faktor genetik dan lingkungan. Faktor lingkungan prenatal dapat mengakibatkan kelahiran prematur, bayi berat lahir rendah/BBLR, dan gangguan pertumbuhan perkembangan gigi. Tujuan penelitian ini untuk mengetahui waktu erupsi gigi sulung pada anak lahir prematur BBLR. Penelitian ini adalah studi potong lintang dilakukan pada bulan Januari sampai Juni 2009 di Rumah Sakit Gigi Mulut Fakultas Kedokteran Gigi Universitas Padjadjaran/RSGM FKG Unpad. Subjek penelitian yaitu anak usia 4–30 bulan, riwayat lahir prematur BBLR, dan lahir normal sebagai kontrol. Erupsi gigi sulung ditentukan berdasarkan jumlah gigi yang telah erupsi. Dengan teknik pengambilan sampel consecutive admission diperoleh 137 anak; 49 anak lahir prematur BBLR (usia gestasi <37 minggu, berat lahir <2.500 gram) dan 88 anak normal (usia gestasi 37–42  minggu, berat badan lahir  >2.500 gram) sebagai kontrol. Dengan regresi korelasi linier dan uji-t student, hasil penelitian terdapat hubungan bermakna waktu erupsi dengan usia (p<0,01) Waktu erupsi gigi sulung pada anak lahir prematur BBLR secara bermakna lebih lambat daripada anak lahir normal (p<0,01). Simpulan, waktu erupsi gigi sulung anak lahir prematur BBLR lebih lambat daripada anak lahir normal. [MKB. 2014;46(1):34–8]Kata kunci: Bayi berat lahir rendah (BBLR), erupsi gigi sulung, lahir prematur Deciduous Teeth Eruption in Prematurely Born, Low Birth Weight ChildrenGrowth and development of the teeth are parts of growth and development of the body. It is influenced by genetic and environmental factors. Prenatal environment might cause premature birth and disturbances of teeth development. The purpose of this research was to find out the time of deciduous teeth eruption in premature born children with low birth weight/LBW. This was a cross-sectional study, conducted in January to June 2009 in Dental Hospital Faculty of Dentistry Universitas Padjadjaran. Subjects were children aged 4–30 months with prematurely born low birth weight and normal birth weight as control. The technique was consecutive admissions; 49 prematurely born LBW children (gestational age <37 weeks, birth weight <2,500 grams) and 88 normal children (37–42 weeks gestational age, birth weight >2,500 grams). Deciduous teeth eruption was determinated by the number of erupted teeth. Linear corelation regression analysis and t- student test were used in this research. The results showed that there was a significant correlation between deciduous teeth eruption and age, (p<0.01) and deciduous teeth eruption in prematurely born children with LBW was significantly delayed (p<0.01). In conclusion, deciduous teeth eruption in prematurely born LBW children was significantly delayed. [MKB. 2014;46(1):34–8]Key words: Deciduous teeth eruption, low birth weight (LBW), prematurely born DOI: 10.15395/mkb.v46n1.225

Hubungan Kadar IL-8 Sekret Mukosa Hidung pada Rinosinusitis Kronik tanpa Polip-Nonalergi dengan Fungsi Penghidu Setelah Pemberian Antibiotik Makrolid

Candra, Edo Wira ( Rumah Sakit Petamedika Sentul City ) , Sumarman, Iwin ( Departemen Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala Leher Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung ) , Ratunanda, Sinta Sari ( Departemen Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala Leher Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung ) , Madiadipoera, Teti ( Departemen Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala Leher Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Rinosinusitis kronik (RSK) merupakan inflamasi kronik dengan etiologi multifaktorial. Interleukin-8 (IL-8) adalah sitokin proinflamasi yang dominan pada RSK tanpa polip-nonalergi. Penurunan fungsi penghidu merupakan suatu gejala yang sering dikeluhkan. Klaritromisin merupakan antibiotik makrolid yang efektif karena memiliki efek antibakteri dan antiinflamasi. Tujuan penelitian untuk mengetahui perbaikan gejala klinis, fungsi penghidu dan kadar IL-8 sekret mukosa hidung, serta mencari korelasi IL-8 dengan fungsi penghidu pada RSK tanpa polip-nonalergi.Penelitian ini merupakan randomized clinical trial open labeled pre and posttest design. Data dianalisis memakai Uji Wilcoxon, Mann Whitney, dan korelasi Rank Spearman. Penelitian berlangsung di poliklinik Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala Leher Rumah Sakit Dr. Hasan Sadikin pada 26 subjek yang dibagi menjadi dua kelompok. Kelompok pertama diberikan klaritromisin dan kelompok kedua diberikan amoksisilin-klavulanat. Diagnosis berdasarkan penilaian skor gejala dengan visual analogue scale (VAS), nasoendoskopi, fungsi penghidu dengan sniffin sticks test, dan dilakukan pengukuran kadar IL-8 sekret mukosa hidung dengan metode enzyme-linked immunosorbent assay (ELISA). Didapatkan perbaikan VAS, nasoendoskopi, fungsi penghidu, dan kadar IL-8 yang signifikan (p=0,001) pada kedua kelompok pascaterapi, dan penurunan skor VAS total yang signifikan pada kelompok klaritromisin (p=0,036). Terdapat korelasi signifikan penurunan kadar IL-8 dengan peningkatan fungsi penghidu (p=0,05) dan dengan gejala hidung tersumbat (p=0,022) hanya pada kelompok klaritromisin. Simpulan, pemberian klaritromisin efektif menurunkan gejala klinis terutama hidung tersumbat, meningkatkan fungsi penghidu, dan menurunkan kadar IL-8 sekret mukosa hidung pada RSK tanpa polip nonalergi. [MKB. 2014;46(1):6–14]Kata kunci: Interleukin-8, klaritromisin, rinosinusitis kronik tanpa polip nonalergi, sniffin sticks testCorrelation between IL-8 level of Nasal Secretion in Non Allergic-Chronic Rhinosunusitis without Nasal Polyp and Olfactory Function After Macrolide Treatment Chronic rhinosinusitis (CRS) is a chronic inflammatory disease caused by multifactorial etiology. Interleukin-8 (IL-8) plays an important role as a major proinflammatory cytokine in non-allergic chronic rhinosinusitis without polyp. The common symptom is olfactory function disturbance. Claritrhomycin as a macrolide antibiotics is effective for CRS because of their antibacterial and antiinflamatory activities. The purpose of this study was to observe improvement of clinical symptom depending on the visual analogue scale (VAS) score, olfactory function, IL-8 level of nasal secretion, and correlation between IL-8 with olfactory function in non-allergic CRS without nasal polyp. This was a randomized controlled trial open labeled pre- and post-test design. Data analysis used Wilcoxon, Mann Whitney, and rank Spearman correlation test. This study was conducted at the Otorhinolaryngology-Head and Neck Surgery Division of Dr. Hasan Sadikin General Hospital Bandung. There were 26 subjects divided in two groups, the first group was given clarithromycin and the second group was given amoxicillin-clavulanate. The two groups underwent visual analogue scale (VAS) assessment, nasoendoscopy, sniffing sticks test and nasal secretion of IL-8 by enzyme-linked immunosorbent assay (ELISA). The two groups had a significant improvement VAS score after therapy (p=0.001) and clarithromycin group showed a statistically significant (p=0.036) effect on decreasing the total VAS score compared to the amoxcicillin-clavulanate group. There was significant correlations between decreasing IL-8 level, increasing olfactory function (p=0.05), and nasal obstruction symptom in VAS (p=0.022) was showed only in clarithromycin group. In conclusion, clarithromycin is effective in reducing clinical symptoms, especially in nasal obstruction, increasing olfactory function and decreasing IL-8 of nasal mucous secretion in non-allergic chronic rhinosinusitis without polyp. [MKB. 2014;46(1):6–14]Key words: Clarithromycin, interleukin-8, non allergic-chronic rhinosinusitis without polyp, sniffin sticks test DOI: 10.15395/mkb.v46n1.221

Efektivitas Latihan Incentive Spirometry dengan Latihan Pernapasan Diafragma terhadap Fungsi Paru, Kapasitas Fungsional, dan Kualitas Hidup Penderita Asma Bronkial Alergi

Nikmah, Sitti Nurun ( Departemen Ilmu Kedokteran Fisik dan Rehabilitasi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung ) , Purba, Ambrosius ( Departemen Ilmu Kedokteran Fisik dan Rehabilitasi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung ) , Defi, Irma Ruslina ( Departemen Ilmu Kedokteran Fisik dan Rehabilitasi Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Prevalensi eksaserbasi asma alergi semakin mengalami peningkatan. Berbagai upaya dilakukan untuk dapat menurunkannya, antara lain dengan latihan pernapasan diafragma dan incentive spirometry, namun, perbandingan efektivitas kedua latihan masih belum jelas. Penelitan ini bertujuan untuk mengetahui perbandingan efektivitas kedua latihan tersebut. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin dan Rumah Sakit Paru Dr. H. A. Rotinsulu Bandung (September−Desember 2012). Sejumlah 20 orang perempuan, berusia 26−40 tahun, penderita asma bronkial alergi terkontrol sebagian yang mengikuti penelitian, dibagi ke dalam 2 kelompok. Tiap kelompok diberi latihan incentive spirometry dan pernapasan diafragma selama 8 minggu. Sebelum dan sesudah perlakuan, dilakukan pengukuran fungsi paru dengan forced expiratory volume in 1 second (FEV1), kapasitas fungsional dengan jarak tempuh (uji jalan 6 menit), dan kualitas hidup dengan St George’s Respiratory Questionnaire (SGRQ). Karakteristik penderita menunjukkan distribusi normal dan homogen. Uji-t independen menunjukkan bahwa latihan incentive spirometry lebih efektif dibandingkan dengan pernapasan diafragma dalam meningkatkan FEV1 (6,19±2,63 vs 0,40±0,33 % prediksi), jarak tempuh (229,07±21,84 vs 140,69±16,91 m) dan memperbaiki SGRQ (nilai total 1.036,51±341,14 vs 360,09±182,10). Simpulan, latihan incentive spirometry lebih efektif dalam meningkatkan fungsi paru, kapasitas fungsional, dan kualitas hidup dibandingkan dengan pernapasan diafragma pada penderita asma bronkial alergi. [MKB. 2014;46(1):39–47]Kata kunci: FEV1, Incentive spirometry, jarak tempuh, latihan pernapasan diafragma, SGRQEffectiveness of Incentive Spirometry and Diaphragmatic Breathing Exercise in Lung Function, Functional Capacity and Quality of Life of Bronchial Asthma Allergic PatientsExacerbation of allergic asthma prevalence is increasing. Various attempts were made to lower it with diaphragm breathing and incentive spirometry exercise. However, comparison of the effectiveness of both exercises are unclear. This study aims to compare those effects. Research conducted in Dr. Hasan Sadikin General Hospital and Dr. H. A. Rotinsulu Pulmonary Hospital (September–December 2012). Twenty female, aged 26−40 years, partially controlled bronchial asthma allergic patients who consented for this study were divided into 2 groups. Each group was given incentive spirometry and diaphragm breathing exercise for 8 weeks. Before and after treatment lung function with forced expiratory volume in 1 second - FEV1, functional capacity with walking distance (6 minute walking test) and quality of life (St George’s Respiratory Questionnaire-SGRQ) were assessed. The characteristics of the subjects were normally distributed and homogeneous. Independent T test results showed incentive spirometry compared to diaphragm breathing exercise was more effective in improving FEV1 (6.19±2.63 vs 0.40±0.33% predicted), walking distance (229.07±21.84 vs 140.69±16.91 m), and SGRQ (total value 1,036.51±341.14 vs 360.09 ±182.10). In conclusion, incentive spirometry is more effective in improving lung function, functional capacity, and quality of life compared to diaphragm breathing exercises in patients with allergic bronchial asthma. [MKB. 2014;46(1):39–47]Key words: Diaphragm breathing exercise, FEV1, incentive spirometry, SGRQ, walking distance DOI: 10.15395/mkb.v46n1.226

Kadar Interleukin-6 Serum pada Karsinoma Payudara Lanjut Lokal dan yang Bermetastasis

Sapari, Toha ( SMF Bedah Rumah Sakit Umum Daerah Tasikmalaya, Jalan Rumah Sakit No. 33 Tasikmalaya 46113 ) , Abdurahman, Maman ( Departemen Patologi Klinik Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung, ) , Tjandrawati, Anna ( Departemen Ilmu Bedah Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Karsinoma payudara merupakan kanker pada wanita dengan frekuensi tertinggi di dunia dan merupakan penyebab kematian utama. Pasien karsinoma payudara mengalami periode stres fisik dan emosional yang mendorong diproduksinya protein seperti interleukin-6 (IL-6). Interleukin-6 berperan penting dalam tumorigenesis karsinoma payudara melalui aktivasi jalur janus kinase (JAK). Penelitian ini mengukur kadar IL-6 serum yang berperan penting pada patogenesis molekuler proses metastasis pada karsinoma payudara lanjut lokal (KPLL) dibandingkan dengan karsinoma payudara bermetastasis (KPM). Rancangan penelitian adalah potong lintang, analitik komparatif dengan membandingkan kadar IL-6 serum rata-rata pada kedua kelompok KPLL dan KPM. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung (RSHS) dari Juni–November 2012. Subjek penelitian adalah 35 pasien yang terdiri atas 18 KPLL dan 17 KPM. Kadar IL-6 diukur dengan teknik pemeriksaan enzyme-linked immunosorbent assay (ELISA). Hasil yang diperoleh dari penelitian ini kadar IL-6 serum rata-rata pada KPLL 4,99 pg/mL dan kadar IL-6 serum pada KPM 32,73 pg/mL. Terdapat perbedaan bermakna kadar IL-6 serum antara KPLL dan KPM, p<0,01. Hasil analisis dengan uji chi-kuadrat pada derajat kepercayaan 95%, bahwa terdapat hubungan kadar IL-6 serum dengan kejadian metastasis. Subjek dengan kadar IL-6 serum >9,85 pg/mL memiliki risiko kejadian metastasis 37,5 kali dibandingkan dengan kadar IL-6 serum ≤9,85 pg/mL. Simpulan, kadar IL-6 serum pada KPM lebih tinggi dibandingkan dengan KPLL. [MKB. 2014;46(1):15–21]Kata kunci: Interleukin-6, KPLL, KPMSerum Interleukin-6 Levels in Locally Advanced and Metastatic Breast CancerBreast carcinoma is a cancer in women with the highest frequency in the world and is the leading cause of death. Patients with breast carcinoma experience periods of stress both physical and emotional which encourages them to produce proteins such as interleukin-6 (IL-6). Interleukin-6 plays an important role in tumorigenesis via activation of janus activated kinase (JAK). This study measured the levels of serum IL-6 which plays an important role in the molecular pathogenesis of metastasis in locally advanced breast cancer (LABC) compared to metastatic breast cancer (MBC). The study design was cross-sectional, comparative analytics by comparing the mean levels of IL-6 in both groups: LABC and MBC. The study was conducted at the Dr. Hasan Sadikin Hospital Bandung (RSHS) from June–November 2012. Subjects were 35 women consisting of 18 LABC and 17 MBC. Levels of serum IL-6 were measured by enzyme-linked immunosorbent assay (ELISA) technique. The results of this study show that the mean levels of serum IL-6 on LABC 4.99 pg/mL and the mean levels of serum IL-6 on MBC 32.73 pg/mL. There was a significant difference between the levels of serum IL-6 on LABC and MBC, p<0.01. Results of the analysis with chi-square test shows there is a correlation between level of IL-6 with metastasis incidence. Subjects with levels of serum IL-6>9.85 pg/mL had 37,5 times higher risk for incidence of metastasis. In conclusion, the levels of serum IL-6 on MBCare higher than LABC. [MKB. 2014;46(1):15–21]Key words: Interleukin-6, LABC, MBC DOI: 10.15395/mkb.v46n1.222

Hypercoagulable State dan Diabetes Melitus Tipe 2: Korelasi antara Fibrinogen dan HbA1c

Aprijadi, Hery ( Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Hasan Sadikin Bandung ) , Sumantri, Rachmat ( Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Hasan Sadikin Bandung ) , Heri, Trinugroho ( Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Hasan Sadikin Bandung ) , Irani, Pandji ( Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Hasan Sadikin Bandung ) , Oehadian, Amaylia ( Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Hasan Sadikin Bandung ) , Arifin, Augusta Y. L. ( Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Hasan Sadikin Bandung )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Hiperkoagulabilitas merupakan penyebab kelainan vaskular pada diabetes melitus tipe 2 (DM tipe 2). Fibrinogen merupakan petanda hiperkoagulabilitas akibat inflamasi sistemik. Kadar HbA1c dipakai untuk menilai kadar gula darah jangka panjang dan berhubungan dengan petanda inflamasi. Terdapat perbedaan hasil penelitian terdahulu tentang bagaimana hubungan antara kadar fibrinogen dan HbA1c. Ada yang menyatakan hubungan bermakna dan ada pula yang tidak. Tujuan penelitian ini untuk melihat adakah korelasi antara fibrinogen dan HbA1c. Penelitian ini merupakan penelitian potong lintang pada penderita rawat jalan DM tipe 2 di RS Dr. Hasan Sadikin Bandung selama Januari−Juli 2010. Kriteria inklusi penderita DM tipe 2 yang baru didiagnosis, normotensi, kadar hemoglobin normal, serta tes fungsi hati dan ginjal normal. Dilakukan pemeriksaan kadar fibrinogen, trigliserida, dan HbA1c. Kriteria eksklusi yaitu mendapat obat antiagregasi trombosit, obat antidiabetik oral, atau menderita penyakit autoimun. Analisis statistik berupa Spearman dan regresi digunakan pada penelitian ini. Terdapat 63 subjek yang diikutkan dalam penelitian. Semua subjek memiliki kadar HbA1c lebih dari 6,5% (rata-rata 8,21±2,5%). Terdapat 33 penderita (53%) dengan kadar fibrinogen di atas harga normal (rata-rata 416,75±102,7 mg/dL). Tidak terdapat korelasi yang bermakna antara kadar fibrinogen dan HbA1c. Simpulan, tidak terdapat korelasi antara kadar fibrinogen dan HbA1c. Meskipun demikian subjek dengan diabetes melitus cenderung mempunyai kadar fibrinogen yang tinggi. [MKB. 2014;46(1):48–51]Kata kunci: Diabetes melitus tipe 2, fibrinogen, HbA1c, hypercoagulable state Hypercoagulable State and Type 2 Diabetes Mellitus: the Correlation between Fibrinogen and HbA1cHypercoagulability has been suggested as a result of type 2 diabetic mellitus vascular disease. Fibrinogen is a marker of hypercoagulability due to systemic inflammation. HbA1c level is used to measure long-term blood glucose level. There was inconsistent findings about the correlation between fibrinogen level and HbA1c. Previous study found a significant correlation between fibrinogen levels and HbA1c, while other study showed different results for this finding. The aim of this study was to determine the correlation between fibrinogen and HbA1c. A cross-sectional study was performed in outpatients type 2 diabetes mellitus (DM) in Dr. Hasan Sadikin General Hospital Bandung during January−July 2010. Patients with newly diagnosed type 2 DM, normotension, normal hemoglobin level, normal liver function test and normal kidney function test were included in this study. Fibrinogen, trigliseride, and HbA1c levels were examined. The exclusion criteria were patients taking antiplatelet drugs or oral antidiabetic and had autoimmune diseases. Spearman and regression analysis were used in this study. Sixty three subjects were included in this study. All subjects had HbA1c level more than 6.5% (mean 8.21±2.5%). Thirty three patients (53%) had fibrinogen level of more than the normal limit (mean 416.75±102.7 mg/dL). The mean of trigliseride level was 235.32±131.3 mg/dL. No significant correlation between fibrinogen and HbA1c. In conclusion, there is no correlation between the fibrinogen levels and HbA1c. However, subjects with diabetes mellitus tend to have high fibrinogen levels. [MKB. 2014;46(1):48–51]Key words: Fibrinogen, HbA1c, hypercoagulable state, type 2 diabetes mellitus DOI:  10.15395/mkb.v46n1.227

Ekspresi Human Leukocyte Antigen-G (HLA-G) dan Heat-Shock Protein-70 (Hsp-70) pada Pertumbuhan Janin Terhambat

Sulistyowati, Sri ( Divisi Fetomaternal Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sebelas Maret/Rumah Sakit Umum Daerah Dr. Moewardi Surakarta ) , Eka, Anak Agung ( Divisi Fetomaternal Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sebelas Maret/Rumah Sakit Umum Daerah Dr. Moewardi Surakarta )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pertumbuhan janin terhambat (PJT) merupakan salah satu penyebab utama tingginya morbiditas dan mortalitas perinatal. Maladaptasi imun berakibat gangguan invasi trofoblas dan remodeling arteri spiralis yang akan menyebabkan hipoksia pada jaringan plasenta. Penelitian ini bertujuan untuk menganalisis ekspresi human leukocyte antigen-G (HLA-G) dan heat-shock protein-7 (Hsp-70) pada trofoblas PJT dan hamil normal, dengan menggunakan metode observasional analitik dan pendekatan potong lintang. Penelitian dilakukan di Bagian Obstetri dan Ginekologi Rumah Sakit Umum Daerah Dr. Moewardi Surakarta, mulai bulan November‒Desember 2011. Jumlah sampel 30, terdiri atas 15 sampel trofoblas pada PJT dan 15 sampel trofoblas pada kehamilan normal. Pada semua sampel dilakukan pemeriksaan ekspresi HLA-G dan Hsp-70 dengan imunohistokimia. Analisis data menggunakan uji-t. Ekspresi HLA-G rata-rata pada kelompok PJT sebesar 32,42±8,90, sedangkan ekspresi HLA-G rata-rata pada kelompok kehamilan normal 43,92±14,91 (p=0,016). Ekspresi Hsp-70 pada kelompok PJT 2,4355+0,26647 dan kelompok kehamilan normal 1,5920+0,17142 (p=0,008). Simpulan, pada PJT ekspresi HLA-G lebih rendah dan ekspresi Hsp-70 lebih tinggi dibandingkan dengan kehamilan normal. [MKB. 2014;46(1):22–7]Kata kunci: HLA-G, Hsp-70, pertumbuhan janin terhambatHuman Leukocyte Antigen-G (HLA-G) and Heat-Shock Protein-70 (Hsp-70) Expression on Intra Uterine Growth RetardationIntra uterine growth retardation (IUGR) is one of the leading causes of higher morbidity and mortality in perinatal. Immune maladaptation affects trophoblast invasion and spiralis arteria remodeling that will cause placental tissue hypoxia. This research aimed to analyze human leukocyte antigen-G (HLA-G) and heat-shock protein-70 (Hsp-70) expression on the IUGR trophoblast and normal pregnancy, by applying analytical observational method and cross sectional approach. This research was conducted at the Obstetric and Gynecology Department of Dr. Moewardi Hospital Surakarta from November to December 2011. The total samples were 30, divided into two groups. There were 15 samples trophoblast on IUGR and 15 samples trophoblast from normal pregnancy. All samples were tested for HLA-G and Hsp-70 using immunohistochemistry. The data were analyzed by using t-test. The mean of HLA-G expression on the IUGR groups was 32.42±8.90 and on the normal pregnancy groups was 43.92±14.91 (p=0.016). Heat-shock protein70 expression on the IUGR groups was 2.4355+0.26647 and on the normal pregnancy groups was 1.5920+0.17142 with p=0.008. In conclusion, in IUGR, the HLA-G expression is lower and the Hsp-70 expression is higher than in normal pregnancy. [MKB. 2014;46(1):22–7]Key words: HLA-G, Hsp-70, intra uterine growth retardation DOI: 10.15395/mkb.v46n1.223

Comparison of Enzyme-Immunoassay and Rapid Immunochromatography Test for Detecting Helicobacter pylori Stool Antigen

Prasetyo, Dwi ( Department of Pediatrics, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung ) , H. J, Gerritsen ( Department of Microbiology Leiden University Medical Center, The Netherland ) , P., Mertens ( Coris BioConcept, Gembloux, Belgium ) , V., Labrune ( Coris BioConcept, Gembloux, Belgium ) , T, Leclipteux ( Coris BioConcept, Gembloux, Belgium ) , E. J, Kuijper ( Department of Microbiology Leiden University Medical Center, The Netherland )

Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

The rapid immunochromatography for Helicobacter pylori stool antigen (HpSA) test is a recently developed method for detection of Heicobacter pylori (H. pylori)  infection. The objective of this study was to compare rapid HpSA test with a conventional enzyme-immunoassay (EIA) and to determine the prevalence of H. pylori infection in symptomatic (recurrent abdominal pain/RAP) Indonesian children. One hundred and two high school children aged 12–18 years old in Bandung with RAP from July to November 2008 were enrolled, excluding children who had additional symptoms, such as diarrhea or fever. First study was performed in 102 samples in laboratory of Leiden University Medical Center (LUMC), Helicobacter pylori infection was detected by a conventional EIA and rapid test. A second study was performed on a stored collection of 32 feces samples previously tested positive for H. pylori by EIA in laboratory of LUMC; these samples were retested by both assays. The results showed the sensitivity, specificity, positive predictive value, and negative predictive value of the rapid test were 100%, 98.2%, accuracy 98.5%, 92.6% and 100%, respectively, from 134 tested samples. The overall prevalence of H. pylori infection among Indonesian children was 3% by EIA at first testing. In conclusion, the prevalence of H. pylori infection among symptomatic Indonesian children is very low and the new developed Pylori-Strip test shows good performance, very fast, and easy to use compared to EIA.  [MKB. 2014;46(1):52–6]Key words: Children, diagnostic, Helicobacter pylori, immunochromatographyPerbandingan Pemeriksaan Enzyme-Immunoassay dan Rapid Immunchromatography untuk Mendeteksi Helicobacter pylori Stool AntigenPemeriksaan Helicobacter pylori stool antigen (HpSA) menggunakan rapid immunochromatography (rapid HpSA) merupakan metode yang saat ini sedang berkembang untuk mendeteksi infeksi H. pylori. Tujuan penelitian ini untuk membandingkan metode rapid HpSA dengan metode konvensional yaitu enzyme-immunoassay (EIA) dan menentukan prevalensi infeksi H. pylori pada anak dengan gejala sakit perut berulang (SPB) di Indonesia. Sebanyak 102 anak sekolah menengah usia 12–18 tahun di Bandung dengan keluhan SPB ikut dalam penelitian ini, dilaksanakan dari Juli–November 2008. Anak dengan gejala tambahan, seperti diare dan demam, dikeluarkan dari penelitian. Penelitian pertama dilakukan pada sampel feses 102 anak di laboratorium Leiden University Medical Center (LUMC), Helicobacter pylori terdeteksi baik dengan pemeriksaan EIA konvensional maupun rapid test. Penelitian kedua dilakukan pada 32 buah sampel feses simpanan di laboratorium LUMC yang sebelumnya menunjukkan hasil positif dengan pemeriksaan EIA, sampel ini juga diperiksa menggunakan kedua metode. Hasil penelitian menunjukkan sensitifitas, spesifisitas, akurasi, positive predictive value, dan negative predictive value, dengan hasil 100%, 98,2%, 98,5%, 92,6%, dan 100% dari 134 sampel yang diuji. Prevalensi infeksi H. pylori pada anak Indonesia dengan keluhan SPB sekitar 3% pada pemeriksaan pertama. Simpulan, prevalensi infeksi H. pylori pada anak SPB di Indonesia sangat sedikit dan pemeriksaan Pylori-strip (rapid test) merupakan pemeriksaan yang sangat baik dan cepat serta mudah digunakan dibandingkan dengan EIA. [MKB. 2014;46(1):52–6]Kata kunci: Anak, diagnosis, Helicobacter pylori, immunochromatographyDOI: 10.15395/mkb.v46n1.228